management of professional conflict in the workplace

MANAGEMENT OF

PROFESSIONAL CONFLICT

IN THE PERIANESTHESIS AREAPresented to Nebraska Association of Perianesthesia Nurses

Alegent Creighton Bergan Mercy Medical Center

Presented by Michelle Homme March 23, 2013

GOAL: TO EDUCATE ON WORKPLACE

VIOLENCE AND HOW TO DEAL WITH THOSE

SITUATIONS SHOULD THEY ARISE.

The definition of workplace violence

Statistics

Forms of violence

Characteristics of attackers

Types of attacks

Confrontation levels

Specific attacks

Prime targets

Constant Change, LLC © @ItStartsToday

2

GOAL: TO EDUCATE ON WORKPLACE

VIOLENCE AND HOW TO DEAL WITH THOSE

SITUATIONS SHOULD THEY ARISE.

Needed elements

Costs

Why?

Lookout!

What can you do?

Prevention

Two for one

Coping

At the top of your game


3

WORKPLACE VIOLENCE

Definition:

Violence or threat against people while they are at work

Forms of workplace violence

Threats

Harassment

Violence, including assaults

Damage to property

Mental anguish

Physical harm


4

WORKPLACE VIOLENCE

Statistics (reported)

Homicide is the third highest leading cause of death on the job (12% of all fatalities)

There was a one-third increase in workers who were killed on the job between the 1980’s and 1992

75% of all deaths in the workplace are the result of gun use

2012 SHRM workplace survey, 36% of organizations reported incidents

2 million employees are affected every year (OSHA)

Violence against women is increasing (perhaps related to more women working)

Bureau of Labor Statistics (2011) – Between 1992 and 2010, there were 13,827 victims (about 700/year)


5

WORKPLACE VIOLENCE


6

WORKPLACE VIOLENCE

Statistics

Next to auto accidents, homicide is the leading cause of death

in the workplace.

There were 1,004 workers murdered in 1992 (33% increase since

the 1980’s.)

Workplace violence in healthcare

45% of all non-fatal assaults

1993-1999, 765,000 assaults resulting in time away from work

8 RN’s were fatally injured at work from 2003-2009


7

MORE HEALTHCARE STATISTICS

4 days away from work was the average

reported by RN’s in 2009 who suffered

from 2,050 attacks

Non fatal assaults included being hit,

kicked or beaten, scratched, squeezed,

punched, and bitten

Patients caused 89% of those assaults

50% of Emergency Nurses experienced

assaults in 2009


8

BULLYING IN NURSING

Also known as “lateral violence” or “horizontal violence”

Has been around for decades

Purposeful in inflicting mental harm on other nurses with verbal and non-verbal actions

Threatening body language and strong verbal abuse has been reported by student nurses (53%) and nurses, pharmacists, and others (48%)

Nurses also report being threatened as well

Effects include low morale, increased absenteeism, nurses leaving the profession

Patient care deteriorates

Additional stress and other medical issuesConstant Change, LLC © @ItStartsToday

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WORKPLACE VIOLENCE

One of the first terrorist attacks that made news

December 21, 1988

Lockerbie, Scotland

Pan Am Flight 103 – 243 passengers and 16 crew were killed in mid air

Most recent attack

Riverside Police Department, Riverside, California –

One officer was killed, another injured as they sat at a red light in their marked car. Alleged attacker – former LAPD Officer. February 7, 2013


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WORKPLACE VIOLENCE

Rules & regulations (Nebraska)

It is unlawful in Nebraska to carry a weapon or a weapon concealed on or about the person, unless it can be shown that the person was engaged in lawful business, calling, or employment at the time the person was carrying any weapon, and the circumstances justify a prudent person carrying the weapon to defend his or her person, property, or family.

It is unlawful to possess a firearm in a school, on school grounds, in a school-owned vehicle, or at a school-sponsored activity or athletic event.

Nebraska is one of 18 states where penalties are increased for workplace violence against nurses and 9 additional states have laws in place requiring that workplace violence programs be in place.


