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Nurse to Nurse Bullying: A Sepsis in Healthcare Susan Strauss, RN, Ed.D. Harassment & Bullying Consultant.

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Presentation on theme: "Nurse to Nurse Bullying: A Sepsis in Healthcare Susan Strauss, RN, Ed.D. Harassment & Bullying Consultant."— Presentation transcript:

1 Nurse to Nurse Bullying: A Sepsis in Healthcare Susan Strauss, RN, Ed.D. Harassment & Bullying Consultant

2 Objectives  To define bullying and harassment  To discuss the misconduct within nursing practice incorporating The Joint Commission’s Disruptive Behavior Standard, Nursing Social Policy Statement, Nursing Code of Ethics, and the Scope and Standards of Nursing Practice  To identify theories, causes and contributing factors of bullying in nursing  To discuss nursing leadership’s role in the prevention and intervention of bullying  To practice communication techniques in confronting bullying behavior  To develop a prevention and intervention action plan to implement for North Dakota Nurses Association

3 The art of nursing is based on caring and respect for human dignity. ANA, (2010). Scope and Standards of Practice

4 Standards of Professional Performance (ANA) Collaboration Collegiality Ethics Research Resource utilization Professional practice evaluation Education Quality of Practice Leadership Environmental Health

5 Code of Ethics for Nurses (ANA) Relationship with colleagues and others….precludes…any form of harassment or threatening behavior, or disregard for the effects of one’s actions on others.

6 Code of Ethics for Nurses (ANA) Preservation of integrity including…verbal abuse from…coworkers.

7 Code of Ethics for Nurses (ANA) Responsibility for the healthcare environment; Responsible for contributing to a moral environment that encourages respectful interactions with colleagues, support of peers, and identification.

8 False True or

9 Ethical Legal Psychological Financial Managerial Health Human Rights Important Implications

10 History of Bullying Research United States Schools Workplaces Europe Scandinavian

11 What is Bullying?

12 Incivility Hostility Petty Tyranny Psychological Terror Violence Dysfunction Bullying Mobbing Abuse Labels

13 Definition of Bullying Bullying is persistent, repeated, malicious, offensive, and intimidating behavior which humiliates, degrades and displays a lack of dignity and respect for the target resulting in them feeling vulnerable and threatened.

14 “Bullying may be more appropriately considered a form of organizational defiance rather than simply a form of interpersonal conflict.” Hutchinson, M., Wilkes, L., Jackson, D. Vickers, M.H. (2010). Integrating individual, work group and organizational factors: Testing a multidimensional model of bullying in the nursing workplace. Journal of Nursing Management 18,173-181.


16 Women’s Hostility to Women

17 Lateral Violence Labels Indirect Bullying Covert Aggression Indirect Hostility Relational Aggression Horizontal Violence Horizontal Hostility Lateral Hostility

18 Exclusion Examples Name-Calling Gossip Poor Eye Contact Sighing Failure: e- and voice mail Eye Rolling Negative Facial Expressions Ignoring Revealing Secrets Manipulation


20 Healthcare Environment: Care vs. Corporate

21 Etiology & Antecedents of Workplace Bullying  Power imbalance  Processes and structures  Change  Informal alliances  Competition  Reward Systems  Role conflict or ambiguity  Tolerance & reward for misconduct  Low satisfaction with management  Psychological theories

22 Meaningless tasksUnrealistic deadlinesBlocking promotion Confusing/contradictory instructions Withhold informati on

23 Accepted Expected Encouraged Endemic Symptomatic Interwoven

24 Sex Segregation

25 System of Patriarchy & Oppression

26 Patriarchy “finds its way into everyone who grows up breathing and swimming in it, and once inside us, it remains however unaware of it we may be….we are involved, if only by our silence.” Allan Johnson: The Gender Knot: Unraveling Our Patriarchal Legacy

27 Oppressors’ actions perceived _________ Internalize oppressor’s thoughts & _______ Believe in own _______ Powerlessness Hopelessness Dislike of _______ Displaced _____ Oppression

28 Horizontal Violence  60% new RNs leave 1 st job  1 in 3 RNs quit  Adaptive response  Symptomatic

29 “Rather than challenging the masculine hegemony of management, some women – particularly those who employ bullying tactics – may be conforming to the masculine ethic that underpins many management practices.” Simpson, R., Cohen, C. (2004). Dangerous work: The gendered nature of bullying in the context of higher education. Gender, Work and Organizations, 11(2), 182.

