CARING
v
Create a Cohesive Culture:
Stop the Bullying
2010 Mary Ann Parsons Lectureship
Sigma Theta Tau
Center for Nursing Leadership
SC Lateral Violence Task Force
Judith A. Vessey,
PhD, MBA, RN, FAAN
• A learned, intentional respectful act designed to
maximize another’s well-being
•
•
•
•
•
Attitude
Intent
Context
Competency
Individualized focus
Central to quality patient care
QUALITY
NURSING CARE
•
•
•
•
Knowledgeable individuals
Appropriate staffing
S it bl physical
Suitable
h i l environment
i
t
Positive collaborative relationships
• Peer to peer interactions
• Interdisciplinary respect
• Administrative support
BULLYING
Repetitive offensive, abusive, intimidating, or
insulting behaviors, or unfair sanctions from a
person of higher
p
g
p
position or p
power with the
deliberate intent to cause psychological or
physical harm. Recipients feel humiliated,
vulnerable, or threatened, thus creating
stress, and undermining their self-confidence.
• Caring is not limited to our patients and their
families
• Need to care for:
• Ourselves
• Each other
CARING
BULLYING
BULLYING
Repetitive offensive, abusive, intimidating, or
insulting behaviors, or unfair sanctions from a
person of higher
p
g
p
position or p
power with the
deliberate intent to cause psychological or
physical harm. Recipients feel humiliated,
vulnerable, or threatened, thus creating
stress, and undermining their self-confidence.
1
BULLYING
BACKGROUND
• Related to horizontal violence and
harassment
• Differs by:
y
• Long recognized internationally
• Prevalence: 17-76% of RNs
• Physician to nurse, patient/family to nurse, and nurse to
nurse
• Little work done in US
• Power differential
• Notion of difference
• E.g., age, race, gender, sexual orientation
• Structure of the healthcare system
• Fear of liability
• Professional attitudes
• Has resulted in a ”culture of silence”
• Terms tend to be used interchangeably
BULLYING
BEHAVIORS
TARGETS FOR
BULLYING
• Behaviors
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•
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Withholding information
Excessive criticism
I
Insults
lt
Shunning
Unreasonable assignments
Denied opportunities
• Frequently “low grade”
SPIRALING
DOWNWARD
Anyone that differs from the group norm on
any major characteristic
Gender
Race/ethnicity,
Personality traits
Educational preparation
Experience
Professionalism
NEW NURSES
Dysfunctional
Unit Culture
Worsening
Bullying
• Fears of retaliation
• Perceptions that nothing will change
Victimization
• New graduates are
virtually all at risk
Individuals
Targeted
• Younger
• Less experienced
• Not knowledgeable of
cultural norms
• 2nd degree grads:
No or
Ineffective
Intervention
• Socially mature
• Clinically naïve
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BULLYING &
WORKPLACE
IMPACT
IMPACT OF
BULLYING
Psychological Symptoms
• Anxiety, irritability, panic attacks
• Tearfulness
• Depression, mood swings, and
irritability
• Loss of confidence
• Diminished self-esteem
• Avoidance and withdrawal
behaviors
• Increased use of tobacco, alcohol,
and other substances
Physical Symptoms
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•
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Disturbed sleep
Headaches
Increased blood pressure
Anorexia
Gastro-intestinal upsets
Loss of libido
Bullying Behaviors
• Withholding
information
• Excessive criticism
• Insults
• Shunning
• Unreasonable
assignments
• Denied
opportunities
Workplace Impact
• Impaired:
• Communication
• Collaboration
• Decision making
• Poorer performance
• Greater absenteeism
• Professional disengagement
• Poorer retention
•In severe cases PTSD also has been reported
THE P.O.S.T.
GROUP
RELATIONSHIP TO
QUALITY OF CARE
Bullying
Bullying
Poorer
P
Quality Care
Poorer
Patient Outcomes
Poorer
Quality
Care
Poorer
Satisfaction
> Absenteeism,
Turnover
• Wendy Budin, PhD, RN-BC
• Rosanna DeMarco, APRN, BC, PhD, RN
• Donna Gaffney, DNSc, APRN, BC, FAAN
Personal &
Organizational
Strategies for
Transformation
INTERNET
SURVEY
• Caring is not limited to our patients and their
families
• Need to care for:
• Ourselves
• Each other
• Primary purpose: To validate the occurrence
of bullying among nurses across the U.S.
and describe outcomes related to bullying
experienced of nurses
• Of specific interest:
• Nurses working in inpatient settings
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PREVENTION
MODELS
PREVENTION
MODEL
• Primary prevention: helps prevent the a condition
from developing
• Requires the identification of those personal,
interpersonal, and environmental factors that contribute
to bullying
• Secondary prevention: activities aimed at early
problem detection
• Requires screening and intervention when bullying has
begun, but is still “under the radar” and/or long-term
sequelae can be prevented or ameliorated
• Tertiary prevention: prevention of progression and
attendant suffering after bullying is clinically
obvious
Lead Time
Prepathological
Preclinical
Clinical
Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
• Often palliative in nature
INTERVENTIONS
Nurse residency
programs
Personal empowerment
Ns manager training
Monitor turnover
Satisfaction surveys
Exit surveys
Policies
Address ‘fit’
Personnel
actions
Unit dissolution
g
Staffing
Magnet status
Lead Time
Prepathological
Preclinical
Clinical
Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
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