1. 1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 17 Personal Workplace Safety

2. 2 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Workplace Violence  Nurses have a right to a safe workplace  Workplace violence ranges from offensive or threatening language to homicide

3. 3 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Perpetrators of Workplace Violence  Strangers  Clients (patients)  Co-workers  Personal relationships

4. 4 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Risk Factors Leading to Violence  People under the influence of alcohol or drugs  Working understaffed  Long waiting times  Overcrowded waiting rooms  Working alone  Unlimited public access  Poorly lit corridors, rooms, parking lots  Contact with public  Exchange of money  Working in community-based settings  Hospitalized prisoners  Isolated work with patients during exams and treatments (Tomey, 2006)

5. 5 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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7. 7 Maintain Behavior That Helps Diffuse Anger  Present calm, caring attitude  Do not match the threats  Do not give orders  Acknowledge the person's feelings (e.g., "I know you are frustrated")  Avoid any behavior that may be interpreted as aggressive (e.g., moving rapidly, getting too close, touching, or speaking loudly)

8. 8 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Be Alert…..  Evaluate each situation for potential violence when you enter a room  Consider staff members, patients, or visitors to have a potential for violence  Be vigilant throughout encounters  Do not isolate yourself with a potentially violent person  Always keep an open path for exiting—do not let the potentially violent person stand between you and the door

9. 9 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Take these steps if you cannot diffuse the situation quickly….  Remove yourself from the situation  Call security for help  Report any violent incidents to management

10. 10 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Conflict Resolution Techniques  Avoiding—If you avoid the problem, you can trick yourself into believing that there is no problem.  Withholding or withdrawing—In this situation, one party removes themselves from participation in a solution; this does not resolve a conflict.  Reassuring—Parties do not withdraw but try to make everyone feel good. In this situation, reassuring strategies are used to diffuse strong conflicts; this may be a way of hindering open communication.  Accommodating—This is often used in vertical conflict when there is a power differential. It may also be used when one individual has a vested interest in a solution that may be relatively unimportant to the other individual.

11. 11 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Conflict Resolution Techniques (Cont’d)  Competing—This is an assertive strategy where one individual’s needs are satisfied at another’s expense.  Compromising—This strategy is when both individuals play a part in the decision. It is a basis of conflict management.  Confronting—Individuals will speak for themselves in a way that the other individual hears the concern.  Collaborating—Parties work together to find a mutually beneficial solution.  Bargaining and negotiating—This involves both parties in a back-and-forth discussion to reach a level of agreement.  Problem-solving—The goal is to find a workable solution for all parties.

12. 12 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

13. 13 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Horizontal Violence in the Workplace  Horizontal violence is an act of aggression towards another colleague  May be verbal, emotional or physical abuse  Can be belittling, withholding information or excluding a colleague from a group activity  This type of behavior can occur between physicians and nurses as well

14. 14 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

15. 15 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Vertical Conflict  Vertical conflict relates to differences between managers and their staff

16. 16 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. How can you manage vertical or horizontal violence???  Observe for verbal and nonverbal cues in behavior  Name the problem when you see it and use the term “horizontal violence”  Discuss horizontal violence at staff meetings; help break the silence  Be responsive when issues are brought to your attention  Engage in self-awareness activities to ensure that your leadership style does not support horizontal violence  Provide staff training about conflict management skills  Empower others to defend themselves against bullying

17. 17 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Sexual Harassment  Sexual harassment is a form of sex discrimination that violates Title VII of the Civil Rights Act of 1964.  It is defined as unwelcome sexual advances, request for sexual favors, or other verbal or physical conduct of a sexual nature when this conduct explicitly or implicitly affects an individual’s employment, unreasonably interferes with an individual’s work performance, or creates an intimidating, hostile, or offensive work environment (The U.S. Equal Employment Opportunity Commission, 2009)

18. 18 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. As a nurse or a nurse manager….  Develop a culture where violence is not tolerated  Incidents should be promptly addressed and managed  Comprehensive support for coworkers who experience violence should be provided  Advocate for enforceable violence management policies in the workplace and hold others accountable for their behavior  Participate in educational training  Mentor colleagues on how to respond to incidents

19. 19 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Violence: Occupational Hazards in Hospitals OSHA has identified 8 essential components for a violence prevention plan: 1. Management commitment 2. Employee involvement 3. Work site analysis 4. Prevention of hazards 5. Training and education 6. Prompt recognition, control, and monitoring 7. Record keeping 8. Evaluation

20. 20 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Impaired Employees  7% of nurses in the United States are impaired by alcohol or drugs (ANA, 1998)

21. 21 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Common Job Performance Changes of the Chemically Impaired Employee  Difficulty meeting schedules and deadlines  Illogical or sloppy charting  High frequency of medication errors or errors in judgment affecting patient care  Frequently volunteers to be medication nurse  Has a high number of assigned patients who complain that their pain medication is ineffective in relieving their pain  Consistently meeting work performance requirements at minimal levels or doing the minimum amount of work necessary  Judgment errors  Sleeping or dozing on duty  Complaints from other staff members about the quality and quantity of the employee’s work

22. 22 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Common Time and Attendance Changes of the Chemically Impaired Employee  Increasingly absent from work without adequate explanation or notification; most frequent absence on a Monday or Friday  Long lunch hours  Excessive use of sick leave or requests for sick leave after days off  Frequent calling in to request compensatory time  Arriving at work early or staying late for no apparent reason  Consistent lateness  Frequent disappearances from the unit without explanation

23. 23 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

24. 24 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

25. 25 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Employee Assistance Programs  EAP services provide counseling to employees and their families for the following:  Personal issues  Job stress  Relationship issues  Eldercare, childcare, parenting issues  Harassment  Substance abuse  Separation and loss  Balancing work and family  Financial or legal  Family violence