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Excerpt: Dealing with the cyberbully

October is National Bullying Prevention Awareness Month, highlighting the dangers of bullying in all settings. The following is an excerpt from Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other by Kathleen Bartholomew, RN, MN that explores the dangers of cyberbullying in the nursing unit.

Facebook boasts more than 1.86 billion monthly users worldwide, with more than 40% of Americans logging in every single day. In 2007, Twitter reported 5,000 tweets a day; and in only six years, tweets jumped to more than 400 million. Ten years later in 2017, we tweet 6000 tweets per second. (Zephoria) Without a doubt, we have entered the digital world:

  • Fifteen nurses received letters of warning from their State Board of Nursing after they were reported by their nurse executive for “liking” a derogatory comment that one nurse posted about a husband who was uncaring and unsupportive during childbirth. They did not heed the first warning.
  • A nursing student was dismissed from the program after taking a picture of herself holding an unidentified placenta and proudly commenting how thrilled she was to assist at her first birth.
  • A group of nurses who were friends started a conversation on Facebook which included several disparaging comments about a nurse they didn’t like, as well as remarks on the safety of the organization’s staffing levels.

We talk to each other on online chat rooms in casual conversations that feel so real we forget that no discussion in this virtual world is ever private. Every one of the nurses in the above situations had no idea that they were violating professional ethical guidelines by breaching confidence.

As social networking becomes more integrated into our daily lives, the boundaries between social conduct and professional misconduct are becoming increasingly difficult to navigate.

—Rose Sherman, EdD

While it is generally accepted that we cannot speak about our patients, even anonymously, many nurses do not realize that it is also not professional to speak about a coworker. According to the National Council for the State Board of Nursing policy on Social Media, any online comments posted about a coworker may constitute lateral violence; even if the post is from home during non-work hours. Communication modes for cyberbullying include: instant messaging, email, text messaging, bash boards, social networking sites, chat rooms, blogs, and even Internet gaming.

Nurses often fail to realize that deleting a comment does not erase it. Talking about coworkers is unprofessional and contrary to the standards of honesty and good morals (moral turpitude). Depending on the laws of a jurisdiction, a Board of Nursing may investigate reports of inappropriate disclosures on social media by a nurse on the grounds of:

  • Unprofessional conduct
  • Unethical conduct
  • Moral turpitude
  • Mismanagement of patient records
  • Revealing a privileged communication
  • Breach of confidentiality

Guidelines for nurses victimized by cyberbullying

  • Save all evidence. Copy messages or use the “print screen” function. Use the “save” button on instant messages.
  • First offense: Ask to speak to the person in private and bring a copy of the evidence. Use the D-E-S-C communication model.
    • Describe: “I was on Facebook yesterday and my friend sent me this post because it was about me.”
    • Explain the impact: “I was really surprised because I had no idea that you didn’t like working with me, or that that was the reason you switched weekends.”
    • State what you need: “No one is perfect. Next time could you come to me privately and let me know if you are having any issues so that we can work together to resolve them?”
    • Conclusion: “I am willing to learn how we can be more mutually supportive of each other for the sake of our relationship, our team, and our patients.”
  • Document the conversation and the outcome.
  • Second serious offense: Report to manager (if not serious, try a mediated conversation).
  • Third serious offense: Report to the chief nursing officer.

Manager guidelines

  • Verbalize that no bullying or hostility of any kind will be tolerated, including online.
  • Set the expectation that all staff are responsible for monitoring their virtual world. Don’t assume the parental or vigilante friend role.
  • Educate staff on standards and policies, and provide examples.
    • National Council of State Board of Nursing Guidelines
    • Hospital/organizational policy (including use of hospital computers, cell phones, etc.)
    • Review common myths. Use case studies from NCSBN YouTube.
  • Be supportive of online targets and take derogatory online comments seriously.

 

Source: National Council for the State Board of Nursing: www.ncsbn.org/2930.htm

Clinical Nurse Leaders, partners in quality improvement

Quality within any healthcare system depends on improving patient outcomes, which rely on continual nursing professional development and overall improvements in system performance. One of your most important resources for managing such improvements is the Clinical Nurse Leader (CNL). This clinician is a Master’s prepared Advanced Generalist nurse who builds quality measures in patient care outcomes and implements evidence-based practice principles at the clinical point of care and service. These outcomes align with the facility’s goals and strategic plan and can positively impact patient care processes.

