Horizontal Violence Elizabeth Bennoch, MHSA, SPHR.
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Horizontal ViolenceEliz
ab
eth
Ben
noch
, MH
SA
, S
PH
R
Horizontal Violence is also calledLateral Violence
Bullying
Interpersonal abuse
Workplace violence
Interpersonal conflict
Psychological violence
Workplace incivility
Horizontal Violence…is a phrase coined by Paulo Friere in 1970, to indicate “the curious behavior of members of oppressed groups who often lash out at their
peers in response to oppression instead of attacking their oppressors.”
Pedagogy of the Oppressed, 1970
“Columbine happened because the whole community failed. Students failed to report what they were hearing and seeing, teachers & administrators failed to take the threats seriously & law enforcement failed to investigate what should have been a very clear & present danger.”
Christopher & Pohl, 2012
SHRM says:
It is “persistent, offensive, abusive, intimidating or insulting behavior or unfair actions directed at another individual, causing the recipient to feel threatened, abused, humiliated, or vulnerable.”
Jusko, 2013
Horizontal Violence
SurveysThe results of a 2012 SHRM survey:
50% of organizations surveyed reported an incident of bullying in their workplace, and for larger organizations
of >500 employees, the % grew to 71%!
Jusko, 20132011 Civility in America poll: 38% of
workers believe the workplace is becoming more disrespectful, and 67%
believe there is a strong need for civility training
Inside Training, 2013
HV Facts & StatsThe American Nurses Association reports:
48% of nurses, pharmacists & others reported strong verbal abuse
43% of nurses, pharmacists & others reported experiencing threatening body language
Student nurses reported that 53% had been put down by a staff nurse
40% of clinicians “kept quiet” or “ignored” an improper medication due to an intimidating colleague
AMA, 2013
Workplace Civility"Organizational success depends on a climate of fairness & compassion; supportive working environments are consistently identified as an
important attribute of an effective learning organization…in order to learn, employees must feel safe to disagree, ask questions, &
make mistakes. They must recognize the value of competing ideas & feel encouraged to take risks. If your organization’s culture is one of negativity & aggressiveness, none of this is
allowed to flourish." Inside Training, 2013
More FactsRoughly 60% of new RN’s quit their first job
within 6 months of being bullied, and 1 in 3 new graduate nurses considers quitting nursing
altogether because of abusive or humiliating encounters
Townsend, 2012
Nurses who survive bullying early in their careers tend to carry their learned behaviors with them. They accept the bully culture as part of the job and eventually choose one of
two paths: leave the unhealthy work environment in search of a healthier one, or participate in the culture either as a bully or
bystander.American Nurse Today, 207
HV as a role issueNurses are educated to process work in teams and most nursing models are built on the team concept; however, physicians are educated to believe they are the “captain of the ship”
This leads to stress between physician and nurses. Nurses expect to work as colleagues with physicians; however, physicians don’t always see this as desirable
Such differing cultural expectations breed conditions that are ripe for horizontal violence
And then nurses “eat their young”
HV as an oppressed group issueThis occurs when one group believes they have been excluded from the power structure
The oppressed group is abusive to peers & those individuals with lesser status because they are unable to or fear addressing the source of the stress affecting them. They then may strike out at peers, students, unlicensed assistive personnel, etc.
“Sociological literature shows that oppressed group members tend to act out against one another because they lack control over their situation…powerlessness further lowers their self-esteem and triggers the cycle of oppressed group behavior undertaken to boost self-esteem – which in turn causes more frustration, lack of coworker support & conflict.”American Nurse Today, 2007
HV as a culture issueA company’s beliefs & attitudes towards Horizontal Violence play a large part in the acceptance of Horizontal Violence. Leadership’s role is vital
A culture of deferred responsibility develops when leadership looks the other way when this type of behavior happens. “When we think that we will not get into trouble, we tend to do things that we know we shouldn’t.” (Christopher & Pohl)
What makes us look the other way when someone’s in distress? “…environment & social mores are at the crux of it.” (Christopher & Pohl)
“…peer groups are a particularly effective & influential source of social learning…groups help create social norms - attitudes, beliefs or behaviors that are commonly accepted as appropriate by the group.” (Christopher & Pohl) We develop socially acceptable codes of conduct affecting the workplace based on group norms
Belittling gestures (eye-rolling, folding arms, staring into space when someone’s talking to you)
Backstabbing/Scapegoating
Withholding information (about patients, meetings, new equipment, etc.)
Verbal abuse (name calling, threatening, intimidating, undermining)
Needling
Horizontal Violence Includes:
For Example:Gossiping, talking behind your
coworker’s back
Finding fault (nitpicking)Telling coworker how to do his/her
jobNot respecting personal
privacy
Also…Personal insults
Criticism
Sarcastic comments, jokes & teasing (used as an insult)
Rude interruptions
Withering e-mail flames
Anonymous letters aimed at hurting the target
Wait, there’s more!
