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Nurse-on-Nurse Violence (4:3)

presentation for Ethics/Professional

Dawid Rarowski

on 11 September 2013

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Transcript of Nurse-on-Nurse Violence (4:3)

is defined as hostile and aggressive behavior by individual or group member towards another member or group members. This is also known as inter-group conflict. In simple words, a member of a group shows aggressive behavior towards another member of the same group.

RN being abusive to another RN
Workplace –
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
an unresolved
estimated associated costs
$30,000 to $100,000 per affected nurse
absenteeism ~26-50%
poor work
med errors
task avoidance
lower morale
turnover rate:
~35% already working RNs
~60% new RNs
Gerardi & Connell, 2007
McMillan, 1995
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

verbal affront
undermining activities
failure to respect privacy
Potential Risks
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
Consolidate improvements
Institutionalizing new approaches
1. Motivational Intervention

begin with a positive statement
express concerns
determine the underlying cause
ask for a change in behavior
2. Conflict Management

Agree on a common goal
Change the pronouns to “we”
Listen actively
Position equally
Set the ground rules for discussion
Limit the number of people
Last resort: Mediation
3. Confrontational

Gain control
Get help from your employer
Make a plan for action
Take 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
Nurse Manager
Analyze and observe employee interaction
Raise the issue at staff meetings
Educate staff
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
Promote teamwork
Assistant Nurse Manager
Assistant General Director
Director of
Director of
and Quality
General Director
Chain of Command
non-verbal innuendo
withholding information
broken confidences
Horizontal/Lateral Violence:

Griffin, 2004
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
Outside Organizations:
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

Support groups

Healthy Workplace Bill
Currently active in 9 states
Help from outside
Diego Acero
Emilia Ahukanna
Comfort Asare
Joe Barone
Cynthia Cassar
Rowena Chua

Andrea Dixon
Gabriel Pietrzak
Dawid Rarowski
Krisna Sricharoon
Heidy Thomas

(out of which 60% quit
within 6 months)
within hospital
Educational Organization
outside sources
The theory of Oppression
1. Assess
2. Address
3. Avoid / Prevent

• Inadequate communication
• Lack of trust
• Misunderstanding of roles & responsibilities;
role conflicts
• 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
• Emotions
• Unmet needs
signs of violence
what will
you do?

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
Exercise regularly
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)
Full transcript