You have the right to work in an environment that is safe. Lateral violence continues to be a recurring topic in health care discussions. Learn the most common types of bullying encountered in our workplace and the best ways to respond in this presentation from a recent webinar. You can also access the webinar replay (http://bit.ly/1cs44w8) and earn one contact hour through November 21, 2014. Learn more about AORN events at www.aorn.org/Events.

1. Welcome to Today’s Webinar
Zero Tolerance for Lateral Violence:
Changing the Culture of Nursing
Practice

2. Lori Ingram MSN, RN, CNOR, CNML
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Lori Ingram is the Nurse Manager of PeriOperative Services at Novant Health Matthews Medical Center, in
Matthews, NC. Her responsibilities include overall accountability for operations of the OR, Admission & Discharge
Area, PACU, Sterile Processing, Endoscopy, Lithotripsy and Pain Management services. During her perioperative
career, Lori has held the positions of Nurse Manger, Clinical Nurse Specialist, Educator and staff nurse. Lori holds
specialty certification in the OR (CNOR) and in Nursing Management & Leadership, (CNML).
Lori is an active member of the Dogwood Chapter of AORN, is the immediate past president and is the Chair–
Elect for the North Carolina Council of PeriOperative Registered Nurses, where she is actively involved in the
legislative efforts focused on the RN Circulator Bill passage. Lori has presented at AORN Congress and
presented two research posters at Congress. Lori was a member of the AORN National Congress Planning
committee for three years and is currently a member of the AORN National Committee on Education. She is also a
member of Sigma Theta Tau, the American Organization of Nurse Executives (AONE), and the American Society
of PeriAnesthesia Nurses (ASPAN). Lori has received the NC Council and the Georgia Council of OR Nurses,
Perioperative Nurse of the Year Award and was selected as one of the “Great 100” Nurses in NC. She is a
recipient of the Novant Health Circle of Excellence Award.
Lori had a research article published in Journal for PeriAnesthesia Nursing and received the third place editor’s
award for research articles in 2012. She has another research article accepted for publication in 2014. She enjoys
participating with her perioperative colleagues in research and evidence based practice initiatives, along with
mentoring new nurses in the OR and encouraging their career growth.

3. Judith Seltzer, MS, BSN, RN, CNOR
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Judith Seltzer is the Surgical Clinical Director, National Accounts for Molnlycke Health Care. Her responsibilities include education,
program development, and research facilitation regarding latex allergies, glove powder, barrier protection issues and antiseptic agents.
This includes planning, producing and implementing clinical education for nurses and other health care professionals. Judi also serves as
an expert clinical specialist for acute and non-acute healthcare facilities, and hospital administrative professionals. Judi is based in the
Mid-Atlantic, and provides clinical expertise for the US Surgical Molnlycke Health Care team.
Judi received both her Bachelor’s and Master’s degrees in Nursing Informatics from the University of Maryland School of Nursing. During
her career as a perioperative nurse, she has held the position of Nurse Manager of Cardio-thoracic Services, Clinical Educator of
Perioperative Services and Professional Development Coordinator. During her tenure, Judi was responsible for the development of many
educational offerings. She was awarded the University of Maryland Medical Center’s President’s Award in 2001 for the implementation of
a Surgical Technology program working in partnership with the University of Maryland Medical Center and the City of Baltimore’s Office of
Employment Development within the Mayor’s Office.
She is a member of the Baltimore, Maryland chapter of the Association of periOperative Registered Nurses (AORN) during which she
presented a poster presentation for the 2004 and 2011 AORN Congress. Judi is also a member of the Baltimore APIC chapter. In
addition, she is a member of the Sigma Theta Tau International Honor Society of Nursing. Judi has held faculty nursing appointments at
Villa Julie College and Baltimore City Community College in Baltimore.
Judi has had several publications including, Advance for Nurses, Forming a Perioperative Consortium, (1999); AORN, Initiating a Clinical
Research Project in the Operating Room (2001); AACN Clinical Issues, Awareness of Surgical Site Infections for Advanced Practice
Nurses, (2002) and Perioperative Nursing Clinics Skin Antisepsis: First Line of Defense / Set Skin Preparation in Motion before the
Incision (2011). Most recently, she is the chapter author of Infection Control Principles for Long-term Care Environments and Infection
Control in the Ambulatory Surgical Centers, in a recently published text book titled: Infection Control for Advance Practitioners, edited by
Denise Korniewicz, 2013.
She continues to speak across the country for AORN chapters including the AORN Fall Conference (2007) in San Antonio, Texas; AVIR
conference in Washington, DC in (2008), AORN Congress in Denver (2010) and AORN Congress in New Orleans (2012) where she
presented Nurses in Industry on the Move: Transatlantic Differences While Competent Nursing Practices Prevail. Judi is a member of the
AORN National Committee on Education (NCE) and most recently accepted the position of Chairperson of Communications for the
AORN Business and Industry SA Committee (BIC).

4. Angela Walsh, MA, BSN, RN,CNOR
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Angi is an active member of Massachusetts Chapter I (37 years). She is currently a Perioperative
Clinical educator in a 497 bed teaching hospital. She is a Master TEAMStepps Trainer, Certified
Bariatric Surgery Support Group Facilitator and avid quilter.
Angi has held a variety of education positions both in the clinical (patient & staff ed) and
classroom (RN, surgical technologist & high school) setting over the past 37 years. Angi has a
masters degree in Critical & Creative Thinking with emphasis on Patient & Family Education, and
is currently facilitating a Perioperative 101 “Grow Your Own“ training program to provide internal
succession.

