JILL A. MARSTELLER, PHD, MPPASSOCIATE PROFESSOR OF HEALTH POLICY AND MANAGEMENT

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

AND THE ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY

JOHNS HOPKINS SCHOOL OF MEDICINE

Oppressed Group Behavior and Ways to Improve

Empowerment

Learning Objectives

By the end of the presentation, you will be able to: Identify oppressed group behaviors Consider whether they are present among coworkers

at your institution Enumerate ideas for combating these behaviors in the

workplace

What is “Oppressed-Group Behavior” (OGB)?

A response of non-dominant groups to their lower position in the hierarchy, lack of autonomy in work, lack of control

Feelings of powerlessnessLack of pride, devaluing of self and own

group

Observed behaviors within oppressed groups

Silencing the self and passive-aggressivenessDefeatism or apathyBehaviors of insecurity

• e.g., aggressive communication; inflexibility; blaming; extreme sensitivity to slights; grudge holding; fear of/anger toward dominant group

Imitation of the dominant group to succeed• b/c leadership granted by the powerful, leaders in non-dominant

group more supportive of the powerful than their own group• Horizontal violence

• e.g., unwarranted criticism of peers and lower status groups;• bullying or hazing; • infighting and internal divisiveness; • disruptive behavior (violence, psychological aggression,

workplace incivility)

OGB in Nursing

Often found among nurses but not openly acknowledged (lit. dates to 70s)

Roots in historical female and male roles (female predominance in nursing and male predominance in medicine)

Lack of autonomy; obedience to physicianValue of nursing care poorly recognized (no

accounting available)Nurses not included in decision-making; little

control over own working conditions; expected to take on non-nursing tasks (e.g., cleaning the floor)

OGBs may exacerbate disempowered status

Hierarchical, competitive relationships amongst nurses; no cohesive action to increase power

Take sides with those outside nursing in cases of conflict

Indirect communication styles can be hard to follow or seem irresolute, indecisive

Sometimes talking about each other; complaining; holding grudges; acting in a petty fashion

Most common management styles used by nurses are avoiding and compromising (Valentine 2001).

Disempowering Nurse Behaviors

20 interviews with Canadian nurses 1998-1999 (17F, 3M; experienced & new; diploma through masters candidates)

Nurses value collaboration and acceptance outside nursing

Freq. failed to advocate for patient wishes and needs b/c of need to fit in with team values, other professionals’ opinions

Daiski 2004

Daiski 2004 Examples

“Nurses eat their young” Worst scheduling for new staff; ignoring requests Concentration on mistakes; lack of praise for

good work Holding back information and letting new nurses

flounder; seeing who is going to “make it;” Criticizing nurses who object to cleaning and

other non-nursing tasks Insistence on the same ways of doing things,

rejection of new approaches Shunning/ bullying those who are different or

breach “the rules”

Disruptive Behavior

10 Focus groups of 96 RNs (Hopkins)225 disruptive behavior events

Nurse instigators in 29% (n = 66)

“Gossiping is huge . . . [it] can be quite maligning and very vindictive.”

Presence of intimidating cliques on the nursing unit that “police” other nurses’ practice

Passive-aggressive emailActual or perceived lack of competency in a new

RN as justifying “being harsh and critical” toward the new nurse

Walrath, Dang and Nyberg 2010

Disruptive Behavior

Survey of 1559/5710 respondents (27.3%)RNs experienced higher frequency of disruptive

behaviors and triggers than MDs Unlike MDs, RNs experienced almost monthly

occurrence of malicious gossip, self-centeredness, and inappropriate use of communication technology

Both MDs (45% of 295) and RNs (37% of 689) reported that the disruptive behavior of a member of their own discipline affected them most negatively

189 incidences of harm to patients as a result of disruptive behavior were reported

Walrath, Dang and Nyberg 2013

Bigger than OGBs: The Bullying Organizational Context

Workplace bullying--repeated, intentional, masked negative behaviors or actions in imbalanced power relationships

Wider environmental/organizational issues may help normalize bullying (not just within-group OGBs) (Hutchinson et al. 2006)

Increasingly complex systems of control within organizations can be co-opted by bullies

Bullying may be condoned/rewarded as appropriate use of power when bullied person is cast as the problem

OGBs can be addressed

Interventions can decrease OGBsDecrease in OGBs has been found to be

related to increased work force performance, satisfaction and retention (Roberts, DeMarco and Griffin 2009)

