Better Communication in Nursing - Ending Nursing Violence
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In Nursing, there exists a culture of lateral violence and bullying, I have finally come to the realization that what we are seeing is the symptom of something much larger, something that starts, grows, and is nurtured with our own participation. We communicate in ways that have the ability to support each other, but we can also communicate in ways that are hurtful, mean, and contribute to a culture of oppression. We need to change our culture.
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Better Communication in Nursing - Ending Nursing Violence
- 1. — Saturday, November 7th, 2015, 9am - 3pm — Regina SK:Wascana Rehabilitation Center Auditorium Better Communication in Nursing Ending NursingViolence LateralViolence – Lateral Kindness Greg Riehl RN BScN MA
- 2. “The real voyage of discovery consists not in seeking new landscapes but in having new eyes.” Marcel Proust
- 3. Outline • Cultural safety in the workplace • Communication senses – eyes and ears • Functional versus dysfunctional conflict • Intergenerational communication • Discussion
- 4. And if there is time… • What is lateral violence • What causes lateral violence • What are the effects of lateral violence • Who gets targeted • Types of bullies • Hierarchy • Mobbing • Identify terms used to describe negative coworker behavior • Describe an experience with negative coworker behavior • Discuss strategies to manage negative coworker behavior • Cultural competence and culture • Zero tolerance policies • Functional versus dysfunctional conflict • Better communication strategies • Types of teams and teamwork • Commitment to co-workers • Increase knowledge and understanding of the four generations • Enhance comprehension of how generational differences affect you • Promote skills for effective intergenerational communication • Expand capacity to manage diverse working styles across the generations
- 5. Why am I here? I ask myself this every day I also ask this to people I work with from time to time
- 6. This is where I work
- 7. This is where I used to workThis is where I used to work
- 8. Objectives To broaden the understanding of the Platinum Rule. To describe how to apply the Platinum Rule. Compare the Golden and Platinum Rules. To explore cultural aspects of nursing care. To identify the unique challenges faced by care providers working with diverse clients.
- 9. Stories • I will use some of my experiences working in health, in the north, and as an male nurse, often an outsider, working in different situations. • You are a part of the story.
- 10. Safe place • Where is the safe place in your organization?
- 11. Hierarchy is systemic. The more vertical an organization is in its hierarchy, the more complicated communication becomes. We go to school, we get a job, but nowhere are we told that lateral violence exists, or that we will have to deal with it, or avoid it, or be drawn into it.
- 12. Communication is about listening • My job description does not say, Greg, you will have to listen to a lot of your co workers bitching and complaining about each other, they will want you to fix their conflicts, and will want you to keep it a secret and tell no one. • This will happen on a very regular basis, consider this ‘duties as assigned’
- 13. LateralViolence “Exists on a spectrum, from seemingly ordinary behaviour such as gossiping or criticism, to intimidation, racism and outright physical intimidation or harm.” Linda Rabyj, 2005
- 14. LateralViolence LateralViolence (LV), also called Horizontal violence, [bullying], incivility, and disruptive behaviours, creates an unpleasant work environment and has harmful effects on individual nurses, patient safety, and health care organizations. Johnson, 2009 & Dimarino, 2011
- 15. The absence of one thing does not mean there will be more of the other thing… “What you see you do not see” – Archi Weenie
- 16. What to do? • Awareness • Education • Dialogue • Zero tolerance policy • Be confident • Develop effective coping mechanisms • Confront the situation • Rehearsal • Enact policy and procedure • Code of conduct • Don’t accept it!
