Lateral Violence in Nursing

1. Lateral Violence in Nursing Kimberly Reed Ferris State University

2. Learning Objectives • Define Lateral Violence • Identify the organizational culture and environmental impact • Understand the ANA Code of Ethics for nurses and lateral violence • Identify QSEN in relation to lateral violence and the nursing field • ANA standards of practice specific to lateral violence in nursing • Be aware of how lateral violence negatively affects the delivery of healthcare services • Acknowledge how lateral violence may have financial and organizational effects of healthcare employers and institutions • How nursing lateral violence effects the efficiency, accuracy, safety and outcomes of patient care • Recognize how lateral violence in nursing may hinder the recruitment and retention of nurses • How can organizations and individuals reduce the incidence and consequences of lateral violence? (Recommendations for improvement)

3. Introduction to Lateral Violence What is lateral violence? • Any inappropriate behavior, confrontation, or conflict-ranging from verbal abuse to physical and/or sexual harassment • Bullying • Nurse on nurse aggression and inter-group conflict

4. Lateral Violence • The National Institute for Occupational Safety and Health defines lateral violence as any physical assault, threatening behavior, or verbal abuse occurring in the workplace (American Nurses Association, 2013)

5. Bullying is often described as acts perpetrated by one in a higher level of authority • (Brothers, Condon, Cross, M., & Lewis, 2011 What do you mean you don’t know how to use an EKG machine? Did you EVEN go to nursing school?! I am sorry…I have never used one…I didn’t want to do it wrong…

6. What causes lateral violence? • Group self-hatred, low self-esteem, and self-loathing • Low self-esteem in addition to lack of respect for others • Oppressed groups or individuals internalize feelings such as anger and rage and then act out onto others (Brothers, Condon, Cross, M., & Lewis, 2011).

7. Nursing Theoryin relation to lateral violence • Bandura’s theory • the workplace (world) and the employees (individuals) on some level cause each other's behavior (reciprocal determinism) • When maltreatment of an employee(s) is occurring, members of the work unit may model the behavior of the individuals participating in the negative behavior as a way to be accepted by them • (Walrafen, Brewer, & Mulvenon, 2012)

8. (Walrafen, Brewer, & Mulvenon, 2012)

9. Freire’s theory of oppression • suggested that the Brazilian people he observed were living in a “situation of oppression” • They were dominated by others who had violently obstructed them from living their lives freely • Freire argued that a situation of oppression can be changed because it results from an imbalanced social structure, not fate. (Purpora & Blegen, 2012)

10. Freire’s theory applied to nursing practice • Nurses have worked in a situation of oppression • caring for patients in hospitals controlled by male physicians and administrators. • Today, nurses continue to bear a great deal of responsibility in patient care • they have little power compared to physicians and administrators (Purpora & Blegen, 2012)

11. Organizational Culture and Environmental Impact • Organizational Culture is defined as commonly held values, beliefs, and attitudes by members of the organization • Nurse-to-nurse lateral violence (NNLV) or nurse aggression profoundly increases occupational stress with psychological, physical, and organizational consequences (Embree, Bruner, & White, 2013)

12. QSEN competencies: influence on lateral violence • Function effectively within nursing and inter-professional teams, nurturing open communication, mutual respect, and shared decision-making to achieve quality patient care. • Respect the unique attributes that members bring to a team, including variation in professional orientations, competencies and accountabilities • (Purpora & Blegen, 2012)

13. American Nurses Association Code of Ethics • ANA website • The right to work in healthy work environments free of abusive behavior (American Nurses Association, 2013)

14. ANA continued… • ANA recognizes that workplace violence is a problem in the health care industry and works hard to provide resources to protect nurses (American Nurses Association, 2013) • Joint Commission on Accreditation of Healthcare Organization created a new standard in the “Leadership” chapter (LD.03.01.01) (American Nurses Association, 2013)

15. New Standard • This standard addresses disruptive and unsuitable behaviors. Additionally, there are several states that have enacted legislation or regulations aimed at preventing workplace violence (American Nurses Association, 2013)

16. ANA professional standards • Provision 1. • The nurse practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. (American Nurses Association, 2013)

17. 1.5 Relationships with colleagues and others • The principle of respect for persons extends to all individuals with whom the nurse interacts. The nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise, and to resolving conflict. (American Nurses Association, 2013)

18. ANA Provision 5.1 • Moral respect accords moral worth and dignity to all human beings irrespective of their personal attributes or life situation. • Such respect extends to oneself as well; the same duties that we owe to others we owe to ourselves. (American Nurses Association, 2013)

