1. Treating others with Respect and Dignity (aka Eliminating the Silent Enemy of a Healthy Culture) Presented by: Karen L. Zimmerman, RN, MSN Chief Nursing Officer – Trinity Health

2. Objectives Identify the characteristics of a healthy culture and work environment Define respect, dignity and professionalism Identify and implement strategies for coaching co-workers Integrate strategies to recognize and diminish (or eliminate) bullying behavior

3. Setting the stage Of all types of aggression nurses experience, peer-to-peer hostility is the most harmful (Farrell, 1999)

4. Bullying 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.

5. Impact of Bullying Bullied staff had lower job satisfaction, higher stress, higher depression, higher anxiety, and higher intent to leave. 60% of newly registered nurses leave their first position within six months because of some form of lateral violence (Griffin, 2004).

6. Why... Bullying exists? Nurses (*healthcare providers) do not have an outlet for frustration; do not have an opportunity to process (reflection); are wounded by horizontal hostility; lack a support system/solidarity; have adapted to increased pace of work and workload.

7. Impact (personal) The impact of bullying includes, but is not limited to: Decreased job satisfaction Increased intent to leave Depression PTSD Burnout (depersonalization, lack of control) Maladaptive responses (substance abuse, over eating) Decreased immune response/resistance to infection Cardiac impact Anger, irritability Poor sleep Nausea/vomiting/diarrhea Decreased self-esteem, increased self-doubt Lack of motivation and feelings of failure Impatience, crankiness, lashing out

8. Impact (organizational) Poor employee satisfaction (ultimately leads to poor patient satisfaction) Decreased productivity (directly related to poor teamwork) Patient safety (increased errors) Unexpected sick time/absenteeism

9. Characteristics of a Healthy Culture Employees exhibit respect and courtesy Employees are engaged and positive Communication is open and transparent There is healthy work life balance There is a commitment to professional development There is recognition of hard work There is a strong spirit of team work

10. How do we get there? Adopt a two-fold approach: – Decrease negativity, gossip and a culture of blame by maintaining zero tolerance for any communication that is unhealthy – Increase a climate of safety and healthy communication by role modeling and utilizing opportunities to teach interpersonal and confrontation skills (Fitzpatrick and Bartholomew, 2007)

11. Call to Action Choose to LEAD Choose to CHANGE Listen with ATTENTION ACT with INTENTION Raise the BAR (Fitzpatrick and Bartholomew, 2007)

12. It is empowering to be part of the solution and not be part of the problem!

13. Respect Having respect for someone means you think highly of a person; you have a positive feeling of admiration or deference for a person or position. Show respect even to people who don’t deserve it; not as a reflection of their character, but as a reflection of yours. ~Dave Willis

14. Dignity In healthcare...it means providing care which supports and promotes, and does not undermine a person’s self respect Maintaining dignity is the result of being treated with respect

15. Professionalism Professionalism is difficult to define Varies depending on situation Elements of professionalism regardless of situation or job: – Paying attention to the cultural norms of the organization – Being pleasant and polite to people (even if you don’t like them) – Taking work seriously – Taking ownership for your work – Realizing that feedback (both positive and negative) is necessary for growth – Writing and speaking clearly and professionally – Being flexible (as opposed to rigid and unbending) – Show up reliably (and be present) – Be helpful (go beyond the job description) – Don’t treat leaders and managers as adversaries – Communicate, communicate, communicate – Don’t assume

16. Characteristics of someone you consider professional Trustworthy Respectful Considerate Approachable Accountable Competent Acts with integrity Empathetic Supportive

17. Concepts Profession Professionalism Teamwork Emotional Intelligence Professional Boundaries Workplace Baggage All have an impact on professionalism and the perception of professionalism!

18. What professionalism is vs. What professionalism is NOT

19. Professionalism is: Having an awareness of how your actions, body language, and words affect others Being fully accountable for one’s actions Utilizing kindness, compassion, intelligence, and direct communication to lead others Learning to master a mindful, calm response to an emergency Valuing teamwork and collaboration more than serving self

20. Professionalism is NOT: Throwing someone under the bus! Nor is it sitting by complacently and watching someone get thrown under the bus! Poisoning the water (waterhole) Being a fire starter or pot stirrer Blaming others for your mistakes or poor response Losing your composure in chaotic situations “When things go wrong, don’t go with them.”

