1. Minimizing Toxicity in the Work Environment Chelsye Bond, Monique Boutilier, Jennifer Fougere, & Jessica MacLean

2. “ V iolence… begins long before fists fly or lethal weapons extinguish lives. Where resentment and aggression routinely displace cooperation and communication, violence has occurred.” - Bernice Fields

3. Objectives Describe toxic work environments Describe toxic work environments Identify how workplace toxicity can affect patients, staff & organizations Identify how workplace toxicity can affect patients, staff & organizations Explain 3 steps taken to combat workplace toxicity Explain 3 steps taken to combat workplace toxicity Summarize the nurses responsibilities in helping to provide effective solutions to workplace toxicity Summarize the nurses responsibilities in helping to provide effective solutions to workplace toxicity

4. Identifying Workplace Toxicity

5. Toxic Work Environments An environment in which individuals are the target of offensive, intimidating, malicious or insulting behavior, and/or experience an abuse or misuse of power through means intended to undermine, humiliate, degrade or injure the recipient. (Randle et al., 2007)

6. Negative Workplace Behaviors  Verbally abusive language  Intimidation  Constant criticism  Threats  Spread of gossip  Physical abuse (i.e. hurling charts)  Undermining others  Social exclusion  Sexual comments  Racial slurs  Delegation of unskilled tasks  Manipulation (Felblinger, 2008; Randle et al., 2007)

7. Workplace Toxicity Two types: 1. Horizontal 2. Vertical Video: http://www.youtube.com/watch?v=4MT8Wnb9ZY8&NR=1

8. Randle, J., a nurse at the University of Nottingham, led a study focusing on bullying of nursing students. Findings suggested that more than half of all nursing students were bullied in their clinical placements. 1/2

9. Anti-toxic Culture A quality practice environment creates a workplace culture that values the wellbeing of clients and employees. (CNA, 2006)

10. Policies that contribute to positive workplace Policies that address: Ethical issues Ethical issues Support safety Support safety Promote employee recognition Promote employee recognition Ensure adequate resources Ensure adequate resources (CNA, 2006)

11. Effects of Workplace toxicity  Patient  Staff  Organization

12. Staff Isolation Isolation Fear Fear Stress-related illnesses Stress-related illnesses Physical & psychological effects Physical & psychological effects Increase in absence or sickness Increase in absence or sickness Intention to leave profession Intention to leave profession (Brown, 2009; Randle et al., 2007; Rocker, 2008)

13. Patient A study by Rosenstein & O’Daniel (2005), reveals that 53 -75% of healthcare providers saw a strong link between disruptive behavior and adverse clinical outcomes such as: Patient Safety Patient Safety Errors Errors Adverse events Adverse events Quality of care Quality of care Patient Satisfaction Patient Satisfaction

14. Organization Understaffing Understaffing Poor work relations Poor work relations Low supervisor support Low supervisor support Increased workload Increased workload Lack of resources Lack of resources (Cooper & Swanson, 2002; Salin, 2003)

15. Combating Workplace Toxicity Assertiveness Assertiveness Conflict Assessment Conflict Assessment Conflict Management Conflict Management

16. Assertiveness Assertive behavior is standing up for your rights while recognizing the rights of others. It is communicating accurately and honestly with others on an equal basis.

17. Assertive behavior has 3 components: 1. The non-judgmental statement 2. The emotional consequence 3. The effect of the behavior on the victim and service provided “ W hen you called me stupid in front of my patient I felt angry and embarrassed because it made me seem unprofessional and undermines my patient’s confidence in my ability to care for them”.

18. Conflict Assessment 1. What is the issue? 2. Who is involved? 3. Where is/was the conflict taking place? 4. Which is the best conflict management style to activate?

19. “ I t is well known that the empowering behaviors of nurse leaders can be paramount importance in the way staff nurses react to their work environment”. (Pangman & Pangman, 2010)

20. Conflict Management Strategies Avoiding Avoiding Accommodating Accommodating Competing Competing Compromising Compromising Collaboration Collaboration (Valentine, 2001 as cited in Pangman & Pangman, 2010)

21. Solutions  Quality practice environment  CNA Model  CRNNS complaint submission  CREW

22. Quality Practice Environments A quality professional practice environment A quality professional practice environment Primary value Primary value Central to ethical nursing Central to ethical nursing Decreases moral or ethical distress Decreases moral or ethical distress (CNA, 2003) #1

23. CNA Model 1. Control over workload 2. Nursing leadership 3. Control over practice 4. Support and recognition 5. Professional development 6. Innovation & Creativity

24. What actions would you take if the CRNNS Standards for Nursing Practice were not followed in the workplace?

25. How to submit a complaint 1. Address your letter of complaint to the Executive Director of the College of Registered Nurses of Nova Scotia. 2. State that you are submitting a complaint 3. Provide name and employment information about nurse involved 4. List and number the incidents about which you are complaining. Give details 5. Letters of complaint should be marked “CONFIDENTIAL’ and addressed to: Executive Director, College of Registered Nurses of Nova Scotia, 4005-7071 Bayers Road, Halifax, NS B3L 2C2 *For more detailed information please refer to pamphlet (CRNNS, 2009). TO: CRNNS

26. CREW Civilitity, Respect, Engagement in the workplace is a program designed to improve workplace relationships within a team Civilitity, Respect, Engagement in the workplace is a program designed to improve workplace relationships within a team Civility Civility Respect Respect Engagement Engagement

27. Discussion Can anyone provide an example of a strategy used to promote a positive work environment?

28. Questions