Workplace Violence: Safety in Knowledge Mary Gullatte, PhD, RN, APRN, BC, AOCN Associate Chief Nursing Officer Emory University Hospital Midtown, Atlanta, Georgia (C) Gullatte 2010 1 Session Objectives At the end of this presentation the participants will be able to 1. Recognize and categorize the types of workplace violence 2. Analyze the characteristics of victims and perpetrators 3. Discuss strategies to de-escalate 4. Generate strategies which promote a healthy work environment (C) Gullatte 2010 2 Definition Workplace Violence Any physical assaults and verbal, implied, or written threats of assault and intimidation (NIOSH). (C) Gullatte 2010 3 1
Types of Workplace Violence Intimidation 75.9% Angry outbursts 71.9% Hypersensitivity to criticism 71.5% Belligerence 66.9% Threatening/disruptive behavior 64.6% Bullying 59.8% Harassment 51.6% Threats of physical violence 38.9% Ominous or specific threats 27.9% Hader, R. (2008). Workplace violence: Survey 2008. Nursing Management. (C) Gullatte 2010 4 Perpetrator Who are the Players Patient 53.2% Nursing colleagues 51.9% Physician 49% Visitor 47% Other healthcare worker 37.7% Victim Nursing colleague 79.7% Other HC provider 50.5% Patient 21.1% Physician 15.5% Visitor 10.9% Hader, R. (2008). Workplace violence: Survey 2008. Nursing Management. (C) Gullatte 2010 5 Cost of Work Place Violence 1993-1999 cost of WP violence =~ $4.2 billion dollars annually* Rate of violent victimization /1000 nurses =21.9% (Duhart, 2001)? Under-reporting *Bureau of Justice National Crime Victimization Survey (2001) (C) Gullatte 2010 6 2
Workplace Violence Profiles Certain jobs with greater risk of violence Working with people in emotional situations Nurses working with patients/families Office personnel handling billing issues Patients dissatisfied with results Working late at night and/or alone Medical records, collection calls, overtime, board meetings Managing drug samples or onsite pharmacy Drug theft and burglary Philip Dickey (2008) (C) Gullatte 2010 7 Workplace Violence Profiles Work situations Layoffs and firing Passed over for promotion or raise Performance reprimands or warnings Ongoing or unresolved arguments between co-workers P. Dickey (2008) (C) Gullatte 2010 8 Workplace Violence Profiles Personnel Problems Failed, one-sided, or abusive personal relationships Romantic obsession that includes stalking or harassment Serious personal problems combined with job-related problems P. Dickey (2008) (C) Gullatte 2010 9 3
Workplace Violence Profiles Which nurses are most at risk? Emergency Department Mental health Geriatric Young nurses (lack of experience)?oncology nurses Mary Gallant-Roman, (2008) (C) Gullatte 2010 10 Workplace Red Flags Employees or Someone who Threatens and intimidates others Blames others for problems Gets angry easily and often Uses abusive language Talks a lot about weapons Holds grudges Reacts angrily to criticisms Difficulty maintaining relationships Abuses drugs History of violent acts P. Dickey (2008) (C) Gullatte 2010 11 Hidden Workplace Violence Combative patients Support staff (UAPs) Co-workers (Nurses, MDs, APPs: NPs, PAs, Managers) Incivility- rude, discourteous acts Bullying-belittling, finding fault Mobbing- multiple people against one person Intimidation frighten, influence through fear (C) Gullatte 2010 12 4
Factors Foster Uncivil Behaviors Occupational stress Difficult working conditions Unresolved conflict Lack of leadership Oppression Isolation of and less social engagement Complexity and fragmentation of relationships Farkas & Johnson (2002) (C) Gullatte 2010 13 Employee Workplace Behaviors What you Permit you Promote Not setting limits when you hear about inappropriate behaviors Employees not respecting leadership decisions Undermining authority Unfair, unilateral decision Uncivil behavior is contagious (C) Gullatte 2010 14 Consequences of Negative Workplace Relationships Job dissatisfaction Decreased worker productivity Job withdrawal (work avoidance: call-outs) Harkreader (2008) (C) Gullatte 2010 15 5
Keys to Prevention (C) Gullatte 2010 16 Prevention: Start with the Work Environment Foster a harmonious, supportive work environment Provide fair treatment and performance management for all employees Offer Conflict Resolution and Effective Communication training for staff (C) Gullatte 2010 17 Prevention: Start with the Work Environment Establish procedures for handling grievances Take threats seriously and respond rapidly Monitor and manage the stress levels of the work environment 18 (C) Gullatte 2010 6
Know your team members: Individual responses to stress Monitor team dynamics Stay connected and engaged Make note of the formal and informal communication of the team Keep lines of communication open with employees Utilize clear, direct communication when engaged in constructive confrontation (C) Gullatte 2010 19 Possible Precipitating Events Work Factors Discipline or Negative Performance Review Reduction In Force/Termination/Demotion/ Promotion Denial Accumulated Grievances Perception of Harassment Personal Factors Loss of Relationship Financial Loss Legal Action Loss of Face/Humiliation Personal Rejection (C) Gullatte 2010 20 Keys to De-escalation (C) Gullatte 2010 21 7
Work Place Violence: Success Strategies Evaluate your workplace Use top-down approach and buy-in Institute zero tolerance Empowerment of Nurses Predict High-risk events Provide education for all (C) Gullatte 2010 22 Progression of Violence Traumatic experience perceived as being unsolvable Projection of Responsibility Defensive Attitude Perception of No Justice Takes Justice into own hands Handbook of Workplace Violence (2006) (C) Gullatte 2010 23 Report Warning Signs Immediately Ominous Treats Threatening Actions Bizarre Thoughts and/or Behaviors Obsessive Thoughts and/or Behaviors Stalking Behaviors Aggressive and threatening emails Sharing inappropriate behaviors with colleagues (e.g., purchase of weapons) Baron (2000) (C) Gullatte 2010 24 8