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FORMS OF WORKPLACE

VIOLENCE

Threats

Hostage situations

Property damage

Intimidation

Bullying

Mental harm

Physical harm


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FORMS OF WORKPLACE

VIOLENCE

Threats

Job related

Forms of aggression

Hostage situations

Need to be heard

Want something to be fixed


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FORMS OF WORKPLACE

VIOLENCE

Property damage Alfred P. Murrah Federal Building

April 19, 1995

168 lives lost, including 19

children

Cost: appox. $652 million


14

FORMS OF WORKPLACE

VIOLENCE

Intimidation

Stalking

rumors

Bullying

Why has it escalated?

What can be done about it?


15

FORMS OF WORKPLACE

VIOLENCE

Mental harm

Additional stress

Sick time taken

Question one’s ability


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FORMS OF WORKPLACE

VIOLENCE

Physical harm

Most severe

Wounded

Lives lost


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CHARACTERISTICS OF POTENTIAL

ATTACKERS

Loners

Mental health issues

Emotionally charged

Intoxicated people

Big ego/control freaks/”untouchable”


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CHARACTERISTICS

Loners

Never has

friends

Plays the

victim

Complains


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CHARACTERISTICS

Mental health issues

May not be known

Subtle signs where something is not

“right’


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CHARACTERISTICS

Emotionally charged

Life and death of loved one

Helpless feeling

Intoxicated

Indications include:

Slurred speech

Difficulty in following conversation

Level of speaking is louder than most conversations

No regard for attention that it brings


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CHARACTERISTICS

Big ego

No vanity or “God” like

Control freaks

Micro managers

Untouchables

Above the law


22

CHARACTERISTICS

The ones you

don’t see

coming

Don’t fit normal

profiles

Keep things

hidden well


23

THE 4 TYPES OF ATTACKS

Strangers

Terrorists

September 11, 2001

Politics

Assassinations of Abraham Lincoln and John F Kennedy

Customers

Educational locations

Columbine

Virginia Tech University

Employees

Postal workers

LA Police Officer

Relationship-based

Domestic violenceConstant Change, LLC © @ItStartsToday

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THE 4 TYPES OF ATTACKS

Strangers

Someone that has no known ties to the workplace environment

Random

85% of all attacks

Tucson, AZ January 28, 2011. US

Rep Gabrielle Gifford was among

the injured that left 6 dead.

Aurora, CO July 20,

2012. 12 dead and 58

injured

**side note: in

Omaha, a basketball referee was attacked and his glasses broken by an angry fan during the week of February 10, 2013 after a game between two church affiliated teams.


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THE 4 TYPES OF ATTACKS Customers or clients

Someone who has used services/products from

the workplace

3% of attacks

Columbine High School,

CO April 20, 1999. 12

students and 1 teacher

were killed. 21 were

injured.

Virginia Tech University,

Blacksburg, VA. April 16, 2007.

32 were killed and 17 were

injured.Constant Change, LLC © @ItStartsToday

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THE 4 TYPES OF ATTACKERS

Employee or former employee

Someone who is a current employee or was an employee

Usually target authority figures (supervisors)

7% of attacks

Fort Hood, TX

November 5, 2009. 13

dead and 29 injured

“Going postal” First attack regarding postal workers was in Australia in 1926. Between 1991 and 1997, there were 10 shootings alone in the US, and the first one took place on August 19, 1983 where one person was killed and two were injured.Constant Change, LLC © @ItStartsToday

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THE 4 TYPES OF ATTACKERS

Personal relationship

Someone that comes to the workplace because of a

relationship with an employee at the workplace

Domestic violence – “Nationally, over 13,000 attacks against

women are made at work each year by partners.”

5% of attacks

Seal Beach, CA October 12, 2011. 8 killed. Alleged gunman’s former wife was an employee and victim.


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LEVELS OF CONFRONTATION

Day-to-day

Moderate

Severe

July 7, 2005,

EnglandConstant Change, LLC © @ItStartsToday

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Day-to-day

Road rage

Inpatient


30


Moderate

Someone who is upset about a situation

and you are the one they direct their

frustration towards


31


Severe

With weapons

Casualties

Millard South High School,

Omaha, NE January 5,

2011. Assistant Principal

killed. Principal injured.


