Lateral Violence in Nursing

Lateral Violence in Nursing

Kimberly ReedFerris State University

1Define Lateral ViolenceIdentify the organizational culture and environmental impact Understand the ANA Code of Ethics for nurses and lateral violenceIdentify QSEN in relation to lateral violence and the nursing fieldANA standards of practice specific to lateral violence in nursingBe aware of how lateral violence negatively affects the delivery of healthcare servicesAcknowledge how lateral violence may have financial and organizational effects of healthcare employers and institutionsHow nursing lateral violence effects the efficiency, accuracy, safety and outcomes of patient careRecognize how lateral violence in nursing may hinder the recruitment and retention of nursesHow can organizations and individuals reduce the incidence and consequences of lateral violence? (Recommendations for improvement)

Learning Objectives

2

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

Introduction to 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)

Lateral Violence

Includes bullying in the workplaceRepeated inappropriate behavior, direct or indirect, verbal, physical, or otherwise, perpetuated by one or more individuals in the workplace (Brothers, Condon, Cross, M., & Lewis, 2011)

4Bullying 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 dont know how to use an EKG machine? Did you EVEN go to nursing school?!I am sorryI have never used oneI didnt want to do it wrong

5Group 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).

What causes lateral violence?

These feelings are then displayed through behaviors such as gossiping, exhibiting jealousy, putting others down, and blaming others for their actions (Brothers, Condon, Cross, M., & Lewis, 2011).

6Banduras 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)

Nursing Theory in relation to lateral violence

7

(Walrafen, Brewer, & Mulvenon, 2012)

Sadly Caught Up in the Moment: An Exploration of Horizontal ViolenceNancy Walrafen, MS, RN, OCN, M. Kathleen Brewer, PhD, ARNP, BC, Carol Mulvenon, MS, RN-BC, AONC, ACHPNDisclosuresNurs Econ.2012;30(1):6-12, 49.http://www.medscape.com/viewarticle/760015_4Nurs Econ.2012;30(1):6-12, 49.2012 Jannetti Publications, Inc. 8suggested 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.Freires theory of oppression(Purpora & Blegen, 2012)

Nursing Research and PracticeVolume 2012 (2012), Article ID 306948, 5 pageshttp://dx.doi.org/10.1155/2012/306948Research ArticleHorizontal Violence and the Quality and Safety of Patient Care: A Conceptual ModelChristina Purpora1 and Mary A. Blegen29Nurses 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

Freires theory applied to nursing practice(Purpora & Blegen, 2012)

Nursing Research and PracticeVolume 2012 (2012), Article ID 306948, 5 pageshttp://dx.doi.org/10.1155/2012/306948Research ArticleHorizontal Violence and the Quality and Safety of Patient Care: A Conceptual ModelChristina Purpora1 and Mary A. Blegen210Organizational 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)

Organizational Culture and Environmental Impact

11Function 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)

QSEN competencies: influence on lateral violence

http://www.aacn.nche.edu/faculty/qsen/competencies.pdfAacn qsen education consortium

12ANA website

The right to work in healthy work environments free of abusive behavior

(American Nurses Association, 2013)American Nurses Association Code of Ethics

Bullying, hostility, lateral abuse and violence, Sexual harassment, intimidation, abuse of authority position Reprisal for speaking out against abuses (American Nurses Association, 2013)

13ANA 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)

ANA continued

(American Nurses Association, 2013)14This 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)

New Standard

15Provision 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)

ANA professional standards

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)

1.5 Relationships with colleagues and others

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)

ANA Provision 5.1

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)

How lateral violence negatively affects the delivery of healthcare services

19Estimation 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)

Financial and organizational effects of employers

20High stress, post-traumatic stress disorderFinancial problems due to absenceReduced self-esteemMusculoskeletal problemsPhobiasSleep disturbancesIncreased depression/self blameDigestive problems

(Ceravolo, Schwartz, Foltz-ramos, & Castner, 2012)

Effects on the efficiency, accuracy, safety and outcomes of care

21Leaving 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)

Recruitment and retention of nurses

A study of student nurses reported that 53% had been put down by a staff nurse (ANA, 2011)52% reported having been threatened or experienced verbal violence at work (ANA, 2011).

22Reducing the incidence and consequences of lateral violence:

Individual versus Institutional

RecommendationsKnow your rightsPrepare for the possibility that the organization will prioritize their interestsIf other measure fail then seek legal counseling

23Recognize when bullying existsUtilize behavioral health servicesBe aware of the effect of bullying and look for signs Be knowledgeable about policies and procedures in your workplaceDocument the specifics for all incidents of bullying(Croft & Cash, 2012)

Individual

Most importantly, be a leader! Take pride in encouraging others, as well as providing helpful insight or direction24Monitoring 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 treatedAmerican Association of Critical Care Nurses Health Work Environment Assessment

(Embree, Bruner, & White, 2013)

Institutional

Hierarchal systems limit the reporting of workplace violence particularly initiated by supervisorHierarchal systems may cultivate a culture of oppression, which others have argues leads to workplace violence

251. Skilled Communication

2. True Collaboration

3. Effective Decision Making

4. Appropriate Staffing

5. Meaningful Recognitions

6. Authentic Leadership

(Croft & Cash, 2012)

Six Standards for nurses to promote a healthy work environment

26Diligence in recognizing lateral violence by institutions and individuals

Move forward by holding oneself and others accountable

Treat all coworkers with dignity and respectConclusion

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!

Conclusion Continued

Thank you! I hope that you enjoyed this seminar and learned a few new things about lateral violence. It is an opportunity to self-reflect about how you can improve the workplace!28American Association of Colleges of Nursing. (2012). Graduate-Level QSEN Competencies. Education Consortium. doi:http://www.aacn.nche.edu/faculty/qsen/competencies.pdfAmerican Nurses Association. (2013). Bullying and workplace violence. Retrieved from American Nurses Association: http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/bullyingworkplaceviolenceBrothers, 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:10.1155/2013/207306Purpora, 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/10.1155/2012/306948The 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=wWalrafen, 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

References