POLICY OPTIONS BRIEF

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1 POLICY OPTIONS BRIEF TO: Dr. Kathleen Scher, Senior Vice President and Chief Nursing Officer and Fenny Carol Marketing Director FROM: Diana Masabanda RN; Shawnett Haywood DATE: March 23th, 2017 SUBJECT: Addressing Bullying, Incivility and Conflict at the Workplace Nursing is a very rewarding profession. I am extremely honored to be part of an institution that has a positive impact on patient s lives. However after working for about 4 years in our facility I have noticed a high turn over rate and it made me want to investigate some of the causes. It is so important for any worker to feel secure, comfortable and to have a sense of teamwork. Those elements have been lacking in the unit making nurses leave the facility. In any place you work we believe that the key to productivity is to feel good with what you are doing and with whom you are working. Being able to be part of a team is not always easy and so problems will arise. In every workplace environment, professionalism is of importance when trying to provide the best quality care or service. In nursing a cohesive working environment brings satisfaction for nurses, it minimizes turnovers, and ultimately improves quality care for patients as well as patient satisfaction. The nursing profession exemplifies caring and compassion for its patients. That is why feeling comfortable in the workplace will enable us to do our job at its best. I have noticed that nurses have to overcome certain obstacles in order to be part of a cohesive and solid environment. Some of these obstacles include incivility and bullying that can lead to work-place conflict. These two disruptive behaviors are present in the work place making it difficult to work as team and to focus in the care of our patients. These social issues need to be addressed in order to put a stop to the damaging impact that this causes not only to nurses but also to patients and the healthcare system on a whole. This is a problem that needs to be solved to prevent psychological abuse from happening and to allow employees to feel safe and supported. Problem: Incivility; Bullying that leads to Work-Place Conflict Providing the best quality care and client satisfaction is the most important goal of an organization. Nevertheless having bullying and incivility that leads to conflict will make it harder for a unit to come together and achieve those goals. According to the American Nurses Association (ANA) incivility and bullying in nursing is prevalent in all settings. In order to address these particular issues, first we have to understand what they mean and how they differentiate from each other. Pearson and Porath define incivility as the exchange of seemingly inconsequential inconsiderate words and deeds that violate conventional norms or workplace conduct. In essence, what is considered uncivil is based on an individual s perceptions of actions and actual words. According to The Cost of Bad Behavior by Christine Pearson and Christine Porath, it is more widespread than people actually realize it and incivility in the workplace has devastating effects.

2 On the other hand bullying is more powerful and is a repetitive behavior. According to Terri Townsend Bullying may exist in all areas where nursing is practiced. From "eating our young" to sabotaging and scapegoating nurse colleagues, bullying is a serious problem that jeopardizes unit morale and patient safety. ANA defines it as repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient, is a very serious issue that threatens patient safety, registered nurse (RN) safety, and the nursing professional as a whole. Moreover bullying is a "repeated, offensive, abusive, intimidating, or insulting behaviors; abuse of power; or unfair sanctions that make recipients feel humiliated, vulnerable, or threatened, thus creating stress and undermining their self-confidence." Common bullying behaviors used by nurses include innuendo, verbal affront, undermining, withholding information, sabotage, and infighting, scapegoating, backstabbing, failing to respect privacy, and breaking confidences. The act of bullying limits the ability to create effective team groups. Also incivility has a devastating effect on employees. An article published by American Nurse Today states bullying tends to create a toxic work environment with serious consequences for victims, institutions and, ultimately, patients. Victims feel isolated from other team members. Their self-esteem decreases and their self-doubt suppresses their initiative and innovation. Eventually, they become impaired psychologically and occupationally. Research on bullied nurses in the United Kingdom showed that workplace bullying accounts for a third to one-half of stress-related absenteeism. In Canada, one in seven adult suicides results from workplace bullying. According to an article published by Diane Berenbaum victims put in less effort into work leading to lower quality of care provide. They lead to losses in productivity, efficiency and, profitability. It reduces patient safety by interfering with teamwork, communication, and collaboration. For example when a nurse manager withholds information, purposely assigns too heavy a patient load, or doesn t provide assistance when needed, patient safety in that unit may decrease and potentially fatal errors may occur. Moreover we can see these two behaviors ending in conflict between staff and management. Not only in nursing but also in other work environments such as Commercial Banking. Conflict has made the working environment moved from a place where Employees come together as a team to achieve a common goal, to a place where employees feel they are not treated fairly and finds the management team to be unprofessional and have little knowledge on how to deal with challenging situations. We strongly believe this is a situation in dire need of attention and we are truly afraid of what will happen if not addressed immediately. As witness of these unprofessional behaviors, we have seen a number of these conflicts in the work place and we watched management handle these situations in a way deemed as unprofessional. Managers need to know how to communicate with a positive tone with employees; doing this will not only avoid conflicts but also help to remain in compliance with company policies and procedures. Outcome: Negative Impact on Employees

