Ending Horizontal Violence in the Workplace

1. Ending Horizontal Violence in the Workplace Catherine Carney, RN SUNY Institute of Technology

2. Purpose • Horizontal violence and bullying has been extensively reported and documented in healthcare, with serious negative outcomes for registered nurses, their patients, and health care employers. Therefore educational programs, such as this, are needed to increase awareness of horizontal violence in the workplace to help prevent undesirable patient outcomes.

3. Objectives • Participants will be able to identify at least five characteristics on horizontal violence. • Describe at least four impacts of horizontal violence whether they are either physical, psychological, or financial. • Be able to describe at least four interventions that can help end horizontal violence in the workplace. • Identify St. Elizabeth’s Medical Center’s policy on horizontal violence.

4. What is Horizontal Violence? “Horizontal violence is psychological harassment that creates hostility in the workplace between two nurses or a nurse and another health-care professional” (Ditmer, 2010). “Horizontal violence creates an unhealthy environment for nurses, nursing students, patients and the public while increasing stress, decreasing job satisfaction, and resulting undesirable clinical outcomes” (Ditmer, 2010).

5. Statistics • On the international level, one out of three nurses plan to leave his or her position due to horizontal violence. • In this United States, 97% of nurses report experiencing verbal abuse from physicians. • The financial cost of HV has been estimated to be $30,000-$100,000 per year for each individual. “Costs are incurred as a result of work absenteeism, treatment for depression and anxiety, decreased work performance, and increased turnover” (Becher & Visovsky, 2012).

6. Myths • HV is only carried out by colleagues at the organization. • HV is only physical. • All HV is reported by the victims. • Victims only have themselves to blame. • Prevention is more expensive than repairing the damage. • Violence is not destructive.

7. Research • One study found 94 % of 1,474 respondents said disruptive behavior negatively effects patient outcomes. • About 60% were aware of an adverse event and 78% believed the event could have been prevented. • Unstable environments can lead to a compromise in patient safety.

8. Research Cont’ • One study of nursing students, found that approximately 50% of students experienced HV during their clinical rotations. • New graduate nurses who experienced HV had a higher level of absenteeism and considered leaving the profession. • Horizontal violence affects all aspects.

9. Horizontal Violence • Names: • Bullying • Horizontal violence • Lateral violence • Horizontal hostility • Aggression • Verbal abuse • “Nurses eating their young”

10. Horizontal Violence Cont.’ • Forms • Intimidation • Disinterest • Discouragement • Threats • Verbal abuse • Humiliation • Excessive criticism • Denial of access to learning opportunities

11. Impacts of Horizontal Violence • Emotional and Physical Effects: • Anger • Decreased self-esteem • Lack of motivation • Decreased job satisfaction • Depression • Stress • Anxiety • Decreased morale • Sleeplessness

12. Impacts of Horizontal Violence • Financial Effects: • Costs to the organization • Increased call ins • Leaving the organization or profession • Decreased productivity • High turnover rates • Decreased morale

13. Interventions • Organizational • Managers have an important role. • Managers need to be able to identify indications of HV. • Create a climate of safety. • Create an environment where staff are talking to their managers about concerns. • Adopt a zero tolerance policy.

14. Interventions Cont’ • Individual • Accepting one’s fair share of the workload. • Respecting other’s privacy • Being cooperative with regard to shared working conditions. • Be willing to help other staff members. • Keep confidences.

15. Interventions Con’t • Formal education sessions defining HV. • Direct approaches to modifying behaviors. • Review consequences. • Use cognitive rehearsal. • Informal education including posters and fliers. • Reinforcement after education.

16. Policy • St. Elizabeth’s Medical Center adopts the Zero-tolerance policy that aims to end workplace violence to create a culture of safety. • Workplace violence is defined by SEMC as “any action, incident or behavior that departs from reasonable conduct in which a person is assaulted, threatened, harmed, injured in the course of, or as a direct result of, his or her work.” • “All persons working for or on behalf of SEMC shall contribute to a safe work environment by conducting themselves in a professional manner, respecting the rights, dignity, and property of others, thereby contributing to the prevention of incidents of workplace violence.”

17. Project Description • Primary prevention was used to create an education program for two med/surg units at SEMC. • Through working with a nurse educator, who covers these two units, availability to staff was accessible. • Implementation of a staff morale survey was used. • Presentation on HV to the two units. • After implementation, a short post-test was given as well as an information sheet to staff members.

18. Relevance to Nursing • All nurses must take a role in combating HV. • Nurse Managers and educators must provide ample opportunities for education and professional development. • Nurses must know the policies. • One study found that inadequate leadership was the causal factor responsible for 62% of violent sentinel events. • Nurse leaders must create and maintain a climate of safety.

19. Relevance to Nursing Cont’ • Nurse leaders are at the forefront in helping to end HV. • The project demonstrated professional nursing leadership as nurse leaders are able to provide education programs to their employees. • Nurse leaders have a moral obligation to help end HV.

20. Theoretical Frameworks • Albert Bandura’s social learning theory states “behavior is learned from the environment through the process of observational learning” (McLeod, 2011). • Betty Neuman’s Health Care Systems Model “focuses on stress reduction and addresses how stress and individual response to it affects the development, maintenance, and restoration of health” (Betty Neuman’s System Model, 2012).

21. Implementation Processes • Nurses address multiple needs and problems in the healthcare setting on a daily basis. • Identification of a need at SEMC to implement a project on HV. • Goal of the project was to enhance awareness on HV as well as enhance staff morale after the implementation process. • Implementation of a staff morale survey to the two nursing units.

22. Implementation Process Cont’ • Presentation on HV to the two units. • Information sheets and post-test were handed out to the employees. • It was deemed not necessary to administer the staff morale survey at the end as staff morale and job satisfaction were already high among the two units.

23. Evaluation • Participants identified five characteristics of HV. • Described at least four impacts of HV. • Described four interventions to end HV. • Identified SEMC’s policy on HV. • The outcome of this project was that it was beneficial to employees and it increased awareness on the issue of HV at SEMC.

24. Key Points • HV is a prevalent problem among healthcare professionals. • HV has been extensively reported and documented. • Nurses, individually and collectively, must enhance their knowledge and skills in conflicts to prevent and eliminate HV. • Nurse leaders are in a unique position to prevent HV. • Through education programs such as this, awareness of HV in the workplace was enhanced contributing to the movement in ending HV.

25. References • Becher, J., & Visovsky, C. (2012). Horizontal Violence in Nursing. MEDSURG Nursing, 21(4), 210-214. • Betty Neuman’s System Model(2012). Nursing Theories.http://www.currentnursing.com/ nursing_theory/Neuman/html. • Brunt, B. (2011). Breaking the cycle of horizontal violence. ISNA Bulletin, 37(2), 6-11.

26. References Cont’ • Ditmer, D. (2010). A safe environment for nurses and patients: halting horizontal violence, Journal of Nursing Regulation, 1(3), 9-14. • McLeod, S. (2011). Bandura-Social Learning Theory. Simply Psychology. http://www.simplypsychology.org/ bandura/html