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Topics About 'Lateral Violence'.

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  1. allnurses

    Addressing Bullying in the ED

    allnurses.com staff recently had the opportunity to interview Lisa Wolf, PhD, RN, CEN, FAEN, Director of ENA's Institute for Emergency Nursing Research. She has published research about bullying and how it affects nurses patient care. How does bullying in the ED manifest itself? Bullying can manifest as the dynamics of aggression, which includes overt hostility, denigrating comments, giving inappropriate assignments for the nurses' experience and expertise, and selective reporting. More difficult to identify and call out, however, are the dynamics of exclusion, which is marked by a withdrawal of help, support, and information. These types of behaviors often result in a nurse being "set up to fail", which has consequences for patient care. How does this differ from bullying in other departments? I don't know that it is very different in other departments, but the constant flow of patients, the short turnaround times, and the initial lack of knowledge about patient conditions make the emergency department a particularly high-risk area for this dynamic to manifest. What kind of collateral damage results from bullying in the ED? Workplace bullying is a significant factor in the dynamics of patient care, nursing work culture, and nursing retention. The impact on patient care cannot be overestimated, both in terms of errors, substandard care, and the negative effects of high turnover of experienced RNs who leave, compounded by the inexperience of newly hired RNs What methods did you find to be the most effective in addressing/decreasing bullying? Our respondents report that a "calling it out" strategy by both staff and management is the most effective way to reduce bullying and its consequences. An assessment of hospital work environments should include nurse perceptions of workplace bullying, and interventions should focus on effective managerial processes for handling workplace bullying As a result of your research, what type of training do you recommend? Given that management is the key role in mitigating bullying behaviors, education in the identification of bullying behaviors (especially those marked by the dynamic of exclusion) and in addressing them with staff is probably the most effective way to reduce workplace bullying. Bullying is becoming more pervasive in our culture as a whole. However, as nurses on the forefront of life and death decisions, it is imperative that nurses have a toolkit to deal with bullying at work. The American Nurses Association published a position paper on this in 2015 with a goal; "to create and sustain a culture of respect, free of incivility, bullying and workplace violence." ENA has also published guidelines to deal with and curb lateral violence which is defined as; "violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse, etc.)." "According to a 2011 study by the Emergency Nurses Association (ENA), 54.5 percent out of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week. The actual rate of incidences of violence is much higher as many incidents go unreported, due in part to the perception that assaults are "part of the job"." ENA offers a toolkit with six distinct steps to address workplace violence. The first step is acknowledging that it exists and that nurses have the capability to decrease the incidence. There are many shareholders in this initiative including the front line staff but managers and administrators also have a key role in this. JCAHO, OSHA and other governmental agencies require documentation of a safe workplace and offer recommendations as well. Violence should never be tolerated. Do you feel safe from lateral violence in your emergency department? What has your ED done to combat lateral violence?
  2. I hear too often in the nursing world that we "eat our young". This is not OK on quite a few levels, but the biggest concern is how often this happens and, despite the fact that so many of us disagree with this behavior and this sentiment, it still occurs frequently. The fancy term for the behavior of "eating our young" is lateral violence. I have been thinking about this a lot lately: Is that mentality different from other professions where people will clamor all over each other to get ahead? Not entirely, but it seems totally out of character for nurses, who give care to others and are healers for a living, to be laterally violent to each other. There may be times where we may, perhaps, be a bit short with an MD when we disagree upon a plan/intervention for a patient, or not be best friends with one of our coworkers, that is part of human nature, especially when working in a stressful environment. Who hasn't been under a lot of stress in the middle of an insanely busy shift, and maybe come across as less than pleasant to a co-worker? Saving lives can be stressful business, but that doesn't mean that we should demean one another. Lateral violence refers to a person of higher "power" or status on a unit, bullying or demeaning a co-worker, either through verbal or non-verbally aggressive acts. Usually, if you snap at someone because you are stressed, you will address it and apologize, or make some sort of note that you didn't intend to come across as you did. Lateral violence is a continued trend of behavior that makes others feel uncomfortable, demeaned, and of less value. The thing about lateral violence is that some of the acts that constitute it, are so subtle. While any administration for any hospital or other healthcare arena would tell you that they take a stance on anti-bullying and/or lateral violence, the behavior and actions can be really tough to nail down, and it has been so long accepted in our culture that it goes under-reported. It's not just the senior nurse on your unit that might get snappy or yell at a newer nurse for not being able to read their mind during an emergent situation, it could be the resource nurse that doesn't schedule a break/lunch time any time that you work with them, or doesn't offer you help when you are drowning in your assignment, but seems to offer to help everyone else out. It's