Workplace Violence
and
Disruptive Behavior in Healthcare
Georgia Hospital Association
September 25, 2014
Dianne M Jacobs, MSN,RN
CoMass Group, LLC
Objectives
• Differentiate disruptive behavior and workplace violence
• Examine the impact of disruptive behavior in the workplace
• Identify best practices for addressing disruptive behavior
Cynthia Clark’s
Stowkowski, L.A,The Downward Spiral: Incivility in Nursing. Retrieved February 12, 201 from http://www.medscape.com/viewarticle/739328_2
We are NOT going to discuss:
• Physical violence
• Disruptive behavior by patients &/or visitors
• Stalking
Old problem…New names
Workplace incivility
Disruptive behavior
Horizontal hostility
Lateral violence
Horizontal violence
Bullying
LV…What is it?
• Lateral violence in nursing is defined as “…nurses
covertly or overtly directing their dissatisfaction
inward toward each other, toward themselves, and
toward those less powerful than themselves.”
Griffin, 2004
• One-on-one aggression
• Inter-group conflict
• Shift-to-shift
• Cliques within a workgroup
• Department-to-department
The 10 Most Frequent Forms of Disruptive Behavior
Nonverbal innuendo (raising of eyebrows, face-making)
Verbal affront (covert or overt, snide remarks, lack of openness, abrupt responses)
Undermining activities (turning away, not available)
Withholding information (practice or patient)
Sabotage (deliberately setting up a negative situation)
Infighting (bickering with peers)
Scapegoating (attributing all that goes wrong to one individual)
Backstabbing (complaining to others about an individual and not speaking directly to
that individual).
Failure to respect privacy.
Broken confidences.
•
•
Griffin, 2004
Personal Experience of Lateral Violence
of Nurses in the Upstate
1000
900
800
700
600
500
400
300
200
100
0
Nurses surveyed
Witnessed lateral violence Victim of lateral violence
Most common forms of LV
Failure to Respect Privacy
Backstabbing
Scapegoating
Infighting
Withholding Information
Undermining
Direct Verbal Affront
Nonverbal Innuendo
0%
10%
20%
30%
40%
50%
60%
70%
80%
How LV is handled…
Ignored
Blamed the victim
Aggressor reprimanded
IGNORED
Conflict escalated to include other
staff
Discussed in group meeting
Other
Who are common targets?
• New employees (particularly new graduates)
• Students or trainees
• Medical students and residents
• Experienced employees, but new to the area or
department
• Temporary staff or someone covering from
another area
• PRN staff
So, what’s the impact?
•
•
•
•
•
•
•
•
Low morale
Diminished teamwork
Increased stress
Increased absenteeism
Decreased quality of patient care
High turnover rates
Increased labor costs
Difficulty in recruiting new staff
Patient Safety
Why is there so much
negative behavior in healthcare?
• Historically, nurses exhibit characteristics of an
“oppressed population” (oppressed group
theory)
* Dominated by the medical profession
and a hierarchical structure
* Excluded from the power structure
* Taught to “silence our voices”
Roberts, 2000
High stress levels due to :
• Heavy workloads
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• Short staffing
• Dealing with people who are under stress
• Rapid turn-around times
• Patients’ lives are at risk
• Unpredictability of the work
• Feeling ashamed of being a victim and don’t report the behavior
• Acceptance of bad behavior from some people
• Fear of retaliation if we do report
• Cultural differences
• Generational differences
Generations
• Baby Boomers (1943-1960) 54- 71 yrs old
• Generation X (1961-1980) 34-53 yrs old
• Gen Y/Nexters/Millenials (1981- ?) ≤ 33
Zemke, Raines & Filipczak, 2000
My Personal Plan
• Identify a conversation you need to have with a colleague
and/or employee
• Plan responses
• Practice to achieve communication competency
• Develop a support system
• Discuss with your manager/colleague
Cognitive Rehearsal Techniques
• Recognize the behavior when it occurs
• Plan ahead for ways to respond
• Practice new responses before you need
them
Things to keep in mind
• Take time to calm down
• Always be respectful of the other person
• Hold discussions in private
• Talk directly to the person, not to coworkers
• Avoid blaming or finger-pointing
• Listen carefully
• Use “I” messages
Format for Effective Feedback
• Describe the situation (“When …happened,”)
• Explore or express your thoughts, feelings or concerns giving
the benefit of the doubt (“Was it your intent to…?”)
• Specify what you want them to do differently next time (“In
the future, would you…?”)
• Consequence-state the positive consequence when they do as
you ask
Bower & Bower, 2004
Scenario
While reporting on a serious patient safety issues in
today’s management meeting, you notice 2 of your
colleagues looking at you, rolling their eyes, whispering
and laughing. You get the impression their behavior is
aimed at you since you have witnessed this behavior
toward other colleagues in previous meetings.
• What behavior are you witnessing in this scenario?
• How would you respond?
Scenario Response:
The behavior in this scenario is nonverbal innuendo
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Suggested response:
D: “Jane, today in our managers meeting while I was discussing the serious
patient safety issue, I noticed you rolling your eyes, whispering to Alice and
laughing.”
E: “It felt like it was directed at me and I felt uncomfortable and distracted.
Was there something you wanted to say to me?”
Jane’s response: “Oh no, Dianne. You are just too sensitive!”
E:“Well it felt like you were directing it to me and it was very distracting.
Please don’t do that again.”
S: “In the future, if there is something you want to say to me, please address
me directly.”
C: “I welcome construction feedback especially when we are discussing such
important issues.”
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Addressing Disruptive Behavior
Adopt professional behavior standards
Raise awareness of the problem
Emphasize the value of the care provided by your
employees
Learn to address the behaviors as they occur
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“Alas, culture is not what we say,
what we think, what we mean, or
even what we intend;
it’s what we do.”
Jon Burrough,MD
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Thanks for attending!
www.comassgroup.com
Dianne M Jacobs,MSN,RN
864-901-6612
dianne.jacobs@comassgroup.com
Deborah L Cox,MBA,MS-CM,MT(ASCP)
678-640-2492
deborah.cox@comassgroup.com
References
1. Bartholomew, K. (20). Ending Nurse to Nurse Hostility. Marblehead, MA:
HCPro, Inc.
2. Bartholomew, K.(2010) Speak Your Truth. Proven Strategies for Effective
Communication. HCPro,Inc
3. Bower, S,&,Bower G. (2004). Asserting yourself: A practical guide to
positive change. MA: Da Capo Press
4. Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral
violence: an intervention for newly licensed nurses. Journal of Continuing
Education in Nursing. 35(6), 1-7.
5. Stanley,K., Martin, M., Michel, Y., Welton, J., & Nemeth, L. (2007).
Examining lateral violence in the nursing workforce. Issues in Mental
Health Nursing, 28, 1247-1265.
6. Stowowski,L.A., The Downward Spiral: Incivility in Nursing.Retrieved
February 12, 2014 from http://www.medsca[e.com/viewarticle/739328_2
7. Zemke R., Raines C. & Filipczak B. (2000) Generations at Work: Managing
the Clash of Veterans, Boomers, Xers and Nexters inYour Workplace.
Amacom, New York, NY.