2 ObjectivesTo understand the definition of workplace violence and the types of workplace violenceHow to prevent workplace violence and what actions to take when violence happensTo learn about lateral violence, how it affects nursing, and how to address it
3 Question:What is your definition of workplace violence?
4 What is Violence?U.S. Occupational Safety and Health Administration (OSHA) and U.S. Centers for Disease Control (CDC), defines workplace violence as “violent acts” (including physical assaults and threats of assaults) directed toward persons at work or on duty (McPhaul & Lipscomb, 2004).
5 Types of Workplace Violence Type I- (Criminal Intent) Criminal activity is being committed and the perpetrator has no legitimate relationship to the workplaceType II- (Customer/Client) Perpetrator is a customer or client at the workplace and becomes violent while being served by the worker
6 Types of Workplace Violence Cont’d Type III- (Worker on Worker) Employees or past employees of the workplace are the perpetratorsType IV- (Personal Relationship) Perpetrator usually has a personal relationship with an employee(McPhaul & Lipscomb, 2004)
7 Question:Where do you think workplace violence typically occur?
8 Where does violence typically happen? Emergency DepartmentsMental Health and Psychiatric UnitsNursing Homes, Extended Care FacilitiesHome and Community Health(McPhaul & Lipscomb, 2004).
9 Risk for Violence in Hospitals Working directly with volatile peopledrugs and alcoholhistory of violencecertain psychotic diagnosesWorking when understaffedTransporting patientsLong waits for serviceOvercrowded, uncomfortable waiting rooms
10 Risk for Violence in Hospitals cont’d Poor environmental designLack of cameras, good lighting, security devicesInadequate securityLack of staff training and policies for preventing and managing crisis with potentially volatile patients(McPhaul & Lipscomb, 2004).
11 How to diffuse or deescalate an angry client/patient Present a calm, caring attitudeDon’t match the threatsDon’t give ordersAcknowledge the person’s feelingsEx. “I know you are frustrated”Avoid any behavior that may be interpreted as aggressiveEx. moving too rapidly, getting too close, speaking loudly, touchingCenters for Disease Control (www.cdc.gov).
12 What should a victim do when violence happens Remove yourself from the situation!File a criminal report with the policeDon’t be silent; speak about what has happened to managers and coworkersPhotograph any injuriesWork with hospital administrators and union representatives to formulate proceduresAsk witnesses to document what they sawBe cautious with patients that have history of violence(American Journal of Nursing, 2007).
13 What are the consequences of work related violence? Jeopardizes patient careNurses suffer posttraumatic stress disorder, poor work performances, sleeping difficulties, and family disruptionFeel unsupported by managementCan cause nurse burnout as well as poor recruitment and retention(Hong Kong Medical Journal, 2006).
14 Ways to prevent violence in the workplace Providing specially trained security staff for high risk situationsTraining in techniques for reducing aggressionImprovement in environmental design such as lighting, metal detectors, mirrors, alarms(McPhaul & Lipscomb, 2004)
15 Lateral/Horizontal Violence Used to describe the physical, verbal, and emotional abuse of an employee. It can be defined as nurse to nurse aggressionIn extreme form, lateral violence can manifest itself as bullying. Bullying is defined as a conscious, willful, deliberate, hostile activity intended to harm, induce fear through threat of further aggression, and to create terror (Sincox & Fitzpatrick, 2008).
16 Lateral Violence- Common Forms Nonverbal innuendoFault findingVerbal affrontSegregationUndermining actions; unavailabilityIsolationUnwarranted criticismsWithholding informationInequitable assignmentsSabotage; “setting up to fail”(Sincox & Fitzpatrick, 2008).BackstabbingBroken confidences
18 Physiological and Psychological Symptoms HeadacheFatigueStomach disordersConflicts in intimate relationshipsWeight changesEngage in substance abuse and experience social isolationHypertensionStressAnxietyPanic(Sincox & Fitzpatrick, 2008).EmbarrassmentDepression
19 As a result of lateral violence… According to the Lateral Violence article by Sincox and Fitzpatrick, 60% of nurses new to practice leave their positions within the first six months because of lateral violence against them.Frustration and dissatisfaction contributes to decreased organizational commitment, increased staff turnover and nursing shortage which can affect the quality of care and negatively impact patient satisfaction(Sincox & Fitzpatrick, 2008).