- 17. Hurt People Hurt People When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; He needs help. Tich Naht Hanh
- 18. Hurt People Hurt People Hurt people hurt people.That’s how pain patterns get passed on, generation after generation after generation. Break the chain today. Meet anger with sympathy, contempt with compassion, cruelty with kindness. Greet grimaces with smiles. When you forget about the fault, there is nothing to forgive. Love is the weapon of the future Yehuda berg
- 19. Who gets targeted? Anyone who is different from the group norm on any major characteristic • Experience • Education • Race/ethnicity • Gender Targeted person’s gender • 79% Female • 21% Male
- 20. Who gets targeted? Anyone who is different from the group norm on any major characteristic • Experience • Education • Race/ethnicity • Gender Targeted person’s gender • 79% Female • 21% Male Basically if you are different you may be a potential target!
- 21. We communicate/bully differently. 2009 survey byWorkplace Bullying Institute: - Main perpetrator’s gender • 65% Female • 35% Male 2009WBI survey sited in NewYorkTimes: - Men target men and women equally -Women target women 70% of the time
- 22. Conflict It’s not all Bad Functional Conflict is considered positive, as it can increase performance, support change, and identify weaknesses or areas that need to be supported. Dysfunctional Conflict is harmful to people and the organization.This type of confrontation does nothing to support goals or objectives.
- 23. Conflict It’s not all Bad
- 24. Back to nursing, Do Nurses eat their young – and each other… This old adage should not be the price the next generation has to pay to join the nursing profession.
- 25. Why? In my profession, nurses practice in a historically patriarchal environment. • Oppression leads to low-self esteem. • Nurses exert power over one another through lateral violence. Lateral violence is perpetuated through the culture of nursing (new nurses, curriculum, etc). • “Nurses eat their own” • “See one do one teach one” We now work with four different generations in the workforce, adding to the complexities of effective communication.
- 26. The Four Generations • The Traditionalists • The Boomers • Generation X’ers • Millennials • 1922–1943/46 • 1943–1960/1946-1964 • 1960-1980/1964-1980 • 1980-2000
- 27. Traditionalist Values • Dedication/sacrifice • Law and order • Strong work ethic • Risk averse • Respect for authority • Patience • Delayed reward • Duty, honor, country • Loyalty to the organization
- 28. Boomer Values • Optimism • Team work • Personal gratification • Health and wellness • Promotion and recognition • Youth • Work • Volunteerism
- 29. Gen X Values • Diversity • Thinking globally • Balance in life • Computer literacy • Personal development • Fun • Informality • Independence • Initiative
- 30. Gen X Values
- 31. Millennial Values • Optimism • Civic duty • Confidence • Ambition/ achievement • Tradition • Education • Idealism • Fun • Diversity
- 33. Why does this happen in theWorkplace? • Isolated from the public and other staff • High-stress environment • Limited autonomy in practice • High-paced environment • Lack of experienced staff • Cliques or closely bonded groups • Hierarchical climate • Gender imbalance • Attitudes to training • Non acceptance of difference
- 34. Mobbing A group of coworkers gang up on another • often with the intent to force them to leave the work group Five phases of Mobbing 1. Conflict 2.Aggressive acts 3.Management/Faculty Involvement 4.Branding as Difficult or Mentally ill 5.Expulsion
- 35. Risk We often face a risk acting We also face a risk when we do not act.
- 36. “We Don’t SeeThings AsThey Are, We SeeThem As We Are” “It has been well said that we do not see things as they are, but as we are ourselves. Every man looks through the eyes of his prejudices, of his preconceived notions. Hence, it is the most difficult thing in the world to broaden a man so that he will realize truth as other men see it.”
- 38. In Conflict who are you: Victim, Villain, Hero or Resolutionary? In conflict, each person feels hit first. The size of the villain determines the size of the hero. “Without goliath, David is just some punk, throwing rocks.” Billy Crystal, My Giant
- 39. Victims • Are you a victim of the victim syndrome?
- 41. Our Culture needs to change • We do not accept bullying in our schools or other workplaces so why is it ok in the workplace? • In Nursing, this is the culture that was learnt by nurses 30 years ago and has propitiously been taught to new nurses.
