When Nurses Help Nurses:
Partnering With Colleagues To
Prevent Relational Aggression
Cheryl Dellasega, CRNP, PhD
Professor, Penn State University
Author
Founder, Club Ophelia
How Does RA Differ from
Bullying and Lateral Violence?
• RA or Relational Aggression is much more complex
than abuse from one person or a set of peers.
• RA is often covert or subtle
• Known by other names
•
•
•
•
•
•
Female bullying
Covert aggression
Bitchy
Catty
Catfighting
Drama
What RA Behavior Looks
Like
•
•
•
•
•
•
•
Gossip
Manipulation
Intimidation
Exclusion
Gestures
Ridicule
Saying something
mean then
pretending you
were “joking”
• Name calling
• Teasing/harassme
nt
• Cliques
• Campaigns
• Shifting loyalties
• Betraying
confidences
B
I
N
G
o
The Newbie
The
Criticism
Queen
Gossip and
Trash Talk
Cliques
Drama
The
Know-ItAll
Incivility
Competition
Taking
undeserved
credit
The
Murse
Generational
Gap
Body
language
FREE
SPACE
Undermining
Colleagues
Intimidat
e
Put downs
in front of
others
Stirring up
Playing
favorites
Focused
Politics and Patients
CYA
as bullies
Jealousy
Poison
Name
calling
Body
Emotional Fallout
• Shattered assumptions
Beliefs about yourself, the world, and how it all
comes together
? Adult RA worse than among youth?
• Times of transition (mergers, new leadership)
• Times of stress (personal crises)
• Romantic relationships
• Understaffing (holidays, vacations)
• Unclear expectations
• Poor leadership
• High risk groups: 60% of new nurses leave first job within six
months
Legal Considerations
• Workplace bullying usually not involving a protected
status
• 62% of those who went to HR got no response
• Most plaintiffs don’t meet burden of proof
• Situations, even with unions, usually become more bitter
• Healthy Workplace Bill proposed but not passed
• 93% of respondents to a Parade poll said workplace
bullying should be outlawed
Workplace Bullying and the
Law
• Therapeutic Jurisprudence (TJ) according to
Professor David Wexler is the “study of the role of
the law as a therapeutic agent” by focusing “on the
law’s impact on emotional life and on psychological
well-being.”
• Employment law in the past ¼ century has been
largely lacking in considering TJ
• TJ must be considered in cases of severe workplace
bullying- the prevalence of which is steadily rising
Employment Law as if People Mattered: Bringing Therapeutic Jurisprudence into
the Workplace by David C. Yamada (Florida Coastal Law Review, Vol.XI, 26-May-10)
A Study of Relational
Aggression,
Organizational Cynicism,
and Commitment
Forthcoming in the Journal
of Nursing Administration
Sample
• All nurses (RN, CRNP, PhD, MS) and physicians
(MD, DO) at a large academic medical center were
offered the opportunity to participate (n=2,835)
• 1,321 questionnaires were returned for a response
rate of 47%
• Online completion of measures: Demographics,
Organizational Commitment, Organizational
Cynicism, & Relational Aggression
Comparison Of RA Roles
RN (n=953) vs. MD (n=205)
Aggressor
RN
MD
142 (15%)
46 (22%)
In
Betweener
86 (9%)
20 (10%)
Victim
725 (76%)
139 (67%)
MD vs. RN Differences
•
RA nonsignificant
•
Nurses more organizationally cynical than physicians (p<.01)
•
Physicians have commitment than nurses
(p<.05), higher job satisfaction (p <.001), and higher job
commitment
Organizational cynicism, relational aggression, and commitment
significantly impacted on job satisfaction and intent to leave (ANOVA)
Organizational Cynicism
• OC is the negative evaluation, by
employees, of the motives, actions and
values of the employing organization
Causes of OC
• Causes—mostly speculation
– Fewer opportunities for autonomous behavior
– Workplace hassles
– Psychological contract violations
– Procedural injustice perceptions
– Perception of organization/management
incompetence
Effects (Correlates) of OC
• People high in organizational cynicism
– Have increased negative behavioral work
intentions
– Are less likely to perform extra-role behaviors
– Have lower work motivation
– Lower job satisfaction, burnout, emotional
exhaustion
Institutional Commitment
• Three types of institutional commitment
1. Affective: employee has an emotional
attachment to the organization; they are there
because they like it
2. Normative: employee feels obligated to the
organization
3. Continuance: employee is there because they
feel like they have to be: golden handcuffs
Institutional Commitment
• Striking intergenerational differences
• Cultural beliefs and values
• Factors that influence commitment can be
modified
• Positively related to job satisfaction
• Negatively related to turnover and burnout
RN RA
Some Common Profiles
What really gets me about nursing
•
Is being around the other nurses themselves. I can withstand the nasty docs, the
nasty pts, the odors, the paperwork, the drudgery, the 12 hrs with no food, etc. - but what I can't stand is walking into the nurses station and just being either
glared at or ignored by a bunch of TOADS who must hate their jobs so much
they can't even muster a descent conversation. I mean, these are SUPPOSED
to be my colleagues -- my peers!
