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Nurse to Nurse Bullying: A Sepsis in Healthcare

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Presentation on theme: "Nurse to Nurse Bullying: A Sepsis in Healthcare"— 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)
Provision 1: 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)
Provision 5: Preservation of integrity including…verbal abuse from…coworkers.

7 Code of Ethics for Nurses (ANA)
Provision 6: Responsibility for the healthcare environment; Responsible for contributing to a moral environment that encourages respectful interactions with colleagues, support of peers, and identification.

8 True or False Page

9 Important Implications Health Legal Financial Psychological
Human Rights Ethical Have each come in with a click, start with legal, end with financial Managerial

10 History of Bullying Research
Schools Scandinavian Workplaces Europe United States

11 What is Bullying?

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

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,


16 Women’s Hostility to Women

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

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

19 Perpetrator System Causation Victim Organization

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 Management Examples Meaningless tasks Unrealistic deadlines
Blocking promotion Confusing/contradictory instructions Withhold information

23 A B U S E Accepted Symptomatic Expected Encouraged Interwoven Endemic

24 Vertical Spill Over Horizontal
Sex Segregation Vertical Spill Over Horizontal

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

28 Horizontal Violence 60% new RNs leave 1st 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 Marginalized Limited access to resources
Low status & power Low autonomy Limited access to resources Missing from decision making

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

34 Effects of Harassment & Bullying

35 Witnesses & Mirror Neurons

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

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 Something red lightning bolt or something

38 Harassment As a Legal Issue
Title VII of the 1964 Civil Rights Act Picture to show anything related to race, gender, disability, religion. (look under Mayo – diversity). Page 38

39 Make computer look more like a computer.

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 Welcome! Severe and/or Pervasive Protected Classes
Sexual and/or gender based Enlarge fonts. Each comes in on a click. Reasonable “VICTIM”

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

43 GENDER HARASSMENT Sex Discrimination Sexual Harassment Abuse/Bullying

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

45 Appropriate? vs. Medical Center Policy vs.

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

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

48 When You Are Bullied: Ignore (most common) Use humor Dismiss
Understand Respectfully confront Report Document

49 Communication Feedback Open & honest Feelings “I” statements

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

51 Why Targets Don’t Confront Offender
Picture of people victim – put hand up to say stop. Page


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 14th 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 Often not responded to by: School Officials Law Enforcement Source: Stein, Nan (2005). A Rising Pandemic of Sexual Violence in Elementary and Secondary Schools: Locating a Secret Problem. pp , Duke Journal of Gender Law and Policy.

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

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 Sexual Harassment Bullying Because of sex or gender – primary target is female Gender neutral Against federal Civil Rights Act Title IX No federal legislation 81% of students 16% - 90% of students Federal agency – Office of Civil Rights, U.S. Department of Education No federal agency Civil Rights, Educational, Anthropology, Sociology, Feminist scholarship Psychology scholarship Definition based on law, case law, research Ambiguous definition 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

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

64 Key Actions Commitment from administration Policy and Procedure
Training Consequences – x2 Teachable moment 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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