 

For example, when working with a CNL, you can align the care team with strategic performance goals. CNLs and the Quality Systems team are important resources for strategic planning for quality and performance improvement (objectives, priorities, expectations, deliverables, and timelines). Working together, you can establish an infrastructure for engaging and motivating staff and other team members to work toward achieving improved patient care outcomes within the organization’s measures of performance. CPI only happens when everyone engages to improve management of operations and care delivery.

 

As the context of healthcare environments continually evolves and changes, your role becomes more complex and demanding. However, these growing challenges offer expanding opportunities for developing partnerships with your nurse manager, CNLs, and interprofessional team members to improve quality, practice, and competency in managing unit operations and coordinating patient care. By taking of advantage of these opportunities, you can help create a unit culture of safety, quality, and practice excellence.

Source: The Effective Charge Nurse Handbook

Registered nurses not immune to industry influence

There’s been a concerted effort over the last few years to provide transparency for medical industries interaction with doctors, thanks to the Physicians Payments Sunshine Act instituted by the US Senate in 2010. The Sunshine Act requires medical manufacturers, such as drug and medical supply companies, to report payments and gifts given to physicians and teaching hospitals; the goal is to ensure that doctors are not swayed to make care decisions based on financial gains and prevent conflicts of interest. Last fall, two senators proposed a bill to amend the Sunshine Act that would include nurse practitioners (NPs) and physician assistants (PAs) as well, acknowledging that NPs and PAs wrote 14% of all drug prescriptions in 2014 and require the same transparency as doctors.

A new study released this week suggests that even registered nurses (RNs) without prescribing authority could be subject to these sort of interactions with the medical industry. All of the RNs that participated in the study said they had interacted with industry over the past year, averaging 13 one-on-one meetings over the year. Many also participated in sponsored meals or events, received gift offers and product samples, and some received payments for speaking, consulting, and market research work. Most interactions were with medical device and pharmaceutical companies, but some reported interactions with health technology and infant formula industries as well.

Though RNs don’t have prescribing authority, many nurses are part of purchasing committees for their facility. RNs play an integral role in decision-making throughout their facility, and there are no regulations for transparency between RNs and medical industries. Though the sample size is small (56 RNs participated in the study), the authors of the study think the results warrant additional research and regulation. As the largest and most-trusted healthcare profession in the US, it’s important to make sure RNs maintain their trustworthy reputation with their patients.

You can read the full study here, and an editorial accompanying the study here.

For more information about open payments data, check out CMS’s open payments site.

Combating depression in nurses

Nurses are twice as likely to experience clinical depression than the general population. Why aren’t we talking about it?

The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) found that 18% of nurses exhibit symptoms of depression, compared to the 9% found in the general public. Nurses are happy to talk about their staff shortages or their back problems, but we almost never see serious discussions about mental health issues.

Minority Nurse suggests that nursing culture exacerbates the depression issue. Nurses take great pride in their survivability and toughness; they often see trials facing new nurses as a proving ground, a way of weeding out those who are not cut out for the job. This leads nurses struggling with depression to bury their feelings and work twice as hard, which will make things worse in the long run.

There’s also the idea that mental health issues are seen as a weakness. Nurses rely on each other to be reliable and trustworthy, and someone who is struggling might be easily dismissed as unreliable. This puts their job at risk, and can affect their relationship with peers. Additionally, the nurse mentality is to put the care of others first; many nurses might not release why their suffering, as they so rarely address their own needs.

If admitting they have a problem or asking for help is often the last thing a nurse wants to do, how do you help them? The process starts with nurse managers. Educating managers about the warning signs of depression, and they in turn train their staff to recognize the condition in themselves and their peers. Coming up with strategies to help depressed nurses that aren’t punitive and making sure their staff have resources available to them can help alleviate the fears associated with mental illness.  Showing the staff that it’s okay to talk about mental illness and that asking for help isn’t a sign of weakness will help change the “tough it out” culture of nursing.

Addressing mental health issues can help improve nurse retention as well. Instead of “weeding out” the weak links, supporting new nurses through a crisis and encouraging them to get help will keep them at their jobs longer, and make them better nurses for the rest of their career.

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Free tool from Ending Nurse-to-Nurse Hostility

As promised last week, we’ve added a free download downloadicon3from Kathleen Bartholomew’s Ending Nurse-to-Nurse Hostility, Second Edition, in honor of being the only book chosen by the American Nurses Association as a recommended bullying and horizontal hostility prevention tool.