20 Calling attention to lateral violence The organization and the unit must have a policy of zero tolerance towards violence and bullying.Blame free, reprisal-free treatment of employeesInterrupt the violence- address it earlyKeep accurate records to help document and track the problemFace lateral violence by technique called cognitive rehearsal
21 Cognitive RehearsalCognitive rehearsal is based on cognitive behaviors.Cognition is a mental characteristic which requires the obtaining, organizing and using of intellectual knowledge.Cognitive rehearsal is a technique using cognition that asks the individual to hold in their mind information that they have just received. During this time, the individual has the opportunity to process the information, and “ponder it” rather than responding immediately.(Rowell, 2007).
22 Suggestive ways to stop lateral violence According to Sincox and Fitzpatrick, nurses must take measures to deal with the problem so it won’t be passed on to future nursesNurse educators and executives setting an example of respectable behaviorHold individuals accountable for respectful behavior in the workplace and clinical environmentStaff nurses must be empowered to speak out and support other nurses than ignoring the situationHave formal education classes to address the issue and change norms of lateral violence
23 Question:Do you think that nursing schools should incorporate formal classes about lateral violence into the curriculum?
24 Violence… (Select all that applies) A: is part of the job of nursing, if a nurse got hit, she/he deserved itB: can be prevented by use of security, training classes, and environmental designsC: is not part of the job of nursingD: in healthcare is the leading sector of workers that has the highest rates of non- fatal assault injuries in the workplace
25 A: Yell back at the patient B: Order the patient to return to his room A patient that has a history of violence approaches you at the nurses station yelling at you, You as the nurse would:A: Yell back at the patientB: Order the patient to return to his roomC: Reply back to the patient in a calm, caring voice and find out what the problem isD: Ignore the patient
26 A: Talk about her among the other nurses B: Deal with it A nurse who worked a shift before you is disorganized which irritates you because it affects your job. What action would you take?A: Talk about her among the other nursesB: Deal with itC: Confront the nurse about itD: Go straight to the DON
27 A: Respond using profanity words B: Lash back out to the nurse A nurse lashes out on you regarding your opinion about an issue on the unit. You should…A: Respond using profanity wordsB: Lash back out to the nurseC: Use cognitive rehearsal to hear what she had to say, and respond in a non-judgmental, non-argumentative tone
28 This weekend I’m going to… (Select all that applies) A: Study, Study, StudyB: Go out on a hot date, tomorrow is sweetest dayC: Go costume shopping for HalloweenD: WorkE: RelaxF: None of the above
29 References(2002). Violence occupational hazards in hospitals. Retrieved from (2006). Preventing workplace violence. American Nurses Association. (2006). Violence in the health care workplace. Hong Kong Medical Journal, 12(1), 4-5. (2007). Violence and nursing. American Journal of Nursing, 107(2), (2008, April). Lateral violence in the workplace [Video Podcast]. You Tube. Retrieved from (2008, February). Nurses confront violence on the job [Video Podcast]. You Tube. Retrieved from McPhaul, K.M., & Lipscomb J.A. (2004). Workplace violence in health care; recognized but not regulated. The Online Journal of Issues in Nursing, 9(3), Retrieved from ofContents/Volume92004/No3Sept04/ViolenceinHealthCare.aspx Rowell, P.A. (2007). Lateral violence: nurse against nurse. Retrieved from Sincox, A.K., & Fitzpatrick M. (2008). Lateral violence: calling the elephant in the room. Michigan Nurse, Retrieved from