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/
Enjoy this Ted Talk given by HCPro author Kathleen Bartholomew. Listen to Kathleen discuss the importance of dismantling the nursing hierarchy that can devalue and shame caregivers and creating an atmosphere of open communication and respect between caregivers which ultimately improves patient care.
The American Nurses Association (ANA) has recommended the second edition of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other, by Kathleen Bartholomew, RN, MN, in its official position statement on Incivility, Bullying, and Workplace Violence as a resource for nurses. Now in its second edition, the cornerstone work has just been released as an eBook and offers 4 continuing education credits (CEU).
The first and most respected book showing new and experienced nurses how to build a better workplace by facing and overcoming horizontal hostility is now updated.
Find out why this book is a best-seller and how it’s empowered thousands of nurses to create positive change for themselves and their peers!
Revised to reflect current research on horizontal hostility in the nursing field (also known as lateral violence), Ending Nurse-to-Nurse Hostility, Second Edition, provides staff nurses and their managers with techniques to create a workplace that promotes team relationships and career development while preventing burnout.
Ending Nurse-to-Nurse Hostility provides staff nurses and their managers with the knowledge they need to:
- Identify verbal abuse, bullying, and other detrimental behaviors
- Develop responses to defuse or head off such behaviors
- Create positive alternatives to hostility
These skills support the success of the individual nurse, the unit, and patient care quality at a time when healthcare systems are publicly ranked on patient experience and outcomes.
Horizontal hostility, also known as bullying or lateral violence, is a major factor in nursing attrition rates. Healthcare organizations that don’t proactively create a healthy workplace face the expense of finding, hiring, and training new nurses to replace burned-out staff.
This book provides the following benefits:
- Skills: Nurses will learn skills for identifying and responding to verbal abuse, bullying, and other detrimental behaviors that undermine individual nurses, the unit, and the quality of patient care.
- Real-world examples: Gain insightful reflections from individual nurses who have experienced horizontal hostility, presented in their own voices.
- Author voice: Kathleen Bartholomew is a beloved nursing author who is authoritative yet approachable and always respectful.
- Scholarship: Extensive references draw on the latest empirical and theoretical literature concerning horizontal hostility.
- Culture change: Improve nurse retention, nurse productivity, and hospital rankings with an improved environment for patient care.
For more information or to order, visit the HCPro Marketplace.
As promised last week, we’ve added a free download from 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.
On August 31, the American Nurses Association issued a press release 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!
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]
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.
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.
This week I have the pleasure of reading the incredible responses we received to our Nurses Week 2015 survey. So many of you shared your insights, challenges, and hopes for the coming year—thank you! We’ll be emailing the winners of copies of Kathleen Bartholomew’s Team-Building Handbook: Improving Nurse-to-Nurse Relationships in the next couple of days. Keep your eyes peeled for our email.
Your generous responses help us understand your needs and aspirations, and we will try to return the favor by covering those important topics in this blog and in our upcoming books, webinars, and e-learning. For starters, I’ve revived a popular post from the past that deals with retention, identified by many of you as a top priority. Let me know if you recognize any of the 20 bad habits in yourself!
Retain staff by breaking these 20 bad habits
Peter Druker, often called the Father of Modern Management, made the following observation, “We spend a lot of time teaching managers what to do. We don’t spend enough time teaching them what to stop. Half the leaders I’ve met don’t need to learn what to do–they need to learn what to stop.” We simply need to [more]
Take advantage of HCPro’s Nursing BOGO event: Buy one nursing book at full price
and get the second one at 50% off* now through May 18, 2015.
To receive the discount on your second book, please enter
discount code EO323822 at checkout.
*50% off lesser or equal value product.
⇒ 5/4: Who inspires you? There’s still time to submit your favorite quotes in posted comments, here.
⇒ 5/6: You can still use the 20% Nurses Week discount offered in this post (though it can’t be used in combination with the BOGO discount).
⇒ 5/8: Enter our 10 question survey here for a chance to win a copy of Team-Building Handbook: Improving Nurse-to-Nurse Relationships, by Kathleen Bartholomew.
Our mission is to provide you with essential tools, articles, tips, and books to support your practice… and we want you to tell us what you need. What kind of challenges do you face? What subjects excite you? Please take a few minutes to answer our 10 question survey, and give us your wish list!
To thank you for participating in our Nurses Week survey, you also
have an opportunity to win a copy of Kathleen Bartholomew’s
Team-Building Handbook: Improving Nurse-to-Nurse Relationships.
Just complete the survey between now and midnight on May 27, 2015, and provide your contact information on the last page.
Click on the link below to begin the survey:
All of your answers are confidential and anonymous, and your contact info will only be used to let you know if you won a handbook. If you have questions related to the survey, please contact firstname.lastname@example.org.
⇒ 5/4: Who inspires you? There’s still time to submit your favorite quotes in posted comments, here.
⇒ 5/6: You can still use the 20% Nurses Week discount offered in this post.