Nonphysical  hos-lity  in  nursing  educa-on  &  prac-ce  

Recognizing  Workplace  Hos-lity  

Aggression  Escalates  to  Violence  

While  aggressive  behavior  refers  to  one  incident,  bullying  or  violence  involves  repeated  a7acks  against  the  target,  crea9ng  an  on-­‐going  pa)ern  of  behavior  that  creates  a  destruc9ve,  

toxic  workplace  for  all  employees.      

Confusion  in  the  language  

As  researchers  have  explored  hos-lity  in  the  workplace  over  several  decades,  differing  

terms  have  been  defined  and  used  to  describe  the  behavior  represented  

 These  varying  terms  generally  describe  a  class  of  

aggressive  behavior  universally  exhibited  across  professional  disciplines,  workplace  

seHngs  and  geographical  loca-on  

Confusion  in  the  language  

Earlier  studies  may  refer  to:  

Hos9lity  Bullying  

“Nurses  Ea9ng  Their  Young”  Interpersonal  Conflict  

Vic9miza9on  Pe7y  Tyranny  

Emo9onal  Abuse  

 

 

Confusion  in  the  language  Later  studies  may  refer  to:  

 

Horizontal  Violence    Interac9ve  Workplace  Trauma  

Workplace  Incivility  Nurse-­‐to-­‐Nurse  Aggression  

Mobbing  An9social  Workplace  Behavior  

Incivility  Ver9cal  Violence  Lateral  Violence  

Confusion  in  the  Language  

 While  there  have  been  many  defini-ons  and  

terms  used  to  describe  this  behavior  depending  upon  the  researcher,  the  discipline  

and  the  study  .  .  .      

Agreement  has  been  reached  on  several  key  points  in  defining  bullying/hos-le  behavior      

Confusion  in  the  language  

Bullying  behavior  is  iden-fied  by  the  following  characteris-cs:  

Consistent,  repeated  behavior  from  bully  to  vic9m  Occurring  over  a  period  of  9me  

Intensity  resul9ng  in  harm  to  the  vic9m  Real  or  perceived  power  disparity  between  bully  and  

vic9m              

(Lutgen-­‐Sandvik  2007)  

No  confusion  in  the  meaning  

 It  is  the  malicious  intent    

and  impact  on  the  recipient    that  characterizes  workplace  bullying  

The  link  between  terms  

Research  on  anger,  aggression,  bullying  and  verbal  abuse  –  terms  used  by  different  professional  groups  -­‐  is  relevant  because  

these  behaviors  are  all  ways  in  which  hos-lity  expresses  itself    

     

(Bartholomew  2006)  

the  link  between  terms  

   

In  this  course  the  focus  is  on  coping  with  nurse-­‐on-­‐nurse  hos-lity,  par-cularly  horizontal  or  lateral  hos9lity  between  co-­‐workers,  through  

the  use  of  bullying  behaviors    

Descrip-ve  terms  used  depend  upon  the  focus  of  each  study  cited  

Key  Defini-ons  

• Workplace  Bullying  • Ver9cal  Violence  • Horizontal  Violence  • Mobbing  

Key  Defini-ons  

Workplace  Bullying    “Repeated  inappropriate  behavior,  direct  or  indirect,  

whether  verbal,  physical  or  otherwise,  offensive  abuse,  in-mida-ng,  malicious  or  insul-ng  behavior  or  abuse  of  

power  conducted  by  an  individual  or  group  against  others,  which  makes  the  recipient  feel  upset,  threatened,  

humiliated,  or  vulnerable  [and]  which  undermines  their  self-­‐confidence  and  may  cause  them  to  suffer  stress”  

     (2008  Task  Force  on  the  Preven-on  of  Workplace  of  Bullying.  Dublin,  Ireland:    

Health  &  Safety  Authority,  p.  5.)  

Key  Defini-ons  

Bullying  

“Repeated  and  persistent  nega-ve  ac-ons  toward  one  or  

more  individual(s),  which  involves  a  perceived  power  imbalance  and  

creates  a  hos-le  work  environment.”  