- 42. Bronze, Silver, Gold, & Platinum Rules
- 43. Bronze rule Do unto others as they have done unto you
- 44. Silver What you do not want done to yourself, do not do to others
- 45. Gold Do unto others as you would have them do unto you.
- 46. Platinum Do unto others as they want done unto them
- 47. THE PLATINUM RULE. TREAT OTHERS HOW THEY WANT TO BE TREATED
- 49. ZeroTolerance Policies The Joint Commission and the American Association of Critical Care Nurses (AACN). •2008: mandate the development and implementation of processes to offset LV that enforce a code of conduct, teach employees communication skills, and supporting staff. •2009: advocates that communication skills should be as proficient as clinical skills.
- 50. Culture of Silence • “Because we set ourselves up to be healers, this kind of behaviour is in the shadows.We don’t know what to do about it, so we try to disown it.” • In practice, this means we can’t stay silent when another person’s actions “makes us cringe”. • Having the conversation is what matters . . . it shows that both professionals share responsibility for behaviour affecting staff and patients. • Monica Branigan, 2009
- 51. Impact is on all staff •Physical •Psychological •Social
- 52. Lateral Silence • It is part of the culture. • Everybody knows about it • Everybody does it • No body talks about it
- 54. Why Don’tWe Stop LateralViolence? “It’s not a problem in our work area” “Everybody does it – just get used to it” “If I say anything, I’ll be the next target” “We have policies but they aren’t enforced” “She sets herself up for getting picked on”
- 55. Using the ACORN Approach •Accommodate employee differences. •Create workplace choices. •Operate from a flexible management style. •Respect competence and initiative. •Nourish retention. Source: Generations At Work, Ron Zemke, Claire Raines, and Bob Filipczak
- 56. Statement of Commitment to Co-workers As your co-worker with a shared goal of providing excellent service to people and families, I commit the following: I will accept responsibility for establishing and maintaining healthy interpersonal relationships with you and every member of this staff. I will talk to you promptly if I am having a problem with you. The only time I will discuss it with another person is when I need advice or help in deciding how to communicate with you appropriately. I will establish & maintain a relationship of functional trust with you and every member of this staff. My relationships with each of you will be equally respectful, regardless of job titles or levels of educational preparation. I will not engage in the '3B's (bickering, back-biting and bitching) & will ask you not to as well. I will not complain about another team member & ask you not to as well. If I hear you doing so, I will ask you to talk to that person. I will accept you as you are today, forgiving past problems, & ask you to do the same with me. I will be committed to finding solutions to problems rather than complaining about them or blaming someone, & ask you to do the same. I will affirm your contribution to quality service. I will remember that neither of us is perfect, & that human errors are opportunities not for shame or guilt, but for forgiveness and growth. (Adapted from Marie Manthey, President of Creative Nursing Management in Caroline Flint's Midwifery Teams and Caseloads 1993; p. 138)
- 57. Lateral Kindness • Please be kind to each other • Respectful and responsible relationships, there are no apps for that. • Be Grateful • Be Great!
- 58. Discussion, questions, comments!!! Thank you Paula for the opportunity, and thank you for spending your time with me today.
- 59. Contact information Greg Riehl RN greg.riehl@saskpolytech.ca gregriehl@sasktel.net @griehl
- 60. References available on request slideshareFind this Presentation on
- 61. Three types of BULLIES Sydney based clinical psychologist and workplace bullying specialist Keryl Egan has formulated three workplace bully profiles: 1.Accidental bully 2.Narcissistic bully 3.Serial bully
- 62. Accidental bully This person is task orientated and just wants to get things done, tends to panic when things are not getting done, and goes into a rage about it.This person is basically decent, they don’t really think about the impact of what’s happening or what they have done. They are responding to stress and it is believed that they can be coached out of this behavior.
- 63. Narcissistic Bully They are grandiose and have dreams of breath taking achievement.They feel they deserve power and position. They can fly into a rage when reality confronts them.This person is very destructive and manipulative, they don’t set out in a callous way to annihilate any person – it is purely an expression of their superiority.