3 These behaviors will create feeling of fear and intimidation. In most cases, those who are in power are the instigators (Joint Commission, 2016). This is called eating our young. The superiors are tying to showcase authority and higher rank by using these harmful behaviors towards the most vulnerable. If these two-behaviors escalate in degree they can end up in physical abuse and threads such as throwing things, slamming objects to the victim and others. The result of this leads to working in a hostile environment that not only affects employees but also it transmits to the care of clients putting their safety at risk. No individual would want to work in a hostile environment such as the one I just described. Conflicts that are not resolved immediately can lead to increased stress among employees; affect the overall productivity of the company; distrust; and disruption of work flow. According to Chron, Failing to communicate in the workplace may cause employees to make incorrect assumptions and believe workplace gossip. Poor communication in the work-place not only causes conflict but decreases productivity and employee morale, (Johnson, 2017). Causes: One important question that rises from these matters is what is it that causes the disruptive behavior from happening. There had being different studies done that tried to explain and give a reason for these conducts. According to Wachs (2009) there are several factors that provoked the use of incivility and bullying for example: Occupational stress, difficult working conditions, unresolved conflict, lack of leadership, oppression, isolation of and less social engagement by employees, increased number, and complexity and fragmentation of workplace relationships (p.88). Others said that it also depends on the workplace and how tolerant they are to these actions. In some workplace incivility maybe ignored, so employees tend to believe that this type of behavior is acceptable. But in reality research have shown that these actions can have a negative impact on employees. Incivility results from the lack of respect to others. This not only occurs between coworkers but also between customers and clients. The impact that this issue has in the workplace is detrimental. When incivility is prevalent in the workplace, stress levels increase and performance suffers. Some disruptive behaviors associated with this particular matter sometimes are blatant such rude comments, disregard for interdisciplinary input about patient care, name calling, ethnic slurs or jokes, sexual comments, yelling, screaming, attacking a person's integrity or professional reputation, blaming others in front of a patient or patient's family member, and withholding important information to name a few (Feblinger, 2009). And other times these tend to be more subtle such as arriving late to a meeting, checking or texting during a meeting, ignoring or interrupting a colleague in the workplace, not saying please or thank you. As mentioned before incivility is based on people s perception that s why the intention behind it is not understood.

4 Additionally bullying and invincibility create conflict in the workplace as mentioned previously. According to the Cambridge Dictionary, Conflict is an active disagreement between people with opposing opinions or principles. Causes of conflicts in the workplace can be the difference in personalities to the difference in values, but the key contributors are, and I quote: Poor Communication: different communication styles can lead to misunderstandings between employees or between employee and manager. Lack of communication drives conflict underground. Different Values: any workplace is made up of individuals who see the world differently. Conflict occurs when there is a lack of acceptance and understanding of these differences. Differing Interests: conflict occurs when individual workers fight for their personal goals, ignoring organizational goals and organizational well-being. Scarce Resources: too often, employees feel they have to compete for available resources in order to do their job. In a resource scarce environment, this causes conflicts despite awareness of how scarce resources may be. Personality Clashes: all work environments are made up of differing personalities. Unless colleagues understand and accept each other s approach to work and problem solving, conflict will occur. Poor Performance: when one or more individuals within a work unit are not performing - not working up to potential and this is not addressed, conflict is inevitable. (University of Oklahoma Human Resources, 2017). Conflicts in the work-place can be very challenging, and majority of the time the end result is unsatisfactory. It is also time-consuming, It has been estimated that managers spend at least 25 percent of their time resolving workplace conflicts causing lowered office performance, (University of Oklahoma Human Resources, 2017). Employers will at some point have conflicts based on difference of opinions on the professional or personal level. With that being said, how do we go about resolving these issues? Options/ Solutions It is so important to face these issues in our company in order to have a harmonious work environment where everyone can feel confortable and perform at their best. Minimizing the conflict that now exists between the staff and management. It is essential that we eliminate bullying and incivility from our workplace by doing so we will be able to foster a better relationship between management and us. There are various solutions and approaches that we can take to solve these issues. Mason (2012) mentioned that there should be a policy implemented in every organization to eliminate abuse in the workplace. (p.432). He also gave some possible actions that we can take to reduce the incident of abuse such as: Reducing anonymity - make yourself known and recognized in the unit