30 Large number of women in power positions = less female to female bullying

31 Nursing 5% annual operating budget $22K - $145K replacement cost 2.5 times salary - turnover cost

32 Nursing Managers  Limited access to resources  Missing from decision making  Marginalized  Low status & power  Low autonomy

33 Impact of Horitzonal Violence Work Satisfaction Self Esteem Powerlessness Disrespect Ask fewer questions Patient Care Costs

34 34 Effects of Harassment & Bullying

35 Witnesses & Mirror Neurons

36 Women Hostile to other Women Cowan, G., Neighbors, C., DeLaMoreau, K., Behnke, C. (1998). Women’s hostility toward women. Psychology of Women Quarterly, 22, 267-284.  Lowered self-esteem  Hostility toward men  Lowered self-efficacy  Increased emotional dependence on men  Less intimacy  Less life satisfaction  Acceptance of interpersonal violence

37 Common Law Tort Claims Against Managers & Organizations Aiding & Abetting Assault & Battery False Imprisonment Intentional infliction of emotional distress Negligent hiring or supervision Personal Injury Intentional interference with business relationship Breach of contract

38 38 Harassment As a Legal Issue Title VII of the 1964 Civil Rights Act


40 Hostile Environment Frequency Duration Repetition Location Severity / Scope of the acts Nature and context of incident Verbal or physical contact Other participants Directed at multiple persons

41 Factors Sexual and/or gender based Welcome ! Severe and/or Pervasive Reasonable “VICTIM” Protected Classes

42 Nurse to Nurse Hostility vs. Sexual Harassment  “Because of Sex”  Occur if male?  Oncale v. Sundowner Offershore Services, Inc.

43 Sexual Harassment GENDER HARASSMENT Abuse/Bullying Sex Discrimination

44 Gender Harassment  Hostile Work Environment  Environmental context  Gender-typing – occupation  Gender composition – work group  Organizational Climate

45 Policy Medical Center

46 Refusal or delay in sharing information Spreading rumors Sabotaging one’s work Making a false complaint _____________ Verbal and/or physical abuse _____________ ____________ Poor performance review Destruction of property Refusal to meet or delays in meeting Threats _______________ Retaliation

47 What To Do If It Happens To You Document, document, document Report Stop Follow Policy

48 Ignore (most common) Use humor Dismiss Understand Respectfully confront Report Document

49 Communication Feedback Feelings Open & honest “I” statements Respectful

50 Describe the situation or behavior State behavior must stop Use “I” statements “Broken Record” Confronting the Offender

51 Why Targets Don’t Confront Offender


53 What Should Management Do? PREVENT harassment & bullying from occurring in STOP harassment & bullying when it occurs KEEP harassment & bullying from reoccurring DON’T TOLERATE reprisals

54 Prevention & Intervention Training Policy & Procedure Document Change environment


56 Title IX No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving federal financial assistance.

57 14 th Amendment: Section 1983 Violated student’s constitutional rights Failed to receive, investigate, act upon complaints Failed to train employees. District’s policy, practice, or custom must cause the alleged constitutional injury.

58 Sexual Harassment Incidents in Schools Younger and Younger Ages More sexually violent Often mis-labled as bullying Source: Stein, Nan (2005). A Rising Pandemic of Sexual Violence in Elementary and Secondary Schools: Locating a Secret Problem. pp. 33-52, Duke Journal of Gender Law and Policy. Often not responded to by:  School Officials  Law Enforcement

59 Grade Level When First Experienced 0%5%10%15%20% K-2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th Boys Girls AAUW Study - 1993

60 Gender-based Harassment Threatening and harassing behaviors based on enforcement of gender-role expectations.

61 Bullying Definition? De-genders problem of sexual harassment/violence Defers attention away from sexual harassment/violence Mislabel interferes with prevention and intervention Obscures legal liability Erodes students’ rights

62 Comparing Sexual Harassment and Bullying Copyright © 2008 by Strauss Consulting. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Author Sexual HarassmentBullying Because of sex or gender – primary target is femaleGender neutral Against federal Civil Rights Act Title IXNo federal legislation 81% of students16% - 90% of students Federal agency – Office of Civil Rights, U.S. Department of EducationNo federal agency Civil Rights, Educational, Anthropology, Sociology, Feminist scholarshipPsychology scholarship Definition based on law, case law, researchAmbiguous definition

63 School Officials Indifferent Unresponsive “go sit down” “Ignore him”

64 Key Actions Commitment from administrationCommitment from administration Policy and Procedure Policy and Procedure Training Training Consequences – x2 Consequences – x2 Teachable moment Teachable moment Title IX Coordinator Title IX Coordinator

65 The nursing profession is particularly focused on establishing effective working relationships and collaborative efforts essential to accomplish its health-oriented mission. ANA, (2010). Nursing’s Social Policy Statement:The Essence of the Profession, 2010


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