Issue for Change

Issue for Change

Part A: Developing a searchable question in PICOT format

PICO question

Among nurses in medical-surgical units, does restorative organizational approaches reduce future incidences of lateral violence among nurses compared to regulatory approaches?

P – Nurses in medical-surgical units

I – Restorative organizational approaches

C – Regulatory approaches

O – Reduced occurrence of lateral violence and bullying

 

Part B: Issue in a Clinical Environment

The type of work environment for nurses has implications for job satisfaction, nurse turnover, and medication errors. An issue of concern that I identified in my previous work environment is lateral violence. As Weaver (2013) observes, lateral violence, also referred to as horizontal violence, is “unwanted behavior occurring in the workplace between coworkers, is either physical or verbal, and is viewed as intolerable by the receiver” (p. 138). In the case of bullying, as Vessey, DeMarco and DiFazio (2010) observe, “real or perceived power differential between the instigator and recipient must be present …” (p. 136). Behavior involved in lateral violence and bullying includes humiliation or ridicule, withholding information another nurse needs, favoritism, gossip, exclusion, offensive remarks, being subjected to work below the level of one’s competence, constant criticism of one’s work by other nurses, and being assigned to unmanageable workload (Simons, 2008). As further noted by Dellasega (2009), being a new graduate, non-transparent promotion, special attention from physicians, and understaffing can predispose nurses to being bullied by colleagues. On the other hand, profiles such as supernurses, resentful nurses, gossiping nurses, backstabbing nurses, envious nurses, and cliquish nurses are linked to perpetrating lateral violence ( (Dellasega, 2009). The adverse effects of lateral violence on work environment, quality of care, and patient outcomes necessitate effective initiatives to reduce their occurrence.

Lateral violence occurs in different care settings but at varying extents. For instance, in a study with a sample of registered nurses across the US, Vessey, Demarco, Gaffney and Budin (2009) found out that lateral violence was more prominent in medical-surgical units (23%) followed by critical care units (18%; p. 302). Emergency units had 12% rate of lateral violence, operating rooms or Post Anesthesia Care units a nine percent rate, and obstetrical unit a seven percent rate (Vessey et al., 2009, p. 302). In a different study prevalence rate of lateral violence among nurses working in emergency units in Washington State was reported to be 27.3% for a period of 6 months prior to the study (Johnson & Rea, 2009). Outside the US, a recent survey of nurses’ experience of violence and bullying in victoria, Australia, 32% of the sample indicated being experiencing violence from colleagues (Hutchinson, 2014). In Spain, a study by Iglesias and Vallejo (2012) found out that about one in every five nurses had experienced a case of lateral violence in their workplaces. Combined, the findings in these studies indicate the need to re-orient nursing practice to its basis of care where it can act as a model for respectful work environment.

In respect to the effects of the issue on work environment, quality of care, patient outcomes, and nursing profession lateral violence has significant adverse effects on the three. In respect to work environment and nurse outcomes various studies (Chipps, Stelmaschuk, Albert, Bernhard, & Holloman, 2013; Read & Laschinger, 2013; Simons, 2008; Vessey et al. 2009; Weaver, 2013; Wright & Khatri, 2014; Yildirim, 2009) have indicated that bullying promotes a negative work environment associated with low job satisfaction, high turnover, and adverse mental and physical health for nurses. In respect to patient outcomes, lateral violence is associated with poor quality of care and increased medical errors (Chipps et al., 2013; Wright & Khatri, 2014). Concerning nursing profession, lateral violence may dissuade new talent from joining the profession thus contributing to the increasing prevalence of nurse shortage. For instance, in a study by Vogelpohl Rice, Edwards, and Bork (2013), 29.5% of the new graduate nurses surveyed indicated that they had considered abandoning the profession because of their experiences with workplace violence. Such adverse effects of lateral violence reinforce the need for effective strategies to address the situation.

To address this issue in my previous organization, the proposed change is for the organization to establish a restorative culture that will help motivate appropriate behavior among nurses. Hutchinson (2009) highlights components of such a restorative organizational approach to be “shared responsibility and shared concern” characterized by non-punitive counseling of perpetrators, encouraging pro-social work groups, and having restorative conferences or circles (p. 149). This would create a culture of concern for others such that each nurse in the unit can serve as an advocate for violence-free environment by discouraging demeaning behaviors even when not being the subject of such behavior. This is preferable as a primary approach rather than the regulatory policies for example where leaders may not have the tools to detect lateral violence (Vessey et al., 2010) or are unwilling to take action (Simons & Sauer, 2013).