(Salin  2003)  

Bully  Seeks  Control  

Co-­‐Workers  Lose  Control  

Co-­‐Worker    

Co-­‐Worker  

Bully  

Key  Defini-ons  

Vertical  Violence  Bullying  or  hos-le  behavior  expressed  by  senior  to  junior  

colleagues    

The  power  differen-al  in  this  rela-onship  is  overt  and  the  bully  can  take  advantage  of  tacit  organiza-onal  support  for  empowerment  along  with  managerial  sanc-ons  to  

punish  the  vic-m  

 

An  Example  Vertical  Violence  

You  are  one  of  the  most  competent  nurses  in  your  unit  but  somehow  you  cannot  sa-sfy  your  

supervisor.    She  unfairly  cri-cizes  your  work,  manages  to  exclude  you  from  informal  mee-ngs  

with  other  staff  members  where  cri-cal  informa-on  is  exchanged,  and  loudly  berates  you  in  the  hallway  for  missing  impossible  deadlines.  

   Chances  are  it’s  not  your  fault,  you’re  being  

bullied.  

Key  Defini-ons  

Mobbing  Bullies  form  alliances  and  engage  in  repeated    destruc-ve  behavior  

toward  individuals  or  groups.    

Mobbing  behavior  not  only  targets  co-­‐workers,  but  can  be  directed  upward  to  supervisors  

and  managers.  

• Nurse  Manager  

• Supervisor  

• Co-­‐Worker  • Co-­‐  Worker  

Bully   Bully  

Bully  Bully  

An  Example  Mobbing  

You  have  just  been  promoted  to  supervise  your  unit  and  it’s  not  siHng  well  with  prior  colleagues  who  now  report  to  you.    They  repeatedly  call  in  sick  at  

the  last  minute,  your  possessions  disappear,  charts  go  missing,  and  snide  comments  are  made  

to  you  and  behind  your  back.  

Chances  are  your  colleagues  have  banded  together  and  targeted  you  for  group  bullying  

behavior.  

Key  Defini-ons  

Horizontal  Violence  Occurs  at  similar  levels  across  peer  groups:  team  members,  nurse-­‐to-­‐

nurse  or  manager-­‐to-­‐manager    

Expressions  of  Horizontal  Violence  may  be  conscious  or  unconscious  

behavior  (Taylor  1996)  Par-cipants  in  Horizontal  Violence  may  

be  ac-ve  or  passive  par-cipants  

Staff  Nurse  

Staff  Nurse  

Staff  Nurse  

Staff  Nurse  

Staff  Nurse  

Horizontal  violence  

 Researchers  have  provided  several  different  defini-ons  of  the  term  horizontal  violence:    “Overt  and  covert  non-­‐physical  hos9lity,  such  as  cri9cism,  sabotage,  undermining,  infigh9ng,  

scapegoa9ng  and  bickering”  (Duffy  1995)  

Horizontal  violence    

“Unwelcome  repeated  hos9le  aggressive  behaviors  (physical  or  non-­‐physical)  of  one  colleague  towards  another”  (Einarsen  1999)  

   “Aggressive  and  destruc9ve  behavior  of  nurses  

against  each  other,  the  demeaning  and  downgrading  of  others  through  unkind  words  

and  cruel  acts  that  gradually  undermine  confidence  and  self-­‐esteem”  (Nazarko  2001)  

An  Example  Horizontal  Violence  

You  have  just  been  hired  and  are  excited  about  your  new  job,  but  on  your  first  day  a  co-­‐worker  makes  a  derogatory  remark  

about  the  program  from  which  you  graduated.    During  the  first  week,  con-nuing  comments  are  dropped  about  your  lack  

of  skills  and  experience.    Disparaging  remarks  are  made  in  front  of  pa-ents  and  co-­‐workers,  undermining  your  

professional  capabili-es.  At  the  end  of  the  first  week  you  know  that  you  have  made  a  serious  mistake  in  taking  the  job.  

Chances  are  you’ve  been  introduced  to  the  bully  you  will  have  to  live  with  in  your  new  job,  and  you’re  her  newest  vic>m.  

Common  Bullying  Behaviors    Griffin  (2004)  iden-fied  the  following  behaviors  as  the  most  common  toolbox  of  bullies  in  the  nursing  workplace:    

Nonverbal  innuendo  Verbal  affront  

Undermining  ac9vi9es  Withholding  informa9on  

Sabotage  Infigh9ng  

Scapegoa9ng  Backstabbing  

Failure  to  respect  privacy  Broken  confidences  

Other  Tools  of  the  Workplace  Bully  Bullies  use  many  tools  to  vic-mize  their  colleagues:    

In9mida9on  Disinterest  and  undervaluing  

Discouragement  Threats  

Humilia9on  Excessive  or  unjust  cri9cism  

Verbal  abuse  and  rude  comments  Verbal  innuendo  

Exclusion  and  isola9on  Implica9ons  of  repercussions  for  exposure  of  conflict  

