welcome to becoming sabotage-savvy: things they dont teach in nursing school ©linda mueller, lee...

Welcome toWelcome to

Becoming Sabotage-Becoming Sabotage-Savvy:Savvy:

Things they DON’T teach Things they DON’T teach in nursing schoolin nursing school

©Linda Mueller, Lee Memorial Health System 2010

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Becoming Sabotage-SavvyBecoming Sabotage-Savvy


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ObjectivesObjectives

1.1. Define “Horizontal Hostility.”Define “Horizontal Hostility.”2.2. Identify 3 examples of Horizontal Identify 3 examples of Horizontal

Hostility.Hostility.3.3. Practice an effective confrontation Practice an effective confrontation

technique.technique.


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BenefitsBenefits

1.1. We’ll know how to behave as We’ll know how to behave as professionals.professionals.

2.2. We’ll be sensitive to “Horizontal We’ll be sensitive to “Horizontal Hostility.”Hostility.”

3.3. We’ll feel confident when we confront We’ll feel confident when we confront effectively. effectively.


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Stages of Group Formation:Stages of Group Formation:

FormForm StormStorm NormNorm PerformPerform


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Exercise:Exercise:

Nurses should…Nurses should…

Nurses shouldn’t…Nurses shouldn’t…


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Scientific definition:Scientific definition:

Stress-induced displacement Stress-induced displacement

aggression…aggression…

OROR……

……Nurses eating their Nurses eating their young.young.


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Definition:Definition:

A consistent pattern of A consistent pattern of behavior designed to control, diminish, orbehavior designed to control, diminish, ordevalue a peer (or group) that creates a devalue a peer (or group) that creates a

riskriskto health and/or safety.to health and/or safety.

-Gerald Farrell, RN, PhD-Gerald Farrell, RN, PhD 20052005


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Horizontal Hostility:Horizontal Hostility:

A DemonstrationA Demonstration

What did Sue do wrong?What did Sue do wrong?


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““Horizontal Hostility” – what is it?Horizontal Hostility” – what is it?

SabotageSabotage Verbal AbuseVerbal Abuse BullyingBullying


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Symptomatic Behaviors:Symptomatic Behaviors:

1.1. PhysicalPhysical

2.2. VerbalVerbal

3.3. EmotionalEmotional


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Call it…Call it…

Horizontal HostilityHorizontal HostilityLateral violenceLateral violenceColleague abuseColleague abuseWorkplace bullyingWorkplace bullying

……Same deadly Same deadly effecteffect


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It’s the healthcare culture,It’s the healthcare culture,

silly…silly…


The BEE The BEE AlgorithmAlgorithm

Appropriate Responses to Appropriate Responses to

Stinging SituationsStinging Situations


Stinging Stinging Situations Situations

and a and a Corrective Corrective AlgorithmAlgorithm

The Goal:The Goal:

Eliminate Disruptive or Eliminate Disruptive or Inappropriate Behavior,Inappropriate Behavior,

to improve performance and to improve performance and outcomesoutcomes ©Linda Mueller, Lee Memorial Health System 2010

The Solution:The Solution:

Default to the Default to the algorithm algorithm when when Disruptive Disruptive Behavior Behavior occurs.occurs.


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The BEE AlgorithmThe BEE Algorithm

BB = Behavior = Behavior What the person is doing or not doing that What the person is doing or not doing that is disruptive, inappropriate, or unacceptable.is disruptive, inappropriate, or unacceptable.

EE = = Effect Effect Why/how the behavior is disruptive, inappropriate, or Why/how the behavior is disruptive, inappropriate, or unacceptable… unacceptable… how it affects me, hurts my productivity, how it affects me, hurts my productivity, destabilizes the team or affects customer service.destabilizes the team or affects customer service.

EE = = Expectation Expectation What do you expect the person to do or not do to meet What do you expect the person to do or not do to meet your expectations? your expectations?