Resources Police/Security Department Human Resources General Counsel Critical Incident Response Team Chaplains/ Pastoral Counseling Services (C) Gullatte 2010 25 Evaluation and Response to Workplace Violence: Zero Tolerance for WP violence (OSHA) Identify your organizational resources Document and seek consultation about the warning signs: Behaviors Interpersonal interactions Persecutory thoughts and emails Changes in work performance Baron (2000) (C) Gullatte 2010 26 Next Steps (C) Gullatte 2010 27 9
Healthy Work Environments Made, NOT Born YOU are the Catalyst. 28 (C) Gullatte & Gomes, 2009 28 A Healthy Work Environment Starts with (C) Gullatte 2010 29 Empowerment Zone What can you do to empower your voice and connect in the workplace? (C) Gullatte 2010 30 10
Consequences of an UN-Healthy Work Environment Lack of team work Risk to patient safety Lack of staff engagement Workplace violence Lateral violence within the work group Lack of patient, employee, and provider satisfaction High staff turnover among all groups (C) Gullatte 2010 www.aacn.org 31 Signs of a Healthy Work Environment 1. Employees laugh often 2. Employees freely share their ideas 3. Employee values and expectations are clear 4. We work simply: decrease complexity 5. Our organization is reasonably orderly and comfortable 6. Employees have strong connections with others 7. Encourage and reward staff that volunteer outside of work Prewitt, http://www.medi-smart.com/career-signs.html (C) Gullatte 2010 32 Characteristics of a Healthy work Environment. adapted from www.aacn.org Skilled communication True collaboration Effective decision making Appropriate staffing/coverage Meaningful recognition Authentic leadership Trust, Value, Respect (C) Gullatte 2010 33 11
A Healthy Work Environment Begins with TRUST (C) Gullatte 2010 34 TRUST: Assets and Liabilities Environment of Nonexistent Trust Organization Dysfunctional environment and toxic culture (open warfare, sabotage, grievances, etc) Micromanagement Punishing systems Personal Relationships Dysfunctional relationships Hot and angry confrontations Defensive posturing Labeling others as enemies Covey, S.R.M. (2006) (C) Gullatte 2010 35 Environment of Very Low Trust Organizational Unhealthy working environment Unhappy employees Excessive time wasted defending positions and decisions Personal Relationships Hostile behaviors (yelling, blaming, accusing) Guarded communication Worrying and suspicion Mistakes remembered and used and weapons Real issues not surfaced or dealt wit effectively Covey, S.R.M. (2006) (C) Gullatte 2010 36 12
Environment-Trust is a Visible Asset Organizational Personal Relationships The focus is on work Cooperative, close Effective collaboration vibrant relationships and execution A focus on looking or and leveraging one another s strengths Uplifting and positive communication Covey, S.R.M. (2006) (C) Gullatte 2010 37 Inspiring TRUST Nothing is as profitable as the economics of trust Nothing is as relevant as the pervasive impact of trust The dividends of trust can significantly enhance the quality of every relationship on every level of your life. Covey (2006), p. 285 (C) Gullatte 2010 38 Shared Governance/ Decision Making An organizational innovation that gives healthcare professionals control over their practice and extends their influence into administrative areas previously controlled only by managers. Governance models should be evidence-based. http://www.sharedgovernance.org/ (Porter-O Grady, 2003) (C) Gullatte 2010 39 13
Positive Consequences of Shared Governance/Decision Making Improved decision making Service excellence Organizational influence Collaboration Improved communication Healthy Work Environment (C) Gullatte 2010 40 Creating a Healthy Culture Collaborative Partnerships Respect and Value of each person Zero tolerance of workplace violence in policy Label disruptive behavior included in policy Enforcement has to be at every level Front-line managers Senior level administrators Medical staff All Healthcare Staff (C) Gullatte 2010 41 Keeping Healthy Integrating into a New Work Culture What works? Self-esteem Self-confidence not cocky Build Knowledge Workplace culture People Clinical Clinical skills People relationships/skills Positive influence with people Leadership Seek a mentor (C) Gullatte 2010 42 14
If all else fails What do you do??? (C) Gullatte 2010 43 Group Discussion Share some unhealthy work environment behaviors (forms of violence in the workplace) you have encountered as a student? How did you handle it? What was the outcome? Would you do anything differently? (C) Gullatte 2010 44 Your Thoughts (C) Gullatte 2010 45 15
Selected References AACN Healthy work environment. http://www.aacn.org ANCC. Magnet. http://www.nursecredentialing.org An overview of healthcare workplace violence. Healthcare hazard Management Monitor, 22(6): 1-6. Barling, J., Dupre, K., & Kelloway, E. (2009). Predicting workplace aggression and violence. Annual Review of Psychology, 60: 671-92. Bigony, L., Lipke, T., Lundberg, A., McGraw, C., Pagac, G., & Rogers, A. (2009). Lateral violence in the perioperative setting. AORN Journal, 89(4); 688-96. Covey, S.M.R. (2006). The speed of trust. FreePress. New York. Danesh, V., Malvey, D., & Fottler, M. (2008). Hidden workplace violence: What your nurses may not be telling you. Health Care Management, 27(4): 357-63. Developing and implementing a workplace violence prevention program and policy. http://www.cdc.gov/niosh/violdev.html Gallant-Roman, M. (2008). Strategies and tools to reduce workplace violence. AAOHN Journal, 56(11): 449-54. 16