Combating OGBs/ Bullying

Recognize and expose oppressed group behavior “For many focus group participants, these

sessions served as a catharsis for pent-up emotions resulting not only from personally observing or experiencing disruptive behavior but also from the fact that when such behavior did occur, the instigators were not consistently and equitably addressed across professional disciplines. –Walrath et al. 2010

Combating OGBs/ Bullying

Encourage staff to appreciate and compliment each other

Create an avenue for complaints/ positive criticism of system; encourage them to make a solid case with data and documentation

Combating OGBs/ Bullying

Advocate for collaboration among staff; create joint projects and opportunities for positive interactions (e.g., writing group)

Create a buddy system/mentorship systemReward helping behaviors and promote

solidarity, esprit de corpsCreate opportunities for communication

across shifts and units (validates views and builds consensus within group)

Combating OGBs/ Bullying

Address issues raised by non-dominant groupsRecognize good work and those working to

improve qualityEncourage involvement on hospital

committees and decision-making bodiesEmphasize group’s contributions to hospitalTrain on appropriate assertion and conflict

resolutionDeal with negative/ bullying coworkers

consistently and equitably

Combating Oppressed Group Behaviors/ Bullying

Train on structured communication strategiesOffer scripted responses to most common

instances of horizontal violence or bullying

Measure OGBs to Intervene

Silencing the Self Scale Workplace Scale (STSS-W) for nurses (DeMarco et al. 2007)

Lateral Violence in Nursing Survey (Stanley et al. 2007)

Nurse Workplace Behavior Scale (NWS) (DeMarco et al. 2008)

Disruptive Clinician Behavior Survey for Hospital Settings (Walrath et al. 2013) for nurses and physicians

Relational Coordination

Measure between-group relationships (Gittell et al. 2008): Frequency, timeliness, accuracy of communication Shared knowledge Shared goals Mutual respect Joint problem solving behavior

On your own

List non-dominant/ low autonomy groups in your organization and any OGBs you notice

Describe roots of the OGBs, ideas for improvement

Generate 3 actions that could support the improvement plans

References

Daiski, Isolde. ”Changing nurses’ dis-empowering relationship patterns,” Journal of Advanced Nursing, 2004, 48(1), 43–50.

DeMarco R. F. & Roberts S. J. (2003) Negative behaviors in nursing: looking in the mirror and beyond. American Journal of Nursing 103(3), 113–116.

DeMarco R., Roberts S. & Chandler G. (2005) The use of a writing group to enhance voice and connection among staff nurses. Journal for Nurses in Staff Development 21 (3), 85–90.

DeMarco R., Roberts S., Norris A. & McCurry M. (2007) Developing of the silencing the self scale (work) (STSS-W) for nurses. Journal of Nursing Scholarship 39 (4), 375–378.

References

DeMarco R., Roberts S., Norris A. & McCurry M. (2008) The development of the Nurse Workplace Scale (NWS): self-advocating behaviors and beliefs in the professional workplace. Journal of Professional Nursing 24, 196–301.

Gittell, J.H., Weinberg, D., Pfefferle, S., Bishop, C. (2008).  “Impact of relational coordination on job satisfaction and quality of care: A study of nursing homes,” Human Resource Management Journal, 18(2): 154-170.

Hutchinson M, Jackson D, Vickers M and Wilkes L. “Workplace bullying in nursing: towards a more critical organisational perspective,” Nursing Inquiry 2006; 13 : 118–126.

References

Roberts S . J . , Demarco R. & Griffin M. (2009) The effect of oppressed group behaviours on the culture of the nursing workplace: a review of the evidence and interventions for change. Journal of Nursing Management 17, 288–293.

Sieloff, Christina Liebold. “Staying Power,” Recruitment and Retention Report, Nursing Management, November 1999.

Stanley K., Martin M., Michel Y., Welton M. & Nemeth S. (2007) Examining lateral violence in the nursing workplace. Issues in Mental Health Nursing 28, 1247–1265.

References

Walrath JM, Dang D, Nyberg D. An organizational assessment of disruptive clinician behavior: findings and implications. J Nurs Care Qual. 2013 Apr;28(2):110-21.  

Walrath JM, Dang D, Nyberg D. Hospital RNs' experiences with disruptive behavior: a qualitative study. J Nurs Care Qual. 2010 Apr-Jun;25(2):105-16.  

Valentine P. (2001) Gender perspectives on conflict management strategies of nurses. Journal of Nursing Scholarship 33 (1), 69–74.