“Freezing or icing out” – excluding coworkers from work-related or social activities and/or
conversations (especially with new staff)
Elitist attitudes regarding your department, job, education, experience, etc. (I’m better than you
attitude)
Treating people as if they are invisible
So, concrete examples… Hiding (or stealing) someone’s lunch, coffee,
etc.
Derogatory statements: “She’s a know-it-all,” “Who died and made her boss?” “Where’d she get her degree, the Cracker Jax box?”
Laughing or snickering behind someone’s back (“Take a look at THAT outfit” “Nice hair – not!”)
Barking orders at people/stomping around
Not responding when a new (or an old!) coworker says hello or asks a question
Withholding paperwork, reports, etc. the coworker needs to complete own work on time
Dilbert on HV
Effects
The 3 Stages
(Hastie, 2002)
Sleeping disorders Free-floating anxiety Reduced self-esteem
Stage 1:
You experience:
Activation of the fight or flight response within you
You have difficulty with emotional control – bursting into tears and/or laughter for little reason
Irritable or angry when responding
Difficulty with motivation
Self-starter seems to be “burnt out”
Stage 2:Your neurotransmitters are depleted from lack of sleep & fatigue; the brain is over-stimulated and
over-sensitive
You experience changed response patterns which superficially resemble a change of personality
You have a loss of ability to ignore things that before were manageable
You experience a relative intolerance of sensory stimulation (slight noise, voices, lights, etc. bother you)
Stage 3:Your brain’s circuit breakers are
activated
Results… You feel like throwing up the night
before work Your family demands you stop
obsessing about work You make mistakes Your health/energy level declines Your favorite activities are no longer
fun
Catalanello, 2009
Turnover“Merely showing up for work in an environment
where bullying goes on is enough to make many of us think about quitting…nurses not
bullied directly, but who worked in an environment where workplace bullying
occurred, felt a stronger urge to quit than those actually being bullied.”
SAGE, 2012
Is This Your Department?
Costs, Direct & Indirect“In the United States, the actual cost [is]…$250 million annually in expenditures related to health care, litigation, staff
turnover, and retraining from workplace bullying…this figure may be low given a lot of these types of costs are not always attributed to bullying when in fact they
could be.”BLR, 2012
Incivility, bullying, harassment, & discrimination affect the bottom line because these behaviors increase
anxiety, depression, absenteeism, presenteeism, & turnover; & decrease motivation, quality of work, output, job satisfaction, & ability to meet goals.
Communication ceases, problems can’t be solved, people can’t learn, gossip takes over, customer
service suffers, & stress prevents effective decision-making. Further, the consequences of negativity
extend far beyond the perpetrator & target relationship. Anyone witnessing the aggressive behaviors, even if they don’t necessarily feel
victimized by it, loses loyalty to managers & the organization, and, thus, their work suffers, too.
Inside Training, 2013
Costs
Costs...“The real problem is not the young,
inexperienced nurse but the experienced nurses who are bullies, and those that stand by silently and allow it to happen. The cost of bullying behavior is in the loss of bright and talented nurses who leave the profession,
increasing turnover, destabilizing patient care systems and putting patient safety at great risk. It is in fact, almost immeasurable in its
cost to society.”Anonymous, 2013
Costs...“Merely showing up for work in an
environment where bullying goes on is enough to make many of us think about
quitting…nurses not bullied directly, but who worked in an environment where workplace bullying occurred, felt a stronger urge to quit
than those actually being bulliedSage, 2012
Effects on the workplace Increased absenteeism
Increased turnover
Increased costs: EAP programs, recruitment, etc.
Increased risk for accidents/incidents
Decreased productivity & motivation, & morale
Reduced corporate image & customer confidence
Poor customer service
How is HR Neutralized?HR reports to the wrong level
HR is extremely decentralized
CEO doesn’t get HR’s strategic value
HR is staffed inexperienced, untrained or unethical people
HR is directly a victim of HVSuzi Benoit, 2013
To be effective in preventing HV, we must be effective in preventing neutralization of HR
How Bullies Neutralize ManagementTelling only part of the storyDeflectionPlaying the victimStrategic partneringExploiting mistakesPre-emptive strikes (complaining about the victim, safety issues, ethical issues, first)“Where is the policy on…”
Classic HV!
Preventing HVMeet w/bully & follow these basic rules:
This in not an investigative interview – it’s not about excuses or the bully’s version of things
Be direct – “People are afraid of you, staff don’t feel safe” – avoid “Please be nicer!”
Bully is often in denial and/or disagrees w/findings
Don’t try to understand why bullies bully – this is not therapy!
Consequences are an absolute must: bullies won’t change unless motivated
Make good on threats – terminate the bully!BLR, 2013
Preventing HV
Ensure that respect is a core value Ensure a zero tolerance towards
abusive behavior policy & start at senior level
Ensure protection from retaliation if reported
Encourage utilization of EAP program Train staff on Horizontal Violence Conduct exit surveys & ask about
bullying Listen!