 

References

Chipps, E., Stelmaschuk, S., Albert, N. M., Bernhard, L., & Holloman, C. (2013). Workplace bullying in the OR: Results of a descriptive study.  AORN Journal, 98(5), 479-493, http://dx.doi.org/10.1016/j.aorn.2013.08.015

Dellasega, C. A. (2009). Bullying among nurses. American Journal of Nursing, 109(1), 52-58.

Hutchinson, M. (2009). Restorative approaches to workplace bullying: Educating nurses towards shared responsibility. Contemporary Nurse, 32(1-2), 147-155.

Hutchinson, M. (2014). Around half of nurses and midwives report workplace aggression in the past month: 36% report violence from patients or visitors and 32% report bullying by colleagues. Evidence Based Nursing, 17(1), 26-27, doi:10.1136/eb-2013-101232

Iglesias, M. E. L., & Vallejo, R. B. B. (2012). Prevalence of bullying at work and its association with self-esteem scores in a Spanish nurse sample. Contemporary Nurse, 42(1), 2-10.

Johnson, S. L., & Rea, R. E. (2009). Workplace bullying: Concerns for nurse leaders. The Journal of Nursing Administration, 39(2), 84-90, doi:10.1097/NNA.0b013e318195a5fc

Read, E., & Laschinger, H. K. (2013). Correlates of new graduate nurses’ experiences of workplace mistreatment. Journal of Nursing Administration, 43(4), 221-228, doi:10.1097/NNA.0b013e3182895a90

Simons, S. (2008). Workplace bullying experienced by Massachusetts registered nurses and the relationship to intention to leave. Advances in Nursing Science, 31(2), E48-E59.

Simmons, S., & Sauer, P. (2013). An exploration of the workplace bullying experience: Coping strategies used by nurses. Journal for Nurses in Professional Development, 29(5), 228-232, doi:10.1097/01.NND.0000433147.33631.c9

Vessey, J. A., DeMarco, R., & DiFazio, R. (2010). Bullying, harassment, and horizontal violence in the nursing workforce: The state of science. Annual Review of Nursing Research, 28(10), 133-157, doi:10.1891/0739-6686.28.133

Vessey, J. A., Demarco, R. F., Gaffney, D. A., & Budin, W. C.  (2009). Bullying of staff registered nurses in the workplace: A preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. Journal of Professional Nursing, 25(5), 299-306, doi:10.1016/j.profnurs.2009.01.022

Vogelpohl, D. A., Rice, S. K., Edwards, M. E., & Bork, C. E. (2013). New graduate nurses’ perception of the workplace: Have they experienced burying. Journal of Professional Nursing, 29(6), 414-422, http://dx.doi.org/10.1016/j.profnurs.2012.10.008.

Weaver, K. B. (2013). The effects of horizontal violence and bullying on new nurse retention. Journal for Nurses in Professional Development, 29(3), 138-142, doi:10.1097/NND.0b013e318291c453

Wright, W. & Khatri, N. (2014). Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Management Review. Advance online publication. doi:10.1097/HMR.0000000000000015

Yildirim, D. (2009). Bullying among nurses and its effects. International Nursing Review, 56(4), 504-511, doi:10.1111/j.1466-7657.2009.00745.x

 

Part C: Appraisal of Articles

Chipps, E., Stelmaschuk, S., Albert, N. M., Bernhard, L., & Holloman, C. (2013). Workplace bullying in the OR: Results of a descriptive study.  AORN Journal, 98(5), 479-493, http://dx.doi.org/10.1016/j.aorn.2013.08.015

This article evaluates whether the occurrence of lateral violence in perioperative and surgical settings in medical centers is a factor of gender, unit experience, professional experience, ethnicity, and job title. It relates lateral violence with nurses’ emotional exhaustion and patient safety. The article offers statistics for incidence of lateral violence. An example is “34 % reported at least two bullying acts weekly.” The article supports the proposed change with authors stating that “Organizational antecedents, such as organizational culture, senior leadership, and hospital policy, must encourage the elimination of bullying” (p. 491).

