Horizontal violence in the workplace

KatieMI, BSN, MSN, RN · Jan 17, 2016

I honestly do not see how on the green Earth you can get people in your own unit to provide "honest responces" about this subject. You can present it as anonymous all you want, I will make a good bet that nobody will trust it.

You can try to find nurses who left your unit or were terminated from it for the last couple of years. They won't have anything to lose and so may be more open about real standing of things. Otherwise, you'll get textbook answers.

soulshine101 · Jan 17, 2016

Survey monkey is anonymous.. While this may be true about honesty but I am also going to have to do something to solicit answers. People talk about it all the time already that I want to believe they will have no problem answering questions

Libby1987 · Jan 17, 2016

A variety of multiple choice/rating answers, circle ABCD/none of the above.

Give a week to submit into a secure container.

Make the questions cut to the core, don't dance around with generalizations.

I did it to survey the thoroughness of assessments, and some anonymously admitted to not assessing something even though boxes were checked. It wasn't meant to flesh out who wasn't doing what or to be punitive but purely to get an idea of what and how we needed to work on better assessments.

KatieMI, BSN, MSN, RN · Jan 17, 2016

Survey Monkey doesn't work like spontaneous questions generator, everybody knows it. So, when such a survey is promoted and "encouraged to participate" by the Powers, then the first question any potential participant (aka staff RN) asks is "who and why needs it?"

Please understand one thing: bullies and bullied have one thing in common, and this thing is that they all desire nothing else but to be left alone. NEITHER of them wants to speak up, bullies for obvious reasons, victims out of fear that things will get even worse. Those who are around may have no desire to be pulled into battle royal, may have suspicions, grounded or not, that they may become the next target, may value their own experience of "passage" too much.

If you really want to battle horizontal violence in your unit, then I would suggest you better start from being totally open for talks and suggestions, especially for any new nurses. Only after people become trusting you and feeling your real support and desire to help them, then hopefully there will be more openneness and then the time will come for detailed survey.

Please also note that many nurses are mentally conditioned for violence. They may not recognize violence and bullying as facts they are exposed to and use all and every pathological coping mechanism you might think of to sort of make it feeling good. You can be harassed and sabotaged every shift but still think that the Nurse X is just the way she is and Nurse Y is just too much protective, just a bit controlling and just wants to teach yous all the wonderful things she knows. Especially so because everybody around tells you just that and nothing else. Meanwhile, Nurses X and Y both are just having mental in-coming every day because of sudden opportunity to inflict a mental torture while keeping their images saintly and shiny.

soulshine101 · Jan 17, 2016

So I am a new nurse and I am partnered with another new RN but 5 year veteran as a tech. I am really just looking for tips for questions. I appreciate your response. In nursing school I was asked to do a survey monkey for the ER nurse's to address why people on the unit were so unhappy and people were brutally honest, almost to honest, however the managers created the questions and ultimately the answers all pointed to management so my peer and I switched directions. So I know it's possible to get people to talk, will everyone talk, no, and that's ok.

KatieMI, BSN, MSN, RN · Jan 17, 2016

So I am a new nurse and I am partnered with another new RN but 5 year veteran as a tech.

So, are you a new grad or, as it is stated on your profile, new "Clinical Leader"? Sounds like two big differences.

When you were a student, everybody knew that, as well as everybody knew the manager. Now, your role is different, and so might be responces for your actions.

If people say things openly and honestly, it doesn'the necessary mean they speak the truth or the whole truth. In one place, from which I was violently bullied out in a few weeks, there was a big gig of "shared nurses' governing", everybody was welcome to come and demand the needed supplies or complain that, say, IV team took its sweet time of 30 min. Nurses almost pretty much come to CNO office and loudly complained on broken lifts and the like things (the hospital was unionized). All that was nicely mixed with the most blatant rasism, xenophobia and ingrained culture and hierarchy of violent bullying brought up to the state of fine art. About which subjects there were no talks in the hospital itself (except of course of abundant policies and beautiful pics), but much later I found out that the very same place was commonly known in surrounding area as "nest of snakes" and local EMTs avoided bringing non-English speaking patients into that ER out of concerns about possible discrimination.

soulshine101 · Jan 17, 2016

The intention of my post was to seek suggestions for questions, not to defend my project. I am very sorry you were bullied.

jadelpn, LPN, EMT-B · Jan 18, 2016

You have a master's in nursing and a clinical nurse leader. Part of the responsibility of that job is to stop any sort of unprofessional behaviors at the source.

No tolerance policies work well if there is consistent follow through.

Every single nurse will answer brutally honestly. But the million dollar question is: what will you do with that information to change anything?

I think by acknowledging that there's issues was a good start (with your ER survey monkey). So why shy away from the brutal honesty? Someone needs to be held accountable. And with accountability comes change.

To approach it as "this has been done so many times we could stick a fork in it" and instead generate from the nurses their top 3 suggestions for meaningful and lasting change. Meaningful meaning NOT "we should just fire everyone but me" and lasting change as policy, review, and consistent follow through.

And horizontal violence is nurse to nurse, CNA to CNA....same job to same job. Lateral violence is someone higher or lower on the totem pole than you. There is a huge difference.

Top answers (unit dependent) have been classically along the lines of acuity based staffing levels, self scheduling, PRN pool, team nursing, and most importantly GETTING one's lunch/breaks/time to pee. And a manager who is not afraid to get on the unit. Extra points if one can actually pick the DON out from a lineup.

A successful leader leads by using resources. Is consistent and fair. And has little tolerance for jr high antics.

And to be completely honest with you, it is difficult to say the least to be a newly minted MSN with a concentration as a clinical nurse leader if you have never been a practicing RN for a length of time. So you need to go to the source. " Any and all suggestions welcomed, we can brainstorm, and see if we can make this foolishness a thing of the past."

dishes, BSN, RN · Jan 18, 2016

soulshine, there are countless publications on the topic, in many of the publications the authors included the survey tool they used in their study, have you considered using a survey tool that has already been developed? It makes more sense to collect data with an established tool than to create your own survey questions.

Mavrick, BSN, RN · Jan 19, 2016

I am doing a project with another nurse on addressing horizontal violence among colleagues from PCTs, PCAs, doctors, HUCs, etc. and I have found some really great articles to address this but I am lacking how to formulate a great survey that would facilitate honest responses from my unit. Can you all suggest some good questions that would get the most information out of people, of course, its anonymous.
The generic definition of horizontal violence is negative interactions/behaviors between your colleagues.
Thanks so much!!

So you are a brand new nurse AND a brand new Clinical Nurse Leader tasked with a little project to "address" horizontal violence.

Does this mean the usual unsettling of the dust and flapping about or is the plan to really do something about it? No one on my unit would risk upsetting the status quo without some assurance they would be protected from retaliation. Our current charge nurse has already established who her favorites are and what kind of assignment you get for being mouthy (i.e asking why).

Depending on the size of the unit and the survey questions (age, education, gender) there is not so much anonymity.

You can't always get what you want. Either from this board or the people you survey.

Good luck, you will need it. This horizontal violence thing has been done to death and the zero tolerance zone just means "shut up".

dishes, BSN, RN · Jan 19, 2016

@soulshine, is your research project going to be run by the hospital's research ethics board? Also, do you have a qualified counsellor available for the research participants to speak to (if they desire) in the event that the questions on your survey stir up strong emotional responses?