In Nursing, there exists a culture of lateral violence and bullying, I have finally come to the realization that what we are seeing is the symptom of something much larger, something that starts, grows, and is nurtured with our own participation. We communicate in ways that have the ability to support each other, but we can also communicate in ways that are hurtful, mean, and contribute to a culture of oppression. We need to change our culture.

1. Home Health Aids Conference
Prince Albert October 27 – 29th
, 2015
Safety in theWorkplace
LateralViolence – Lateral Kindness
Greg Riehl RN BScN MA

2. Outline
• What is lateral violence?
• What causes lateral violence?
• What are the effects of lateral violence
• Who gets targeted
• Types of bullies
• Hierarchy
• Mobbing
• Cultural competence and culture
• Zero tolerance policies
• Functional versus dysfunctional conflict
• What can be done?
• Discussion

3. Objectives
1. Identify terms used to describe negative coworker
behavior
2. Describe an experience with negative coworker
behavior
3. Discuss strategies to manage negative coworker
behavior

4. Why am I here?
• I ask myself this every day, and I also ask those who I am
working with from time to time

6. Stories
• I will use some of my experiences working in health, in
the north, and as an male nurse, often an outsider,
working in different situations.
• You are a part of the story.

7. Hierarchy
• The more vertical an organization is in its hierarchy, the
more complicated communication becomes.
• We are hired into a certain job, or role, but no where does
it tell us of all the lateral violence that exists, or what to
do about it.

8. Communication is about listening
• My job description does not say, Greg, you will have to
listen to a lot of your co workers bitching and complaining
about each other, they will want you to fix their conflicts,
and will want you to keep it a secret and tell no one.
• This will happen on a very regular basis, consider this
‘duties as assigned’

9. LateralViolence
“Exists on a spectrum, from seemingly ordinary
behaviour such as gossiping or criticism, to
intimidation, racism and outright physical
intimidation or harm.”
Linda Rabyj, 2005

10. Definition
LateralViolence (LV), also called Horizontal
violence, [bullying], incivility, and disruptive
behaviours, creates an unpleasant work
environment and has harmful effects on individual
nurses, patient safety, and health care
organizations.
Johnson, 2009 & Dimarino, 2011

11. Cyber Lateral Violence
Sending emails without greetings?
CAPS LOCK

12. Hurt People Hurt People
When another person makes you suffer, it is because he
suffers deeply within himself, and his suffering is spilling
over. He does not need punishment; he needs help.
Tich Naht Hanh

13. Hurt people hurt people
Hurt people hurt people.That’s how pain patterns get passed on,
generation after generation after generation.
Break the chain today.
Meet anger with sympathy, contempt with compassion, cruelty with
kindness.
Greet grimaces with smiles.
When you forget about the fault, there is nothing to forgive.
Love is the weapon of the future
Yehuda berg

14. Building a culture of respect
combats lateral violence
A 2003 study in the Journal of Advanced Nursing
found that half of newly qualified nurses report
first-hand experience with lateral violence.
Linda Rabyj, 2005

15. Who gets targeted?
Anyone who is different from the group norm on any major
characteristic
• Experience
• Education
• Race/ethnicity
• Gender
Targeted person’s gender
• 79% Female
• 21% Male

16. Who is Doing the Bullying?
2009 survey byWorkplace Bullying Institute:
- Main perpetrator’s gender
• 65% Female
• 35% Male
2009WBI survey sited in NewYorkTimes:
- Men target men and women equally
-Women target women 70% of the time

17. Why does this happen in theWorkplace?
• Isolated from the public and other staff
• High-stress environment
• Limited autonomy in practice
• High-paced environment
• Lack of experienced staff
• Cliques or closely bonded groups
• Hierarchical climate
• Gender imbalance
• Attitudes to training
• Non acceptance of difference

18. Why?
In my profession, nurses practice in a historically patriarchal
environment.
• Oppression leads to low-self esteem.
• Nurses exert power over one another through lateral violence.
Lateral violence is perpetuated through the culture of nursing (new
nurses, curriculum, etc).
• “Nurses eat their own”
• “See one do one teach one”
We now work with four different generations in the workforce,
adding to the complexities of effective communication.

19. Who is doing it?
Co-worker-on-coworker aggression
• Directed toward individuals at same power level
• Intended to cause psychological pain
• Does not include physical aggression
Intergroup/hierarchy conflict
• Shift to shift/class to class/group to group…
• Cliques within a workgroup
• Department to department
• We are a team but some people are more important than the others??