Failure  to  support  in  a  colleague’s  defense  False  accusa9ons  

 

Other  tools  of  the  workplace  bully  

Some  tools  of  the  bully  are  illegal  or  ac-onable  if  brought  to  light:  

Physical  assault  Sexual  harassment  Sexual  In9mida9on  

Slander  Property  damage  or  theb  

Other  tools  of  the  workplace  bully  Manager  have  addi-onal  tools  available:  

 Ver9cal  Threats  Reduced  income  Denying  benefits  

Termina9on  without  cause  Discrimina9on  

Undeserved  performance  evalua9ons  Unsafe  assignments  Denying  opportunity  Arbitrary  instruc9ons  

Behavioral  typology  of  bullies  

 Bullies  develop  a  par-cular  style  over  -me      

 Researchers  have  amempted  to  provide  a  

framework  for  understanding  bullying  types  to  assist  in  iden-fying  style  and  developing  

appropriate  strategies  in  dealing  with  each  

Behavioral  Typology  of  Bullies  

Rayner  (1997)  grouped  bullying  behaviors  into  several  categories  with  examples:      

Threat  to  professional  status      Beli7ling  opinion,  public  professional  humilia9on,  

accusa9on  regarding  lack  of  effort    

Threat  to  personal  standing      Name-­‐calling,  insults,  in9mida9on,  devaluing  with  

reference  to  age  

Behavioral  typology  of  bullies  Isola8on    

 Preven9ng  access  to  opportuni9es,  physical  or  social  isola9on,  withholding  of  informa9on  

   

Excessive  overwork      Undue  pressure,  impossible  deadlines,  unnecessary  

disrup9ons      

Destabiliza8on      Failure  to  give  credit  when  due,  meaningless  tasks,  removal  of  responsibility,  repeated  reminders  of  

blunders,  secng  up  to  fail  

Behavioral  Typology  of  Bullies  

Hutchinson  (2009)  grouped  bullying  behavior  into  the  following  types:  

Personal  ACack    The  personal  iden9ty  and  self-­‐concept  of  the  vic9m  are  

threatened  through  isola9on,  in9mida9on  and  degrada9on  

Behavioral  typology  of  bullies  

 Erosion  of  Professional  Competence  and  Reputa8on    The  professional  iden9ty  is  damaged  and  the  result  

is  limited  career  opportuni9es    

ACack  Through  Work  Roles  and  Tasks    Work  obstruc9on,  including  denial  of  due  process  and  economic  sanc9ons  are  used  to  undermine  the  

vic9m  

Is  The  Bully  Hiding?  

 Bullies  typically  exhibit  a  lifelong  preference  of  bullying  styles  which  have  been  reinforced  by  their  success  in  establishing  control  over  their  vic-ms  -­‐  some  prefer  to  operate  in  the  open  

and  others  are  more  subtle        

While  both  can  inflict  considerable  damage  on  others,  subtle  bullying  styles  are  more  

difficult  to  recognize,  confront  and  manage  

Is  The  Bully  Hiding?  

Examples  of  Overt  Bullying  Behavior      

Abusive,  insul9ng  or  offensive  language  Behavior  or  language  that  frightens,  humiliates,  beli7les  or  degrades  

Comments  about  appearance,  lifestyle  or  family  Regularly  targe9ng  someone  with  pranks  or  prac9cal  jokes  

Interfering  with  an  individual’s  personal  effects  or  work  equipment  Physical  assault  or  threats  

Cri9cism  delivered  with  yelling  or  screaming  Direct  threats,  physical  in9mida9on  and/or  sexual  harrassment  

Is  the  bully  hiding?    

Covert  Bullying  Behavior        

More  subtle  and  less  public  behavior  that  undermines  a  vic9m  Much  harder  to  manage  for  vic9ms  Oben  not  recognized  by  supervisors  

Keeps  peers  from  coming  to  the  defense  of  the  vic9m  Does  not  involve  a  paperwork  or  other  incrimina9ng  trail  to  use  for  complaints  by  

vic9ms  

 

Is  the  bully  hiding?  

