3. WHAT IS WORKPLACE
VIOLENCE?
• Yoder-Wise definition of violence: overt or covert behaviors
ranging from offensive or threatening language to homicide
(Yoder-Wise, 2011)
• ANA’s definition of bullying: repeated, unwanted harmful
actions intended to humiliate, offend and cause distress
(ANA, 2016)
4. Box 1: Types of 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%
Obsession with a supervisor 28.5%
Ominous or specific threats 27.9%
Physical violence 25.8%
Intentional property damage 17.0%
Preoccupation with recently publicized violent
events
8.3%
Carrying or storing weapons 7.5%
Preoccupation with violent themes 5.9%
Recent acquisition of or fascination with
weapons
5.6%
Box 1; Retrieved from Hader, R (2008) Workplace Violence Survey 2008.
Nursing Management, 39(7), 13-19. As cited in Yoder-Wise (2011, p. 500)
5.
6.
7. NURSING RESOURCE
MANAGEMENT
• SKILLED AND KNOWLEDGEABLE
NURSE WORKFORCE; HIGH IN
QUALITY AND QUANTITY OF STAFF
• OSHA GUIDELINES
• ”THREAT-MANAGEMENT TEAM”
8. EVIDENCE BASED PRACTICE,
QUALITY, & SAFETY
• The literature on workplace violence has
certainly emerged, however, there are not many
evidenced-based & credible interventions to
reduce and prevent violence and bullying
METHODS & STRATEGIES
• Violence Prevention Framework
• Recording an incident, witnesses involved,
descriptive characteristics, pre- and post-
interventions, outcomes
• Emotional Intelligence
9.
10.
11. CONCLUSION
• INSTITUTE OF MEDICINE CORE
COMPETENCIES
• VIOLENT ACTS IMPOSE NEGATIVITY ON
WORKPLACES
• EVIDENCE BASED PRACTICE = UP TO DATE
PREVENTION METHODS AND STRATEGIES
• REPORTING ALL VIOLENT ACTS = IMPROVE
QUALITY CARE OF PATIENTS
12. REFERENCES• ANA. (2016). HEALTHY WORK ENVIRONMENT. RETRIEVED DECEMBER 01, 2016, FROM
HTTP://WWW.NURSINGWORLD.ORG/MAINMENUCATEGORIES/WORKPLACESAFETY/HEALTHY-WORK-
ENVIRONMENT
• KUPPERSCHMIDT, B., KIENTZ, E., WARD, J., REINHOLZ, B., (JAN. 31, 2010) "A HEALTHY WORK
ENVIRONMENT: IT BEGINS WITH YOU" OJIN: THE ONLINE JOURNAL OF ISSUES IN NURSING VOL. 15, NO. 1,
MANUSCRIPT 3.
• MULLER, R., & KARSTEN, M. (2012, MARCH). DO YOU SPEAK FINANCE? NURSING MANAGEMENT, 43(3), 50-
54. RETRIEVED NOVEMBER 9, 2016, FROM
HTTP://JOURNALS.LWW.COM/NURSINGMANAGEMENT/FULLTEXT/2012/03000/DO_YOU_SPEAK_FINANCE_.13.
ASPX
• NOTAROBERTA, A. S. (2012, MARCH). WORKPLACE VIOLENCE PREVENTION: TEAM COLLABORATION
IS THE KEY. PROQUEST, 49(3). RETRIEVED NOVEMBER 10, 2016, FROM
HTTP://SEARCH.PROQUEST.COM.EZPROXY.NEU.EDU/DOCVIEW/993165558?ACCOUNTID=12826&RFR_
ID=INFO:XRI/SID:PRIMO
• OSHA. (2015). GUIDELINES FOR PREVENTING WORKPLACE VIOLENCE (REP. NO. 3148). RETRIEVED
DECEMBER 1, 2016, FROM OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION WEBSITE:
HTTPS://WWW.OSHA.GOV/PUBLICATIONS/OSHA3148.PDF
13. REFERENCES CONT.
• PAPA, A., & VENELLA, J. (2013, JANUARY 31). WORKPLACE VIOLENCE IN HEALTHCARE: STRATEGIES FOR
ADVOCACY. THE ONLINE JOURNAL OF ISSUES IN NURSING, 18(1). DOI:10.3912/OJIN.VOL18NO01MAN05
• POTERA, C. (2016). VIOLENCE AGAINST NURSES IN THE WORKPLACE. AMERICAN JOURNAL OF NURSING, 116(6),
20.