20. Risk
• We often face a risk acting, and we also face a risk when
we do not act.

21. David and Goliath

22. Three types of BULLIES
Sydney based clinical psychologist and workplace bullying
specialist Keryl Egan has formulated three workplace bully
profiles:
1.Accidental bully
2.Narcissistic bully
3.Serial bully

23. Accidental bully
This person is task orientated and just wants to get things
done, tends to panic when things are not getting done, and
goes into a rage about it.This person is basically decent,
they don’t really think about the impact of what’s
happening or what they have done.
They are responding to stress and it is believed that they
can be coached out of this behavior.

24. Narcissistic Bully
They are grandiose and have dreams of breath taking
achievement.They feel they deserve power and position.
They can fly into a rage when reality confronts them.This
person is very destructive and manipulative, they don’t set
out in a callous way to annihilate any person – it is purely an
expression of their superiority.

25. Serial Bully
Has a sociopathic and psychopathic personality.This type of bully is intentional,
systematic and organized and is often relentless.They usually get things done in
terms of self-interest.
They employ subtle techniques that are difficult to detect or prove. Coaching is often
ineffective.
They exhibit the following:
•Grandiose, but charming
•Authoritative, aggressive and dominating
•Fearless and shameless
•Devoid of empathy or remorse
•Manipulative and deceptive
•Impulsive, chaotic or stimulus seeking
•Master of imitation or mimicry

26. Conflict It’s not all Bad
Functional Conflict is considered positive, as it can increase
performance, support change, and identify weaknesses or
areas that need to be supported.
Dysfunctional Conflict is harmful to people and the
organization.This type of confrontation does nothing to
support goals or objectives.

27. In Conflict who are you: Victim, Villain, Hero or
Resolutionary?
In conflict, each person
feels hit first.
The size of the villain
determines the size of the
hero.
“Without goliath, David is
just some punk, throwing
rocks.”
Billy Crystal, My Giant

28. Victims
• Are you a victim of the victim syndrome?

29. WorkplaceViolence & Harassment
Experts identify two primary categories of
lateral violence.
Overt(direct)
Covert (passive)

31. 10 Most Common Forms of LateralViolence in
Health Care
1. Non-verbal innuendo,
2. Verbal affront,
3. Undermining activities,
4. Withholding information,
5. Sabotage,
Griffin. 2004

32. 10 Most Common Forms of LateralViolence in
Health Care
6. Infighting,
7. Scapegoating,
8. Backstabbing,
9. Failure to respect privacy, and
10.Broken confidences.
Griffin. 2004

33. Mobbing
A group of coworkers gang up on another
• often with the intent to force them to leave the work group
Five phases of Mobbing
1. Conflict
2.Aggressive acts
3.Management/Faculty Involvement
4.Branding as Difficult or Mentally ill
5.Expulsion

34. Who else is involved?
• Students/Patients/Visitors/Family
• Quality care
• The Team
• Co-workers as bystanders
• Systems
• Employers
• Faculty
• The ‘System’

35. Back to nursing, Do Nurses eat their
young – and each other…
This old adage should not be the price the next generation
has to pay to join the nursing profession.
What stories do you want your students to talk about with
their peers, co-workers, or at their 5 or 10 year reunion?

36. Health Settings - Impacts on
Patients and Families
Disruptive behavior linked to:
• 71%: medical errors
• 27%: patient mortality
• 18%: witnessed at least one mistake as a result of disruptive
behavior Rosenstein & O’Daniel, 2008
Ruminating about an event takes your attention off task
and leads to increased errors and injuries
Porath & Erez, 2007

38. Impact is on all staff
•Physical
•Psychological
•Social

39. Impacts on Health Systems
• Dwindling workforce
- 1 in 3 nurses will leave the profession (2003)
• Reduced professional status
• Corrosion of recruitment and retention

40. Impacts on Health SystemsNegative Impact on the work environment:
• Communication and decision making
• Collaboration and teamwork
Leading to:
⇑ employee disengagement
⇓ job satisfaction and performance
⇑ risk for physical and psychological health problems
⇑ absenteeism and turnover

41. Impacts on Health Systems cont.
Cost of LateralViolence:
•“Turnover costs up to two times a nurses salary, and the
cost of replacing one RN ranges from $22,000 to $145,000
depending on geographic location and specialty area.”
Jones, C & Gates, M. (2007).
•The lag in time for a new nurse to become proficient is a
significant consideration.

