1 (C) Gullatte 2010 1 Workplace Violence: Safety in Knowledge Mary Gullatte, PhD, RN, APRN, BC, AOCN Associate Chief Nursing Officer Emory University Hospital Midtown, Atlanta, Georgia (C) Gullatte 2010 2 Session Objectives At the end of this presentation the participants will be able to… 1. Recognize and categorize the types of workplace violence 2. Analyze the characteristics of victims and perpetrators 3. Discuss strategies to de-escalate 4. Generate strategies which promote a healthy work environment (C) Gullatte 2010 3 Workplace Violence… Definition… Any physical assaults and verbal, implied, or written threats of assault and intimidation (NIOSH).
16
Embed
Workplace Violence: Safety in Knowledge - ONSldi.vc.ons.org/.../89344/ONS+Workplace+Violence+Webcast+Gullatte.pdfWorkplace Violence: Safety in Knowledge Mary Gullatte, ... Managing
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
(C) Gullatte 2010 1
Workplace Violence:
Safety in Knowledge
Mary Gullatte, PhD, RN, APRN, BC, AOCN
Associate Chief Nursing Officer
Emory University Hospital Midtown, Atlanta, Georgia
(C) Gullatte 2010 2
Session Objectives
At the end of this presentation the participants will be able to…
1. Recognize and categorize the types of workplace violence
2. Analyze the characteristics of victims and perpetrators
3. Discuss strategies to de-escalate
4. Generate strategies which promote a healthy work environment
(C) Gullatte 2010 3
Workplace Violence…
Definition…
Any physical assaults and verbal, implied, or written threats of assault and intimidation (NIOSH).
2
(C) Gullatte 2010 4
Types of Workplace Violence
Intimidation 75.9%
Angry outbursts 71.9%
Hypersensitivity to criticism 71.5%
Belligerence 66.9%
Threatening/disruptive behavior 64.6%
Bullying 59.8%
Harassment 51.6%
Threats of physical violence 38.9%
Ominous or specific threats 27.9%
Hader, R. (2008). Workplace violence: Survey 2008. Nursing Management.
(C) Gullatte 2010 5
Who are the Players
Perpetrator
Patient 53.2%
Nursing colleagues 51.9%
Physician 49%
Visitor 47%
Other healthcare worker37.7%
Victim
Nursing colleague 79.7%
Other HC provider 50.5%
Patient 21.1%
Physician15.5%
Visitor10.9%
Hader, R. (2008). Workplace violence: Survey 2008. Nursing Management.
(C) Gullatte 2010 6
Cost of Work Place Violence
1993-1999 cost of WP violence
=~ $4.2 billion dollars annually*
Rate of violent victimization /1000 nurses =21.9% (Duhart, 2001)
? Under-reporting
*Bureau of Justice National Crime Victimization Survey (2001)
3
(C) Gullatte 2010 7
Workplace Violence Profiles
Certain jobs with greater risk of violence
Working with people in emotional situations…
Nurses working with patients/families
Office personnel handling billing issues
Patients dissatisfied with results
Working late at night and/or alone Medical records, collection calls, overtime, board
meetings
Managing drug samples or onsite pharmacy
Drug theft and burglary
Philip Dickey (2008)
(C) Gullatte 2010 8
Workplace Violence Profiles
Work situations
Layoffs and firing
Passed over for promotion or raise
Performance reprimands or warnings
Ongoing or unresolved arguments between co-workers
P. Dickey (2008)
(C) Gullatte 2010 9
Workplace Violence Profiles
Personnel Problems
Failed, one-sided, or abusive personal relationships
Romantic obsession that includes stalking or harassment
Serious personal problems combined with job-related problems
P. Dickey (2008)
4
(C) Gullatte 2010 10
Workplace Violence Profiles
Which nurses are most at risk?