• SMITH, T. (2015, MAY 6). REDUCING WORKPLACE VIOLENCE INCIDENTS. HEALTH FACILITIES MANAGEMENT.
RETRIEVED NOVEMBER 13, 2016, FROM
HTTP://WWW.HFMMAGAZINE.COM/ARTICLES/1544?DCRPATH=/TEMPLATEDATA/HF_COMMON/NEWSARTICLE/DATA/H
FM/MAGAZINE/2015/MAY/HFM-VIOLENCE-REDUCTION-STRATEGIES
• TAYLOR, K. (2014). MANAGING CONFLICT. PRACTICE NURSE, 44(10), 32-34
• YODER-WISE, P. S. (2011). LEADING AND MANAGING IN NURSING (5TH ED.). UNITED STATES: ELSEVIER HEALTH
SCIENCES.
Editor's Notes
To begin our presentation on workplace violence and incivility, we first wanted to establish the means of a healthy workplace environment and the importance of it. A healthy environment can actually align with the World Health Organization’s definition of health: a place of ”physical, mental, and social well-being” (ANA, 2016). Promotion of a healthy workplace begins with nurses and other health care providers, as they are the primary influences of a positive environment. As you can see on this slide, there is a collective list of characteristics that are important for the overall health of nurses and that contribute to a culture that breeds safe, effective patient care. Trust and respect between managers and employees, authenticity, and dignity conceptualized to a professional practice environment. Face-to-face interactions should be open, positive, effective and consistent with one’s professional mandates (Kupperschmidt, Kientz, War, Reinholz).
We ask YOU: [ask audience] What is workplace violence, bulling, and incivility?
[audience responses]
Gathering all of your responses to our question, I think we can conclude that workplace violence and incivility can be quite complex. It is seen on a continuum, encompassing a wide array of negative actions, and according to the literature “inactions” (likely referring to acts of negligence). Interestingly enough, based on evidence based practice within the literature, there were no consistent definitions of workplace violence to be found. There were many varying definitions and perceptions of what it entails. Some depicted acts of violence as spitting, pulling hair, biting, and stalking, while others thought it to be abuse, harassment, sexual harassment, and sexual assault, for instance. From what we have found, workplace violence and incivility can encompass all of these acts, and more. Believe it or not, the lack of a consistent definition acts as a barrier in identifying trends, therefore implementing effective strategies and programs is a challenge.
- - These two definitions are quite broad, which is essentially necessary considering the complexity behind the topic; the definitions seem to embody the wide-array of negative actions.
Here is a list of different types of violence, created by Yoder-Wise (2011)
In the context of workplace violence, every nursing role can play a part in finding and implementing solutions to this hazardous clinical situation. It can all begin with nurse leaders, as they typically possess a set of qualities and inborn traits, all of which allow them to accurately identify and take initiative to act. A nurse leader, for instance, may form focus groups to gather direct opinions and perceptions of nurses in relation to any contributing factors of workplace violence (since this is the first step in combatting this issue). In assembling such factors, a nurse leader could then work to form educational and/or prevention programs to train and guide other staff members in sustaining a healthy workplace environment.
Managers, on the other hand, maintain structure and stability to keep an organization operating effectively. So, what they would do, working off of a nurse leader, would be to support the structure of the nurse leader’s initiative of eliminating workplace violence. A manager would do this by raising commitment of all staff members, encouraging attendance to meetings or education/prevention programs. They would also assure that staff members report violent incidences to them in precedence of gaining a trusting relationship with all staff members.
They also oversee the entire nursing staff, validating one’s strengths, knowledge, skills, and abilities (Yoder-Wise, 2011). I think that this is important because part of coping with workplace violence can relate to one’s self-esteem.
Lastly, are nurse followers. These nurses also play a vital role in eliminating workplace violence because of the input that they provide. This input can influence logical solutions to remedy violence and bullying. Equally as important is their feedback after the implementation of strategies, reporting to leaders and managers their efficiencies, or lack thereof.
Overall, nurse leaders, managers, and followers all put forth valuable efforts in facing complex problems within the healthcare system.
As we all know, communication is fundamental to many things in life (for instance: to better understand one another, to resolve differences, and nurture problem solving, amongst many others); it is almost endless. But in regards to workplace violence, it is one of the most important aspects in reducing and preventing bullying and incivility. It is believed that effective communication can reduce the potential risk of violence and conflict between patients and co-workers. So, if lacking, each and every individual must work to improve their personal communication skills, verbal and non-verbal (Taylor, 2014).
