1. Workplace Violence and Disruptive Behavior in Healthcare Georgia Hospital Association September 25, 2014 Dianne M Jacobs, MSN,RN CoMass Group, LLC

2. Objectives Differentiate disruptive behavior and workplace violence Examine the impact of disruptive behavior in the workplace Identify best practices for addressing disruptive behavior

3. Cynthia Clark’s Stowkowski, L.A,The Downward Spiral: Incivility in Nursing. Retrieved February 12, 201 from http://www.medscape.com/viewarticle/739328_2http://www.medscape.com/viewarticle/739328_2

4. We are NOT going to discuss: Physical violence Disruptive behavior by patients &/or visitors Stalking

5. Old problem…New names Workplace incivility Disruptive behavior Horizontal hostility Lateral violence Horizontal violence Bullying

6. LV…What is it? Lateral violence in nursing is defined as “…nurses covertly or overtly directing their dissatisfaction inward toward each other, toward themselves, and toward those less powerful than themselves.” Griffin, 2004 One-on-one aggression Inter-group conflict Shift-to-shift Cliques within a workgroup Department-to-department

7. The 10 Most Frequent Forms of Disruptive Behavior Nonverbal innuendo (raising of eyebrows, face-making) Verbal affront (covert or overt, snide remarks, lack of openness, abrupt responses) Undermining activities (turning away, not available) Withholding information (practice or patient) Sabotage (deliberately setting up a negative situation) Infighting (bickering with peers) Scapegoating (attributing all that goes wrong to one individual) Backstabbing (complaining to others about an individual and not speaking directly to that individual). Failure to respect privacy. Broken confidences. Griffin, 2004

8. Personal Experience of Lateral Violence of Nurses in the Upstate

9. Most common forms of LV

10. How LV is handled… IGNORED

11. Who are common targets? New employees (particularly new graduates) Students or trainees Medical students and residents Experienced employees, but new to the area or department Temporary staff or someone covering from another area PRN staff

12. So, what’s the impact? Low morale Diminished teamwork Increased stress Increased absenteeism Decreased quality of patient care High turnover rates Increased labor costs Difficulty in recruiting new staff Patient Safety

13. Why is there so much negative behavior in healthcare? Historically, nurses exhibit characteristics of an “oppressed population” (oppressed group theory) * Dominated by the medical profession and a hierarchical structure * Excluded from the power structure * Taught to “silence our voices” Roberts, 2000

14. slide14 High stress levels due to : Heavy workloads Short staffing Dealing with people who are under stress Rapid turn-around times Patients’ lives are at risk Unpredictability of the work Feeling ashamed of being a victim and don’t report the behavior Acceptance of bad behavior from some people Fear of retaliation if we do report Cultural differences Generational differences

15. Generations Baby Boomers (1943-1960) 54- 71 yrs old Generation X (1961-1980) 34-53 yrs old Gen Y/Nexters/Millenials (1981- ?) ≤ 33 Zemke, Raines & Filipczak, 2000

16. My Personal Plan Identify a conversation you need to have with a colleague and/or employee Plan responses Practice to achieve communication competency Develop a support system Discuss with your manager/colleague

17. Cognitive Rehearsal Techniques Recognize the behavior when it occurs Plan ahead for ways to respond Practice new responses before you need them

18. Things to keep in mind Take time to calm down Always be respectful of the other person Hold discussions in private Talk directly to the person, not to coworkers Avoid blaming or finger-pointing Listen carefully Use “I” messages

19. Format for Effective Feedback Describe the situation (“When …happened,”) Explore or express your thoughts, feelings or concerns giving the benefit of the doubt (“Was it your intent to…?”) Specify what you want them to do differently next time (“In the future, would you…?”) Consequence-state the positive consequence when they do as you ask Bower & Bower, 2004

20. Scenario While reporting on a serious patient safety issues in today’s management meeting, you notice 2 of your colleagues looking at you, rolling their eyes, whispering and laughing. You get the impression their behavior is aimed at you since you have witnessed this behavior toward other colleagues in previous meetings. What behavior are you witnessing in this scenario? How would you respond?

21. Slide 21 Scenario Response: The behavior in this scenario is nonverbal innuendo Suggested response: D: “Jane, today in our managers meeting while I was discussing the serious patient safety issue, I noticed you rolling your eyes, whispering to Alice and laughing.” E: “It felt like it was directed at me and I felt uncomfortable and distracted. Was there something you wanted to say to me?” Jane’s response: “Oh no, Dianne. You are just too sensitive!” E:“Well it felt like you were directing it to me and it was very distracting. Please don’t do that again.” S: “In the future, if there is something you want to say to me, please address me directly.” C: “I welcome construction feedback especially when we are discussing such important issues.”

22. Slide 22

23. Addressing Disruptive Behavior Adopt professional behavior standards Raise awareness of the problem Emphasize the value of the care provided by your employees Learn to address the behaviors as they occur

24. Slide 24 “Alas, culture is not what we say, what we think, what we mean, or even what we intend; it’s what we do.” Jon Burrough,MD

25. Dianne M Jacobs,MSN,RN 864-901-6612 dianne.jacobs@comassgroup.com Deborah L Cox,MBA,MS-CM,MT(ASCP) 678-640-2492 deborah.cox@comassgroup.com www.comassgroup.com Thanks for attending! Slide 25

26. References 1.Bartholomew, K. (20). Ending Nurse to Nurse Hostility. Marblehead, MA: HCPro, Inc. 2.Bartholomew, K.(2010) Speak Your Truth. Proven Strategies for Effective Communication. HCPro,Inc 3.Bower, S,&,Bower G. (2004). Asserting yourself: A practical guide to positive change. MA: Da Capo Press 4.Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of Continuing Education in Nursing. 35(6), 1-7. 5.Stanley,K., Martin, M., Michel, Y., Welton, J., & Nemeth, L. (2007). Examining lateral violence in the nursing workforce. Issues in Mental Health Nursing, 28, 1247-1265. 6.Stowowski,L.A., The Downward Spiral: Incivility in Nursing.Retrieved February 12, 2014 from http://www.medsca[e.com/viewarticle/739328_2http://www.medsca[e.com/viewarticle/739328_2 7. Zemke R., Raines C. & Filipczak B. (2000) Generations at Work: Managing the Clash of Veterans, Boomers, Xers and Nexters inYour Workplace. Amacom, New York, NY.