- 64. Serial Bully Has a sociopathic and psychopathic personality.This type of bully is intentional, systematic and organized and is often relentless.They usually get things done in terms of self-interest. They employ subtle techniques that are difficult to detect or prove. Coaching is often ineffective. They exhibit the following: •Grandiose, but charming •Authoritative, aggressive and dominating •Fearless and shameless •Devoid of empathy or remorse •Manipulative and deceptive •Impulsive, chaotic or stimulus seeking •Master of imitation or mimicry
- 65. What can you do? • Dialogue is ultimately far more effective than pointing fingers • Cognitive RehearsalTechniques • Health care professionals across the spectrum working together more effectively and patients receiving better care.
- 66. DESC COMMUNICATION MODEL Describe – the behavior Explain – the effect the behavior has on you, coworkers, patient care State – the desired outcome Consequences – what will happen if the behavior continues?
- 67. Rehearsal Research has demonstrated the benefit of rehearsal for new employees. i.e. When a staff member makes a facial gesture (raising an eyebrow) the participant was instructed to say “I see from your facial expression that there may be something you wanted to say to me. It’s ok to speak directly to me”. Griffin, 2004
- 68. Teamwork and Communication • Involve everyone in solving problems related to these issues. • Develop a set of “RIGHTS” for everyone. • Effective anti-bullying practices must include a statement of exactly what constitutes bullying. • Communication needs to be a part of culture.
Notas del editor
- What is lateral violence What causes lateral violence What are the effects of lateral violence Who gets targeted Types of bullies Hierarchy Mobbing Identify terms used to describe negative coworker behavior Describe an experience with negative coworker behavior Discuss strategies to manage negative coworker behavior Cultural competence and culture Zero tolerance policies Functional versus dysfunctional conflict Better communication strategies Types of teams and teamwork Commitment to co-workers Increase knowledge and understanding of the four generations Enhance comprehension of how generational differences affect you Promote skills for effective intergenerational communication Expand capacity to manage diverse working styles across the generations
- Prisoners Vacationers Keeners and Experts Last night I gave a talk on illicit drugs and safer sex.
- Fond du lac SK
- The Golden Rule “do unto other as you would have them do unto you” or treat others how we would like to be treated, is a value many people learn growing up. Nursing education reinforces this adage and supports nurses to treat clients with similar conditions in similar ways. But, the Golden Rule does not support holistic care of addressing physical, mental, spiritual, or emotional needs of the client who may be culturally, ethnically, or spiritually different from the person or group providing care. For social justice to support inclusivity there needs to be a shift to the Platinum Rule, “do unto other as they want do unto them” or treat others how they want to be treated. The challenge implementing the Platinum Rule is evident in practice and occurs when providers work with clients who are culturally, ethnically, or socially different from themselves or with clients who actively engaging in risky behaviours or unhealthy choices. The Golden Rule supports healthcare provider morals and personal values; the Platinum Rule supports clients’ values and realizes that all humans have certain rights, even the right to make “bad” choices. In nursing, we should not treat everyone the same; we are all different. Patients, families, groups, and communities possess the knowledge to be active consumers and partners in health programming. Acceptance of all clients, with a focus on genuine empathy, regardless of lifestyles, behaviours, and choices, is required to deliver optimal client-first health care. This presentation is about the Platinum Rule and you.
- Someone is always watching you,
- I saw you talking about me…
- New nurses finding that to survive and succeed one needs to be able to throw one’s weight around in this fashion may constitute a pool of new recruits to the culture. Many more, however, are deciding that this is not for them. Health care facilities cannot afford this loss. Often, experienced nurses have firm views on the necessity for younger nurses to endure what they themselves had to endure in their "training" for the profession. http://www.reseaufranco.com/en/best_of_crosscurrents/bullying_in_nursing.html Building a culture of respect combats lateral violence
- Tackling the nursing shortage and addressing retention and recruitment requires action. It is not enough to train RNs and LPNs with skills and competencies. We need to make it easier for them to stay and be a part of the team. Many senior nurses expect graduates to hit the ground running," says Judith Tompkins, chief of Nursing Practice and Professional Services and executive vice-president of Programs at the Centre for Addiction and Mental Health (CAMH) in Toronto. "When there is a lack of collegiality and mentoring from peers, young nurses are thrown into the workforce and are left feeling unsupported."