The nurse, or other healthcare provider for that matter, should make sure to engage in active listening, through body language, gestures, and of course, their undivided attention. This way, they will be able to recognize a patient’s feelings and emotions, furthermore allowing them to respond the best way that they can. This communication can reduce the rise of any patient frustration, anger, or tension.
Nonetheless, it is also very important for the staff to also achieve effective communication. The importance of this communication lies within the concept of teamwork (Yoder-Wise, 2011). Each member of the team should have the willingness to listen to suggestions, constructive criticism, and provide quality feedback whenever necessary. These concepts draw on a successfully functioning team, thus deflecting any violence or bullying.
We’d also like to emphasize communication in regards to reporting incidents. This is absolutely crucial because violence should not be “part of the job”
As for information technology, the National Institute of Occupational Safety and Health (NIOSH) now offers free online workplace violence training programs which educate healthcare workers on how to prevent and recognize any risk factors that may precede violence. There are videos, text, and module quizzes.
A safe, effective and successfully functioning workplace culture derives from a skilled and knowledgeable nurse workforce, all of who should possess the right attitude in performing the right tasks in the right place at the right time. These characteristics will foster positive relations, a positive work culture, and teamwork.
In developing a set of guidelines to prevent and reduce workplace violence, the Occupational Safety and Health Administration’s (OSHA) guidelines can be used as a foundation. These guidelines guide the identification and assessment of workplace violence hazards, provide the building blocks in developing an effective workplace violence prevention program, how to gain commitment from all staff, and more (OSHA, 2015).
Within the literature, we had also found that assembling representatives from legal, security, human resources, psychiatric departments, and local law enforcement to create a “threat-management team” can be trained to detect and handle potential threats within the workplace (Smith, 2015)
It is quite necessary to incorporate resolute, organized strategies and methods that come from credible, evidence-based resources. Although there are some strategies and methods available within the literature, there are not many. This can likely be due to minimal reporting of workplace violence, as many consider it to be “part of the job.” This is where the establishment of that consistent definition of violence and bullying that we discussed earlier becomes important…because if everyone shared the same perceptions, it could be more consistently reported, therefore influencing more reliable prevention strategies to be formed.
Two significant strategies we had found were adherence to a violence prevention framework and instilling emotional intelligence in all staff members. A violence prevention framework assists managers in filing detailed reports of workplace violence incidents which would include […read off of slide]. Emotional intelligence…is an idea thought to play a role in combatting lateral violence. It can help nurses and other healthcare providers with conflict management and stress tolerance, thus reducing maladaptive emotional responses.
From the strategies and methods that are out there, their effectiveness and efficiencies have not been tested which leaves researchers uncertain as to whether or not to consider trialing them. Accordingly, further research must be done to assess the value of such interventions.
Sub-line (Muller & Karsten, 2012)
The cost of workplace violence is high, as both direct and indirect costs are involved. Costs result from lost business and productivity (which is one outstanding cost; WV aftermath can drop one’s self esteem and self-sufficiency), litigation, medical care, psychiatric care, higher insurance rates, increased security measures, and negative publicity.
Direct costs include:
-court case
-replacing a nurse can range from $22,000 for a new nurse to $64,000 for a more experienced nurse (Potera, 2016)
Indirect costs include:
-higher than average turnover, increased requests for leave of absence related to medical repercussions, injuries/illnesses related to stress
Due to such financial burdens, it is crucial for healthcare facilities to take preventative measures and for all staff members to report ANY acts of violence or bullying.
A collaborative team is a common group working to achieve a common goal. The main goal here, would be to create the best solutions in combatting workplace violence. A team of the sort could meet quarterly, for instance, to discuss incident reports and/or to develop new solutions or interventions that appropriately align with the current safety manual. Inter- and intra-professional collaboration leads to more well-rounded and balanced solutions by breaking down the causes, preventative measures, and outcomes of any workplace violence incidents (Notaroberta, 2012).
The institute of medicine incorporates five core competencies to provide optimum quality care towards patients. The competencies are 1) membership of an interprofessional team 2) delivery of optimum client-centered care 3) practicing and incorporating evidence-based medicine 4) focusing care on quality improvement and 5) using information technology. Although we always want the bet for our workplace, any act of violence imposes negativity leaving detrimental percussions. To solve the burden of violence, a multidisciplinary approach is used, also known as interprofessional approach. As for evidence-based research, it provides us with the best and most up to date prevention methods. As for promoting quality improvement, it is extremely important to consistently remain compassionate even when there are acts of violence. All incidences of violent acts need to be reported. No act of violence should ever be hidden.
