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Elizabeth Bennoch, MHSA, SPHR

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1 Elizabeth Bennoch, MHSA, SPHR
Horizontal Violence Elizabeth Bennoch, MHSA, SPHR

2 Horizontal Violence is also called
Lateral Violence Bullying Interpersonal abuse Workplace violence Interpersonal conflict Psychological violence Workplace incivility

3 Horizontal Violence …is a phrase coined by Paulo Friere in 1970, to indicate “the curious behavior of members of oppressed groups who often lash out at their peers in response to oppression instead of attacking their oppressors.” Pedagogy of the Oppressed, 1970 “Columbine happened because the whole community failed. Students failed to report what they were hearing and seeing, teachers & administrators failed to take the threats seriously & law enforcement failed to investigate what should have been a very clear & present danger.” Christopher & Pohl, 2012

4 Horizontal Violence SHRM says:
It is “persistent, offensive, abusive, intimidating or insulting behavior or unfair actions directed at another individual, causing the recipient to feel threatened, abused, humiliated, or vulnerable.” Jusko, 2013

5 The results of a 2012 SHRM survey:
Surveys The results of a 2012 SHRM survey: 50% of organizations surveyed reported an incident of bullying in their workplace, and for larger organizations of >500 employees, the % grew to 71%! Jusko, 2013 2011 Civility in America poll: 38% of workers believe the workplace is becoming more disrespectful, and 67% believe there is a strong need for civility training Inside Training, 2013

6 The American Nurses Association reports:
HV Facts & Stats The American Nurses Association reports: 48% of nurses, pharmacists & others reported strong verbal abuse 43% of nurses, pharmacists & others reported experiencing threatening body language Student nurses reported that 53% had been put down by a staff nurse 40% of clinicians “kept quiet” or “ignored” an improper medication due to an intimidating colleague AMA, 2013

7 Workplace Civility "Organizational success depends on a climate of fairness & compassion; supportive working environments are consistently identified as an important attribute of an effective learning organization…in order to learn, employees must feel safe to disagree, ask questions, & make mistakes. They must recognize the value of competing ideas & feel encouraged to take risks. If your organization’s culture is one of negativity & aggressiveness, none of this is allowed to flourish." Inside Training, 2013

8 More Facts Roughly 60% of new RN’s quit their first job within 6 months of being bullied, and 1 in 3 new graduate nurses considers quitting nursing altogether because of abusive or humiliating encounters Townsend, 2012 Nurses who survive bullying early in their careers tend to carry their learned behaviors with them. They accept the bully culture as part of the job and eventually choose one of two paths: leave the unhealthy work environment in search of a healthier one, or participate in the culture either as a bully or bystander. American Nurse Today, 207

9 HV as a role issue Nurses are educated to process work in teams and most nursing models are built on the team concept; however, physicians are educated to believe they are the “captain of the ship” This leads to stress between physician and nurses. Nurses expect to work as colleagues with physicians; however, physicians don’t always see this as desirable Such differing cultural expectations breed conditions that are ripe for horizontal violence And then nurses “eat their young”

10 HV as an oppressed group issue
This occurs when one group believes they have been excluded from the power structure The oppressed group is abusive to peers & those individuals with lesser status because they are unable to or fear addressing the source of the stress affecting them. They then may strike out at peers, students, unlicensed assistive personnel, etc. “Sociological literature shows that oppressed group members tend to act out against one another because they lack control over their situation…powerlessness further lowers their self-esteem and triggers the cycle of oppressed group behavior undertaken to boost self-esteem – which in turn causes more frustration, lack of coworker support & conflict.” American Nurse Today, 2007

11 HV as a culture issue A company’s beliefs & attitudes towards Horizontal Violence play a large part in the acceptance of Horizontal Violence. Leadership’s role is vital A culture of deferred responsibility develops when leadership looks the other way when this type of behavior happens. “When we think that we will not get into trouble, we tend to do things that we know we shouldn’t.” (Christopher & Pohl) What makes us look the other way when someone’s in distress? “…environment & social mores are at the crux of it.” (Christopher & Pohl) “…peer groups are a particularly effective & influential source of social learning…groups help create social norms - attitudes, beliefs or behaviors that are commonly accepted as appropriate by the group.” (Christopher & Pohl) We develop socially acceptable codes of conduct affecting the workplace based on group norms

12 Horizontal Violence Includes:
Belittling gestures (eye-rolling, folding arms, staring into space when someone’s talking to you) Backstabbing/Scapegoating Withholding information (about patients, meetings, new equipment, etc.) Verbal abuse (name calling, threatening, intimidating, undermining) Needling