- What to do? When nurses don't have control but must be accountable, you can see where they might not be happy with one another. Other unhealthy coping strategies include taking up smoking, using alcohol excessively and abusing prescription medication. Anti-harassment and diversity initiatives can make a big difference.
- Women were more often the perpetrator – 65% Men target men and women equally Women target other women 70% of the time Hierarchy makes us different
- Women were more often the perpetrator – 65% Men target men and women equally Women target other women 70% of the time Hierarchy makes us different
- Image http://www.homebirth.net.au/2010/03/bullying-culture-of-midwifery.html To effectively intervene in situations where toxic work environments lead nurses to exit the profession, understanding the dynamics of relational aggression (RA) can be helpful. Females and males express negative feelings differently across different ages and stages of development. This is relevant to female-dominated professions like nursing. http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx
- http://www.mediate.com/articles/belak1.cfm
- http://www.mediate.com/articles/belak1.cfm
- http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx
- http://tilt.colostate.edu/proDev/pdi/archives/Files/2009/IntergenerationalPowerPoint_2009.pptx slides 20 - 24
- Image http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx Hierarchy versus the medicine wheel
- Emotional abuse committed directly or indirectly by a group.
- This is when people come and talk to me about their issues, time for a story.
- http://quoteinvestigator.com/2014/03/09/as-we-are/ Anaïs Nin? Babylonian Talmud? Immanuel Kant? G. T. W. Patrick? H. M. Tomlinson? Steven Covey? Anonymous? 1891, The Province of Expression: A Search for Principles Underlying Adequate Methods of Developing Dramatic and Oratoric Delivery by S. S. Curry (Samuel Silas Curry) (Dean, School of Expression: Instructor of Elocution, Harvard College), Quote Page 392, Published by School of Expression, Boston, Massachusetts. (Google Books Full View) link ↩
- This meeting only took place after both sides had waited for 40 days. Are you facing a big problem? Do you know what you are facing?
- roles focus on problems, feed on each other, generate anxiety and perpetuate the toxic interplay between the people within the drama. Sometimes you switch back and forth between these roles so fast you can't keep it all straight. Drama Triangle Gary Harper
- http://www.reseaufranco.com/en/best_of_crosscurrents/bullying_in_nursing.html Building a culture of respect combats lateral violence We often personalize our experiences and assume they are unique to ourselves. "Our program empowered nurses to advocate for themselves. As it liberated them, retention rates improved. We attribute this to recognition of lateral violence. Newer nurses can learn from those who've gone before.“ Dr. Martha Griffin, 2005
- http://theprospectorsite.com/blog/?p=2753 http://www.forbes.com/sites/afontevecchia/2011/11/15/is-gld-really-as-good-as-gold/ http://bizmology.hoovers.com/2012/02/22/anglo-american-reviewing-platinum-business-despite-record-2011/stacks-of-platinum-bars/ Bronze rule - Do unto others as they have done unto you Silver – negative form of the golden rule - what you do not want done to yourself, do not do to others Confucius or One should not treat others in ways that one would not like to be treated Gold – do unto others as you would have them do unto you. Platinum – do unto others as they want done unto them, basically treat other people how they want to be treated. This is really what we are trying to do with all people.
- Unfortunately this is often how nursing is, we had to endure certain hardships as new nurses, and many feel the need to see one, do one, and teach one in the same manner, putting new graduate nurses through the same hardships they endured.
