August 09, 2016 | | Comments 0
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Book Excerpt: Ending Nurse-to-Nurse Hostility

Years ago, at a National League of Nursing meeting, Loretta Nowakowski, former director for Health Education for the Public at Georgetown University School of Nursing in Washington, D.C., proposed that disease could be best understood by looking at hurricanes. She noted that, like a serious illness, hurricanes occurred only when many factors were present within relatively narrow parameters and that an appropriate intervention could alter the severity or course of a disease or hurricane. This discovery was encouraging to Nowakowski—it meant that an intervention, made at any point, could alter the final outcome.

And so it is with horizontal hostility. History, gender, education, work practices, interpersonal relationships, communication skills, and organizational structure all contribute to horizontal hostility. The “hurricane” of horizontal hostility cannot manifest without these predisposing factors, so to intervene anywhere in this vast array can change the outcome from hostile to healthy.

The good news is that no matter what our current role—whether CNO, staff nurse, director, educator, or manager—we can implement interventions that will decrease hostility. Multiple opportunities are available at various levels.

Framework for leading organizational change to eliminate hostility

Enacting a twofold method (i.e., increasing a healthy environment while simultaneously decreasing hostility) is the most effective approach that managers can take to enact change at the organizational level.

To increase a healthy culture, leaders must:

  • Firmly establish board and senior leadership team commitment
  • Make harm visible: Frame disruptive behavior as a safety issue; importance of teams:

       – Create infrastructures to support managers and staff: Include behaviors in annual reviews for all staff including physicians

  • Shift the power structure from a hierarchy to a team/tribe:

       – Provide a constructive feedback system for accountability and performance

       – Provide leadership training and confrontation skills training for managers

       – Provide assertiveness training and confrontation skills training for managers

       – Monitor the organizational climate

       – Increase social capital—build a strong informal network

 To decrease hostility, leaders must:

 Adopt a zero-tolerance policy for all disruptive behavior:

  • Same rules for all roles!
  • Transform power from a hierarchy to a tribe/team
  • Adopt a zero-tolerance policy for horizontal hostility
  • Provide leadership and conflict management training for managers
  • Educate staff about the etiology and impact of hostility
  • Create a system for reporting and monitoring the culture
  • Participate with other hospitals to pass state legislation

– See more at: http://www.psqh.com/analysis/leadership-ending-nurse-to-nurse-hostility-1/

For more information or to order, visit the HCPro Marketplace.

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Filed Under: nurse-to-nurse hostility

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About the Author: Kenneth Michek is the Associate Editor for nurse management at HCPro.

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