Nevada Collaborative on Incivility and
Bullying in the Healthcare Workplace
At the end of this presentation, participants
will be able to:
 Discuss personal and financial costs to
individuals and the organization of lateral
violence
 Describe how nurse incivility and bullying
impact patient safety.
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Salli J. Vannucci, DNP, MSN/E, RN, GCPH, CNE
Nancy Brewster-Meredith, MSN/ED, RN
Stephen J. Hayden, DNP, APRN
Margaret Curley, BSN, RN
Horizontal Violence
Incivility
Lateral Violence
Disruptive Behavior
Workplace Violence
Bullying
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The definitions of each term portray the same
behaviors that are usually non-physical in
nature such as sabotage, verbal abuse, devaluing, backbiting and criticism (D’Ambra &
Andrews, 2014; Khadjehturian, 2012; Roberts, 2014).
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Negative behavior that is directed from one
nurse to another through words, attitudes,
and actions (Vannucci, 2012).
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Statistics from the International Council of
Nurses (ICN) reveal that world wide nurses
are three times more likely than any other
service occupational group to experience
violence in the workplace (Del Bel, 2013).
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In a study by Odell (2008) conducted in
California, 90% of the nurses surveyed
stated that they had been the victims of
verbal abuse at least once in their career.
◦ Widespread threat that occurs in every aspect of the
nursing profession from academia to practice!
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Clinical and non-clinical settings
Nursing students*
Between faculty members
Faculty to students
Global problem
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85% nurses surveyed experienced HV
(Cameron, 2011)
91.1% of 1000 first year nurses surveyed
stated they experienced HV (Araujo & Sofield,
2010).
AORN reported 94% OR nurses experienced
HV.
◦ Oppressed group theory (Freire, 1970)
◦ “Because nurses lack autonomy,
accountability and control over their
profession, they too can be said to be
oppressed.”
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“General and hierarchical abuse” (Leiper,
2005)
◦ Thrives in nursing because of the importance of
status quo. Manager or senior nurse might believe
they’ve “earned the right” to abuse others. Evident
in assignments
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Disenfranchising work practices (Leiper,
2005)
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Long hours/double shifts
Patient ratios
Stressful situations
Low morale
No support from administration*
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“Nurses eat their young”
◦ Learned behavior passed on from one decade to
another
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Bullies as Children
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Why do nurses continue to accept the abuse?
 Do not have the power to change it
 No support from administration*
 No support from other nurses
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Integrity: Act with high moral principle. Adhere to the highest
professional standards. Maintain the trust and confidence of all
with whom I engage.
Commitment: Work diligently to serve Veterans and other
beneficiaries. Be driven by an earnest belief in VA’s mission.
Fulfill my individual responsibilities and organizational
responsibilities.
Advocacy: Be truly Veteran-centric by identifying, fully
considering, and appropriately advancing the interests of
Veterans and other beneficiaries.
Respect: Treat all those I serve and with whom I work with
dignity and respect. Show respect to earn it.
Excellence: Strive for the highest quality and continuous
improvement. Be thoughtful and decisive in leadership,
accountable for my actions, willing to admit mistakes, and
rigorous in correcting them.
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American Nurses Association reported that
53% of nurses were considering leaving their
current position due to incivility in the
workplace.
With the anticipated retirement of Baby
Boomer nurses, there is a projected nursing
shortage of 260,000 nurses by 2025 (Twibell
et al., 2012).
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Organizations are losing their ability to retain
qualified nurses especially new graduates
(Porterfield, 2010; Small, Porterfield, & Gordon, 2014)
Nursing turnover rates were estimated at
30% in the first year of practice and as high
as 57% in the second year (Twibell, St. Pierre,
Johnson, Barton, Davis, Kidd, & Rook, 2012).
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Increased rate of nurse turnover estimated to
cost between $22,000 to $64,000 per nurse
(Oyeleye, Hanson, O’Connor, & Dunn, 2013).
Cost of orienting new nurses has been
estimated at between $40,000 and $80,00
depending on unit and specialty.