AMA, 2013, BLR, 2013
At management/system level:
Help staff:
To understand that they did nothing wrong: the bully usually chooses a victim for no good reason (or because s/he feels threatened by him or her for some reason)
To engage in reflective practice: keep a journal, raise self-awareness about their values, beliefs, attitudes, & behavior – are they guilty of horizontal violence? (are they supportive, encouraging – or do they create an environment infected w/horizontal violence)
To ensure self-caring behaviors: seek counseling, promote peer support, good nutrition, adequate sleep, take time out to relax, exercise
Be willing to speak up when they see it happening & name “horizontal violence” for
what it is
Preventing HV
If staff are subjected to horizontal violence, have them:Address the problem immediately with the person – often the person has no idea s/he is doing it
Use conflict management strategies – Say “I feel … when you …”
Again, name it, and if not stopped – have them take comprehensive notes, and refer it to their supervisor or to HR
What to do
Use positive & respectful tone
Use respectful & active listening – look coworkers in the eye when they are talking
Lead by example!
Own up to your mistakes, don’t attempt to shift the blame
When making requests, be polite & tactful –remember, it’s just that: a request
Be willing to help when requested
Don’t participate in gossip
Coach staff on these methodsWhat you permit, you
promote
Invite loners & newcomers to breaks/meals
When others do a kind act, thank them in front of others
Accept your fair share of the workloadWork together (despite personal dislikes)
Address coworkers by their first names
Ask for help & advice when needed
Stand up for peers in their absence, don’t be critical of them
Don’t engage in vertical violence – it just perpetuates horizontal violence in others
Smile!
And…
So…be a buddy, not a bully!
Because…“The real problem is not the young,
inexperienced nurse but the experienced nurses who are bullies, and those that stand by silently and allow it to happen. The cost of bullying behavior is in the loss of bright and talented nurses who leave the profession,
increasing turnover, destabilizing patient care systems and putting patient safety at great risk. It is in fact, almost immeasurable in its
cost to society.”Stopbullyingnurses.com, 2013
Pearls of Wisdom
More Pearls
Practice the 3 R’sRespect for self
Respect for others
Responsibility for all your actions
Anonymous (n.d.) Horizontal violence: The CNA’s worst enemy & the nursing home’s number one threat to quality care. Retrieved from the World Wide Web on January 28, 2004: http://www.nursingassistants.net/HV~ns4.html
BLR (2012) Bullying at the workplace: statistics on bullying. Retrieved from http://hr.blr.com/HR-news/Health-Safety/Violence-in-the-Workplace/zn-Bullying-workplace-Statistics-on-Bullying/
Center for American Nurses (2008) Lateral Violence and Bullying in the Workplace.
Catalanello, R (2009) Bullying at work can make you sick, but remedies are few. Retrieved from: http://www.tampabay.com/news/humaninterest/article1021546.ece
Funk, C. (2002, September 1). Cutting down the tall poppies: horizontal violence: Sam Houston State University
Hastie, C. (2002, August 6) Horizontal violence in the workplace. Retrieved from: http://preparingforbirth.com/articles/hastie02.html
NIOSH (2004) Most workplace bullying is worker to worker, early findings from NIOSH study suggest Retrieved from: http://www.cdc.gov/NIOSH/updates/upd -07-28-04.html
Bibliography
BibliographyOppermann, S (2008) Workplace Bullying: Psychological Violence? Retrieved from the World Wide Web on July 30, 2009: http://www.workplacebullying.org/2009/05/04/workplace-bullying-psychological-violence-
Orlando Business Journal, (2002) Workplace bullying’s high cost: $180M in lost time, productivity. Retrieved from http://orlando.bizjournals.com/orlando/stories/2002/03/18/focus1.html
SAGE Publications (2012, July 2) “The Effects of Bullying and ‘Ambient’ Bullying in the Workplace” Medical News Today. Retrieved from www.medicalnewstoday.com/releases/247299.php
Skillings, L. N. (1990) Perceptions and feelings of nurses about horizontal violence as an expression of oppressed group behavior. USM.
Vanderwahl, T. (2005) Retrieved from the World Wide Web on July 31, 2009: Http://www.itstimes.com/jul2005.htm
BibliographyJusko, J. (2013) Operations: New Year’s resolution – stop workplace bullies. Retrieved from the world wide web on January 22, 2013: http://www.industryweek.com/safety/operations-new-years-resolution-stop-workplace-bullies
American Nurses Association (2013) Lateral violence and bullying in nursing. Retrieved from the world wide web on January 22, 2013: http://www.nursingworld.org/Mobile/Nursing-Factsheets/lateral-violence-and-bullying-in-nursing.html
Christopher, E. & Pohl, JC (2012) Teen truth. why youth have something to hide. Horizon Intertainment, LLC.
Inside Training (2013) Civility at work. Retrieved from the world wide web on May 29, 2013: http://trainingmag.com/content/civility-work
Townsend, T (2007) Break the bullying cycle. Retrieved from the world wide web on May 29, 2013: http://www.americannursetoday.com/article.aspx?id=8648&fid=8612
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