•
The managers, promoted by relation/friendship-not merit, do not back up their
own nurses--quite the opposite--steady flows of 'nasty grams' to let you know
you didn't refill the ice pitcher in room 450 on the day you were understaffed
by 17 hours.
•
I'm absolutley dried up, washed out, and burnt to a crisp. I got into the game
when I was 17 as an assistant while I worked my way through university. I
don't know WHAT I thought I was working toward - I'm 25 now, and realise
that I have an absolute joke for a "profession" and have to spend all my
working life with vile, malevolent, evil and malicious bitches. I'm in law school
now, but it's a shame that my career to this point has been wasted.
The RN “RA Rut”
http://www.realityrn.com/more-articles/power-authority/stunned-into-silence/44/
The Queen
Staines, Tavrid, and
Epstein (1970s) coined
the term "Queen Bee”
based on responses from
20,000 women.
The Queen Bee was
successful in a maledominated field and
identified with male
colleagues rather than
with women
The PGR Nurse (Putdowns,
Gossip, & Rumors)
The Resentful Nurse
The Drama Queen
The Backstabber
• Figure out what makes her tick
• Be aware
• Be proactive and have Plan A,
B, and C
• Develop alternatives
• Stake your boundaries and
stick to them
• Backlash aggression
• Outside help
•
•
•
•
•
Queen Bee
Middle Bee
Afraid to Bee
Kind Bee
No Bee
Are You AWARE?
A= Assess yourself
W=What has gone before?
A= Awareness of choices, context
triggers
R= Recognize relationship
power
E= Enforce & accountability
What’s Your RA Quotient?
1.
I’ve changed jobs a lot because of the people I had to work with.
2.
Every day on my way to work, I plan what I will say and how I will act around my coworkers, just to be sure I don’t get taken advantage of.
3.
I’m always angry when I’m at work, but rarely tell anyone.
4.
I’m sick of watching the other people on my unit bicker.
5.
People I work with don’t like me, and I don’t care. None of them are worth hanging around with anyway.
6.
I take secret joy out of seeing another coworker “get what she deserves” for poor performance.
7.
Secretly, I think I am more competent than most of the people I work with. It’s a shame.
8.
I work harder than everyone else on my unit.
9.
No one gets the last word with me; even if I have to respond later, I’ll make sure they know I can’t be pushed around.
10.
At least once a day when I’m at work, I listen to gossip, pass on gossip, start gossip,or am the subject of gossip.
11.
If I’m angry, I sometimes ignore or act rude to my coworkers as a stress reliever.
12.
I get excluded from joining others in breaks or meals, or I do the excluding.
13.
The emotional climate at my workplace contains a lot of “drama”
14.
My feelings are often hurt by people(women) I work with.
15.
I can’t say “no” to my coworkers without worrying they will be because I know they will be upset with me.
Developed by Cheryl Dellasega, PhD, October 25, 2006
Be proactive!
Some solutions
•
Shame
•
Write it down and keep a paper trail
•
Shrug it off
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Get input from others
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Anticipate—Plan A, B,C
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Don’t blow up!