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SPECIFIC ATTACKS

Sandy Hook Elementary School

Newtown, CT

December 14, 2012

Lives lost:

20 students

6 staff


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SPECIFIC ATTACKSSeptember 11, 2001

The Pentagon, Washington, DC – 59 lives lost

World Trade Center, New York City, NY - nearly 3,000 lives lost

Shanksville, PA

– 44 lives lostConstant Change, LLC © @ItStartsToday

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SPECIFIC ATTACKS

Von Maur Department Store

Omaha, NE

December 5, 2007. 8 killed, 5 injured.


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PRIME ENVIRONMENTS FOR

ATTACKS

Employees working

with the public are

at the most risk


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TOP 10 INDUSTRIES FOR ATTACKS

1. Manufacturing

2. Health care & social assistance

3. Professional, scientific, and technical services

4. Finance and insurance

5. Educational services

6. Transportation and warehousing

7. Public administration

8. Retail trade

9. Construction of buildings; heavy & civil engineering construction; specialty trade contractors

10. Accommodation and food servicesConstant Change, LLC © @ItStartsToday

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TOP 10 ENVIRONMENTS OF ATTACKS

January 2013Constant Change, LLC © @ItStartsToday

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HEALTH CARE ENVIRONMENTS

Why?

• Emotions are peaked

• Access to medications

• Mentally unstable people


39

NECESSARY ELEMENTS TO

VIOLENCE

• Emotional

• Involves people

• Location, location, location!


40


VIOLENCE

Emotional

Feelings get in the way

Not rational

There does not have to be an

explanation


41


VIOLENCE Involves people

Makes the biggest impact

We pay attention

It makes us angry

Senseless, regardless of the explanations


42

NECESSARY ELEMENTS TO VIOLENCE Location, location, location!

Where are the innocent?

Where no one would ever imagine it

happening?

Where is the biggest impact?


43

ASSOCIATED COSTS

$120 billion a year


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COSTS ASSOCIATED WITH WORKPLACE VIOLENCE

1. Management time

2. Loss of productivity

3. Replacing staff/turnover

4. Additional training expenses

5. Increased security

6. Debriefing with staff (after an incident)

7. Communication costs increase

8. Legal expenses are higher

9. HR expenses

10. Increased absenteeism


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EXPLANATIONS OF WHY

Unfairly treated

Lost their job

Someone else is

responsible


46

EXPLANATIONS OF WHY

Unfairly treated

It doesn’t have to make sense –

the person just has to feel like they

were wronged


47

EXPLANATIONS OF WHY Lost their job

It doesn’t matter if it was legitimate or not

No future


48

EXPLANATIONS OF WHY

Someone else is responsible

It doesn’t matter if they believe that they have

any part in what is happening or not

Holding onto what got them there instead of

how to make it better

Holding grudges


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BE ON THE LOOKOUT!

Possible signs

Trust your gut

Ask for help


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BE ON THE LOOKOUT!

Possible signs

challenges authority

Has no accountability

Stalks other employees

Disregard for normal accepted society

practices


51

BE ON THE LOOKOUT!

Possible signs:

Words used

References to violence or weapons

Enjoys making people nervous


52

BE ON THE LOOKOUT!

Possible signs

Threatening demeanor

Changes in behavior

Abusing drugs or alcohol

Emotional state


53

BE ON THE LOOKOUT!

Trust your gut Hide

Report


54

BE ON THE LOOKOUT!

Ask for helpFind co-workers who will listen

Talk to law enforcement


55

WHAT TO DO

Communicating

Stay calm (Breathe)

Don’t show fear (Breathe)

Don’t disregard their feelings (Breathe)

Indicate your willingness to help (Breathe)

Don’t argue (Breathe)


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WHAT TO DO

Keep your distance

Be on the same level

(don’t be sitting if they are

standing)


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PREVENTION

Have a plan

Access your surroundings

Address the situation immediately

Environment

Ask for help

Talk to law enforcementConstant Change, LLC © @ItStartsToday

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PREVENTION

Have a planUse technology

Send emails to all employees

Mass callout on all phone lines

Intercom system

Install cameras


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PREVENTION

Access your surroundings

Are their triggers that might upset someone?