21. Coaching for Success, Verbal De-escalation and Confronting Unacceptable behavior

22. What you accept is what you teach!

23. Crucial Conversations

24. What happens when conversations are crucial? “When conversations turn from routine to crucial, we’re often in trouble.” Practice makes perfect! Walking away with a “what just happened?” feeling.

25. Adrenaline Brain diverts blood from “nonessential” to high-priority tasks (hitting and running i.e. arms and legs) Less blood to higher-level reasoning...i.e. brain gets less blood. Result: You face challenging conversations with the same equipment available to a rhesus monkey. What just happened?

26. Coaching & Communication

27. Effective communication is defined as passing information between one person and another that is mutually understood 70% of communication is misunderstood Communication

28. Successful Coaching Build a relationship of mutual trust Clarify the reason for the meeting Get agreement Explore alternatives Get a commitment to act Handle excuses Provide feedback (timely; specific; focused on the what, not the why; sincere)

29. Respond to statements made by the person to encourage him/her to continue talking. – For example: Help me understand... I see... Tell me more about it... That would be one option... What other options do you have?... Uh huh, ok... Reflecting on Statements

30. They are Communicating... Vulnerability Overload of emotional stress Fear Feelings of helplessness Powerlessness Feelings behind the words...when someone is upset or angry

31. Putting it all into motion

32. Situation 1: Nonverbal innuendo (raising eye-brows, face making) Response: I sense (I see from your facial expression) that there may be something you wanted to say to me. It’s okay to speak directly to me.

33. Situation 2: Verbal affront (covert or overt, snide remarks, lack of openness, abrupt responses) Response: The individuals I learn the most from are clearer in their directions and feedback. Is there some way we can structure this type of situation?

34. Situation 3: Undermining activities (turning away, being unavailable) Response: When something happens that is “different” or “contrary” to what I thought or understood, it leaves me with questions. Help me understand how this situation may have happened.

35. Situation 4: Withholding information (practice or patient) Response: It is my understanding that there was (is) more information available regarding the situation, and I believe that if I had known that, it would have affected how I learn.

36. Situation 5: Sabotage (deliberately setting up a negative situation) Response: There is more to this situation than meets the eye. Could “you and I” meet in private and explore what happened?

37. Situation 6: Infighting (bickering with peers) There is nothing more unprofessional than a contentious discussion in a nonprivate place. Always avoid. Response: This is not the time or place. Please stop (physically walk away or move to a neutral spot).

38. Situation 7: Scapegoating (attributing all that goes wrong to one individual) Rarely is one individual, one incident, or one situation the cause for all that goes wrong. Scapegoating is an easy route to travel, but it rarely solves problems. Response: I don’t think that is the right connection.

39. Situation 8: Backstabbing (complaining to others about an individual and not speaking directly to that individual) Response: I don’t feel right talking about him/her/the situation when I wasn’t there or don’t know the facts. Have you spoken to him/her?

40. Situation 9: Failure to respect privacy Response: It bothers me to talk about that without his/her/their permission. I only overheard that. It shouldn’t be repeated.

41. Situation 10: Broken confidences Response: Wasn’t that said in confidence? That sounds like information that should remain confidential. He/she asked me to keep that confidential.

42. “I’m not concerned with your liking or disliking me...All I ask is that you respect me as a human being.” –Jackie Robinson

43. References Bartholomew, K. (2014). Ending nurse-to-nurse hostility: Why nurses eat their young and each other. Danvers, MA: HCPro. Cohen, M.H. (2007). What you accept is what you teach. Minneapolis, MN: Creative Health Care Management. Farrel, G. (1999). Aggression in clinical settings: Nurses views – a follow-up study. Journal of Advanced Nursing. Volume 29(3), 532-534. Fitzpatrick and Bartholomew, K. (2007). Solutions to end nurse-to-nurse hostility: Tips and tools to create a healthy work environment. HCPro – The Healthcare Compliance Company. Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal for Continuing Education in Nursing. Volume 35 (6). Longo, J. (2012). Bullying in the workplace: Reversing a culture. Silver Spring, MD: Nursebooks. Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2005). Crucial confrontations. New York, NY: McGraw Hill. Patterson, K., Grenny, J., Maxfield, D., McMillan, R., & Switzler, A. (2013). Crucial accountability. New York, NY: McGraw Hill. Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2012). Crucial conversations. New York, NY: McGraw Hill. Skehan, J. (2015). Nursing leaders: Strategies for eradicating bullying in the workforce. Nurse Leader. Volume 13(2), 60- 62.

44. Questions?