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Body language
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Time off
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Support network outside & inside work
Woman One Woman Two
Aggressive
I win
You lose
Passive
I lose
You win
Assertive
I win
You win
•Name it
•Share it
•Release it
•Resolve it
Create Clear Policies That
Address Problem Behaviors
Medsurg Nurs. 2013 May-Jun;22(3):172-9.
Understanding nurse-to-nurse relationships and their impact on
work environments.
Moore LW1, Leahy C, Sublett C, Lanig H.
Findings revealed participants had considered leaving
the profession, and had considered leaving or had left a
nursing unit because of poor nurse relationships.
Participants identified environmental characteristics
necessary for good relations. The crucial role nurse
managers play in establishing good nurse relations was
highlighted. Participants cited new graduate actions
that could enhance relationships with expert nurses.
Participants also noted missing factors on many
nursing units that are essential for good nurse-to-nurse
relationships.
Intrinsic Motivation
What is driving her behavior?
• Aggressive
• Assertive
• Passive
What is driving your behavior?
Example: Relationship built on gossip
Understanding Motivations
Self-actualization
(Achieving individual potential)
Esteem
(Self-esteem and esteem from others)
Belonging
(Love, affection, being a part of groups)
Safety
(Shelter, removal from danger)
Physiological
(Health, food, sleep)
Maslow’s Hierarchy & Work*
1. Gain access to those primary needs of food,
clothing, shelter through earnings
2. Satisfy one’s need for love and companionship
when strong friendship bonds are formed at
the workplace
3. Fulfill the highest level of self-actualization
and realizing full potential when there is
satisfaction with a chosen career
*Employment Law as if People Mattered: Bringing Therapeutic Jurisprudence into
the Workplace by David C. Yamada (Florida Coastal Law Review, Vol.XI, 26-May-10)
Help Others Have a Vision
Everyday can be blessed for someone
else by your presence
This will change your life-
Negativity fuels negativity
 The most difficult woman
in your life may have the
most to teach you
 Bring out her good side
 Help her feel safe
 Find out what makes her
feel happy or confident
 Make her look good
 Offer something
 Show good will to all
 “Tell me more about
that.”
From “Everyday Ways to Bring Out Their Best Side and Build Your Positive Power and Influence” by
Kare Anderson, the “Say It Better Expert.”
Never Forget the Power of
Unity
Crucial Conversations
When do you need a crucial conversation?
• Different opinions
• A lot at stake
• Very emotional
What are your options?
• Avoid it
• Face it and handle it poorly
• Face it and handle it well
Emotions just don’t happen. We create them.
Teamwork
• Relationships are more than saying “Hi” in the
morning
• All team members should be made to feel needed and
important
• Individual and collective goals should center on patient
care
ANA/AONE Principles
for Collaborative Relationships between
Clinical Nurses and Nurse Managers
1. Engage in active listening to fully understand and contemplate
what is being relayed.
2. Know the intent of a message, and what is the purpose and
expectations of that message.
3. Foster an open, safe environment.
4. Whether giving or receiving information, be sure it is accurate.
5. Have people speak to the person they need to speak to, so the
right person gets the right information
Crucial Conversations
When do you need a crucial conversation?
• Different opinions
• A lot at stake
• Very emotional
What are your options?
• Avoid it
• Face it and handle it poorly
• Face it and handle it well
Emotions just don’t happen. We create them.
Teamwork
• Relationships are more than saying “Hi” in the
morning
• All team members should be made to feel needed and
important
• Individual and collective goals should center on patient
care
Intergenerational Differences
• Can be four different generations in same workplace:
Matures: Sixtish, perhaps traditional, longevity
Boomers: Forties to Sixties, more competitive,
women in workforce
Gen-X: Twenties to forties, techno oriented,
may not accept the status quo
Millenials: Under thirty, “me generation,”
global,diverse
Do it for the Next Generation
• Violence is increasing in young women
• Relationship skills are a critical life skill for
women
• The health care environment will continue to
become more complex
TOMORROW I WILL:
• Restore a Friendship
• Apologize
• Use Dialogue
Shannon Martin, Girl desigtner-