Go outside your box

Know your fellow employees

Acknowledge those that are new

Learn people’s names

Assist strangers

Greet them

Make eye contact

Ask questions


60

PREVENTION

Address the situation immediately

Better to be safe

Take every threat seriously (you can

apologize later for a false alarm)

Treat every employee with respect


61

PREVENTION

EnvironmentDevelop relationships with nearby

businesses

Have well lighted parking lots

Advertise that even threats are taken

seriously

Hire security guards


62

PREVENTION

Ask for helpDifficult but necessary

Expertise


63

PREVENTION

Talk to law enforcement

Ask them to review your procedures

Have numbers close by

Evacuation

Do you have a plan?

Is it practiced?

How do you know that everyone is accounted for?


64

TWO FOR ONE!

Not only can you be a victim

of an attack, but you are

involved with victims of an

attack that took place

elsewhere.


65

HOSPITAL STAFF ASSAULTS

St. Vincent’s Hospital

Birmingham, AL

December 15, 2012

Gunman walked in with a gun and

started shooting, injured 3 and

then was killed by an officer.


66

TWO FOR ONE!

Keep emotions in check

Difficult

Think first

Ignore insults


67

TWO FOR ONE!

Sudden, quick decisionsHave to react

Life and death related


68

COPING

Employee Assistance Program

(EAP)

Writing

Talking

Reporting


69

COPING

EAP (Employee Assistance Program)

Most employers have a program to help with work situations

Very inexpensive or no cost

Professionals


70

COPING

Writing

Start a journal

Write letters you never mail

Why? To get it “off your chest”


71

COPING

Talking

Family

Friends

Co-workers (compare

stories)

Helps to process

Becomes a teaching

momentConstant Change, LLC © @ItStartsToday

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COPING

Reporting

Statistics

Document the event


73

AT THE TOP OF YOUR GAME

Why nursing?

You can make a difference

Helping others brings you joy

Monotony is not for you!!

Fast paced environment

No chance for errors


74

RESOURCES

U.S. Department of Labor, OSHA

American Nurses Association

The National Institute for the Prevention of

Workplace Violence, Inc.

And many others!

Printed OSHA checklists & OSHA factsheet


75

SOURCES

Society for Human Resource Management

OSHA

Bureau of Labor Statistics

US Dept of Justice

Violence and Theft in the Workplace, July 1994

National Traumatic Occupation Fatality Study,

1994

Workplaceviolence911.com

US Dept of Labor

American Nursing Association

Nursingworld.org

Neckerman.com (Neckerman Insurance,

March 19, 2012)Constant Change, LLC © @ItStartsToday

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HOW DO WE KEEP IT GOING? Truth is, workplace violence is a part of our

society it is very depressing

What did we learn?

What workplace violence is and how to identify it

The signs we need to look for to identify possible attackers and potential situations

What to do in case we are victims of workplace violence

How to deal with the after effects of workplace violence

How can we use this knowledge?

We can report ALL acts of workplace violence, regardless of how minor they may seem and if we feel anything changes

Prepare our work environment to be as safe as possible

Being better people makes better nurses


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BEING A NURSE

Can you sell it?


78

STRESS IS EVERYWHERE

Do you carry stress? How do you relieve it?

I carry it in my shoulders and I run to relieve it

How does it affect you?

I don’t sleep like I should

We cannot carry our burdens all of the time – we have to set it down

“Use what you have learned and then make a choice…you either keep it & let it weigh you down OR you lose it & never let it slow you down.”

Sayings to keep you grounded:

Accept the fact that some days you are the pigeon and some days you are the statue.

Always read stuff that will make you look good if you die in the middle of it.

It may be that your sole purpose in life is to serve as a warning to others.

Nobody cares if you can’t dance well. Jut get up and dance.

When everything’s coming your way, you are in the wrong lane.

We are like crayons – different colors, different shades, but all have to live in the same box


79

WHY A NURSE? WHY A

PERIANESTHESIA NURSE?

Why do you keep coming back? What do you love

about nursing?