- Confucius or One should not treat others in ways that one would not like to be treated
- This is really what we are trying to do with all people. Basically treat other people how they want to be treated. The Platinum Rule meets people where they are at, it is a balanced approach that gives power to the client. Just like all areas of the medicine wheel need to be balanced for (w)holistic health for the client, where the client is the person, family, group, or community. Indigenous teachings support addressing all areas of the person to achieve balance. The culture of Western medicine places diagnosis as a central goal Aboriginal medicine, see diagnosis as less central and pay more attention to finding a safe environment in which the patient may recover.
- We all know the Golden Rule “do unto others…” but in health care, this does not work all the time for all people receiving or providing care. The Platinum Rule supports acceptance of all and avoids value and moral judgments to support care. Learn about the Platinum Rule and you.
- http://walrusmagazine.com/articles/2009.04-doctor-evil-miriam-schuchman/
- Physical Fatigue or insomnia Stress GI distress Headaches, depression Increased blood pressure Psychological Shame or guilt Prolonged duress stress disorder or post traumatic stress disorder Substance abuse. Increased stress, anxiety, irritability Poor concentration, feeling overwhelmed Inability to concentrate Social Isolation Loss of libido Loss of self confidence, decreased self esteem Avoidance and withdrawal behaviors, disconnection from others Increased use of tobacco, alcohol, and other substances Griffin, m. Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of continuing nursing. 2004; 35(6): 257-263. Cortina & Magley, 2003; Gilmour & Hamlin, 2003; Longo & Sherman, 2007; Normandale & Davies, 2002 May also be PTSD and suicidal ideation Individual factors: Type A personality Emotional state – anger, burnout Inadequate conflict management skills Beliefs and expectations No time for reflection No acknowledgement of the emotional work required
- Kathleen Bartholomew quote
- Exercise, listening,
- Denial that behavior is a problem Manager condones the behavior Manager exhibits the behavior Negative behavior is accepted as the norm Information about negative behaviors is suppressed Manager protecting someone with good clinical skills Employee fear of retaliation causes ‘silencing of voice’ Policies are in place but not enforced Manager lacks confrontation skills Time pressure used as an excuse not to confront perpetrators Human resources department not consulted or not helpful Blame is shifted to the victim
- Cognitive Rehearsal Techniques Introduced by Dr. Martha Griffin in her study with new graduate nurses Taught nurses about the behaviors Provided suggestions for what to say in response to each behavior Provided laminated cards with the information that nurse could put behind her ID badge Gave nurses the opportunity to practice responding to lateral violence behaviors Image http://nursing.advanceweb.com/features/articles/no-tolerance-for-bullying.aspx
- “I feel (state a feeling) when you (describe the behavior). I would really like to do something about this situation so that it will not happen again. I’m wondering if you have any ideas about possible solutions. Here are some of my ideas. (State alternative solutions and come to an agreement on one of them.) Now, since this problem has come up before, I want some assurance that the problem will work this time. (Negotiate positive and/or negative consequences.) I feel much better now that we’ve spoken about this issue. I appreciate your willingness to work this out with me.” 2. What do you say after you hear that someone has been backstabbing you? D “I’d like to talk with you in private. I heard from another nurse that you said I didn’t know what I was doing, that I am a terrible nurse.” E “When I hear that someone has been saying things about me and I don’t know why, or even what situation it pertains to, I feel sabotaged and set up to fail.” S “I want to be a good nurse, and I can’t do that without your honest feedback and support. Can you say what you feel and think directly to me in private?” C “Without that support, I am sure to fail. I will have to find another place to work, even though this is the specialty I had chosen.” (Bartholomew 2007)
- Issues such as this, within both organizations and professions, need to be brought out into the open in a non-blaming way with a focus on the future Policy documents on bullying and intimidation was developed. Specify the sorts of behavior that would not be tolerated, and instead the policy referred to the general "rights" of individuals to be treated fairly and with respect.