Civility and Nursing Practice: Let s Talk About Bullying

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1 Civility and Nursing Practice: Let s Talk About Bullying Professional Practice Nursing Maxine Power-Murrin March 2015

2 A rose by any other name... Lateral violence Horizontal violence Bullying Intimidation Incivility Relational aggression

Prevalence In 2003 the Institute for Safe Medication Practices (ISMP) conducted a national survey of pharmacists, nurses and physicians regarding intimidation in the workplace.

3 Prevalence In 2003 the Institute for Safe Medication Practices (ISMP) conducted a national survey of pharmacists, nurses and physicians regarding intimidation in the workplace. In the previous year: 88% reported that they had encountered condescending language or voice intonation 87% encountered impatience with questions 79% encountered a reluctance or refusal to answer questions or phone calls ISMP, 2004

4 Prevalence In 2009 the American College of Physician Executives conducted a survey of more than 2,100 physicians and nurses that showed a fundamental lack of respect between the two groups. Nearly 85% indicated that degrading comments and insults were the most common form of disrespectful behavior followed by: Yelling (73%) Cursing (49%) And inappropriate joking (46%) Johnson, C. 2009

5 Prevalence A study conducted by Nursing 2011 in the United States and published in 2012 about experiencing or witnessing horizontal violence: 955 nurses responded to the survey consisting of 5 questions and was measured using a 6 point Likert scale 82% of respondents reported experiencing or witnessing at least one of the behaviors weekly or daily 34% reported that all five behaviors occur weekly or daily Dumont et al; 2013.

6 Prevalence Harshly criticizing someone without having heard both sides of the story Belittling or making hurtful remarks to or about coworkers in front of others Complaining about a coworker to others instead of attempting to resolve a conflict directly by discussing it with that person Raising eyebrows or rolling eyes at another coworker Pretending not to notice a coworker struggling with his or her workload Dumont et al; 2013

7 Prevalence In a survey of 1337 U.S. nurses in 2008 more than 50% had experienced or witnessed at work: intimidation, angry outbursts, severe and/or inappropriate criticism, belligerence, disruptive behaviors, bullying or harassment Hader, 2008

8 Stokowski, 2011

Difficult People Argue a point over and over Choose their own self-interest over what s best for the team Talk rather than listen Show disrespect Motivation: they wear

9 Difficult People Argue a point over and over Choose their own self-interest over what s best for the team Talk rather than listen Show disrespect Motivation: they wear people down and get what they want Some difficult people are bullies Difficult people tend to behave the same way with everyone; bullies target certain people Sherman, 2013

10 Tips for Coping with Difficult People Don t try to change the difficult person Don t take it personally Set boundaries Acknowledge the person s feelings Try empathy Hold your ground Use fewer words Sherman, 2013

11 Bullying Repeated inappropriate behavior, direct or indirect, Verbal, physical or otherwise, conducted by one or more persons against another or others, at the place of work and/or in the course of employment, Persistent, systemic and ongoing Could reasonably be regarded as undermining the individual s right to dignity at work. Task Force on the Prevention of Workplace Bullying

12 Bullying Healthcare occupations have the highest rates of workplace bullying Most frequent sources of verbal abuse to nurses: other nurses, patient s families, physicians and then patients (Rowe and Sherlock, 2005) Johnson & Rea, 2009

13 Common Behaviors Giving the silent treatment Spreading rumors. Using humiliation and put-downs, usually regarding a nurse s skills/ability. Excluding a nurse from on-or-off the job socializing. Dellasega, 2009

14 Common Behaviours Teasing another nurse about his or her lack of skill or knowledge. Over-checking of work Refusing to share information with another nurse or otherwise setting him or her up to fail. Dellasega, 2009

15 What it is... The aggressor (BULLY) often is insecure and angry. The target (victim) often lives in fear of what might come next. Those who witness the aggression (bystanders) are often affected. Dellasega, 2009

16 Causes Hierarchical workplaces Task orientation Low morale Administrative retreat Educational shortcomings Oppressed group model Hurley, 2006; Rainford et al, 2015

17 Causes Stressful healthcare environments Productivity demands Cost containment Embedded hierarchies Unfortunate progression of victims who become perpetrators Survival strategy for some Generational differences Mishandling the integration of new nurses ISMP, 2013

