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Creating A New Story
Part IICreating Healthy Worplaces
Kathleen Bartholomew, RN, MN
Summary
• History of powerlessness• Lack of time for reflection• Decreased social capital• Human Adaptability
The work is compressed and complex – we have adapted to an increased pace• Inadequate confrontation skills
How do we end horizontal hostility and create a
healthy work enviornment?
Action Plan !
Depends entirely on three things:
• Awareness
• Communication
• Response
Awareness
Indications of Horizontal Hostility
Poor employee satisfaction scoresHigh Turnover ratesDueling shifts or unitsPresence of cliquesIncident report increaseAbsenteeismBehavior Clues
Response: Strategies and Tools
1. Decrease negativity, gossip and a culture of blame by maintaining a zero tolerance for any communication
that is unhealthy
2. Increase a climate of safety and healthy communication by role modeling and utilizing opportunities to teach interpersonal and confrontation
skills.
Any intervention that…
1. Flattens the hierarchical structure2. Empowers staff, increases “voice”3. Builds self esteem4. Raises awareness of the problem5. Provides opportunities for networking6. Supports reflective practice7. Illuminates the problem by showing the
consequences
…will decrease horizontal hostility
To thrive horizontal hostility needs:
secrecyshamesilent witness
“Our lives begin to end the day we become silent about things that matter”
M. L. King
Why don’t you speak your truth?
• Fear of retaliation• Fear of hurting the relationship/feelings• Fear of gossip, scapegoating,• No time• Why bother? Nothing will change• Fear of being isolated from the group
(Bartholomew, 09)
DESC Communication Model
• Describe - Lead with the facts• Explain – Let them know the impact (pause, pause, pause)• State – What you want. Be descriptive• Consequences – Describe the impact
(individual, social and work env.)
What do you say when you hear
someone talking about you?
DESC Communication Model
D - When…
E - I feel…because
S - Therefore, I want (I need)
C - So that…
How do I approach experienced staff when she makes it obvious in many ways that she has no time patience or empathy for my concerns?
D
E
S
C
D – I noticed today you felt bothered by my questions and I felt in the way
E - I understand your workload is heavy, but when you ignore me, I feel unimportant and get the message that you wish I wasn’t here
S - I need to find some way or some time to connect with you. I really want to learn and be the best nurse I can be.
C - If you continue to ignore me, I can’t learn and I won’t stay
What do I do when I walk into my boss’s office and I can tell by his tone and expression that he has already jumped to a conclusion?
D
E
S
C
D – As soon as I walked into your office I noticed that your jaw is set and your face looks stern
E - This makes me feel defensive, anxious and afraid that the open dialogue that I wanted to have with you just isn’t going to happen
S - What I need is for you to listen to me before you make up your mind because I need your support and understanding. Ask me questions instead of jumping to any conclusions
C - So that I can tell you what I know and together we can solve this issue
Sample Questionnaire
I am respected by my peers 1 2 3 4 5
I feel supported by my peers 1 2 3 4 5
I can safely express my opinions 1 2 3 4 5
What I like the most about my team is_____________
What I need more from this team is ______________
The Grey Zone
Nurturing Our Young
“ The profession of nursing has an obligation to reduce lateral violence...
Griffin 2004
Professional Behaviors
• Accept one’s fair share of the workload• Keep confidences• Work cooperatively, despite feelings of dislike• Always look co-workers in the eye• Don’t engage in conversation about a coworker• Stand up for an “absent member” in
conversations• Don’t criticize publicly• Don’t be overly inquisitive about each other’s lives• Do repay debts, favors, and compliments
Responding to to Horizontal Hostility
Non-verbal inuendos (raising eyebrows or making faces)
“I see from your facial expression that there may be something you wanted to say to me. It’s ok to speak to me directly”
Sabotage (deliberately setting up a negative situation)
“There is more to this situation than meets the eye. Could you and I (or whoever) meet in private and explore what happened?”
Verbal affront (covert or overt snide remarks, lack of openness or abrupt responses)
“Can I talk to you in private? When you____ I got the feeling that you______. Is that the case?”
Undermining activities (turning away or being unavailable)
“Can you help me understand how this situation could have happened?”
Withholding information (practice or patient)“It is my understanding that there was more
information available regarding the situation, and I believe if I had known that, it would have affected what I did and how I learn “
M. Griffin
Infighting (bickering with peers)“This is not the time or place. Please stop” Then
physically walk away or move to a neutral spot
Backstabbing (complaining to others about an individual)
“I don’t feel right talking about him/her/the situation when I wasn’t there. Have you spoken to him/her? “
M. Griffin
Action Plan for New Nurses
1. Teach cognitive rehearsal skills in nursing school
2. Student nurse feedback to preceptor
3. Utilize a coaching model for education
4. Share a meal 1:1 in the first 2 weeks
5. Affirm individual contributions
6. Make the time for reflective practice
7. Adopt a mentorship program
8. Decrease precepting nurse’s workload
9. Share a story from your first week
RN Action Plan
1. Be aware of the signs and symptoms of HH2. Understand the many forces nurses affecting
nurses today3. Speak your truth – hold crucial conversations4. Adopt a zero tolerance unit philosophy5. Take care of yourself
Revolutionary New Nurse Beliefs
• A good nurse takes care of herself• A good nurse needs the help and support of
her peers• A good nurse seizes the details of a mistake
and shares them to improve practice• A good nurse speaks her truth at all times• A good nurse nurtures and feeds new nurses• A good nurse demonstrates professionalism
6. Evaluate your belief system7. Take the time to reflect on your practice8. Education
- Assertiveness training - Confrontation skills – DESC model
- Crucial Conversation skills- Non-violent communication
8. Compliment each other – often!9. Provide opportunities for socialization10. Never be a “silent witness”11. Ask for feedback – peer review
Faculty
Integrate into Nursing School curriculum -
1. Norms and culture of Nursing2. Cognitive Rehearsal – role play3. Assertive communication models4. Professional image of Nursing
1. Survey both Faculty and Students on current culture
“By continuing to conceptualize workplace bullying as an inherent feature of nursing, we risk passive acceptance that bullying is a feature of nursing, rather than what it is – an abusive and harmful activity perpetuated within organizations.”
(Hutchinson, Vickers, Wilkes, Nursing Inquiry 2006 13(2).
Organizational Level
Major concepts….
• Flatten the hierarchy• Focus on Language and Behavior• Zero Tolerance Policy - 100% compliance
• “Chase ZERO” • Lead Physicians to critical mass
Strategies and Tactics:
• Follow “Roadmap” for professional behavior• Educate and empower front line leadership• Provide skills in confrontation training• Adopt structures as forcing MD/RN functions• Adopt a “Just Culture” Model• Adopt Senior Leadership Rounding• Vision and values – “If that were…”• TCAB at the bedside - then share
“The future …materializes from the actions, values and beliefs we’re practicing now.
We are creating the future every day by what we choose to do…
…If we want a different future
we have to take responsibility for what we are doing
in the present.”
Wheatley 2002
Thank you!
• Kathleen Bartholomew• [email protected]• 206-356-2599• www.kathleenbartholomew.com• To Purchase books at 40% off
800 650-6787 code# MB90008A