Dellasega, C. A. (2009). Bullying among nurses. American Journal of Nursing, 109(1), 52-58.

This article reviews various studies on lateral violence and offers author’s experiences in discussion with other nurses about the issue. The article provides statics in parts of the review. An example is that “A British survey… found that 44% of nurses … reported experiencing ‘peer bullying’” (p. 52). The article supports the proposed change noting that “Once nurses are speaking a common language about relational aggression, it can be useful to encourage dialogue and brainstorm solutions” (p. 56).

Hutchinson, M. (2009). Restorative approaches to workplace bullying: Educating nurses towards shared responsibility. Contemporary Nurse, 32(1-2), 147-155.

This article highlights the need for a restorative approach to combat lateral violence. The article discusses the issue of lateral violence in its literature review. It does not provide statistics on the issue but cites studies that compare the incidence to “high risk occupations such as police and prison officers” (p. 147). The study supports the proposed change.

Hutchinson, M. (2014). Around half of nurses and midwives report workplace aggression in the past month: 36% report violence from patients or visitors and 32% report bullying by colleagues. Evidence Based Nursing, 17(1), 26-27, doi:10.1136/eb-2013-101232

This brief report presents results of survey of lateral violence in Australia. It provides statistics indicating the prominence of the issue even in Australian care settings. An example is the finding that “32% report bullying by colleagues” (p. 26). It supports the proposed change stating that “it is important to develop programmes that enable bystanders to take action when they witness bullying” (p. 26).

Iglesias, M. E. L., & Vallejo, R. B. B. (2012). Prevalence of bullying at work and its association with self-esteem scores in a Spanish nurse sample. Contemporary Nurse, 42(1), 2-10.

This article evaluated the extent of lateral violence among nurses in Spain. It gives statistics on the gravity of the issue. An example is that “one in five nurses (17%) experienced subjective bullying …” (p. 2). It supports the proposed change noting that “by raising awareness about the problem of workplace bullying, healthcare staff may become less tolerant of negative behaviours …” (p. 8).

Johnson, S. L., & Rea, R. E. (2009). Workplace bullying: Concerns for nurse leaders. The Journal of Nursing Administration, 39(2), 84-90, doi:10.1097/NNA.0b013e318195a5fc

This study evaluates the extent of lateral violence within emergency care environments in Washington State. It provides statistics to support the seriousness of the issue, stating that “27.3% [of those surveyed] had experienced workplace bullying in the last 6 months” (p. 84). The article supports the proposed change concluding that nurse leaders can “lead their nurses to examine their own bulling behavior and work together to create workplace environments in which bullying is not tolerated” (p. 89).

Read, E., & Laschinger, H. K. (2013). Correlates of new graduate nurses’ experiences of workplace mistreatment. Journal of Nursing Administration, 43(4), 221-228, doi:10.1097/NNA.0b013e3182895a90

This study evaluates aspects that facilitate lateral violence and the individual and organizational outcomes of such violence. It provides statistics indicating the occurrence of the issue. An example is that “Workplace incivility happened less than once or twice a week and bullying only every now and then” (p. 224). The article offers indirect support for proposed change by advocating for “authentic leadership and empowering work environments … [and] practices to prevent and reduce workplace mistreatment targeting new graduate nurses” (p. 227).

Simons, S. (2008). Workplace bullying experienced by Massachusetts registered nurses and the relationship to intention to leave. Advances in Nursing Science, 31(2), E48-E59.

This article evaluates the association between lateral violence behaviors and nurses’ intentions to leave their work. It provides statistics indicating extent of the issue among the participants where 31% “reported being bullied” (p. E48). It supports the proposed change noting that “Nurses have a responsibility to change the culture and foster an environment that nurtures and inspires rather than flagellates and humiliates those entering the profession” (p. E57).

