Teach others about lateral violence

Please visit Youtube by clicking the link listed below and you will find a video with three examples of lateral violence, retaliation, bullying, and exclusion. Below the link you will find a suggestion on how to use these vignettes in order to teach others about lateral violence as well as alternate responses when encountering lateral violence. Please leave us your feedback, and ENJOY!!!

http://www.youtube.com/watch?v=mBCRBaLHR1k

How to use these vignettes to teach about Lateral or Horizontal Violence: (approx. 1 hour)

1. Show the video and ask the participants to note if lateral violence occurred. (approx. 2 min)
2. Divide the participants into groups of 4-6. Assign one of the vignettes and ask them to discuss their findings. (approx. 5 minutes)
3. Ask the group to come up with other ways to deal with the assigned scenario. (approx. 10 minutes)
4. Ask the group to role play the alternate way to deal with the lateral violence noted in the video. (approx. 15 minutes)
5. Encourage the group to first discuss what went well, then what could have been done different. (approx. 15 minutes)
6. Report the techniques discussed and the findings with the entire group. (approx. 30 minutes)


Assertive Techniques to address the lateral violence noted in the videos:

Retaliation: broken confidences, complaining about a person without directly speaking to them:
“It upsets me to think that you spoke to ______ without my permission.”
“I don’t feel right talking about ______ without them present. Have you addressed these issues with them?”
“That sounds like information that should remain confidential.”

Bullying: a nurse not making self available for clarification:
“When you leave before report has been listened to it leaves me with questions. Help me understand what can be done to assist with report and avoid unanswered questions.”
“I know you and I are both concerned with the safety of our patients. When you leave before I listen to report, I am fearful our patients will not get the best care possible. Let’s talk about a way for us to work together in order to best take care of our patients.”

Exclusion: leaving out the new nurse, refusing to assist with needed tasks:
“I sense that there is something you would like to say about working with me. I don’t mind if you would like to talk to me about that.”
“I see you are unavailable to assist me with nursing tasks. Is there some way we can work together in which both of us are able to assist one another in order to provide the best possible nursing care.”

Lateral Violence in the Workplace

Lateral Violence is EXPENSIVE.........
- Effecting patient safety
- Poor staff morale
- Decreased recruitment
- Lack of retention of new nurses

What can be done?

1. Assess:
÷Why does lateral violence occur
on your floor?
÷Is your staff educated ?
÷Does your leadership style support or negate lateral violence?

2. Plan:
÷Include discussion in orientation
÷Provide yearly in-service
•For staff and managers
÷Use the term “lateral violence”

3. Intervention:
÷Allow staff to tell their stories
•Make staff aware of the process to address lateral violence
•Respond quickly and consistently to incidents of lateral violence
÷Hold a staff meeting to discuss expectations of the unit
÷Teach communication skills and conflict resolution
-Set an example

4. Evaluation:
÷Are the interventions working?
•Staff satisfaction surveys
•Staff turn-over
÷Respond to feedback
- Self-evaluation

Expected Behaviors: Can we come up with more?

From the following article comes Expected Behaviors:

—Griffin, M. (2004). Teaching Cognitive Rehearsal as a Shield for Lateral Violence: And Intervention for Newly Licensed Nurses. The Journal of Continuing Education in Nursing, 35 (6), 257-263.

1. Accept one's fair share of the workload.
2. Respect the privacy of others.
3. Be cooperative with regard to the shared physical working conditions.
4. Be willing to help when requested.
5. Keep confidences.
6. Work cooperatively despite feelings of dislike.
7. Don't denigrate to superiors (e.g., speak negatively about, have a pet name for).
8. Do address coworkers by their first name, ask for help and advice when necessary.
9. Look coworkers in the eye when having a conversation.
10. Don't be too overly inquisitive about each others lives.
11. Do repay debts, favors, and compliments, no matter how small.
12. Don't engage in conversation about a coworker with another coworker.
13. Stand-up for the "absent member" in a conversation when he/she is not present.
14. Don't criticize publically.

