Welcome to
Becoming Sabotage-Savvy:
Things they DON’T teach in
nursing school
©Linda Mueller, Lee Memorial Health System 2010
Becoming Sabotage-Savvy
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Objectives
1.
2.
3.
Define “Horizontal Hostility.”
Identify 3 examples of Horizontal Hostility.
Practice an effective confrontation technique.
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Benefits
1.
2.
3.
We’ll know how to behave as professionals.
We’ll be sensitive to “Horizontal Hostility.”
We’ll feel confident when we confront effectively.
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Stages of Group Formation:




Form
Storm
Norm
Perform
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Exercise:
Nurses should…
Nurses shouldn’t…
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Scientific definition:
Stress-induced displacement
aggression…
OR…
…Nurses eating their young.
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Definition:
A consistent pattern of
behavior designed to control, diminish, or
devalue a peer (or group) that creates a risk
to health and/or safety.
-Gerald Farrell, RN, PhD
2005
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Horizontal Hostility:
A Demonstration

What did Sue do wrong?
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
“Horizontal Hostility” – what is it?
Sabotage
 Verbal Abuse
 Bullying

©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Symptomatic Behaviors:
1.
2.
3.
Physical
Verbal
Emotional
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Call it…
Horizontal Hostility
Lateral violence
Colleague abuse
Workplace bullying
…Same deadly effect
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
It’s the healthcare culture,
silly…
©Linda Mueller, Lee Memorial Health System 2010
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The BEE Algorithm
Appropriate Responses to
Stinging Situations
©Linda Mueller, Lee Memorial Health System 2010
Stinging
Situations
and a
Corrective
Algorithm
The Goal:
Eliminate Disruptive or Inappropriate
Behavior,
to improve performance and outcomes
©Linda Mueller, Lee Memorial Health System 2010
The Solution:
Default to the
algorithm when
Disruptive Behavior
occurs.
©Linda Mueller, Lee Memorial Health System 2010
The BEE Algorithm
B = Behavior
What the person is doing or not doing that
is disruptive, inappropriate, or unacceptable.
E = Effect
Why/how the behavior is disruptive, inappropriate, or
unacceptable…
how it affects me, hurts my productivity,
destabilizes the team or affects customer service.
E = Expectation
What do you expect the person to do or not do to meet your
expectations?
©Linda Mueller, Lee Memorial Health System 2010
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For Example
Your coach snaps her fingers at you to hurry up…
Give her a B.E.E. to provide correcting feedback.
©Linda Mueller, Lee Memorial Health System 2010
Example 1
Your coach snaps her fingers at you to hurry
up…
B: Sue, when you snap your fingers at me to
hurry up…
E: …it feels demeaning and disrespectful.
E: …I need you to give me the same respect you
want from me. Can we structure something like
this?
©Linda Mueller, Lee Memorial Health System 2010
Another Example
Your coach remarks, “I thought you were smart!”
Give her a B.E.E. to provide correcting feedback.
©Linda Mueller, Lee Memorial Health System 2010
Example 2
Your coach remarks, “I thought you were smart!” …
B: Jane, when you make remarks like that…
E: …it offends me and makes me not want to work with
you.
E: …I need you to stop making such remarks so we can
continue to work together. Can we agree on this?
©Linda Mueller, Lee Memorial Health System 2010
Example 3
Your coach asks you to draw blood, a task which
you had never done before. She tells you, “It’s
now or never!”
Give her a B.E.E. to provide correcting feedback.
©Linda Mueller, Lee Memorial Health System 2010
Example 3
When told to draw blood, your coach tells you,
“It’s now or never!” …
B: Nancy, when you make remarks like that…
E: …it makes me feel anxious and unsupported,
and not want to do what you ask.
E: …I need you to stop making such remarks so I
can feel more confident when I learn new skills.
Can I count on you?
©Linda Mueller, Lee Memorial Health System 2010
Skills Practice:
Your Turn!
Use the B.E.E. method to provide correcting
feedback.
(Use the case studies provided.)
©Linda Mueller, Lee Memorial Health System 2010
The BEE Algorithm




Describe the specific behavior that was
unacceptable.
Describe why the behavior was unacceptable
(the effect or impact).
Collaborate on or suggest a better way.
Request their cooperation.
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
If it happens to you:
 Don’t blame yourself
 Speak up!
 Confront the aggressor
 Keep detailed records
 Make a formal written complaint
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Action Planning…
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
“Somebody has to do something,
and it’s incredibly pathetic that
the somebody is us.”
-Jerry Garcia
Grateful Dead
Our Response: There’s nobody better than us!
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage Savvy
References:

Ending Nurse to Nurse Hostility: Why Nurses Eat Their Young And Each Other
--Kathleen Bartholomew, RN, MN

Zapping Conflict in the Health Care Workplace
--Judith Briles, PhD

Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations,
and Bad Behavior
--Patterson, Grenny, McMillan, & Switzler

“Developmental sequence in small groups,” Psychological Bulletin
--Bruce Tuckman, Ph.D.

Coaching for Results
--Berry, Cadwell & Fehrmann

“Aggression in clinical settings: Nurses’ views,” Journal of Advanced Nursing
--Gerald A. Farrell, RN, PhD
©Linda Mueller, Lee Memorial Health System 2010
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Becoming Sabotage-Savvy
Evaluations, please:




All feedback is positive
What went well
What should be changed next time
Suggestions for making the course better
©Linda Mueller, Lee Memorial Health System 2010
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Welcome to Ending Nurse to Nurse Hostility