5. Disclosure Information
Speaker:
Lori Ingram, MSN, RN, CNOR
Judi Seltzer, MS, BSN, RN, CNOR
Angi Walsh, MA, BSN, RN, CNOR
All Speakers Disclose No Conflict
Planning Committee:
Susan D. Root, MSN, RN, CNOR
Manager Perioperative Education, AORN
Discloses No Conflict
AORN’s policy is that the subject matter experts for this product must disclose any financial relationship
in a company providing grant funds and/or a company whose product(s) may be discussed or used
during the educational activity. Financial disclosure will include the name of the company and/or
product and the type of financial relationship, and includes relationships that are in place at the time of
the activity or were in place in the 12 months preceding the activity. Disclosures for this activity are
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1. Consultant/Speaker’s Bureau
2. Employee
3. Stockholder
4. Product Designer
5. Grant/Research Support
6. Other relationship (specify)
7. No conflict of interest
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AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019.
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6. Objectives
• Discuss three assessment skills nurses can
utilize that will alert them to potential dangers
from lateral violence within the workplace
and at home.
• List five of the most prevalent examples of
lateral violence and bullying occurring in the
workplace today.
• Identify three strategies for achieving
professional and personal emotional health.

7. Take Out….
Objective 1:
 Discuss three assessment
skills nurses can utilize that will
alert them to potential dangers
within the workplace and at
home.

8. Situational Awareness
Recognize Higher Risk Environments:
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Healthcare workers / Service focus
Working with volatile/unstable people
Working in Isolated Areas or Alone
Working Late at night
Working in High Crime Rate Areas
Workplace Violence can strike
Anytime, Anywhere.

9. Disruptive Behavior
Recognizing Early Warning Signs:
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Mood changes, behavior out of character
Increased aggressive behavior
Passive-Aggressive behavior
Uncooperative or intimidating behavior
Verbal outbursts or abusive language
Physical threats

10. Imminent Violence
Recognize Non-Verbal Cues:
• Lowering of the head
• Tucking in the chin so the bottom
whites of the eyes are showing
• Clenching & Re-clenching fists
• Touching their head or pulling hair
• Difficulty controlling fine motor skills.
2 Million American workers are victims of workplace
violence each year. (OSHA -Workplace Violence, 2012)

11. Take Out….
Objective 2:
 List five of the most prevalent
examples of lateral violence
and bullying occurring in the
workplace today

14. Consequences
 Absenteeism
 High Turnover
 Job dissatisfaction
 Poor performance
 Change in work culture
 Increased medical errors

15. Perpetuated By…
ADDICTIVE
BEHAVIOR
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•
Physicians
Nurses
Managers
Allied Health
Providers
• Patients
POOR
MANAGEMENT
SKILLS
STRESS

16. WHAT WOULD YOU DO?
On one particular night, the shift included three nurses: a
newly licensed nurse, her preceptor who spoke English
as a second language, and another nurse who also
spoke the preceptor’s native language and English as a
second language.
The newly licensed nurse felt that the two experienced
nurses were talking about her shortcomings in their
native language and that they excluded her from general
conversation for the entire shift.

17. Doreen, an experienced new RN
The MD
Jill, the circulator

18. Take Out….
Objective 3:
 Identify three strategies for
achieving professional and
personal emotional health

19. Calling out the Elephant in the room…
Objective 3: Lateral Violence
Identify three strategies
for achieving
professional and
emotional health
Sincox, A & Fitzpatrick, M, Michigan Nurse, 2013. Lateral
violence: Calling out the elephant in the room

20. Workplace Violence Incidence
1.7 million healthcare
workers annually
Is it simply
part of the
job?
Nursing
Homes
Acute care

21. How
Can
You
Stop
It?

22. Written and Implemented Policies
Training on Reporting
De-Escalation Techniques
Nursece4less.com, 2013
Guidelines for Preventing Workplace Violence for Health Care and Social Workers, OSHA , 2012

23. Environment of Care Processes
Better Patient
Assessment
Access: In and
Around
Environment
Staff Issues
and
Consequences

24. Constructive Peer Relationships
Color
Code
Code of
Conduct
“Eating Our
Young”

25. OSHA
WHO
Joint
Commission
AORN
AACN
Guidelines for Preventing Workplace Violence for Health Care and Social Workers, OSHA , 2012
Nursece4less.com, 2013
ANA
ENA

26. Recognize early
behavior signs
Incorporate
early
defensive
action
Have a well
developed plan on
hand
Immediately
Initiate defense
actions
Be familiar with Law
Enforcement
responses
Know when
Violence is
Imminent
Educate and Train
Assemble crisis
response kits
Create a
Continuity of
Operations Plan
(COOP)
LiveProcess Emergency Preparedness, January 2013

27. Key Take Away
Workplace violence between patients
and staff; as well as between staff with
other staff members is a phenomenon
affecting every country, and every
workplace.
Make the changes necessary in your
workplace to stop the Violence Now!

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