Horizontal Violence or Generational Conflict: Is Care-Fronting the Answer

1. Horizontal Violence or Generational Conflict: Is Care-Fronting the Answer Yvonne Wesley, RN, Ph.D., FAAN Independent Health Consultant www.ywesleyconsulting.com

2. Overview • Upon completion of this session, participants will be able to: • Define Horizontal Violence and Generational Conflict • Compare and contrast HV and GC similarities and differences • Illustrate the effect of Care-Fronting on HV and GC

3. Horizontal Violence • Antagonistic behaviors such as: • Gossiping, undue criticism, • Innuendo, scapegoating, • Undermining, passive aggression, • Bickering , blaming behaviors • Sabotage • Emotional dumping, indiscriminate venting

4. Weinand, M. R. (2010)

5. Weinand, M. R. (2010)

6. Weinand, M. R. (2010) Formal training in teamwork, positive feedback, conflict management and confrontation skills • Solutions to the problem • Embrace transformational leadership • Inspire and challenge staff; • Utilize active listening, • Advise and coach staff; • Have a positive vision Reward resolution vs. identification of problems

7. King-Jones, M. (2011)

8. King-Jones, M. (2011) • HV stems from oppression • HV is how oppressed people cope with powerlessness • HV, a display of powerlessness & negative emotions • Knowledge is power -- a cycle of power and resistance • To resolve HV, address the dynamics of power and conflict

9. Generational Conflict

10. Hahn, J.A. (2011) • Veterans – before 1945 • Grew up in times of political and economic uncertainty, • lived experience of the Great Depression and World War II • Nursing as a helping profession and unselfish • Expect rewards for hard work • Baby Boomers – ‘46 to ‘64 • Strong sense of duty, called workaholics • Lived experience of prosperity • Look to empower • Arrive early to work

11. Hahn, J.A. (2011) • Generation X – ’65 to ‘76 • Independent, self-directed, and techno-savvy • Latchkey kids • Grew-up quicker and stayed adolescents longer • Quality of life important their parents work long hours and experienced downsizing • Millennium/Gen Y – ’77 to ‘97 • Technology and instant communication • Accepting multiculturalism • After-school activities, such as swimming, soccer, dance • Want work-life balance

13. Carefronting

14. Kupperschmidt, B. (2006). • Treating each other with respect is a nurse's ethical responsibility • Carefronting, a model of communication used when professional nurses care enough about themselves and their patients to confront disrespectful behavior face-to-face

15. Kupperschmidt, B. (2006) • Failure to confront is dishonest communication • Carefronting embodies forgiveness, caring and valuing, while addressing the anger in the disrespectful behavior, and focuses on the here and now

16. Kupperschmidt, B. (2006) • Kean University Graduates • Bivins & Primus 2012 Developed the: • Perceived Carefronting Ability Questionnaire

17. A newly registered nurse Renee is working alongside Jeanette, a nurse of twenty five years in a busy trauma emergency room. Patient Glendale, a frequent flyer, presents complaining of chest pain radiating to his right arm, his history includes hypertension managed with a beta blocker and drug seeking behavior. • Jeanette blurts out, “Back so soon. Ran out of your Percocets in three days did you?” Renee goes to his bedside places him on the cardiac monitor, performs and EKG and tells the physician the patient may be experiencing a heart attack. • Jeanette waltzes over, rolls her eyes, sighs and sarcastically says, “This rookie needs to go back over there and complete his history and physical before jumping to conclusions. Embarrassed Renee walks away. Later she seeks out Jeanette and asks to speak to her in a private area.

18. Yvonne Bivins MSN RNNadia Primus MSN RN • Carefronting Techniques based on Kupperschmidt (2006) • When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction). • Because it portrays me as someone in a rush (what does it look, sound or feel like). • Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response) • In the future talk to me in private (what behavior you want to see). • Are you committed to treating me as respected colleague? (What you want them to do?) • If there isn’t a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence).

20. Yvonne Bivins MSN RNNadia Primus MSN RN • A paired t test compared pre and post mean scores of the participants’ perceived ability to utilize Carefronting • pre-test M= 40. 75, SD=4.15 • post-test M= 43.08, SD=3.08 • Highest possible score being 50 and the lowest 10 • Alpha set at p<0.05 • There was no significant difference t(11) = -2.17, p = 0.053. The 95% confidence interval for the mean difference between the two means was -4.70 to 0.03.

21. Yvonne Bivins MSN RNNadia Primus MSN RN • An independent t test compared Baby Boomer to Gen X mean scores on perceived ability to utilize Carefronting • No significance difference in the Baby Boomer & Generation X mean scores • pre-test t(24) = .992, p = .33 • post-test t(11) = .154, p = .88

22. Carefronting Techniques based on Kupperschmidt (2006) • When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction). • Because it portrays me as someone in a rush (what does it look, sound or feel like). • Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response) • In the future talk to me in private (what behavior you want to see). • Are you committed to treating me as respected colleague? (What you want them to do?) • If there isn’t a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence).

23. Take homeMessage • Caring enough to confront may help • Carefronting comes from a place of love, not bitterness or hate Horizontal Violence and Generational Conflict are a problem within nursing Both are highly detrimental to the body of Black nurses