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Nurse-on-Nurse Violence (4:3)
Transcript of Nurse-on-Nurse Violence (4:3)
RN being abusive to another RN
Identifying, Addressing and Preventing Nurse-on-Nurse Violence
Conflict can occur when:
two or more parties holding differing views about a situation, or
the consequence of real or perceived differences in mutually exclusive goals, values, ideas, etc. within one person or among groups of two or more.
an extreme form of aggression
which can occur from
estimated associated costs
$30,000 to $100,000 per affected nurse
~35% already working RNs
~60% new RNs
Gerardi & Connell, 2007
Rosenstein & O'Daniel, 2010
patient safety and outcome compromised due to lateral violence
you can lose your
RN license & job!
can be defined as two or more parties holding differing views about a situation, or as the consequence of real or perceived differences in mutually exclusive goals, values, ideas, and so on within one person or among groups of two or more
failure to respect privacy
Create Climate and structure of the institution
Embrace transformational leadership
Maintain a violence prevention program
Human resource department policies
Take a stand on the issue
Inspire and challenge
Listen, advise, coach
Have a positive vision
Kotter‘s Model of Change
Create a sense of urgency
Build the guiding team
Developing a common vision
Communicate the vision
Empower individuals and remove barriers
Celebrate short-term wins
Institutionalizing new approaches
1. Motivational Intervention
begin with a positive statement
determine the underlying cause
ask for a change in behavior
2. Conflict Management
Agree on a common goal
Change the pronouns to “we”
Set the ground rules for discussion
Limit the number of people
Last resort: Mediation
Get help from your employer
Make a plan for action
Confront the aggressor
Make a formal written complaint
Take legal action
Educate nursing students
- Integrate it into the curriculum
Bring awareness to the issue
Analyze and observe employee interaction
Raise the issue at staff meetings
Allow staff members to share their stories
Ensure staff there is a process
Engage in self-awareness
Provide training for conflict management
Ombudsman and Mediators
Assistant Nurse Manager
Assistant General Director
Chain of Command
Briles, J. (2003). Zapping conflict in the health care workplace. SSM, 9(6), 27.
Campbell, R.J. (2008). Change management in health care. The Health Care Manager, 27(1), 23-39.
Davies, N. (2009). Measures to stop the rot. Nursing Standard, 23(39), 64.
Gerardi, D., Connell, M.K. (2007). The emerging culture of health care: from horizontal violence to true collaboration. Nebr. Nurse, 40(3), 16-18.
Griffin, M. (2004). Teaching cognitive rehearsal as a shield against lateral violence. J Contin Educ Nurse, 36(6), 257-263.
Kupperschmidt, B. (2006). Addressing multi-generational conflict: mutual respect and carefronting as a strategy. Online Journal of Issues in Nursing, 11(2).
Leiper, J. (2005). Nurse against nurse: how to stop horizontal violence. Nursing, 35(3), 44-45.
Longo, J., Sherman, R.O. (2007). Leveling horizontal violence. Nursing Management, 38(3), 34-37, 50-51.
McNamara, S.A. (2010). Workplace Violence and Its Effects on Patient Safety. AORN Journal, 92(6), 677.
Melnyk, B.M., Fineout-Overholt, E. (2010). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.
Northam, S. (2009). Conflict in the workplace: part 2. Am J Nurs., 109(7), 65-67.
Reinholz, B., Cash, J.K., Kupperschmidt, B. (2009). Employee bad behavior: selected thoughts and strategies. Okla Nurse, 54(1), 20.
Sellers, K. et al. (2010). The Prevalence of Horizontal Violence in New York State Registered Nurses. J N Y State Nurses Assoc., 40(2), 20-25.
Stanley, K. (2010). Lateral and Vertical Violence in Nursing. South Carolina Nurse, 17(4), 10.
"break the cycle"
Seach 'Horizontal Violence'on
The Workplace Bullying Institute and Bully Busters: www.bullyinginstitute.org
Occupational Safety and Health Administration: www.osha.gov
National Institute for Occupational Safety and Health: www.cdc.gov/niosh
Healthy Workplace Bill
Currently active in 9 states
Help from outside
(out of which 60% quit
within 6 months)
The theory of Oppression
3. Avoid / Prevent
• Inadequate communication
• Lack of trust
• Misunderstanding of roles & responsibilities;
• Unclear, incompatible or differing goals
• Inadequate action plans & directions
• Unstable leadership or a lack of leadership
• Lack of power in decision-making
• Scarcity of & competition for resources
• Inability to accept change
• Power issues
• Differing perceptions
• Diversity; differing values & beliefs
• Unmet needs
signs of violence
As a future nurse
OSHA has set forth recommendations that employers establish and maintain a violence prevention program
Pursuant to McNamara (2011), “All healthcare organizations should implement a zero tolerance policy related to disruptive behavior, including: a professional code of conduct (Code of Ethics in Nursing) and educational and behavioral interventions to assist nurses in addressing disruptive behavior.”
Preventing Disruptive Behavior
Address communication needs
Use interdisciplinary collaboration
Allow for and mandate opportunities for education & training in understanding horizontal violence, communication skills, conflict management, etc.
Ask yourself, what I am about to say,
is it respectful and productive?
Identify Conflict Early
Deep breaths and count to 10
Step away from the situation before responding
Instead of lashing out, talk to someone about your feelings or
write it in a journal
Consider the situation from all perspectives
Avoid situations that tend to make you angry
Act only after you have your anger under control
Tiredness or being under pressure can make you more prone to anger
Lastly, if you find yourself as the aggressor, recognize it and apologize
Avoid Being the Bully
The Code of Ethics of Nursing
is a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.
It is the responsibility of
all professional nurses
to be aware of the
Code for Nurses.
The principle of respect for persons extends to all individuals.
The nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise, and to resolving conflict.
Treats colleagues, employees, assistants, and students with respect and compassion.
This standard of conduct precludes any and all prejudicial actions, any form of harassment or threatening behavior, or disregard for the effect of one’s actions on others.
Provision 1.5 of the Code of Ethics for Nursing (Relationships with Colleagues and Others)