nursing perceptions of horizontal violence in an acute ... · nursing perceptions of horizontal...
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Nursing Perceptions of
Horizontal Violence in an Acute
Care SettingNicole R. Malmstrom MBA, MSN, RN
CHI Health St. Francis
Disclosures to Participants
I would like to note that I have no financial or other conflicts to disclose.
Objectives
• Define the difference between overt and covert forms of horizontal violence
• Identify strategies used to decrease horizontal violence at one hospital
Review of Literature
• Little research on nurses’ perception
• Studies conducted have little generalizability outside their areas
• Why bullying happens
• Prevalence
– Reported incidents range from 18-31%
• Ethics involved
– American Nurses Association Code of Ethics
• Damaged dignity
• Loss of self-worth
The Research Question
• How does bullying effect nurse engagement
• PICO
Method
• Two phase design
• Horizontal Violence Workplace Inventory (HVWI)
• NDNQI
Examples of survey questions
• Being verbally threatened by a co-worker (O)
• Criticizing someone without having heard both sides of the story (C)
• I have felt discouraged because of a lack of positive feedback (P)
• I have not spoken up for fear of retaliation (P)
Who Exhibited?
• Aides
• Peers
• Supervisors
• Physicians
Results of Phase 1
• 38% Reported Being Bullied by Peers
• 24% report seeing or experiencing
• Only 16% were able to answer this as “once” or “never”
Top 5 Rated Questions
1) Complaining about someone
2) Negative remarks
3) Belittling
4) Making hurtful remarks
5) Criticizing
Safety Concerns
• 7 Questions
– Address as soon as possible
• Not helping
• Not speaking up
– Not asking questions
– Asking for help
Actions Taken
• Disseminated findings to staff
• Code of conduct
• Enforcement
• Education
Phase 2
• Pre-selected questions
– Job enjoyment
– Job satisfaction
Results of Phase 2
0.775
0.678 0.685
0.873
0.317
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Good place to work Manager backs up Feel they have to forcethemselves to come to
work
Respect MD cooperation
“RNs Pitch In to Work” versus NDNQI Questions
Co
rre
lati
on
48
50
52
54
56
58
60
62
64
66
2011 2012 2013 2014
Job Enjoyment All UnitsEn
joym
en
t (s
cale
0-1
00
)
National Data
Hospital Data
42
44
46
48
50
52
54
56
58
2011 2012 2013 2014
Job Enjoyment 5 Med-Surg
National Data
Hospital Data
Interventions
• Mentor/buddy
• Conflict resolution
• Character agreement
• Code word
• Education
• Personal assessment
• Bully Free buttons
Results Over the Years
0
0.5
1
1.5
2
2.5
3
Overt Covert Personal Who Bullies?
Bullying Through the Years
2014 2015 2016
0
10
20
30
40
50
60
70
80
90
100
Low Observations Medium Observations High Observations
Overt Horizontal Violence
2014 2015 2016
P= 0.011
0
20
40
60
80
100
120
Low Observations Medium Observations High Observations
Personal Horizontal Violence
2014 2015 2016
P= 0.0174
NDNQI
4.1
4.15
4.2
4.25
4.3
4.35
4.4
4.45
4.5
2014 Unit 2014 Mean 2015 Unit 2015 Mean
I have to force myself to come to work much of the time
4.04
4.06
4.08
4.1
4.12
4.14
4.16
4.18
4.2
2014 Unit 2014 Mean 2015 Unit 2015 Mean
In my job, I am treated with dignity and respect by everyone
3.8
4
4.2
4.4
4.6
4.8
5
5.2
2013 Unit 2013 Mean 2014 Unit 2014 Mean 2015 Unit 2015 Mean
Would recommend this hospital/would recommend unit
Limitations
• Linking results to units
• Different NDNQI surveys
• Generalizability
Thank you
• Beth Bartlett, MSN, RN, CENP, Vice President of Patient Care Services, CHI Health St. Francis
• Dr. Brenda Bergman-Evans, PhD, CHI Health, for initial data analysis
• Coordinating Council CHI Health St. Francis
1. Alspach, G. (2007). Critical care nurses as coworkers: Are our interactions nice or nasty? Critical Care Nurse, 27, 10-14
ANA (2014). National database for nursing quality indicators. Retrieved from http://nursingworld.org/Research-Toolkit/NDNQI
2. Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. MEDSURG Nursing, 21(4), 210-213, 232. Retrieved from
http://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/resources/MSNJ-Becher-
Visovsky-21-04.pdf
3. Cohen, S. (2012). From sheep to lion: Confronting workplace bullying. Nursing Management, 45(7), 9-11
4. Katrinli, A., Atabay, G., Gunay, G., & Cangarli, B.G. (2010). Nurses’ perceptions of individual and organizational political
reasons for horizontal peer bullying. Nursing Ethics, 17(5), 614-627
5. Reynolds, G., Kelly, S., & Singh-Carlson, S. (2014). Horizontal hostility and verbal violence between nurses in the
perinatal area of health care. Nursing Management, 20(9), 24-30
6. Riggleman, K., Lein, A., Meisinger, S., Dumont, C. (2010). Horizontal violence (bullying) and relationships to nurse job
satisfaction in acute care. Podium presentation for the NDNQI Conference, New Orleans
7. Thompson, R. (2013). Take action against nurse bullying: strategies for individuals. MEDSURG Nursing, 22(6), 403-404
References