1. So, The System Made You Angry Claudia Beverly, PhD, RN, FAAN Murphy Chair in Rural Aging Leadership and Policy Associate Director, Donald W. Reynolds Center on Aging Director, Hartford Center for Geriatric Nursing Excellence Director, Arkansas Aging Initiative Professor, Colleges of Nursing and Medicine University of Arkansas for Medical Sciences

2. Selected System Situations Nurses role in developing systems of care delivery within an academic setting Nurses role in developing systems of care delivery within an academic setting The system represses reimbursement for Advanced Practice Nurses The system represses reimbursement for Advanced Practice Nurses

3. Precipitating Factors- System Turbulence in the workforce/system Turbulence in the workforce/system Change in any place in the system (downsizing) Change in any place in the system (downsizing) Environmental pressures, poor or none strategic efforts, future challenges Environmental pressures, poor or none strategic efforts, future challenges Changing societal needs Changing societal needs Changing values Changing valuesSources: Kivimaki, M. and Vahitera, J. et al. (2000). Factors underlying the effect of organisational downsizing on health of employees; longitudinal cohort study. British Medical Journal. 320.971-974

4. Precipitating Factors- Individual PowerlessnessLow Job control PowerlessnessLow Job control Core values and principles are violated Core values and principles are violated Injustice Injustice Irresponsibility Irresponsibility Job Demands Job Demands Importance/value of one employee over another job insecurity Importance/value of one employee over another job insecuritySources: Thomas, S; Smucker, C; and Droppleman, P. (1998). It hurts most around the heart: A phenomenological exploration of womens anger. Journal of Advanced Nursing. 28(2), 311-322 Kivimaki, M. and Vahitera, J. et al. (1997). Psychosocial Factors Predicting Employee Sickness Absence During Economic Decline. Journal of Applied Psychology. 82; No. 6, 858-872

5. Threat to Employee Well Being Past History of dealing with anger –The knee jerk response –The red head response –The button/purse your lip response –The silent treatment

6. Where does the anger go Suppressing and expressing anger are linked with health risks: Both Physical and Cognitive/Emotional Suppressing and expressing anger are linked with health risks: Both Physical and Cognitive/Emotional

7. Physical Health Sickness resulting in absenteeism Sickness resulting in absenteeism It hurts most around the heartcoronary heart disease It hurts most around the heartcoronary heart disease Irritable bowel syndrome Irritable bowel syndrome Cancer Cancer Arthritis ArthritisSources: Thomas, S; Smucker, C; and Droppleman, P. (1998). It hurts most around the heart: A phenomenological exploration of womens anger. Journal of Advanced Nursing. 28(2), 311-322 Thomas, S; Groer, M; et al. (2000). Anger and Cancer: An analysis of the linkages. Cancer Nursing. 23, No. 5, 344- 348. Jack, D. (2001). Understanding Womens Anger: A Description of Relational Patterns. Health Care for Women International. 22:385-400

8. Cognitive/Emotional Threat to self efficacy Threat to self efficacy Depression Depression Substance Abuse Substance Abuse

9. Anger Management Anger DiversionCovert emotional routes women escape Anger DiversionCovert emotional routes women escape –Anger containmentmeans of restraint –Anger Internalizationwoman reallocates responsibility –Anger Segmentation--dissociation from anger –Externalizationprojection, aggression or both Source: Cox, D; Van Vebsor, P; and Hulgus, J. (2004) Who Me, Angry? Patterns of Anger Diversion in Women. Health Care for Women International. 25:872-893

10. Anger Management Assertive Anger Expression Assertive Anger Expression –Women remain aware and directly conveys emotion to target person emotion to target person –Intention of either resolving conflict or defining a position Source: Cox, D; Van Vebsor, P; and Hulgus, J. (2004) Who Me, Angry? Patterns of Anger Diversion in Women. Health Care for Women International. 25:872-893

11. Sustaining Optimism in Spite of the System VisionEnvision the possibilities VisionEnvision the possibilities –Resources needed to be successful –Powerbase PATIENCE PATIENCE Be inclusiveWelcome participation in decision making Be inclusiveWelcome participation in decision making When to escalate and when to not When to escalate and when to not

12. Sustaining Optimism in Spite of the System Develop own personal confidence Develop own personal confidence –Inventory of leadership style Be prepared to: Be prepared to: –Take incremental steps –Work for years to achieve success –Walk the journey down many unforeseen paths

13. Selected System Situations Nurses role in developing systems of care delivery within an academic setting Nurses role in developing systems of care delivery within an academic setting The system represses reimbursement for Advanced Practice Nurses The system represses reimbursement for Advanced Practice Nurses

14. The only limitation in the world is yourself