13 For Example: Gossiping, talking behind your coworker’s back
Finding fault (nitpicking) Telling coworker how to do his/her job Not respecting personal privacy

14 Also… Personal insults Criticism
Sarcastic comments, jokes & teasing (used as an insult) Rude interruptions Withering flames Anonymous letters aimed at hurting the target

15 Treating people as if they are invisible
Wait, there’s more! Elitist attitudes regarding your department, job, education, experience, etc. (I’m better than you attitude) “Freezing or icing out” – excluding coworkers from work-related or social activities and/or conversations (especially with new staff) Treating people as if they are invisible

16 So, concrete examples… Hiding (or stealing) someone’s lunch, coffee, etc. Derogatory statements: “She’s a know-it-all,” “Who died and made her boss?” “Where’d she get her degree, the Cracker Jax box?” Laughing or snickering behind someone’s back (“Take a look at THAT outfit” “Nice hair – not!”) Barking orders at people/stomping around Not responding when a new (or an old!) coworker says hello or asks a question Withholding paperwork, reports, etc. the coworker needs to complete own work on time

17 Dilbert on HV

18 Effects The 3 Stages (Hastie, 2002)

19 Activation of the fight or flight response within you
Stage 1: Activation of the fight or flight response within you You experience: Sleeping disorders Free-floating anxiety Reduced self-esteem

20 Stage 2: Your neurotransmitters are depleted from lack of sleep & fatigue; the brain is over-stimulated and over-sensitive You have difficulty with emotional control – bursting into tears and/or laughter for little reason Irritable or angry when responding Difficulty with motivation Self-starter seems to be “burnt out”

21 Your brain’s circuit breakers are activated
Stage 3: Your brain’s circuit breakers are activated You experience changed response patterns which superficially resemble a change of personality You have a loss of ability to ignore things that before were manageable You experience a relative intolerance of sensory stimulation (slight noise, voices, lights, etc. bother you)

22 Results… You feel like throwing up the night before work
Your family demands you stop obsessing about work You make mistakes Your health/energy level declines Your favorite activities are no longer fun Catalanello, 2009

23 Turnover “Merely showing up for work in an environment where bullying goes on is enough to make many of us think about quitting…nurses not bullied directly, but who worked in an environment where workplace bullying occurred, felt a stronger urge to quit than those actually being bullied.” SAGE, 2012

24 Is This Your Department?

25 Costs, Direct & Indirect
“In the United States, the actual cost [is]…$250 million annually in expenditures related to health care, litigation, staff turnover, and retraining from workplace bullying…this figure may be low given a lot of these types of costs are not always attributed to bullying when in fact they could be.” BLR, 2012

26 Costs Incivility, bullying, harassment, & discrimination affect the bottom line because these behaviors increase anxiety, depression, absenteeism, presenteeism, & turnover; & decrease motivation, quality of work, output, job satisfaction, & ability to meet goals. Communication ceases, problems can’t be solved, people can’t learn, gossip takes over, customer service suffers, & stress prevents effective decision-making. Further, the consequences of negativity extend far beyond the perpetrator & target relationship. Anyone witnessing the aggressive behaviors, even if they don’t necessarily feel victimized by it, loses loyalty to managers & the organization, and, thus, their work suffers, too. Inside Training, 2013

27 Costs... “The real problem is not the young, inexperienced nurse but the experienced nurses who are bullies, and those that stand by silently and allow it to happen. The cost of bullying behavior is in the loss of bright and talented nurses who leave the profession, increasing turnover, destabilizing patient care systems and putting patient safety at great risk. It is in fact, almost immeasurable in its cost to society.” Anonymous, 2013

28 Costs... “Merely showing up for work in an environment where bullying goes on is enough to make many of us think about quitting…nurses not bullied directly, but who worked in an environment where workplace bullying occurred, felt a stronger urge to quit than those actually being bullied Sage, 2012

29 Effects on the workplace
Increased absenteeism Increased turnover Increased costs: EAP programs, recruitment, etc. Increased risk for accidents/incidents Decreased productivity & motivation, & morale Reduced corporate image & customer confidence Poor customer service

30 How is HR Neutralized? HR reports to the wrong level
HR is extremely decentralized CEO doesn’t get HR’s strategic value HR is staffed inexperienced, untrained or unethical people HR is directly a victim of HV Suzi Benoit, 2013 To be effective in preventing HV, we must be effective in preventing neutralization of HR

31 How Bullies Neutralize Management
Telling only part of the story Deflection Playing the victim Strategic partnering Exploiting mistakes Pre-emptive strikes (complaining about the victim, safety issues, ethical issues, first) “Where is the policy on…”