5 Create stable inter-professional teams to promote healthy environments Eliminate the feeling that there s no support: It is viable to recognize the resources of the institution to help them cope. Develop an understanding of others roles and expertise: Communication between healthcare teams is key. Staff meetings can facilitate this. Provide feedback on unprofessional behaviors: The cycle of abuse will continue unless the victim verbalized the actions and reports the acts. Reduce fear of retaliation: The victim should not think that he or she is not protected is the opposite they are protected by whistleblower law. All these actions are beneficial for employees and employer at almost no cost. I believe making these issues public through seminars and sharing these ideas will be an eye opener for all, thus decreasing the incident of bullying and incivility that can also lead to conflicts in the workplace Another alternative solution to the problem is the use of Alternative Dispute Resolution (ADR). ADR is voluntary and is not a replacement for formal dispute resolution system such as grievances and discrimination. This process allows individuals who are involved to arrive at a solution to a problem quickly. Employees can openly discuss their problems and agree on suggested solutions to resolve the issue with the presence of a neutral third party. Therefore making it a safe environment for the employees to talk about their conflicts and concerns. Furthermore the Joint Commission advices healthcare organizations create a policy that promotes safety and respect in the workplace. One policy developed by the Joint Commission is zero tolerance. The most important aspect to pass across this is education. The staff and management; understanding the reasons for bullying and associated behaviors can help nurses realize they re capable of stopping the oppression. Nurse leaders can benefit from learning how to identify and curb bullying behaviors. Also, learning effective communication strategies helps nurses respond to bullying in a positive manner. The American Nurses Association also set Zero Tolerance Policy for Workplace Violence, Bullying (8/31/15). Among the position statement s recommendations to prevent and reduce violence are: Establishing a shared and sustained commitment by nurses and their employers to a safe and trustworthy environment that promotes respect and dignity; Encouraging employees to report incidents of violence, and never blaming employees for violence perpetrated by non-employees; Encouraging RNs to participate in educational programs, learn organizational policies and procedures, and use situational awareness to anticipate the potential for violence; and Developing a comprehensive violence prevention program aligned with federal health and safety guidelines, with RNs input. Nevertheless it is not a one-person solution we all have to work together to make this happen. For our managers it is important to provide a mechanism for RNs and any

6 employee to seek support when feeling threatened; inform employees about available strategies for conflict resolution and respectful communication; and offer education sessions on incivility and bullying, including prevention strategies. By creating seminars along with implementing the zero tolerance policy we can increase awareness, create workplace standards, value civility, encourage open communication and feedback. We can also provide an employee conduct handbook that describes these issues and gives corrective actions; also making it mandatory for all employees to be aware of these policies. Culture for safety is the goal that should be part of all working environment. Numerous nursing facilities face these issues in 2008; the Center for American Nurses released a position statement on lateral violence and bullying in the workplace that calls for promoting a culture of safety that encourages open, respectful communication. Also, the Joint Commission has issued leadership standards that include creating processes for managing bullying behaviors and adopting a code of conduct for employees. We have the solutions in our hands, their implementation is simple and their complexity is minimal. Educating employees is an investment that will be beneficial for our institution. We believe that by implementing a zero tolerance policy our work environment will change making our employee feel more confident and happy, thus decreasing our high turn over rates. In conclusion abusive and disruptive behavior in the workplace must end. Whether it s bullying or incivility, both are harmful and have a devastating effect that ends in conflict that if not address immediately can escalate to physical abuse, thus creating unhealthy, unsatisfying work environments that affect the ability to perform at our best. Putting at risk patients and clients safety and affecting employees psychological state. As mentioned before we need to have a zero tolerance policy against conflicts of any form. We need to have seminars, coaching groups that promote a culture of safety and respect where we can foster open communication. It makes sense to cultivate a climate of civility and a culture of openness According to P.M. Forni, the co-founder of the Johns Hopkins Civility Project, Encouraging civility in the workplace is becoming one of the fundamental corporate goals in our diverse, hurried, stressed and litigation-prone society. We are entitle to do the right thing so why not start today and do what will benefit everyone not just us. We have to stop being selfish and be more open-minded to what needs to change in the work-place. Thank you in advance for your attention. We hope this is an issue that you can relate to. We look forward in collaborating with you in order to find the best solution in resolving these issues to create a healthier and friendlier working environment for all employees.

7 Reference: American Nurses Assiation (2016). Incivility, Bullying, and Workplace Violence. Retrieved from Cambridge Dictionary. (n.d.). Conflict. Retrieved from Cambridge Dictionary Web site: Diane Berenbaum. "Workplace Incivility on the Rise: Four Ways to Stop It." Human Resources (HR) & Human Resource Management (HRM) - Human Resources IQ. N.p., 23 Mar Web. 10 Dec Joint Commission (2016) Behaviors that Undermine a Culture of Safety. Sentinel Event Alert. Retrieved from Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert July 9; 40:1-3. Johnson, R. (2017). What Causes Employee Conflict in the Workplace. Retrieved from Chron Website: Workplace html Mason D, Leavitt J, & Chaffee M. (2012). Policy & politics in nursing and health care. St. Louis, MO: Elsevier Saunders University of Oklahoma Human Resources. (2017, January 01). Resolving Conflicts at Work: Employee Information. Retrieved from Human Resources: The University of Oklahoma: Work Vessey JA, Demarco RF, Gaffney DA, Budin WC. Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. J Prof Nurs Sep-Oct; 25(5): Wachs, J. (2009). Workplace incivility, bullying, and mobbing. AAOHN Journal. 57(2): 88 What is Conflict? (n.d.). Retrieved from content/uploads/2014/08/conflict-and-peace.pdf

Text-based Document. Workplace Bullying: More Than Eating Our Young. Authors Townsend, Terri L. Downloaded 12-Apr :51:27

Text-based Document. Workplace Bullying: More Than Eating Our Young. Authors Townsend, Terri L. Downloaded 12-Apr :51:27 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based