the charge nurse that gives you the heaviest assignment every single shift. It's the person who runs the schedule and they put you on every single shift that you request off. It's the co-worker that ignores you, or rolls their eyes at you, when you ask for help. If you have ever been in a situation at work where you've felt distressed by how you have been treated, you may have been the victim of lateral violence. These actions are what create a toxic environment that leads to a high turnover of nurses, and severely unhappy nurses on the unit in their short time there. And not only do the clinical staff suffer, but the patients suffer as well. When clinical staff are not working as a team, helping each other when they need it, and giving unequal patient assignments, it can be hard to meet the needs of our patients. If I can't find a co-worker willing to help me reposition my bed bound patients, they are at a higher risk of pressure ulcers, right? And if my assignment is so heavy I don't have time to change out that IV that was due to be changed at the beginning of my shift, that patient is at a much higher risk for phlebitis. What can we, as a culture of nurses, do about lateral violence? Just saying we won't tolerate it isn't enough. One of the biggest ways to prevent it is to educate staff on what lateral violence actually is; once behaviors are pointed out, and it becomes a part of the culture that those behaviors will be scrutinized and not tolerated, people tend to have more self awareness of their actions. We also need to speak out when we see it occur to others, or experience it directly, and report it. Nurse leaders on units should lead by example and set the tone for their unit, not only that they don't bully their own staff or colleagues, but that they are supported by the policies set forth by their institution, and enforce a culture of anti-lateral violence. And when staff report lateral violence to their managers/directors, they need to feel comfortable and that there will be no repercussions for their actions, and that the person reported will actually be dealt with. None of us should feel uncomfortable or scared going to work, for any reason, and if you do, you need to speak out about it, and report it higher and higher in your institution until someone listens! Feel empowered to stand up for yourself, your colleagues, and our community.
  3. I believe nurses are very special individuals. Think about it. They are professionals who take care of others in their dire moments. They patiently heal the putrid wounds of some; calm the fear and hopelessness of others; tolerate ingratitude and hostility daily; endure day after day of toiling around the sick and dying. Is only natural you'll find compassionate and warm hearted beings among nurses. I have been in other professions and the contrast is clear to me. But because nursing is a tough job; some of us develop a thick skin. In a way, is a protection mechanism some develop to survive - you either get tough or you die. Although there is nothing wrong with being tough, some nurses can become quite aggressive and hostile to other nurses. We all have met them at some point, I surely did. But even being aggressive and assertive, nurses cannot match the aggressiveness of some bosses. Oh yes, let's talk about them bosses. But bosses are people too. Yes, there are reasons why nurse bosses are sometimes so bossy. But bosses also have their though fights to fight. They too must develop an even tougher skin to survive the trials and tribulations of health care. Sometimes bosses are just nurses who left the floor because they simply couldn't take it anymore. Then to find even more stress in management. Nurses are usually between a rock and a hard place. They have lots of responsibility, but lack the power to make decisions on their own. Doctors have much more say so in regards to their professional lay out. They call the shots, they can fire patients and are respected by most. Nurses on the other hand need to make decisions but always filtered by a set of rules created by others. Nurses must endure whatever BS is thrown at them. If you have an abusive patient, all you can do is to write a note and hope for the best. Most nurses can't simply fire a patient or they'll get fired. Nurses run the show but are told how things should run. Often by someone who is deciding for them from an office chair; people who never worked on a floor or have not worked in years and can't remember anything. So, nurses are in a pressure cooker situation. Pressure from all sides and not an outlet in sight. Well actually there is: and that is to relief the pressure on the least dangerous and inconsequential outlet - the young and vulnerable ones. The perplexed and scared nurslings are the recipient of a lot of pent-up anger. But why older nurses engage in this predatory and coward behavior? It must be their inability to change the system and claim their power. Their extreme frustration lead them to eat their young. The ones they should be nourishing, protecting and grooming to take nursing to the next level just got eaten for lunch. Just like scared animals - they step on their own eggs. This is unfortunate. If young nurses were well groomed and nurtured they would be the ones able to take nursing to the next level. Instead nurses create a culture of perpetuating the errors inflicted in them by transferring it to the young. Protecting the young Again, if you want to bully someone bully the oppressor and not the oppressed. Bully your problems and not the people who are here to learn. The bully energy is good energy but wasted and pointed in the wrong direction. The alternative to bullying is to preserve and protect the young: because teaching the young the right ways is the only viable way to change nursing culture. It changes things because the young always will change the world. But instead we teach them the culture of bullying. We create perfect students in the art of bullying others. Nothing changes. So, Mr. Bully next time you decide to torture the young, think of why you went into nursing back in the day. Bullying the young will only perpetuate the culture of abusiveness you were ounce, and continues to be a victim of.
  4. mindy kaling

