Incivility Of Organizations : Who Is The Blame?

Conflict is an unfortunate part of life and it is truly inevitable, however in the field of nursing it can be detrimental. “Conflict is defined as the discord that results when two or more parties have opposing or incompatible ideas, beliefs, or goals.” (Schub & Schub, 2015). Within healthcare settings there are an outstanding number of differences in opinions that could potentially lead to conflict throughout a number of different levels of the employees. Focusing in on one of those areas would be the nurse to nurse, or horizontal/lateral violence.

The purpose of this integration paper is to educate about lateral violence in the professional setting, more specifically within the nursing profession. Lateral violence is defined as “profound and pervasive source of occupational stress with physical and psychological and organizational consequences.” (Cervalolo, D). Types of lateral violence include rude comments, verbal attacks, condescending language, sexual misconduct, lack of collaboration, professionally attacking a person integrity and reputation, blaming others for your own mistakes in front of others and family members of the patient, withholding important information and other non-professional behaviors.

According to Purpora and Blegen, approximately 60% of actual errors in patient care result from poor and ineffective communication (para. 3). Horizontal violence causes a decrease in effective communication between caregivers which places the patient’s safety in jeopardy. Horizontal violence decreases staff morale which leaves room for error in the workplace (Longo & Smith, 2011).

Incivility is an umbrella term used to describe any type of negative behavior directed towards another individual that may impact the way that they behave and/or feel. While incidences of incivility may be visible in most professional careers, it’s significance in nursing has prompted a provisional statement from the American Nurses Association. “The nurse creates an ethical environment and culture of civility and kindness. Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors” (American Nurses Association, 2015, p. 4). Dumont, Meisinger, Whitacre, & Corbin (2012)

Nurses have a professional responsibility to ensure that safe boundaries are kept in the relationship between patient and Nurse. It is these boundaries that provide the nursing profession with integrity, and according to Baca (2010, pp.195) it is essential these boundaries be maintained because of the difference in power between the nurse and patient. However, boundary violations can occur, when a nurse crosses from the zone of helpfulness to over involved, the ANMC (2011 pp.3) believes that when a violation occurs a nurse is behaving unprofessional manner and misusing their power in the patient nurse relationship. This misuse of power can be categorized into 3 types; boundary crossing, boundary violation and the extreme form of sexual misconduct. Often by mistake a nurse could cross the boundary without thought, a

Moreover, another type of violence which nurses experience is horizontal violence. Horizontal violence is described as “hostile, aggressive, and harmful behavior by a nurse or group of nurses toward a co-worker or group of nurses via attitudes, actions, words, and behaviors” (Becher & Visovsky, 2012, p. 210). Horizontal violence not only involves nurse-nurse violence but includes nurse-physician and nurse-supervisor violence. The perpetrator displays behaviors associated with horizontal violence which may include refusing to lend assistance, criticizing, intimidation, gossiping, name-calling, and ignoring (Becher & Visovsky, 2012). The American Nurses Association sets the expectations for nursing standards. According to the American Nurses

Thesis • Horizontal violence among nurses reduces the quality of care patients receive and influences whether students remain in the nursing profession based on clinical experiences during placement. • The Canadian Nurses Association (2005) defines horizontal aggression “as aggressive behaviour that one registered nurse commits against another in the workplace.” • Tolerance of horizontal violence is connected with hierarchical nature of abuse and continues to be unreported and overlooked because in many incidents the perpetrator involved is a supervisor, nurse manager or charge nurse. “In order to succeed, [nurses] must accept that their role is defined by those with power and authority (pitts, 1985).

Nurses continually strive to bring holistic, efficient, and safe care to their patients. However, if the safety and well-being of the nurses are threatened or compromised, it is difficult for nurses to work effectively and efficiently. Therefore, the position of the American Nurses Association (ANA) advocate that every nursing professional have the right to work in a healthy work environment free of abusive behavior such as bullying, hostility, lateral abuse and violence, sexual harassment, intimidation, abuse of authority and position and reprisal for speaking out against abuses (American Nurses Association, 2012).