19. How lateral violence negatively affects the delivery of healthcare services • Emotional withdrawal from patients and co-workers • Perpetuation of power imbalances • Moral residue • Fragmented care • Emotional withdrawn or angry care providers (The center of American nurses calls for an end to lateral violence and bullying in nursing work environments, 2008)

20. Financial and organizational effects of employers • Estimation of annual cost • $4.3 billion dollars or nearly $250,000 per incident • Each percentage point of nurse turnover results in an annual cost to an average hospital of nearly $300,000 and $3.6 million in poorly performing hospitals (Embree, Bruner, & White, 2013)

21. Effects on the efficiency, accuracy, safety and outcomes of care • High stress, post-traumatic stress disorder • Financial problems due to absence • Reduced self-esteem • Musculoskeletal problems • Phobias • Sleep disturbances • Increased depression/self blame • Digestive problems (Ceravolo, Schwartz, Foltz-ramos, & Castner, 2012)

22. Recruitment and retention of nurses • Leaving position or the profession due to emotional and physical effects • Nearly 60% of new nurses leave their initial employer within the first six months due to NNLV perpetrated in the workplace (Ceravolo, Schwartz, Foltz-ramos, & Castner, 2012)

23. Reducing the incidence and consequences of lateral violence: Individual versus Institutional Recommendations

24. Individual • Recognize when bullying exists • Utilize behavioral health services • Be aware of the effect of bullying and look for signs • Be knowledgeable about policies and procedures in your workplace • Document the specifics for all incidents of bullying (Croft & Cash, 2012)

25. Institutional • Monitoring the work environment for signs of ineffective communication • Move away from a hierarchical system towards a model of shared governance • Clearly communicate expectations for how persons are to be treated • American Association of Critical Care Nurses Health Work Environment Assessment • (Embree, Bruner, & White, 2013)

26. Six Standards for nurses to promote a healthy work environment • 1. Skilled Communication • 2. True Collaboration • 3. Effective Decision Making • 4. Appropriate Staffing • 5. Meaningful Recognitions • 6. Authentic Leadership (Croft & Cash, 2012)

27. Conclusion • Diligence in recognizing lateral violence by institutions and individuals • Move forward by holding oneself and others accountable • Treat all coworkers with dignity and respect

28. Conclusion Continued… • Appropriate reporting of any lateral violence • Institutions policies and procedures to reflect the ANAs standard of lateral violence and bullying in the workplace. • Be a leader! Set the example! Keep the common goal of providing excellent and safe patient-centered care!

29. References American Association of Colleges of Nursing. (2012). Graduate-Level QSEN Competencies. Education Consortium. doi:http://www.aacn.nche.edu/faculty/qsen/competencies.pdf American Nurses Association. (2013). Bullying and workplace violence. Retrieved from American Nurses Association: http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/bullyingworkplaceviolence Brothers, D., Condon, E., Cross, B., M., G. K., & Lewis, E. (2011). Taming the beast of lateral violence among nurses. Virginia Nurses Today, 18(4), 7-11. Ceravolo, D., Schwartz, D., Foltz-ramos, K. M., & Castner, J. (2012). Strengthening communication to overcome lateral violence. Journal of nursing management, 20, 599-606. Croft, R. K., & Cash, P. A. (2012, October). Deconstructing contributing factors to bullying and lateral violence in nursing using a postcolonial feminist lens. Contemporary nurse: a journal for the Australian nursing profession, 42(2), 226-242. Embree, J., Bruner, D., & White, A. (2013). Raising the Level of Awareness of Nurse-to-Nurse Lateral Violence in a Critical Access Hospital. Nursing Research and Practice. doi:10.1155/2013/207306 Purpora, C., & Blegen, M. (2012). Horizontal violence and the quality and safety of patient care: a conceptual model. Nursing Research and Practice, 1-5. Retrieved from http://dx.doi.org/10.1155/2012/306948 The center of american nurses calls for an end to lateral violence and bullying in nursing work enviornments. (2008, April-June). South Carolina Nurse, 15(2). Retrieved from http://0go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE%7CA241626703&v=2.1&u=lom_ferrissu&it=r&p=AONE&sw=w Walrafen, N., Brewer, K., & Mulvenon, C. (2012). Sadly caught up in the moment: an exploration of horizontal violence. Nursing Economy, 30(1), 6-12, 49. Retrieved from http://www.medscape.com/viewarticle/760015_4