-Strategies to Reduce & Eliminate Horizontal & Lateral Violence at the Unit Level-

Presented by: Lauren Tronsgard –Scott BSRN Linda Knight APRN Elaine Koenig BSRN

-Catalysts- Speaking at charge nurse workshop on situational leadership Reports of horizontal violence on our units by new and ancillary staff Nurse’s Week Grand Rounds on Nurse to Nurse hostility and health relationships Personal experience

-Horizontal Violence- A consistent (hidden) pattern of behavior designed to control, diminish, or devalue another peer (or group) that creates a risk to health and/or safety (Quine 1999, Farrell 2005) -Horizontal Violence-

-Horizontal Violence- Overt: name-calling, sarcasm, bickering, fault-finding, back-stabbing, criticism, intimidation, gossip, shouting, blaming, put-downs, raising eyebrows, etc. Covert: unfair assignments, eye-rolling, ignoring, making faces (behind someone’s back), refusal to help, sighing, whining, sarcasm, refusal to work with someone, sabotage, isolation, exclusion, fabrication, etc. “Mister, everybody knows you don’t need a lid on a bucket of crabs. 6 6

Horizontal Violence AKA: Lateral Violence Workplace Incivility Bullying Workplace Aggression Nurses Eating Their Young

Why Should We Promote Civility, Communication, Teamwork? It’s all about the Patient

What we have done….

-“Poll the Audience”- Survey of multi-disciplinary staff - Nursing 2011 horizontal violence survey. Dumont, Cheryl PHD, RN, CRNI; Riggleman, Kammie MSN, RN, NEA-BC; Meisinger, Sandy BSN, RN; Lein, Alicia BSN; RN, CCRN

-Survey of multidisciplinary staff- Within the last 12 months, how often have you personally experienced or witnessed the following: Harshly criticizing someone without having heard both sides of the story.   never once a few times monthly weekly daily Within the last 12 months How often have you personally experienced or witnessed the following. Complaining about a co-worker to others instead of attempting to resolve a conflict directly by discussing it with that person?   never

-Presented plans to our psych practice council-

Results of Survey….

Inpatient Psychiatry Survey Responses Answer these questions from the perspective of how you personally have been affected within the last 12 mos; I’ve not spoken up about something because of fear of retaliation. Never 54.9% 39 Once 5.6% 4 A few times 25.4% 18 Monthly Weekly 8.5% 6 Daily 0%

Inpatient Psychiatry Survey Responses Answer these questions from the perspective of how you personally have been affected within the last 12 mos; I have hesitated to ask a question for fear I would be ridiculed. Never 66.2% 47 Once 0% A few times 23.9% 17 Monthly 4.2% 3 Weekly 5.6% 4 Daily

Inpatient Psychiatry Survey Responses In general, horizontal or lateral violence occurs on psychiatry? Never 33.8% 24 Once 2.8% 2 A few times 28.2% 20 Monthly 8.5% 6 Weekly 16.9% 12 Daily 9.9% 7

-Placed Commitment to my Co-worker laminated poster in several locations on units- (Creative Heath Care Management, Inc)

-Bought “Commitment to my Co-worker” pins and cards- Encouraging staff to meet with each other and facilitating conversations with staff to address communication issues, summing up conversation by giving out pins and cards to those in attendance.

-Popcorn and a Movie- “Healing Nurse-to-Nurse Hostility and Creating Healthy Relationships” Presented by: Kathleen Bartholomew, RN, MN National Speaker and Author of “Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication;” “Ending Nurse to Nurse Hostility,” “Stressed Out About Communication,” and “The Image of Nursing” Kathleen’s thoughtful presentations inter-laced with research reawaken every nurse’s commitment and love of nursing. Her most ardent desire is to empower nurses through knowledge and the power of story. Come and be inspired!

-We Shared the Results of the Survey before showing the movie-

Commitment to My Coworkers Card included with each bag of popcorn!

Over 40 staff viewed the video during 3 presentations – Standing room only!

-Commitment to My Co-Workers Poster-

-”Feedback Board”-

Sample Comments: “ The silence is painful and not helpful at all.” “This article illustrates how standing up for yourself engenders respect and can alter dynamics in the relationship.”

-Added annual evaluation goal: To reduce and eliminate horizontal and lateral violence on Inpatient Psychiatry by using Caring and Collaborative Communication-

-”Walking the Walk”- Talking about how I (Lauren) plan to improve my own communication style and holding myself accountable in front of other staff members. Apologizing publicly if needed. Making a commitment as a manager to make this a priority and project in the next year 2012. “Managers are the culture carriers of the organization.” - Farrell (2005)

-Commitment to Coworkers- Linda and Elaine emphasize our commitment to no horizontal violence when orienting new staff to our units FAHC Standards of Excellence

-Purchased books for units by Kathleen Bartholomew-

-Addressing and meeting with identified staff on our units to assist them in getting greater awareness about their communication style and offer assistance for improvement. (Gave out crucial conversation book)- FAHC offers Crucial Conversation Program which Linda (Clinical Nurse Specialist) and Elaine (Nurse Educator) have attended

-Sharepoint Blog – Lauren’s Desk- Why should we spend time on relationships? How we treat each other has a direct impact on our ability to produce quality work. When we are  ineffective communicators or don't trust and respect one another, delays in accomplishing our work occur.  We can create safety issues by not speaking up or to another employee.  Patients are impacted by our ability to communicate as a team.

HIT BY IRENE!

-Anecdotal Evidence-

-Future Plans- Resurvey our staff Continue to post information on horizontal violence Encourage staff to communicate openly about lateral violence when it occurs Support staff in attending Crucial Conversations classes and conferences dealing with related topics

-Finding Our Voice- “The truth is that neither checklists, nor procedures, or process improvement will work in the absence of meaningful, collegial relationships in which every member of the team feels comfortable communicating what they see, feel and know at all times. Silent cultures never change. Find the courage. Find your voice.” - Kathleen Bartholomew RN,RC,MN (2009)