    ICU with a toxic environment

    In my last year of nursing school, before graduating, I got offered a critical care nurse resident position in a level one Trauma hospital. This was very exciting and I couldn't wait to dive right into it. I studied day and night for the NCLEX and did it as soon as I had the chance to. I passed on my first try. I was on top of the world! I had chosen to go straight into critical care because I had worked as an LPN for 2 years in a busy rehab, so I felt like I had nailed down the basics of nursing and was ready for critical care. During my last semester in RN school, I had been fortunate enough to precept in a level 2 critical care unit which was the only ICU in that hospital, so they got a mix of everything. That was very good experience for me and my preceptor was awesome. I however learnt that ICU nurses in that hospital were very competitive and hated when new grads came right into the ICU. I was told constantly that I needed med-surg experience first, which I understood the reasoning but felt like was not entirely true. That attitude from those ICU nurses led me to picking a bigger hospital ICU with a residency program because they were geared towards helping you along the way as you develop skills towards becoming a critical care RN. Fast forward, I am now 7 months into working in this ICU and I love the work, but the environment is very toxic. I am very appreciative of the skills I am acquiring each day, and this is what helps me wake up and go to work everyday. I however go home either crying or blood boiling in anger because of all the bullying behavior on my unit. The only person I would talk to about this issue is the manager, but I have seen too many people report issues to her and they have ended up leaving because she dismisses any "whistle-blowers" and things just get bad for them. ICUs are very team oriented, but our ICU has people who form cliques and constantly gossip about certain people. They pretend they are busy when they are needed to help, and when things are going well for you, they constantly come into your room and pick on things here and there, then spread lies about how you are not doing your job, you are lazy and dumb etc. I have overheard these types of labels in conversations. I constantly get misquoted and have been termed as rude and that I disregard whatever the charge nurse tells me. This is very frustrating for me because I feel as though if I ever came across as rude, it is subconscious from protecting myself from all these nurses who portray bullying behavior towards me. Second, if a charge nurse asked me to do something and I disregarded it (which in my opinion I have never done), she has authority to surpass me and do whatever it is I refused to do in favor of good patient care or tell me in person to do it ASAP because of ABCD..(the instance in question was reporting a critical vital sign to the doctor). I decided to try other methods to lower the vital sign (which is in the policy as an action an RN can take in this case), and called 30 minutes after my failed intervention. This charge nurse went ahead and put in a note in my pt's chart saying I had been advised by her and had disregarded the advice. (This note is a legal document that could get me in trouble if a court case was ever pursued or if they needed to fire me). A family member of mine has asked me to either email or talk to the clique/charge nurse, but I do not think this will solve the problem. If anything it will make the environment more unbearable for me and I will end up leaving sooner than I wanted to. Other bullying behaviors are the constant sending the new nurse to do ABCD... regardless of whether they are in the middle of patient care or not, and failure to carry out whatever it is they asked you to, leads you to getting labeled as a non team player. It has been very frustrating to say the least. I am not over confident. I try as much to take the humble student path, but also prevent being walked all over. The labels and isolation are the main thing. I try to ask as many questions as possible when in doubt, but I overhead people in a conversation with the charge nurse calling me dumb with dumb questions. English is my second language and I do hesitate at times when looking for what to say, especially when I am rushing, and I have had instances where this one nurse yelled at me, what?! (I find this to be very rude and unprofessional, I don't have a heavy accent, I just sound like am from somewhere else at times) Majority of this behavior is from nurses around my age (20's). Older nurses are very nice and I always enjoy working with them. I have tried associating the bullying behavior with lack of maturity. I also work very well with floats and travelers because they don't sit around and gossip with this clique. I would like to hear stories from you if you have seen this kind of behavior and what your actions were towards stopping it. I have thought of giving it as feedback when we get employee surveys. I don't trust our manager and I really do not want to leave my job yet. I am learning a lot and would like to stick it out hoping that the better my co-workers get to know me and my work ethic, the easier things will get. I have hope

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