   

Resul8ng  stress  turns  the  spotlight  on  the  vic8m  while  the  bully  remains  in  the  shadows  –  

the  vic>m  can  appear  to  be  the  problem  

Covert  Bullying  From  a  Supervisor  

Supervisors  have  many  subtle  ways  of  undermining  their  vic8ms:  

 Unreasonable  workloads  for  long  periods  of  9me  

Secng  impossible  9melines  or  changing  deadlines  frequently  Consistently  assigning  tasks  beyond  an  employee’s  skill  level  

Ignoring  a  person  to  isolate  them  Deliberately  denying  access  to  informa9on  or  resources  Unfairly  denying  en9tlements  such  as  leave  or  training  

opportuni9es  

Covert  Bullying  From  a  Co-­‐Worker  How  colleagues  can  make  each  other  miserable:    

Excessive  cri9cism  Verbal  abuse  including  comments  that  are  rude  or  humilia9ng  

Verbal  and  non-­‐verbal  innuendo  Exclusion  from  groups  and  important  informa9on  

Implica9ons  of  repercussions  for  exposure  of  conflict  Failure  to  defend  a  colleague  

Scapegoa9ng  Spreading  lies  about  the  vic9m  

Broken  confidences  Backstabbing  

Intent  and  Systema-c  In-mida-on  

While  every  person  is  occasionally  capable  of  behaviors  that  appear  to  be  “bullying”,  this  is  different  from  the  intent  to  use  systema-c  

in-mida-on  to  control  others.        

Individuals  without  the  intent  to  bully  can  learn  to  change  their  style.  

 

   

Inten8onal  bullies,  however,  oLen  require  specific  interven8on  by  vic8ms,  co-­‐workers,  managers  and  companies  to  force  changed  

behavior  

Physical  results  of  stress  MacIntosh  (2005)  catalogues  many  of  the  physiological  impacts  of  violence  in  the  workplace  for  both  vic-ms  and  witnesses:  

 Frequent  Headaches  

Dry  Throat  Gastrointes9nal  Problems  Changes  in  Body  Weight  

Sleep  Disturbances  Diminished  Energy  

Exhaus9on  Disrupted  Concentra9on  

Hypervigilence  

Physical  results  of  stress  

Other  researchers  describe  a  myriad  of  problems  that  con-nue  and  can  worsen  with  -me,  even  aber  leaving  the  toxic  work  environment:    

 

Cardiac  arrhythmias    

Cardiovascular  Problems  (Hypertension  to  Strokes,  Heart  A7acks)  

 

Adverse  Neurological  Changes  (Neurotransmi7er  Disrup9on,  Hippocampus  Shrinkage)  

 

Physical  signs  of  stress  

 Immunological  Impairment  

(More  frequent  infec9ons  of  greater  severity)    

Fibromyalgia  and/or  Chronic  Fa9gue  Syndrome      

Diabetes    

Skin  Disorders  

Physical  Signs  of  stress  

Bullied  workers  oqen  demonstrate  a  variety  of  physical  symptoms  from  related  stress:    

Complaints  of  Nausea  Tremors  of  the  Lips,  Hands,  Etc.  

Feeling  Uncoordinated  Chills  

Profuse  Swea9ng  Diarrhea  

Physical  signs  of  stress  

Rapid  Heartbeat    

Rapid  Breathing    

Reports  of  Elevated  Blood  Pressure    

Complaints  of  Chest  Pain    

Uncontrollable  Crying    

Headaches  

Psychological  impact  

MacIntosh  also  catalogues  a  number  of  longer  term  serious  problems  reported  in  the  research  for  vic-ms  and,  to  a  lesser  extent,  witnesses:      

 

Depression    

Complex  Post  Trauma9c  Stress  Disorder  (CPTSD)      

Burnout  from  depersonaliza9on  and  lack  of  control    

Maladap9ve  responses  such  as  substance  abuse  and  overea9ng  

Signs  of  emo-onal  stress  

Emo-onal  stress  symptoms  may  include:    

Anger  and  irritability    

Decreased  self-­‐esteem,  increased  self-­‐doubt    

Lack  of  mo9va9on    

Feelings  of  failure  from  being  unable  to  meet  expecta9ons  

The  Responsibility  For  Change  

Nurse-­‐on-­‐nurse  hos-lity  affects  everyone  associated  and  any  of  these  toxic  behaviors  can  pertain  to:  

 

Students  Faculty  

Experienced  Nurses  New  Nurses  

Nurse  Managers  Nurse  Administrators  

 The  responsibility  for  reducing  this  destruc-ve  behavior  

rests  with  each  nurse  in  each  situa9on  and  in  every  place  of  work  or  study.  

 

For  details  on  slide  nota9ons  see  bibliography  included  in  this  course