Arresting Nurse to Nurse gViolence

Nursing < than 1 Nursing < than 1 year?Nursing 1 5 Nursing 1-5 years?M th 5?More than 5?More than 10?More than 20?

How many of you have heard the term “ t th i ”?“nurses eat their young”?Ponder over why we do this?

I survived it so can you!I survived it so can you!One good yelling and you will never forget again!I want to see how she handles pressure…pOthers…

Early research focused on Lateral/ Horizontal Early research focused on Lateral/ Horizontal HostilityMore than 25 years this phenomenon has been recognizedWhy does this survive in a profession built on th i i l f i i d the principles of caring, compassion, and service ?

Physical, verbal or emotional abuse of an Physical, verbal or emotional abuse of an employeeNurse to nurse aggressionDisruptive behaviorBullying

Low self-esteem and lack of respect for Low self esteem and lack of respect for othersResponses are not directed at an individual nurse but rather a response to the practice environment

Down sizingDown-sizingChange/alteration in management styleOthers

Unable to confront the source the anger is directed at a safer person…. The VICTIM

Think of your own experiences where these Think of your own experiences where these happened

Non-verbal innuendosVerbal affrontUndermining activitiesWithholding informationWithholding informationSabotageBackstabbinggFailure to respect privacyBroken confidences

Origins found in the oppressed- group modelNurses are a powerless and oppressed group Nurses are a powerless and oppressed group dominated by othersControlled and exploited by the hierarchy

Could this be related to the fact that most nurses are women reporting to a male d i t d h i i / d i i t ti l d ?dominated physician/administrative leaders?Reactions to the feeling of loss of power results in aggressive overpowering of othersresults in aggressive overpowering of others

~Nurses have little autonomy yet great accountability… often sandwiched between the angry patient and the confines of which they have no control.

~It’s often hard for nurses to admit f fthat they could be hurting one another.

Higher Ups

Directors

Front Line Managers

Charge Nurses

Staff Nurses Staff Nurses Staff Nurses 

A 2003 study of 551 new grads 34% of them A 2003 study of 551 new grads 34% of them reported some form lateral violence“Rite of passage”Blocked learning opportunitiesGiven too much responsibilityN l t d i i iNeglected in a crisis

Griffin (2006) reported 60% of nurses new to practice leave their first position within 6 practice leave their first position within 6 months because of some form of lateral violence

Nursing shortageNursing shortageHealth problemsStress-related problemsp

Real world not like what we learned in schoolReal world not like what we learned in schoolBehaviors of how to confront the problem are unknown/unlearned“When what you do is disconnected from what you value you begin to feel anger, fear, h l l d l k f ”helplessness and lack of energy”

(Quine, 1996)

Physical Physical HypertensionIBSWeight loss/gain

EmotionalPTSDPTSDAcute anxietydepressiondepression

Estimated at $22000- $64000 lost when a Estimated at $22000 $64000 lost when a nurse leaves within the first 6 months of hirePatient harm

Poor performance Lack of initiativeM d / id tMed errors/accidents

Higher absentee rate

Sofield and Salmond (2003) found that Sofield and Salmond (2003) found that primarily physicians, then patients, then patients’ families were responsible for most of the verbal abuse towards nurses.Rowe and Sherlock (2005) reported nurses were the most freq ent so rce of verbal were the most frequent source of verbal abuse towards other nurses.

For the reasons it started in the first placeFor the reasons it started in the first placeOppressed groupWomen dominatedFear or retaliation/loss of job

Avoidance is easier than dealing with the issueissueLack of knowledge about problem and how to address the problemaddress the problem

Not an unexpected result …Not an unexpected result …Many front line nurses feel they have been abandoned by supervisors/management.

Deserted in the trenchesPerceived power

SecrecyShameSilent Witness

Ask your staff! Ask your staff! Open the door for them to talk about itAdmit there is a problem…p

AwarenessAwarenessPoor satisfaction scoresHigh turn over ratesDueling shifts or unitsCliquesIncreased incident reportingIncreased incident reportingAbsenteeismBehavior clues

An important first step in breaking the cycle An important first step in breaking the cycle of lateral violence is recognition

Make an effort to care about your peersAcknowledge the role they have played in LV

Managers should analyze the culture of the unit (practices verbal and non verbal clues)unit (practices, verbal and non-verbal clues)When behaviors are observed they must be addressed and brought forth in staff addressed and brought forth in staff meetings, etc.

Education about methods to have crucial Education about methods to have crucial conversationsMake cognitive choices to react differently-non- aggressivelyAdministration must assist those adversely ff t d b i l t h lth d t kaffected by violence to health and to work

Cognitive rehearsalCognitive rehearsalSteps to learn to confront the behavior in a constructive mannerHold information in your mind and ponder before responding

CarefrontingCarefrontingRespectForgivenessCourage

Stand up for the “absent members” in ti !conversations!

Short term interventions aimed at problem Short term interventions aimed at problem resolutionLong term directed at changing organizational culture

Zero toleranceT d b tt Top down bottom upNO passive observation

If you do not address the problem you are f y p yparticipating in the problem!

We are creating the future every day by future every day by what we chose to do today…today…

Keep confidencesKeep confidencesDon’t criticize publicallyAccept your fair share of the workloadp yWork cooperatively despite feelings of dislikeDo repay debts, favors and compliments!p y , pZero tolerance policy with no fear of retribution

References available on request