A major problem our nurses face today is the lack or respect that they are given. Patients,

Nursing is a profession founded on caring, compassion and collaboration. I believe that all nurses come to work with good intentions, but sometimes something happens along the way. “Horizontal violence can exist to some extent in any institution, with the potential to disrupt the integrity of the nursing profession and ultimately compromise patient care” (Becher&Visovsky, 2012, P. 213). I think that its important for us as professional nurses to acknowledge the “existence of horizontal violence, confront horizontal violence, and take appropriate actions to mitigate it (Becher&Visovsky, 2012, P. 213).

Of all professions, nursing has been consistently ranked as the most honest and ethical of all professions polled. In fact, this year our profession was ranked the most honest and ethical for the thirteenth year in a row (Sachs & Jones, 2014). But for our consistent rankings, there is a quiet festering problem that has been growing among us; a problem that has largely been disregarded as too infrequent to worry about or just paying your dues. The problem is “not new to nursing, but has been long ignored as an issue critical to the profession. As a result, the behaviors have been allowed to contaminate the work environment” (Longo, 2013, p. 951). Only in the last decade has substantial research been conducted across many cultures that shows this problem to be a widespread and serious problem (Ekici & Beder, 2014, p. 24). This problem is workplace bullying, also referred to as lateral/horizontal violence or vertical violence. This bullying, while seemingly trivial at times, can have broad and devastating consequences. Most notable of these effects of the consequences are employee productivity, mental and physical health, retention of staff, facility costs, and most importantly, patient safety (Ekici & Beder, 2014, pp. 25,31; Gaffney, DeMarco, Hofmeyer, Vessey, & Budin, 2012, p. 2). Bullying can be experienced by anyone at any level of the work place: graduate nurses, experienced nurses, charge

Wilson, B., & Phelps, C. (2013, January). Horizontal Hostility: A Threat to Patient Safety. Retrieved April 03, 2017, from http://www.nursingcenter.com/cearticle?an=00128488-201301000-00004&Journal_ID=260876&Issue_ID=1512692#P19

I was particularly impressed by way this meeting dissected critical issues. The participants of this gathering welcomed openness and honesty from all. This meeting investigated ethical issues regarding patient care, and scenarios in which one’s discretion licensed him/her to question a patient’s judgments. This gathering also addressed the issue of productivity, in terms of sustaining it and enhancing it amid a taxing and demanding environment. The participants then proceeded to address common relational issues, which involved disagreements among nurses, and conflict mitigation. After witnessing the dynamics of this meeting, it became readily apparent that conflict

Nurses have a professional responsibility to ensure that safe boundaries are understood and maintained in a patient/nurse relationship. Nurses should be knowledgeable regarding professional boundaries and continued education assists them to achieve this. It is these boundaries that provide the nursing profession with integrity, and according to Baca (2010, pp.195) it is essential these boundaries be maintained because of the difference in power between the nurse and patient. However, boundary violations can occur, when a nurse crosses from the zone of helpfulness to over involved, the ANMC (2011 pp.3) believes that when a violation occurs a nurse is behaving in an unprofessional manner and misusing their power in the patient nurse relationship. This misuse of power can be categorized into 3 types; boundary crossing, boundary violation and the extreme form, of sexual misconduct. Often a nurse could cross the boundary without thought, a violation is a more serious matter when according to the ANMC (2011 pp. 5) the nurse puts his or her own needs in front of the

Harassment and discrimination contradict the ethical principles of beneficence and nonmaleficence which nurses are required to live by, and in doing so the work environment is desecrated. According to Lee, Bernstein, Lee, & Nokes (2014) nurses reported being bullied more than any other group of health care workers (p.257), hence it was not surprising that this writer’s literary review revealed that 30% - 50% of all new Registered Nurses elect to either change positions or leave nursing completely within the first three years of clinical practice (MacKusick &