Championing Civility

Communicating to Stop Horizontal Violence

ObjectivesVerbally define horizontal violence and name at

least two other terms for this phenomena.

Identify circumstances in which a crucial conversation needs to occur.

Name all four components of the D-E-S-C model

Discuss a situation that occurred in the work environment in which you felt your communication skills could have been better; describe how you would approach that circumstance if it happened tomorrow.

One Voice Personal experience with mentors

positive. Previous experience to this one highly positive.

Set an example!

Signs of an Experience…

What happened?

New position

Individuals hostile from the beginning

Positive attitude – people felt they were not being heard. Admitted vulnerability, started communicating, obtained coaching

Improved situation

Left me wondering if I was alone in my experience

It’s All About…

https://youtu.be/-4EDhdAHrOg

Why, in a field that consistently scores ‘most trusted’, are nurses known for eating their young?

In The Beginning…A list of rules for nurses…from 1887

1887 Nursing Job Description

In addition to caring for your 50 patients, each bedside nurse will follow these regulations:

1. Daily sweep and mop the floors of your ward, dust the patient’s furniture and window sills.

2. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day’s business.

3. Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys and trim wicks.

A History of…

4. The nurse’s notes are important in aiding your physician’s work. Make your pens carefully; you may whittle nibs to your individual taste.

5. Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m., except on the Sabbath, on which day she will be off from 12 noon to 2 p.m.

6. Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes, or two evenings a week if you go regularly to church.

A History of…

7. Each nurse should lay aside from each payday a goodly sum of her earnings for her benefits during her declining years, so that she will not become a burden. For example, if you earn $30 a month, you should set aside $15.

8. Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions and integrity.

9. The nurse who performs her labors [and] serves her patients and doctors faithfully and without fault for a period of five years will be given an increase by the hospital administration of five cents per day. ($1.39 in 2018).

Is this a set-up? Nurse patient ratios are

an ongoing source of contention.

Maintain an even temperature – warm blanket runs, anyone?

Whittling nibs are a thing of the past; we now have e-charting!

Smoking? Liquor in any form? Getting hair done at a beauty shop? Dance Halls?

Social standards and conduct are addressed in the Code of Ethics for Nurses….debate exists here.

“Bully”Threatening and abusive language

Constant and unreasonable criticism

Deliberately undermining another person

Hostile verbal attacks

Rumor spreading

Horizontal ViolenceHorizontal violence is displaced violence directed against one's peers rather than adversaries. This form of bullying is based on the theoretical construct of oppression theory. Also called lateral violence, workplace incivility.

Who, US? What? Where?New nurses are more susceptible to horizontal violence.

Seen in facilities that have a more hierarchical construct, nurses are not given a voice.

More likely to be perpetuated by nurses who have experienced it and/or view it as part of the culture

The Silent Treatment

Blaming and Undermining

A form of insanity?

The Theories Behind the Scenes

Oppression Theory: Freire (1990)Theory of Self-Transcendence: Reed (Smith & Liehr, 2014)

Oppression Theory Pedagogy of the oppressed: it’s about the perception of

power

Feeling marginalized; does not speak up (Silencing)

Expression of the workplace character rather than that of the individual

Solution begins with the individual; one person has the power to impact overall culture

Why do we care?

Why do we Care? 60% of new graduate nurses will leave their their

jobs in the first year. Half of these will leave healthcare altogether.

The effects of lateral violence impact EVERYONE. Patient care suffers; sentinel events linked to hostility between nurses.

It is not ethical, and is addressed in the Nurses Code of Ethics

Can we fix this?

Theory of Self-Transcendence “Philosophical belief in the enduring human potential

for healing and well-being”

Moves through three phases: Vulnerability: Experienced through difficult life events;

must be present in order to self-transcend and attain well-being

Self-transcendence: Attained through life experiences, greater awareness of one’s environment and of inner-self

Well-being: Attained through transcending adverse events in vulnerability stage.

Vulnerability….?Brené Brown’s “Power of Vulnerability” Video:

Willing to share

Feeling worthy

Trust

Communication Skills

High level communication skills a must

Communication skills are every bit as important as any clinical skill a nurse

will ever learn (ANA).

Interdisciplinary cultures, each of which have their own language

Various cultures and the verbal/non-verbal cues can be confusing; primary language

Introvert/extrovert

Cognitive Rehearsal Pre-rehearsed phrases (and, in some

cases, conversations) for instances that occur most often.

Can be one-on-one live or via electronic media (Spotlight on Professionalism).

Rehearsing a preprogrammed retort to a colleague’s uncivil affront increases the level of personal confidence.

Patient satisfaction score mirror this.

D E S C in Action!D = Describe the incident

E = Explain the impact of the behavior

S = State the desired outcome

C = Consequence of what will happen if the behavior continues/is resolved

“This is what happened”

“I feel _________ about the incident”

“ I want ___________”

(to understand, more equipment, etc…)

“If this continues, I will______________”

Intent Matters! COMMITMENT TO MY COWORKERS

I will accept responsibility for establishing and maintaining healthy interpersonal relationships with you and every other member of this team.

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 and maintain a relationship of functional trust with you and every other member of this team. My relationship with each of you will be equally respectful, regardless of job titles or levels of educational preparation.

I will not engage in bickering, back-biting, and blaming (3Bs). I will practice caring, committing, and collaboration (3Cs) in my relationship with you and ask that you do the same with me.

Intent Matters! I will not complain about another team member and 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 and 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 for them, and ask you to do the same.

I will affirm your contribution to the quality of our service.

I will remember that neither of us is perfect, and that human errors are opportunities not for shame or guilt, but for forgiveness and growth.

Thank you!It has been a pleasure sharing time with you!

Arna Robins, RN, BSN, CEN, CFRN, NREMT

Arobins@PeaceHealth.org

References

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Budin, W. C., Brewer, C. S., Chao, Y., & Kovner, C. (2013, September). Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of Nursing Scholarship, 45(3), 308-316. http://dx.doi.org/10.1111/jnu.12033

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ReferencesGriffin, M., & Clark, C. M. (2014, November 22). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542. http://dx.doi.org/10.3928/00220124-20141122-02

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ReferencesNorgaard, B., Ammentorp, J., Kyvik, K. O., & Kofoed, P. (2012). Communication skills training increases self-efficacy of health care professionals. Journal of Continuing Education in the Health Professions, 32(2), 90-97. http://dx.doi.org/http://dx.doi.org.library.gcu.edu:2048/10.1002/chp.21131

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