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Effective July 22, 2015
ANA’s Code of Ethics for Nurses with Interpretive
Statements states that nurses are required to “create
an ethical environment and culture of civility and
kindness, treating colleagues, co-workers,
employees, students, and others with dignity and
respect.” Similarly, nurses must be afforded the same
level of respect and dignity as others (ANA, 2015a).
Thus, the nursing profession will no longer tolerate
violence of any kind from any source. All registered
nurses and employers in all settings, including
practice, academia, and research must collaborate to
create a culture of respect, free of incivility, bullying,
and workplace violence.
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Colosi (2013) reports 83.9% of hospitals do
not track this cost
With diminishing hospital margins, why would
these costs not be tracked?
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The failure to track these costs is largely due
to limitations of accounting systems
No systematic way to consolidate affected
unit’s per diem costs, HR’s recruitment costs,
etc.
Yet these enormous costs are largely
avoidable
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Two Year Longitudinal Study to Determine
Effectiveness of LV/VV Training Underway
NV Nurses report as serious to very serious (%):
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Vertical Violence directed downward – 69%
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Lateral Violence Among Peers – 79%
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Lateral Violence Toward New Graduate Nurses – 84%
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Leaders not willing to intervene in work area – 69%
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Targeted nurses not willing to stand up to LV/VV –
73%
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Fear of retaliation if vertical violence downward
reported – 49%
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Left position due to Vertical Violence – 12.4%
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Wide variation in cost estimates for replacing
nurses
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Largely due to methodology differences
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Some replacement costs estimates:
-Oyeleye et al, (2013) $22,000 - $64,000
-American Nurses Association 1.1 to 1.6 a
nurse’s annual salary
-Krsek (2011) $88,000
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Assume Modest $50,000 to Replace a Nurse
Who Left Due to VV
NV Rate of Nurse Departures due to VV–
12.4%
Loss of 12.4 Nurses per Hundred due to
Vertical Violence = $620,000
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Since a moderate size hospital may have 500
nurses, this is a $3 million problem; more so for
larger hospitals
Since 83.9% of hospitals do not track these costs,
how will the C-suite become aware of and correct
this hemorrhaging of cash in this era of
diminishing reimbursements and margins?
This C-Suite action is a requirement if LV/VV is
to be significantly reduced.
1.Raise awareness of the problem
2.Adopt professional behavior standards
 The ANA Code of Ethics
 The ANA Standards of Practice
 Joint Commission Disruptive Behavior
Standard
3.Emphasize the value of Nursing
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Low morale
Diminished teamwork
Increased stress
Decreased quality of patient care
Increased absenteeism
High turnover rates
Increased labor costs
Difficulty in recruiting new staff
Patient Safety
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Newly licensed nurses
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Newly hired nurses (including transfers or
experienced nurses from other places)
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Hospital pool, float & traveling nurses
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Student nurses
(continued)
4. Learn to address behaviors as they
occur
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Cost of incivility and bullying on
◦ nursing,
◦ quality and safety of patient care, and
◦ financial costs to health care facilities
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Formed task force of stakeholders to examine
the problem
Purchased curriculum from South Carolina
Upstate AHEC
Presented a Train the Trainers in 2012
Free training to heath care facilities and
nursing organizations in Nevada
Outcomes:
 Study to measure effectiveness of the training
is in progress
 Two large hospitals, with strong management
support, have been training new hires and
new grads since 2012
 One of these hospitals reports that internal
surveys show complaints of incivility and
bullying between nurses have dropped from
top of the list for years to no longer a
concern
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Management
support,
Good policy, and
Consistent Training
=A Positive
Impact on
Lateral
Violence
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If you are
considering a
similar effort in
your organization
at any level, we are
more than willing to
share our
experience and
lessons learned
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Come to Nevada
Collaborative
meetings
Attend a training
Contact us if we
can help
Nevada
Collaborative on
Prevention of
Incivility and
Bullying in the
Healthcare
Workplace
775-747-2333
Margaret Curley, BSN, RN
Executive Director
Nevada Nurses Association
Chair, Nevada Collaborative
[email protected]
775-747-2333
Be the change you want to see in the world.
--Ghandi