Emergency Department
Mental health
Geriatric
Young nurses (lack of experience)
?oncology nurses
Mary Gallant-Roman, (2008)
(C) Gullatte 2010 11
Workplace…Red Flags
Employees or Someone who… Threatens and intimidates others
Blames others for problems
Gets angry easily and often
Uses abusive language
Talks a lot about weapons
Holds grudges
Reacts angrily to criticisms
Difficulty maintaining relationships
Abuses drugs
History of violent acts
P. Dickey (2008)
(C) Gullatte 201012
Hidden Workplace Violence
Combative patients
Support staff (UAPs)
Co-workers (Nurses, MDs,
APPs: NPs, PAs, Managers)
Incivility- rude, discourteous acts
Bullying-belittling, finding fault
Mobbing- multiple people against one person
Intimidation –frighten, influence through fear
5
(C) Gullatte 2010 13
Factors Foster Uncivil Behaviors
Occupational stress
Difficult working conditions
Unresolved conflict
Lack of leadership
Oppression
Isolation of and less social engagement
Complexity and fragmentation of relationships
Farkas & Johnson (2002)
(C) Gullatte 2010 14
Employee Workplace Behaviors
What you Permit you Promote…
Not setting limits when you hear about inappropriate behaviors
Employees not respecting leadership decisions
Undermining authority
Unfair, unilateral decision
Uncivil behavior is contagious
(C) Gullatte 2010 15
Consequences of Negative
Workplace Relationships
Job dissatisfaction
Decreased worker productivity
Job withdrawal (work avoidance: call-outs)
Harkreader (2008)
6
(C) Gullatte 2010 16
Keys to Prevention
(C) Gullatte 2010 17
Prevention: Start with the Work
Environment Foster a harmonious, supportive work
environment
Provide fair treatment and performance management for all employees
Offer Conflict Resolution and
Effective Communication
training for staff
(C) Gullatte 2010
18
Prevention: Start with the Work
Environment
Establish procedures for handling grievances
Take threats seriously and respond rapidly
Monitor and manage the stress levels of the work environment
7
(C) Gullatte 2010 19
Know your team members:
Individual responses to stress
Monitor team dynamics
Stay connected and engaged
Make note of the formal and
informal communication of
the team
Keep lines of communication
open with employees
Utilize clear, direct communication
when engaged in constructive confrontation
(C) Gullatte 2010 20
Possible Precipitating Events
Work Factors Discipline or Negative Performance Review
Reduction In Force/Termination/Demotion/
Promotion Denial
Accumulated Grievances
Perception of Harassment
Personal Factors Loss of Relationship
Financial Loss
Legal Action
Loss of Face/Humiliation
Personal Rejection
(C) Gullatte 2010 21
Keys to De-escalation
8
(C) Gullatte 2010 22
Work Place Violence:
Success Strategies
Evaluate your workplace
Use top-down approach and buy-in
Institute zero tolerance
Empowerment of Nurses
Predict High-risk events
Provide education for all
(C) Gullatte 2010 23
Progression of Violence
Traumatic experience perceived as being unsolvable
Projection of Responsibility
Defensive Attitude
Perception of “No Justice”
Takes “Justice” into own hands
Handbook of Workplace Violence (2006)
(C) Gullatte 2010 24
Report Warning Signs
Immediately Ominous Treats
Threatening Actions
Bizarre Thoughts and/or Behaviors
Obsessive Thoughts and/or Behaviors
Stalking Behaviors
Aggressive and threatening emails
Sharing inappropriate behaviors with colleagues (e.g., purchase of weapons)
Baron (2000)
9
Resources
Police/Security Department
Human Resources
General Counsel
Critical Incident Response Team
Chaplains/ Pastoral Counseling Services
(C) Gullatte 2010 25
(C) Gullatte 2010 26
Evaluation and Response to
Workplace Violence:
Zero Tolerance for WP violence (OSHA)
Identify your organizational resources
Document and seek consultation about the warning signs:
Behaviors
Interpersonal interactions
Persecutory thoughts and emails
Changes in work performance
Baron (2000)
(C) Gullatte 2010 27
Next Steps
10
(C) Gullatte & Gomes, 2009 28
28
Healthy Work Environments
Made, NOT Born…YOU are the Catalyst.
(C) Gullatte 2010 29
A Healthy Work Environment
Starts with
(C) Gullatte 2010 30
Empowerment Zone
What can you do to empower your voice and connect in the workplace?