18 The Victim Reduction in self-confidence and self-esteem Fear, anxiety, sadness, depression Symptoms resembling post traumatic stress disorders Low morale-apathy-disconnectedness Irritability Burnout Sleep disorders Hurley, 2006

19 The Victim Impaired interpersonal relationships Removal of self from workplace: sick leave Absenteeism Significantly lower job satisfaction, increased job-induced stress, and a greater intent to leave a position (Quine, 1999) Quine, 1999

20 Consequences Compromised patient safety Disillusionment with nursing-intention to leave the profession Victim can be viewed as the problem McKenna et al, 2001

21 Bystanders May feel ashamed or guilty because they have failed to intervene. Fear they will be the next target

22 Why is Bullying Underreported? The behavior is not recognized as bullying Being unfamiliar with the reporting procedure Fear of retribution The belief that nothing will change Concern that they will be labeled a complainer WorkCover NSW, 2008

23 Step 2: Realize the Cost Negativity leads to a sense of isolation and destroys teamwork Every man for himself rather than we re all in this together mentality Poor teamwork and communication can cause trouble for patients Low satisfaction and morale lead to turnover which triggers other negative outcomes

24 Step 3: Take Action! Speak up Confront the offender Make sure its not you!! Arm yourself Create shared values Enlist management s support Be patient and persistent. Culture change can occur, but it happens slowly

25 Response Strategies for the Victim Create a log of all incidents including bystander names Confront the bully with the appropriate evidence and support Involve manager early on Become familiar with workplace bullying policies The danger-effect ratio must be high to stop bullying Johnson et al, 2010

26 Unit Response Strategies Decrease negativity, gossip and a culture of blame by maintaining zero tolerance for any communication that is unhealthy Increase climate of safety and healthy communication by role modeling and utilizing opportunities to teach interpersonal and confrontation skills MAKE SURE IT S NOT YOU!!!!!!

27 Organizational Strategies Develop policies Create awareness Identify risk factors Inform, instruct, and train Control risks Encourage safe reporting to bodies with the power to act WorkCover 2008

28 Eastern Heath Strategies

29 Code of Ethics for RN s Ethical nursing practice involves core ethical responsibilities that nurses are expected to uphold. Nurse are accountable for those ethical responsibilities in their professional relationships with individuals, families, groups, populations, communities and colleagues (Code of Ethics, 2008). CNA, 2008

30 References Canadian Nurses Association. (2008). Code of Ethics for Registered Nurses. Dellasega, C. (2009). Bullying Among Nurses. American Journal of Nursing. 109(1), Dumont, Cheryl., Meisinger, Sandy., Whitacre, Mary Jo and Corbin, Gloria. (2013). Horizontal Violence Survey Report. Nursing 2013, 42(1), Hader, R. (2008). Workplace Violence Survey Unsettling findings. Employees safety isn t the norm in our healthcare settings. Nursing Management, 39, Hurley, Janice E. (2006). Nurse-to-Nurse Horizontal Violence. Retrieved from on January 29, Institute for Safe Medication Practices. (July, 2013). Disrespectful behavior in healthcare Have we made any progress in the last decade? Medication Safety Alert! 11(7). Institute for Safe Medication Practices. (2004). Intimidation: practitioners speak up about this unresolved problempart 1. Medication Safety Alert! 9(5).

31 References Johnson, C. (2009). Bad blood: doctor-nurse behavior problems impact patient care. Physician Executive, 35(6): Johnson, M.,Phylavanh, P., & Jackson, B. (2010). The Bullying Aspect of Workplace Violence in Nursing. JONA s Healthcare Law, Ethics, and Regulation, 12(2). Johnson, S.L., & Rea, R.E. (2009). Workplace bullying: Concerns for Nurse Leaders. Journal of Nursing Administration, 39, Rainford, W, Wood, S. et al (2015). The Disruptive Force of Lateral violence in the Health Care Setting. Journal for Nurse Practitioners, 11(2), Sherman, Rose. O. (2013). Dealing with Difficult People. American Nurse Today, 8(7), 1-3. Stokowski, Laura A. (2011). The Downward Spiral: Incivility in Nursing. Retrieved from on February 17, 2014

32 References

Bullying in Nursing: Sepsis in a Caring Profession

Bullying in Nursing: Sepsis in a Caring Profession Pam Hutchinson, DNP, RN, CPN Cincinnati Children s Hospital February 8, 2017 Objectives Identify behaviors that are considered bullying behaviors in nursing