80

MOMENTS OF INSPIRATION

Seeing you in action

1995 baseball game

2013 volleyball game


81

HOW TO BE BETTER PEOPLE

Give more

Always have hope because miracles happen

Never give away YOUR power!

It Matters

Show MOXIE! (Making Ourselves Xtraordinary In Everything)

Positive ATTITUDE

It Starts Today!Constant Change, LLC © @ItStartsToday

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GIVE MORE

Give unconditionally…always

Give because you want to, not out of obligation

Give away a smile, compliment, or hug – they are free!

“No one ever wishes they had done less. They always wish

they had done more.”


83

FIND INSPIRATION It will be where you least expect it

In a song, movie, or book -- or in everyday moments

My favorites are quotes (I get these from Pinterest)

How do you know if it is true inspiration? It touches you! You feel something and you remember it.


84

ALWAYS HAVE HOPE

Hope is what you have left to hold onto, despite what you have

in front of you

Sometimes, it is the ONLY thing you have

When do you see hope? When miracles happen!


85

NEVER GIVE AWAY YOUR POWER

What happens when something or someone upsets us?

We can let it ruin our mood and how we take on the world

Why are bullies successful? Because we allow them to be.

“No one can make you feel inferior without your consent.” -

Eleanor Roosevelt


86

IT MATTERS!

Do you think it matters?

“Living with failure is easier than living with

regret.”

Because we NEVER know if something we

do or say can affect someone, we have

to believe that everything can.


87

SHOW MOXIE!!!Making

Ourselves

Xtraordinary

In

Everything

“To get

something

you never

had, you

have to do

something

you never

did.”Constant Change, LLC © @ItStartsToday

88

POSITIVE ATTITUDE

How do you get a positive

ATTITUDE?

Achieve

This

Through

Insight

Time

Understanding

Dedication

Empowerment


89

IT STARTS TODAY

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3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24/31 25 26 27 28 29 30


90

TO INSPIRE YOU

Sara Tucholsky’s unforgettable

home run – April 28, 2008

A rendition of the National Anthem

I will never forget

A football player carries a

teammate off the field

The story of Shay


91

ARM IN ARM, CROSSING THE FINISH LINE

June 5, 2012

Ohio Division III Girls

State Track Meet

3,200 meter runMeghan Vogel helps

Arden McMath cross the

finish line


92

5 WAYS TO ENERGIZE!

Here are 5 ways to help you feel energized and that momentum will keep you riding the waves all day:

1. Exercise. Yes, we have all heard this one before, but it can truly change your outlook and "pump you up." You don't have to run a marathon in one day, but moving your body and pushing yourself to do what we all need is never a bad thing. Even if I walk in the mornings, by 6am I am so ready for what happens next!

2. Smile. I know, this one is easy too. But when you wish someone a "Good morning" with a smile or just say hello, you pass along your energy to someone else and that starts a ripple effect. This world needs more smiles.

3. Sing. And not just sing, but dance too. Who cares what everyone else thinks? Secretly, they are wishing they had your confidence to sing "Call me Maybe" as you drive your co-workers back to work. It's ok, I know who they are and yes, that was me. Give those people in the car next to you something to smile about too!

4. Find your joy. What gives you joy? It doesn't have to cost much and it won't consume all of your time. What do you love to do that fills your heart? I love to write and to give to others. When you find it, make your joy as much of a priority in your life just as everything else is because it makes dealing with everything else better. It just does.

5. Surround yourself with energized people. I know negativity when I see it and hear it. So do you. Make a conscious effort to be around people who bring you up, not down. Ask them what energizes them and some of it may actually surprise you. It is not difficult to be drawn to those that inspire you, but you do have to make an effort to seek them out.


93

THANK YOU

Gayle Kiviniemi & Kristy Iwansky

Alegent Creighton Bergen Mercy Medical Center

Nebraska Association of Perianesthesia Nurses


94

MICHELLE HOMMECONSTANT CHANGE, LLC

WWW.CONSTANTCHANGETODAY.COM

EMAIL: [email protected]


95

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management of professional conflict in the workplace

Education

game constant change

medical issues constant

yearconstant change

student nurses

lateral violence

attacksnon fatal assaults

highest leading cause

perianesthesis areapresented