To access the download site for a tool you can use to evaluate the health of your workplace as regards bullying, lateral violence, and other undesirable behaviors, click here.

To read last week’s story the ANA position statement on workplace violence and the nursing profession, click here.

New ANA Hostility Prevention Guide Recommends Bartholomew Book

On August 31, the American Nurses Association issued a press NTNH2 coverrelease announcing its updated position statement on workplace bullying and violence, stating that the “nursing profession will no longer tolerate violence of any kind from any source.”

Among the interventions recommended as “primary prevention” is the HCPro classic work by Kathleen Bartholomew,
Ending Nurse-to-Nurse Hostility, Second Edition. In fact, Ending Nurse-to-Nurse Hostility has the distinction of being the only book recommended to RNs and their employers in the statement as a front line tool for preventing incivility and bullying.

We are so honored to have published Kathleen’s work, and congratulate her for this wonderful recognition of a lifetime commitment to making the nursing workplace a healthier, more collegial place. If you would like to add your best wishes, feel free to comment below!

Free tool: Build nursing team self-esteem

As promised in last week’s post, Try This: Build nursing team self-esteem, downloadicon2the exercise that Kathleen Bartholomew uses to encourage nurses’ self-esteem has been posted to our Tools Library.

To download the Hierarchy of Voice tool, click here.

 


Excerpted from Ending Nurse-to-Nurse Hostility, Second Edition, by Kathleen Bartholomew

Try This: Build nursing team self-esteem

Hierarchy of Voice

Excerpted from Ending Nurse-to-Nurse Hostility, Second Edition, by Kathleen Bartholomew

Try the following exercise that I often use to encourage nurses’ self-esteem. I call it a “hierarchy of voice” because each step results in greater empowerment. Addressing specific behaviors that are a challenge to a nurse stimulates meaningful conversations about that individual’s stumbling blocks to empowerment and self-esteem.

In performance evaluations, share the following list and ask team members to pick 10 meaningful actions that they would like to [more]

A Simple Interprofessional Accountability Technique

Listening, validating and asking for a commitment

From Team-Building Handbook: Accountability Strategies for Nurses, by Eileen Lavin Dohmann, RN, MBA, NEA-BC

accountability scenario

When working with a group, I assume that people are rational and logical.

So, if I want them to do something, I just need to explain it and they’ll do it. When I don’t get the results I am seeking, I tend to think “Oh, I must not be explaining it well. Let me try it again.”

It’s taken me a long time to realize that what I was hearing as “not understanding me” was often someone’s polite way of telling me no. So, now when I find myself explaining the same thing to someone for the third time, I stop and ask the person what he or she is hearing me request. If I can validate that the person is hearing me correctly, I ask for the commitment: yes or no.

Validating… and asking for a yes or no

We can hold ourselves accountable, but holding other people accountable can be much more difficult. Consider this nurse-physician scenario and ask yourself [more]

Positive Pushback for Nurses

I’ve posted in the past on accountability strategies, communication techniques, and building team relationships, all of which can improve the workplace. Recently I ran across the term “positive pushback”—easy to remember thanks to those alliterative “p” words—and felt that the technique might be helpful in those potential conflict situations that arise from time to time.pushback2

The promise of positive pushback is that you can communicate your concerns in an unequivocally strong and clear manner that doesn’t damage your professional relationships. No yelling and certainly no retreating to an unassertive approach.

According to Susanne Gaddis, the Communications Doctor:

A “positive pushback” is the ability to deliver an appropriately assertive response to a potentially negative and/or harmful situation. A positive pushback is executed by looking someone straight in the eye, and saying with an even, non-stressed tone what you want or need. (If you want to be really assertive include the word “I,” such as “I really need for you to stop and review this now…”)

What resources do you need to use positive pushback? Self-esteem, self-confidence, and an ability to convey urgency without “emoting” your emotions. I highly recommend that you read this blog post from Susanne Gaddis, to see if this is a tool that you can add to your collection. As with all the “soft skills,” practice makes perfect.

If you try the techniques, please post a comment here to let us know how it worked out for you!

 


 

With thanks to Susanne Gaddis, PhD, CSP and CEO of The Communications Doctor, is an acknowledged communications expert who has taught the art of effective and positive communication since 1989.