Preserving The Profession

At The Annual 2008 Nursing Summit, "Leadership Imerative: The Time is Now", yesterday I am happy to say that the 2007-2008 Cockcroft Fellows successfully launched the "Youth Outreach Initiative" and "The Stand Up Against Lateral Violence Campaign".

Thank you to all of you that were supportive during the conference, it was more than we ever expected!

Sincerely,
2007-2008 Amy V. Cockcroft Fellows

References about Lateral or Horizontal Violence

—Patterson, P. (2007). Lateral Violence: Why it’s serious and what OR Managers can do. OR Manager, 23 (12), 1, 7, 9-11.

—Longo J., Sherman RO. (2007). Leveling Horizontal Violence. Nursing Management, 38 (3), 34-37, 50-51.

—Farrell, GA. (2001). From tall poppies to squashed weeds: why don’t nurses pull together more? Journal of Advanced Nursing, 35 (1), 26-33.

—Griffin, M. (2004). Teaching Cognitive Rehearsal as a Shield for Lateral Violence: And Intervention for Newly Licensed Nurses. The Journal of Continuing Education in Nursing, 35 (6), 257-263.

McKenna, B., Smith, N., Poole, S., and Cloverdale, J. (2003). Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42, 90-96.

Pugh, A. (2005). Bullying in nursing: Building a culture of respect combats lateral violence. Journal of Addictions and Mental Health. Retrieved from http://findarticles.com/p/articles

South Carolina Hospital Association (2006). One Voice One Plan: Critical Needs Nursing Initiative [Brochure].

Stanley, K. M., Martin, M. M., Nemeth, L. S., Michel, Y., & Welton, J. M. (2007). Examining lateral violence in the nursing workforce. Issues in Mental Health Nursing, 28(11), 1247-1265.

Martin, M. M., Stanley, K.M., Dulaney, P., & Pehrson, K. M. (2008). The role of the Psychiatric Consultation Liaison Nurse in evidence-based approaches to lateral violence in nursing. Perspectives in Psychiatric Care, 44(1), 58-60.

Please share your stories of Lateral Violence.... Here is one of mine

Being a nursing instructor I have heard and seen many acts of lateral violence. The other day a few of my students were talking about a nurse at a local hospital they call "Nurse Ratchet". Most of the students knew of this one nurse and had horrible stories to share. I was in shock, probably because I am naive. They all were negatively impacted by one nurse, incredible. Do we even think about what we are doing to our future? If not, we need to start!

I sat during clinical in awe and yet I too remembered a time where I was a victim of lateral violence. It was my first job, in an inpatient psychiatric unit. I was off over the weekend and on Monday, was dealing with a specific patient for the first time. The nurses gave me a vague report on the patient and away I went, ready to save the world. While giving medications, I noticed the nurses gathering behind the nurse's station, but didn't question the situation. I went into the milieu to give this patient medication. The patient was helping another staff member move chairs for group. I gave the patient medication, he placed them in his hand, took his hand to his mouth, and looked as though he took the meds. However, I noticed that he was holding his hand, the one I put the medication in, differently. I asked the patient to open his hand, when he did, there were the medications. I told him he then needed to take the medication, he did, I double checked, and then went to document the situation. There were 4 staff members sitting behind the nurses station clapping. What they didn't share in report (purposely? maybe) is that this patient tried to "cheek" his medications this weekend as well. They wanted to see if I noticed. I am scared to think about my possible experience on that unit if I would have "failed" their test. WE ALL NEED TO STAND UP AGAINST LATERAL VIOLENCE!!!!!

I ask you to please comment and share your stories, the good, bad, and ugly. It is liberating and worth it if we reach just one person.........

THANK YOU

We would like to thank the following individuals who guided us in our journey:
Michael Bleich PhD, RN, CNAA-BC for your inspiration and knowledge.
Joby Robinson, PhD for your insight and understanding.
Phyllis Beck Kritek, RN, PhD, FAAN for your strength and ability to expand our perspectives.
Lydia Zager, MSN, RN-BC for your energy and spirit.
Susan Williams, PhD, RN for your dedication and support.