December 22, 2017 | | Comments 0
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Q & A: Ending Nurse-to-Nurse Hostility

Editor’s Note: Strategies for Nurse Managers recently sat down with Kathleen Bartholomew, RN, MSN, author of Ending-Nurse-to-Nurse Hostility, Second Edition to discuss strategies to end hostility in the workplace. The following is an edited version of our conversation.

Strategies For Nurse Manangers: What inspired you to write Ending Nurse-to-Nurse Hostility?

Kathleen Bartholomew:
I wrote “Ending Nurse-to-Nurse Hostility” because of my deep love and respect for Nursing. The intimate and poignant moments that nurses share with their patients as well as their high level critical thinking skills have always blown me away. Yet I also witnessed occasions when nurses took each other down – mostly in subtle ways. I wanted to understand why. I wanted to discover and illuminate these unconscious learned behaviors so that we could all lift each other up and show the world the best of humanity.

SFNM: What is nurse-to-nurse hostility?

KB: A formal definition is: “…any behavior that interferes with effective communication among healthcare providers and negatively effects performance and outcomes.” (The Center for American Nurses)
An informal definition would be: Any interaction or behavior that leaves you feeling ‘less than’ the capable, skilled, caring person that you really are – like eye-rolling. Some people unconsciously try to make someone feel smaller so they can feel bigger (remember middle school?).  Some other examples would be: raised eyebrows, making faces behind someone’s back, withholding information, bickering, fault-finding, back-stabbing, intimidation, put downs, ignoring someone’s greeting, blaming or an unfair assignment. These are all unconscious behaviors.  No one thinks to (themselves, “I’m going to roll my eyes at her right now”. The insidious nature of these hostile behaviors is what makes them so dangerous because we don’t even realize that we are taking each other down.

SFNM: How does it differ from regular bullying? 

KB:
In the United States, bullying is a term used to describe someone a power level above you like a manager or physician who uses overt and covert behaviors to ‘put you in your place’. “Horizontal” hostility refers to the way your peers try to take away or under-mine each other’s power. It is more common in a unit where the manager has an authoritarian or laisse-fare style of leadership and where nurses do not have the resources or staffing to do their job.

SFNM: What are some examples of hostility in the workplace that are often overlooked?

KB:
Many nurses don’t recognize that talking about someone when they are not present is a form of hostility. Gossip erases trust as the underlying message to our psyche is “If they are talking about people who are not here, then they are probably talking about me when I am not here. “
Other covert forms of hostility are withholding information (let’s see how good she/he is), refusing to work with other people, and cliques. If you have cliques in your department, then you are not a team – and high reliability standards have consistently proven that only collegial teams can keep patients safe. People join cliques for two reasons: to elevate their own self-esteem, and/or to stay safe. So become inclusive by letting everyone belong, look for the good in each other, and compliment freely.

SFNM: What can a manager do to prevent bullying and horizontal hostility in their department?

KB: These three strategies and tactics set the foundation for trust and therefore civility:

  1. Say what you see.  If you see someone rolling their eyes, stop and say, “I noticed that you rolled your eyes…”   These covert behaviors lose their power when we call them out into the open.
  2. Dismantle the hierarchy. We may have different roles, levels of education and paychecks, but each and every single person is a critical member of the team.  The fastest way to even the power play is to ask for feedback by individually asking his/her staff: What do you like that I do well? And what would you like to see more of?

    Another way to equal the playing field (which is critical to Millennials especially) is to job shadow. This sends a strong message that you care about their world when you ‘walk in their shoes.”  And if you walk onto the unit and everything is chaotic, ask the charge nurse what you can do and then do just that.

  3. Nothing About Me, Without Me. Gossip undermines trust. If someone comes into your office to complain about someone else, ask them to go get that person and explain that you would do the same for them. This is the most fundamental leadership behavior because it sets up the conditions for trust. Furthermore, it emphasizes that we are adults who should be able to bring our concerns or observations to each other. The AACN standards say that we must be as competent in our communication skills as we are in our clinical skills – but we are not. Encourage, roll play and coach staff to speak with each other about the important stuff.

SFNM: Do you have any suggestions for a manager that suspects their staff is experiencing hostility?

KB:
Yes! I can’t tell you how many managers ask their staff is a problem and the group says “no”. Group think doesn’t allow it. The best way to evaluate the presence of hostility is to send out a simple Survey Monkey (there are two short surveys in “Ending Nurse-to-Nurse Hostility”). After you have compiled the results, share them at a staff meeting. As managers, we need to hold up a virtual mirror so that staff can see how their behaviors affect each other and patient care.

The second step would be awareness training. There are three free educational videos, each only ten minutes long on my website complete which end with a question for the group. Show one each month at a staff meeting; or include in your annual education and new hire curriculum.

SFNM: What advice would you give someone who was experiencing horizontal hostility in the workplace?

KB: Every month someone emails me with a story expressing the shear pain of being rejected from the group. Their letters are heart breaking. It is difficult to understand how in a profession based on caring, how nurses could be so downright mean.

My advice is to know without a doubt that it’s not about you. Horizontal hostility is a symptom of an unhealthy group. If you quit, they will just do the same thing to the next person. If you are different in any way, you become a vulnerable target. When humans work closely together under stressful conditions, have low self-esteem, have a bully for a manager, or a manager that doesn’t care what they do, or plays favorites, you can be certain that staff will be hostile.

About Kathleen Bartholomew
Kathleen Bartholomew, RN, MSN is the author of HCPro titles: Ending Nurse-to-Nurse Hostility, second edition, Speak Your Truth: Proven Strategies for Effective Nurse-to-Physician Communications, along with the Team Building Handbook: Improving Nurse-to-Nurse Relationships. Additionally, Bartholomew has recently published “The Dauntless Nurse: Communication Confidence Builder” with co-authors Martha Griffn and Arna Robins along with the Dauntless Communication Tool app on iTunes.

 

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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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