Horizontal Violence or Generational Conflict: Is Care-Fronting the Answer Yvonne Wesley, RN, Ph.D., FAAN Independent Health Consultant www.ywesleyconsulting.com

Overview Upon completion of this session, participants will be able to: Define Horizontal Violence and Generational Conflict Compare and contrast HV and GC similarities and differences Illustrate the effect of Care-Fronting on HV and GC

Horizontal Violence Antagonistic behaviors such as: Weinand, M. R. (2010). Horizontal violence in nursing: history, impact, and solution. JOCEPS: The Journal Of Chi Eta Phi Sorority, 54(1), 23-26. Antagonistic behaviors such as: Gossiping, undue criticism, Innuendo, scapegoating, Undermining, passive aggression, Bickering , blaming behaviors Sabotage Emotional dumping, indiscriminate venting

Weinand, M. R. (2010) Why susceptibility among nurses Antagonistic behaviors among oppressed people i.e.: women Nursing predominately women Antagonistic behaviors, a form of self-hate Demonstrated in the classroom with faculty dominating student nurses. Nurse managers and supervisors cited as frequent users of bullying culture & top down style

Weinand, M. R. (2010) End Product from HV Overwhelming sense of negativity cultivated Aggression breeds aggression Low morale High turnover Increased absence Low productivity

vs. identification of problems Weinand, M. R. (2010) Formal training in teamwork, positive feedback, conflict management and confrontation skills Solutions to the problem Embrace transformational leadership Inspire and challenge staff; Utilize active listening, Advise and coach staff; Have a positive vision Reward resolution vs. identification of problems

King-Jones, M. (2011) King-Jones, M. (2011). Horizontal Violence and the Socialization of New Nurses. Creative Nursing, 17(2), 80-86. overt and covert nonphysical hostility, criticism, sabotaging, undermining, infighting, scapegoat, and bickering unkindness, discourtesy, divisiveness, and lack of cohesiveness belittling gestures, verbal abuse, gossiping, sarcastic comments, faultfinding, devaluing comments, disinterest and discouragement, and controlling behaviors

King-Jones, M. (2011) HV stems from oppression HV is how oppressed people cope with powerlessness HV, a display of powerlessness & negative emotions Knowledge is power -- a cycle of power and resistance To resolve HV, address the dynamics of power and conflict

Generational Conflict Hahn, J.A. (2011), Managing Multiple Generations: Scenarios From the Workplace. Nursing Forum, 46(3), 119-127. Increased numbers of generations working together creates more opportunity for misunderstanding Veterans, [born before 1945] Baby Boomers, [born 1946-1964] Generation X, [1965-1976] Gen Y/Millennials [1977-1997]

Hahn, J.A. (2011) Veterans – before 1945 Baby Boomers – ‘46 to ‘64 Grew up in times of political and economic uncertainty, lived experience of the Great Depression and World War II Nursing as a helping profession and unselfish Expect rewards for hard work Baby Boomers – ‘46 to ‘64 Strong sense of duty, called workaholics Lived experience of prosperity Look to empower Arrive early to work

Hahn, J.A. (2011) Generation X – ’65 to ‘76 Independent, self-directed, and techno-savvy Latchkey kids Grew-up quicker and stayed adolescents longer Quality of life important their parents work long hours and experienced downsizing Millennium/Gen Y – ’77 to ‘97 Technology and instant communication Accepting multiculturalism After-school activities, such as swimming, soccer, dance Want work-life balance

Generation Generational styles Veterans <1945 Stable Reliable Practical Loyal Baby Boomers 1946–1964 Involvement Personal growth Optimism Mentors Generation X 1965–1976 Think globally Techno-literacy Pragmatic Asynchronous communication Skeptical Millennials 1977–1997 Multitasking Technologically savvy Outcome driven Determined

Carefronting Kupperschmidt, B. (2006). Addressing multigenerational conflict: mutual respect and carefronting as strategy. Online Journal Of Issues In Nursing, 11(2), Kupperschmidt argues that professional nurses must care enough about their patients, profession, colleagues, and themselves to ‘carefront’ disrespectful behavior

Kupperschmidt, B. (2006). Treating each other with respect is a nurse's ethical responsibility Carefronting, a model of communication used when professional nurses care enough about themselves and their patients to confront disrespectful behavior face-to-face

Kupperschmidt, B. (2006) Failure to confront is dishonest communication Carefronting embodies forgiveness, caring and valuing, while addressing the anger in the disrespectful behavior, and focuses on the here and now

Kupperschmidt, B. (2006) The goal is the ability to work together to provide safe patient care in an environment based upon mutual respect Kean University Graduates Bivins & Primus 2012 Developed the: Perceived Carefronting Ability Questionnaire

A newly registered nurse Renee is working alongside Jeanette, a nurse of twenty five years in a busy trauma emergency room. Patient Glendale, a frequent flyer, presents complaining of chest pain radiating to his right arm, his history includes hypertension managed with a beta blocker and drug seeking behavior. Jeanette blurts out, “Back so soon. Ran out of your Percocets in three days did you?” Renee goes to his bedside places him on the cardiac monitor, performs and EKG and tells the physician the patient may be experiencing a heart attack. Jeanette waltzes over, rolls her eyes, sighs and sarcastically says, “This rookie needs to go back over there and complete his history and physical before jumping to conclusions. Embarrassed Renee walks away. Later she seeks out Jeanette and asks to speak to her in a private area.

Yvonne Bivins MSN RN Nadia Primus MSN RN Carefronting Techniques based on Kupperschmidt (2006) When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction). Because it portrays me as someone in a rush (what does it look, sound or feel like). Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response) In the future talk to me in private (what behavior you want to see). Are you committed to treating me as respected colleague? (What you want them to do?) If there isn’t a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence).

Number of Participants Pre-test Post-test Baby Boomer RNs 7 4 Generation X RNs 17 8

Yvonne Bivins MSN RN Nadia Primus MSN RN A paired t test compared pre and post mean scores of the participants’ perceived ability to utilize Carefronting pre-test M= 40. 75, SD=4.15 post-test M= 43.08, SD=3.08 Highest possible score being 50 and the lowest 10 Alpha set at p<0.05 There was no significant difference t(11) = -2.17, p = 0.053. The 95% confidence interval for the mean difference between the two means was -4.70 to 0.03.

Yvonne Bivins MSN RN Nadia Primus MSN RN An independent t test compared Baby Boomer to Gen X mean scores on perceived ability to utilize Carefronting No significance difference in the Baby Boomer & Generation X mean scores pre-test t(24) = .992, p = .33 post-test t(11) = .154, p = .88

Carefronting Techniques based on Kupperschmidt (2006) When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction). Because it portrays me as someone in a rush (what does it look, sound or feel like). Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response) In the future talk to me in private (what behavior you want to see). Are you committed to treating me as respected colleague? (What you want them to do?) If there isn’t a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence).

Take home Message Caring enough to confront may help Carefronting comes from a place of love, not bitterness or hate Horizontal Violence and Generational Conflict are a problem within nursing Both are highly detrimental to the body of Black nurses