11
(C) Gullatte 2010 31
Consequences of an UN-Healthy
Work Environment
Lack of team work
Risk to patient safety
Lack of staff engagement
Workplace violence
Lateral violence within the work group
Lack of patient, employee, and provider satisfaction
High staff turnover among all groups
www.aacn.org
(C) Gullatte 2010 32
Signs of a Healthy Work Environment
1. Employees laugh often
2. Employees freely share their ideas
3. Employee values and expectations are clear
4. We work simply: decrease complexity
5. Our organization is reasonably orderly and comfortable
6. Employees have strong connections with others
7. Encourage and reward staff that volunteer outside of work
Dysfunctional environment and toxic culture (open warfare, sabotage, grievances, etc)
Micromanagement
Punishing systems
Personal Relationships
Dysfunctional relationships
Hot and angry confrontations
Defensive posturing
Labeling others as enemies
Covey, S.R.M. (2006)
(C) Gullatte 2010 36
Environment of Very Low Trust
Organizational
Unhealthy working environment
Unhappy employees
Excessive time wasted defending positions and decisions
Personal Relationships
Hostile behaviors (yelling , blaming, accusing)
Guarded communication
Worrying and suspicion
Mistakes remembered and used and weapons
Real issues not surfaced or dealt wit effectively
Covey, S.R.M. (2006)
13
(C) Gullatte 2010 37
Environment-Trust is a Visible
Asset Organizational
The focus is on work
Effective collaboration and execution
Personal Relationships
Cooperative, close vibrant relationships
A focus on looking or and leveraging one another’s strengths
Uplifting and positive communication
Covey, S.R.M. (2006)
(C) Gullatte 2010 38
Inspiring TRUST
Nothing is as profitable as the economics of trust
Nothing is as relevant as the pervasive impact of trust
The dividends of trust can significantly enhance the quality of every relationship on every level of your life.
Covey (2006), p. 285
(C) Gullatte 2010 39
Shared Governance/
Decision Making
An organizational innovation that gives healthcare professionals control over their practice and extends their influence into administrative areas previously controlled only by managers. Governance models should be evidence-based.
http://www.sharedgovernance.org/
(Porter-O’Grady, 2003)
14
(C) Gullatte 2010 40
Positive Consequences of Shared
Governance/Decision Making
Improved decision making
Service excellence
Organizational influence
Collaboration
Improved communication
Healthy Work Environment
(C) Gullatte 2010 41
Creating a Healthy Culture
Collaborative Partnerships
Respect and Value of each person
Zero tolerance of workplace violence in policy
Label disruptive behavior included in policy
Enforcement has to be at every level
Front-line managers
Senior level administrators
Medical staff
All Healthcare Staff
(C) Gullatte 2010 42
Keeping Healthy…
Integrating into a New Work Culture
What works? Self-esteem
Self-confidence not cocky Build Knowledge
Workplace culture
People
Clinical
Clinical skills
People relationships/skills
Positive influence with people
Leadership
Seek a mentor
15
(C) Gullatte 2010 43
If all else fails…
What do you do ???
(C) Gullatte 2010 44
Group Discussion…
Share some unhealthy work environment behaviors (forms of violence in the workplace) you have encountered as a student?
How did you handle it?
What was the outcome?
Would you do anything differently?
(C) Gullatte 2010 45
Your Thoughts…
16
Selected References
AACN Healthy work environment. http://www.aacn.org ANCC. Magnet. http://www.nursecredentialing.org An overview of healthcare workplace violence. Healthcare hazard
Management Monitor, 22(6): 1-6. Barling, J., Dupre, K., & Kelloway, E. (2009). Predicting workplace
aggression and violence. Annual Review of Psychology, 60: 671-92. Bigony, L., Lipke, T., Lundberg, A., McGraw, C., Pagac, G., &
Rogers, A. (2009). Lateral violence in the perioperative setting. AORN Journal, 89(4); 688-96. Covey, S.M.R. (2006). The speed of trust. FreePress. New York.
Danesh, V., Malvey, D., & Fottler, M. (2008). Hidden workplace violence: What your nurses may not be telling you. Health Care Management, 27(4): 357-63.
Developing and implementing a workplace violence prevention program and policy. http://www.cdc.gov/niosh/violdev.html
Gallant-Roman, M. (2008). Strategies and tools to reduce workplace violence. AAOHN Journal, 56(11): 449-54.