32 Classic HV!

33 Preventing HV Meet w/bully & follow these basic rules:
This in not an investigative interview – it’s not about excuses or the bully’s version of things Be direct – “People are afraid of you, staff don’t feel safe” – avoid “Please be nicer!” Bully is often in denial and/or disagrees w/findings Don’t try to understand why bullies bully – this is not therapy! Consequences are an absolute must: bullies won’t change unless motivated Make good on threats – terminate the bully! BLR, 2013

34 Preventing HV At management/system level:
Ensure that respect is a core value Ensure a zero tolerance towards abusive behavior policy & start at senior level Ensure protection from retaliation if reported Encourage utilization of EAP program Train staff on Horizontal Violence Conduct exit surveys & ask about bullying Listen! AMA, 2013, BLR, 2013

35 Preventing HV Help staff: To understand that they did nothing wrong: the bully usually chooses a victim for no good reason (or because s/he feels threatened by him or her for some reason) To engage in reflective practice: keep a journal, raise self-awareness about their values, beliefs, attitudes, & behavior – are they guilty of horizontal violence? (are they supportive, encouraging – or do they create an environment infected w/horizontal violence) To ensure self-caring behaviors: seek counseling, promote peer support, good nutrition, adequate sleep, take time out to relax, exercise Be willing to speak up when they see it happening & name “horizontal violence” for what it is

36 What to do If staff are subjected to horizontal violence, have them:
Address the problem immediately with the person – often the person has no idea s/he is doing it Use conflict management strategies – Say “I feel … when you …” Again, name it, and if not stopped – have them take comprehensive notes, and refer it to their supervisor or to HR

37 What you permit, you promote
Coach staff on these methods What you permit, you promote Use positive & respectful tone Use respectful & active listening – look coworkers in the eye when they are talking Lead by example! Own up to your mistakes, don’t attempt to shift the blame When making requests, be polite & tactful –remember, it’s just that: a request Be willing to help when requested Don’t participate in gossip

38 And… Invite loners & newcomers to breaks/meals
When others do a kind act, thank them in front of others Accept your fair share of the workload Work together (despite personal dislikes) Address coworkers by their first names Ask for help & advice when needed Stand up for peers in their absence, don’t be critical of them Don’t engage in vertical violence – it just perpetuates horizontal violence in others Smile!

39 So…be a buddy, not a bully!

40 Because… “The real problem is not the young, inexperienced nurse but the experienced nurses who are bullies, and those that stand by silently and allow it to happen. The cost of bullying behavior is in the loss of bright and talented nurses who leave the profession, increasing turnover, destabilizing patient care systems and putting patient safety at great risk. It is in fact, almost immeasurable in its cost to society.”, 2013

41 Pearls of Wisdom

42 More Pearls Practice the 3 R’s Respect for self Respect for others
Responsibility for all your actions


44 Bibliography Anonymous (n.d.) Horizontal violence: The CNA’s worst enemy & the nursing home’s number one threat to quality care. Retrieved from the World Wide Web on January 28, 2004: BLR (2012) Bullying at the workplace: statistics on bullying. Retrieved from Center for American Nurses (2008) Lateral Violence and Bullying in the Workplace. Catalanello, R (2009) Bullying at work can make you sick, but remedies are few. Retrieved from: Funk, C. (2002, September 1). Cutting down the tall poppies: horizontal violence: Sam Houston State University Hastie, C. (2002, August 6) Horizontal violence in the workplace. Retrieved from: NIOSH (2004) Most workplace bullying is worker to worker, early findings from NIOSH study suggest Retrieved from: html

45 Bibliography Oppermann, S (2008) Workplace Bullying: Psychological Violence? Retrieved from the World Wide Web on July 30, 2009: Orlando Business Journal, (2002) Workplace bullying’s high cost: $180M in lost time, productivity. Retrieved from SAGE Publications (2012, July 2) “The Effects of Bullying and ‘Ambient’ Bullying in the Workplace” Medical News Today. Retrieved from Skillings, L. N. (1990) Perceptions and feelings of nurses about horizontal violence as an expression of oppressed group behavior. USM. Vanderwahl, T. (2005) Retrieved from the World Wide Web on July 31, 2009:

46 Bibliography Jusko, J. (2013) Operations: New Year’s resolution – stop workplace bullies. Retrieved from the world wide web on January 22, 2013: American Nurses Association (2013) Lateral violence and bullying in nursing. Retrieved from the world wide web on January 22, 2013: Christopher, E. & Pohl, JC (2012) Teen truth. why youth have something to hide. Horizon Intertainment, LLC. Inside Training (2013) Civility at work. Retrieved from the world wide web on May 29, 2013: Townsend, T (2007) Break the bullying cycle. Retrieved from the world wide web on May 29, 2013:

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