Update June 2021 Show
Issue:
Workplace bullying (also referred to as lateral or horizontal violence) is repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators.3 Bullying is abusive conduct that takes one or more of the following forms:3
There are four recognized categories of workplace violence:4
In the scientific literature, several types of bullying have been studied: intimidation, harassment, victimization, aggression, emotional abuse, and psychological harassment or mistreatment at workplace, among others.5 Bullying does not include illegal harassment and discrimination, and while bullying can create a hostile work environment, it is not the same as the organization allowing an illegal hostile work environment (for example, the employer tolerating inappropriate jokes). Other examples that are not bullying include setting high work standards, having differences of opinion or providing constructive feedback. The Workplace Bullying Institute estimates that 65.6 million U.S. workers are directly impacted by or have witnessed bullying. A 2014 Workplace Bullying Institute survey found that 69 percent of bullies are men and 57 percent of targets are women, and that women bullies target women in 68 percent of cases. It is more common than sexual harassment, and can be direct physical, verbal or indirect bullying (such as social isolation).6 Bullying is typically deliberate, causes negative effects on the victim, and is an attempt to control employees. Bullying is behavior that is aggressive, intentional, and frequent. Bullies tend to target employees who have inadequate support or are not able to defend themselves from the aggression. An essential component of bullying is that it is perceived as a hostile act by the target. Some examples of bullying are a manager who is never pleased with performance, gossiping or spreading rumors, intentionally excluding an employee from team meetings, being told “you are too thin skinned,” or being repeatedly called to unplanned meetings with the manager where the employee is denigrated. Factors that contribute to this problem include a culture that allows bullying (normalization of deviance), poor staffing levels, excessive workloads, power imbalances and poor management skills. Specific organizational factors that can lead to workplace bullying are role conflict and ambiguity, work overload, stress, lack of autonomy and a lack of organizational fairness.7,8 In the health care setting, 44 percent of nursing staff members have been bullied. Nurses tend to accept nurse-on-nurse bullying as part of the job, particularly the new or novice nurse, thus the coining of the phrase “nurses eat their young.”9 In a study of 284 health care workers, it was found that 38 percent of U.S. health care workers reported psychological harassment.5 The most common health care settings where bullying is prevalent are behavioral health units, emergency departments and intensive care units. In long term care settings, bullying occurs more frequently during evenings and night hours. The targets of bullying are employees who are typically under 40 years old; female physicians; and unmarried, female employees with less education and who have children at home. Impact of workplace bullying
The impacts on patient and care team safety include under-reporting of safety and quality concerns, and increases in harm, errors, infections and costs. As an example, the estimated cost of replacing a nurse is $27,000 to $103,000.10 Bullying exacerbates the stress and demands of already stressful and demanding professions. Bullying contributes to burnout and drives talented and caring people out of the health professions. The kinds of improvements needed in patient safety and health care cannot be achieved if talented people are lost. Battling workplace bullying
A team led by Dr. Hickson is implementing a Co-Worker Observation Reporting SystemSM (CORSSM) at VUMC. The CORSSM project aims to encourage collegial respect and accountability and to couple safe, contemporaneous reporting with consistent, timely delivery of the captured stories.12 The indications are that self-reporting of unprofessional and disrespectful behaviors increases self-regulation and civility. Alan Rosenstein, a physician and leading expert in unprofessional behavior, states that, with respect to eliminating behaviors that undermine a safety culture, “The primary goal should be to improve care relationships by increasing understanding and responsiveness to individual (physician, staff, patient) needs (emotional Intelligence), provide training in diversity, stress, anger, and conflict management, improve communication and collaboration skills, and enhance an organizational culture that respects and supports physicians, staff, and patient-centered care.”13 A method used to prevent bullying of novice nurses is cognitive rehearsal. In the original 2004 study,14 26 newly licensed nurses hired by a large acute care tertiary hospital in Boston, Massachusetts, participated in an exploratory descriptive study. They were taught about lateral violence in nursing practice and the use of cognitive rehearsal techniques as a shield from the negative effects of lateral violence on learning and socialization. Knowledge of lateral violence in nursing appeared to allow newly licensed nurses to depersonalize it, thus allowing them to ask questions and continue to learn. The learned cognitive responses helped them confront the lateral violence offender. Confrontation was described as difficult, but it resulted in the resolution of the lateral violence behavior. Overall, the retention rate in this study population was positively affected.14 Safety Actions to Consider:
To correct bullying behaviors that can undermine a safety culture, all health care facilities should consider taking the following specific safety actions, which are highlighted in The Joint Commission’s Sentinel Event Alert, Issue 40:16
In developing these policies and procedures, solicit input from an inter-professional team that includes representation of medical and nursing teams, administrators, and other employees.16 Resources:
5. Ariza-Montes A. Workplace bullying among healthcare workers. International Journal of Environmental Research & Public Health, 2013;10:3121-3139 6. Rayner C and Hoel H. A summary review of literature relating to workplace bullying. Journal of Community & Applied Social Psychology, 1997;7:181-191 7. Bowling NA and Beehr TA. Workplace harassment from the victim’s perspective: A theoretical model and meta-analysis. Journal
of Applied Psychology, Sept. 2006;91(5):998-1012 Note: This is not an all-inclusive list. When educating families on fire safety it is important to quizlet?Obtain a three-prong grounded plug adapter. When educating families on fire safety, it is important to: have a meeting place outside the home.
What is the most important safety concept that a nurse should include in the teaching plan for a family with a newborn infant in the household quizlet?What is the most important safety concept that a nurse should include in the teaching plan for a family with a newborn infant in the household? Avoid stuffed animals and blankets in the crib. The nurse is caring for a young child in the hospital who is being discharged home with his grandmother, who has guardianship.
What is the first thing a nurse should do in the event of a fire?Right away, you need to implement the RACE protocol: rescue, alert, confine, and extinguish and evacuate. Rescue. Size up the fire scene and determine whether entering the immediate area is safe. If it is, remove everyone from the immediate fire scene.
Which information would the nurse provide to a toddler's parent who asks how do you prevent burns at home select all that apply?To prevent burns at home:. Reduce water temperature. ... . Avoid hot spills. ... . Establish 'no' zones. ... . Keep hot devices out of reach. ... . Test food temperature before feeding young children. ... . Choose a cool-mist vaporizer. ... . Address outlets and electrical cords. ... . Choose fire-resistant fabrics.. |