Simmons, S., & Sauer, P. (2013). An exploration of the workplace bullying experience: Coping strategies used by nurses. Journal for Nurses in Professional Development, 29(5), 228-232, doi:10.1097/01.NND.0000433147.33631.c9

This study assessed strategies that nurses who are subjected to lateral violence use to cope. The study does not provide statistics on the issue since it aims at conducting a qualitative exploration of themes for coping strategies starting with a convenience sample of nurses who have already experienced the vice. Despite such an approach, the article offers support for the proposed change with the authors concluding that “the cycle of disrespect can be changed through a committed effort at the individual and organizational level [to change a] culture that tacitly accepts workplace bullying behavior” (p. 231).

Vessey, J. A., DeMarco, R., & DiFazio, R. (2010). Bullying, harassment, and horizontal violence in the nursing workforce: The state of science. Annual Review of Nursing Research, 28(10), 133-157, doi:10.1891/0739-6686.28.133

This review provides the evidence generated over the years about lateral violence. It provides statistics from reviewed studies indicating the seriousness of the issue. An example is that “Five studies conducted in the international arena reveal that between 17% and 76% of professional nurses report experiencing BHHV” (p. 141). It supports the proposed change by noting “ongoing nonconfrontational surveillance” and “a system for assessing staff perceptions of the seriousness and extent of unprofessional behaviors” as some of the evidence-supported interventions for addressing lateral violence. (pp. 146-147).

Vessey, J. A., Demarco, R. F., Gaffney, D. A., & Budin, W. C.  (2009). Bullying of staff registered nurses in the workplace: A preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. Journal of Professional Nursing, 25(5), 299-306, doi:10.1016/j.profnurs.2009.01.022

This study assesses the extent of lateral violence in different care settings. It provides statistics that, for example, indicate the medical-surgical units to be the settings where lateral violence is most predominant among the assessed settings. The study supports the proposed change noting the need for “innovative strategies be implemented to improve positive collaborative relationships and facilitate open communication among nurse colleagues” (p. 305).

Vogelpohl, D. A., Rice, S. K., Edwards, M. E., & Bork, C. E. (2013). New graduate nurses’ perception of the workplace: Have they experienced burying. Journal of Professional Nursing, 29(6), 414-422, http://dx.doi.org/10.1016/j.profnurs.2012.10.008.

This study evaluated experiences of lateral violence among newly registered nurses in Northwestern Ohio. It provides statistics to highlight the extent of the issue within such a population noting that “21.1% of new graduates reported that they were ignored and secluded” during monthly meetings (p. 418). The study supports the proposed change noting that “a supportive mentor who helps the new graduate feel confidence may be a deterrent for the new nurse graduate’s decision to change jobs or leave the profession” (p. 420).

Weaver, K. B. (2013). The effects of horizontal violence and bullying on new nurse retention. Journal for Nurses in Professional Development, 29(3), 138-142, doi:10.1097/NND.0b013e318291c453

This review highlights the link between lateral violence and nurse turnover. It provides statistics of the vice by citing the reviewed studies. For instance, the study cites the review by Vessey et al. (2010) indicating “between 17% and 76% of nurses report interpersonal conflict” in their workplaces (Weaver, 2013, p. 139).  The review supports the proposed change noting that “healthcare organizations may assist in preventing horizontal violence by supporting interprofessional discussions that promote collaboration and deter conflict” (p. 141)

Wright, W. & Khatri, N. (2014). Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Management Review. Advance online publication. doi:10.1097/HMR.0000000000000015

This study evaluated how lateral violence influences personal outcomes and medication errors. The study provides statistics for the extent of lateral violence among the sampled nurses of a university hospital system. Twenty three percent reported having experienced lateral violence, which was linked to adverse mental and physical health and medication errors. The study supports the proposed change in the authors’ observation that “an organization’s culture may contribute to continued bullying behaviors [and that] leadership should evaluate the current culture’s tolerance of bullying behaviors” (p. 8).

Yildirim, D. (2009). Bullying among nurses and its effects. International Nursing Review, 56(4), 504-511, doi:10.1111/j.1466-7657.2009.00745.x

This study assesses the occurrence of lateral violence and effects in Turkey. It provides statistics to support occurrence of the vice even out of the US noting that 21% of those surveyed had been exposed to behaviors identified to indicate lateral violence, which was associated to adverse effects such as depression. The study supports the proposed change in its conclusion that “As employees become aware of the subject of psychological violence in the workplace, they will no longer accept dishonouring or belittling behaviours as part of their jobs …” (p. 510).

 

 

 

 

 

 

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