42. Impacts on NewTeam Members
• New team members are extremely susceptible to
LateralViolence and experience more negative impacts
than experienced team members.
Prevention Strategies are needed
• Top down and bottom up approaches
• Mentoring and investigation systems
• Role Models
• Education
• Empowerment

43. We All need to ask ourselves:
• “Did I participate in bullying?”
• “Did I support this kind of behavior in others?”
• “Did I intervene if and when I observed it?”
“We must work to uncover and reverse atrocities, one person, one
company, and one law at a time”
BullyproofYourself atWork, G & R Namie

44. What to do?• Awareness
• Education
• Dialogue
• Zero tolerance policy
• Be confident
• Develop effective coping mechanisms
• Confront the situation
• Rehearsal
• Enact policy and procedure
• Code of conduct
• Don’t accept it!

45. ZeroTolerance Policies
The Joint Commission and the American Association of Critical Care Nurses
(AACN).
•2008: mandate the development and implementation of
processes to offset LV that enforce a code of conduct, teach
employees communication skills, and supporting staff.
•2009: advocates that communication skills should be as
proficient as clinical skills.

46. Safe place
• Where is the safe place in your organization?

47. Lateral Silence
• It is part of the culture.
• Everybody knows about it
• Everybody does it
• No body talks about it

48. Culture of Silence
• “Because we set ourselves up to be healers, this kind of
behaviour is in the shadows.We don’t know what to do about
it, so we try to disown it.”
• In practice, this means we can’t stay silent when another
person’s actions “makes us cringe”.
• Having the conversation is what matters . . . it shows that both
professionals share responsibility for behaviour affecting staff
and patients.
• Monica Branigan, 2009

49. Our Culture needs to change
• We do not accept bullying in our schools or other
workplaces so why is it ok in the workplace?
• In Nursing, this is the culture that was learnt by nurses 30
years ago and has propitiously been taught to new
nurses.

50. Why Don’tWe Stop LateralViolence?
“It’s not a problem in our work area”
“Everybody does it – just get used to it”
“If I say anything, I’ll be the next target”
“We have policies but they aren’t enforced”
“She sets herself up for getting picked on”

51. How do we deal with the stress?
• 75% talk to family, friends, colleagues
• 50% experience a desire to resign
• 49% lose interest in job, disengage
• 23% use more sick time
• 35% use formal channels
 23% HR representative
 12% Union or professional organization representative

52. What can you do?
• Dialogue is ultimately far more effective than pointing
fingers
• Cognitive RehearsalTechniques
• Health care professionals across the spectrum working
together more effectively and patients receiving better
care.

53. DESC COMMUNICATION MODEL
Describe – the behavior
Explain – the effect the behavior has on you,
coworkers, patient care
State – the desired outcome
Consequences – what will happen if the behavior
continues?

54. Rehearsal
Research has demonstrated the benefit of rehearsal for new
employees.
I.e.
When a staff member makes a facial gesture (raising an
eyebrow) the participant was instructed to say “I see
from your facial expression that there may be something
you wanted to say to me. It’s ok to speak directly to me”.
Griffin, 2004

55. Teamwork and Communication
• Involve everyone in solving problems related to these
issues.
• Develop a set of “RIGHTS” for everyone.
• Effective anti-bullying practices must include a statement
of exactly what constitutes bullying.
• Communication needs to be a part of culture.

56. Statement of Commitment to Co-workers
As your co-worker with a shared goal of providing excellent service to people
and families, I commit the following:
I will accept responsibility for establishing and maintaining healthy
interpersonal relationships with you and every member of this staff.
I will talk to you promptly if I am having a problem with you. The only
time I will discuss it with another person is when I need advice or help
in deciding how to communicate with you appropriately.
I will establish & maintain a relationship of functional trust with you and
every member of this staff. My relationships with each of you
will be equally respectful, regardless of job titles or levels of educational preparation.
I will not engage in the '3B's (bickering, back-biting and bitching) &
will ask you not to as well.
I will not complain about another team member & ask you not to as well.
If I hear you doing so, I will ask you to talk to that person.
I will accept you as you are today, forgiving past problems,
& ask you to do the same with me.
I will be committed to finding solutions to problems rather than
complaining about them or blaming someone, & ask you to do the same.
I will affirm your contribution to quality service.
I will remember that neither of us is perfect, & that human errors
are opportunities not for shame or guilt, but for forgiveness and growth.
(Adapted from Marie Manthey, President of Creative Nursing Management in Caroline Flint's Midwifery Teams and Caseloads 1993; p. 138)

57. Lateral Kindness
• Please be kind to each other
• Respectful and responsible relationships, there are no
apps for that.
• Be Grateful
• Be Great!

58. Discussion, questions,
comments!!!
Thank you for your participation

59. Contact information
Greg Riehl RN BScN MA
greg.riehl@saskpolytech.ca
gregriehl@sasktel.net
@griehl

60. References available on request
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