For ExampleFor Example

Your coach snaps her fingers at you to hurry Your coach snaps her fingers at you to hurry up…up…

Give her a B.E.E. to provide correcting Give her a B.E.E. to provide correcting feedback. feedback.


Example 1Example 1Your coach snaps her fingers at you Your coach snaps her fingers at you to hurry up…to hurry up…

B:B: Sue, when you snap your fingers Sue, when you snap your fingers at me to hurry up…at me to hurry up…

E: E: …it feels demeaning and …it feels demeaning and disrespectful.disrespectful.

E: E: …I need you to give me the same …I need you to give me the same respect you want from me. Can we respect you want from me. Can we structure something like this?structure something like this?


Another Another ExampleExample

Your coach remarks, “I thought you Your coach remarks, “I thought you were smart!”were smart!”

Give her a B.E.E. to provide Give her a B.E.E. to provide correcting feedback. correcting feedback.


Example 2Example 2Your coach remarks, “I thought you were Your coach remarks, “I thought you were smart!” …smart!” …

B:B: Jane, when you make remarks like that… Jane, when you make remarks like that…

E: E: …it offends me and makes me not want to …it offends me and makes me not want to work with you.work with you.

E: E: …I need you to stop making such remarks …I need you to stop making such remarks so we can continue to work together. Can so we can continue to work together. Can we agree on this?we agree on this?


Example 3Example 3Your coach asks you to draw blood, a Your coach asks you to draw blood, a task which you had never done task which you had never done before. She tells you, “It’s now or before. She tells you, “It’s now or never!”never!”

Give her a B.E.E. to provide Give her a B.E.E. to provide correcting feedback. correcting feedback.


Example 3Example 3When told to draw blood, your coach When told to draw blood, your coach tells you, “It’s now or never!” …tells you, “It’s now or never!” …

B:B: Nancy, when you make remarks like Nancy, when you make remarks like that…that…E: E: …it makes me feel anxious and …it makes me feel anxious and unsupported, and not want to do what unsupported, and not want to do what you ask.you ask.E: E: …I need you to stop making such …I need you to stop making such remarks so I can feel more confident remarks so I can feel more confident when I learn new skills. Can I count when I learn new skills. Can I count on you?on you?


Skills Practice: Skills Practice:

Your Turn!Your Turn!

Use the B.E.E. method to provide Use the B.E.E. method to provide correcting feedback. correcting feedback.

(Use the case studies provided.)(Use the case studies provided.)


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The BEE AlgorithmThe BEE Algorithm

Describe the Describe the specificspecific behavior that behavior that was unacceptable.was unacceptable.

Describe why the behavior was Describe why the behavior was unacceptable (the effect or impact).unacceptable (the effect or impact).

Collaborate on or suggest a better Collaborate on or suggest a better way.way.

Request their cooperation.Request their cooperation.


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If it happens to you:If it happens to you: Don’t blame yourselfDon’t blame yourself Speak up!Speak up! Confront the aggressorConfront the aggressor Keep detailed recordsKeep detailed records Make a formal written complaintMake a formal written complaint


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Action Planning…Action Planning…


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““Somebody has to do something, Somebody has to do something,

and it’s incredibly pathetic that and it’s incredibly pathetic that

the somebody is us.”the somebody is us.”

-Jerry Garcia-Jerry Garcia Grateful DeadGrateful Dead

Our Response:Our Response: There’s nobody better There’s nobody better than than us!us!


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Becoming Sabotage SavvyBecoming Sabotage Savvy

References:References: Ending Nurse to Nurse Hostility: Why Nurses Eat Their Ending Nurse to Nurse Hostility: Why Nurses Eat Their

Young And Each OtherYoung And Each Other----Kathleen Bartholomew, RN, MNKathleen Bartholomew, RN, MN

Zapping Conflict in the Health Care WorkplaceZapping Conflict in the Health Care Workplace--Judith Briles, PhD--Judith Briles, PhD

Crucial Confrontations: Tools for Resolving Broken Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations, and Bad BehaviorPromises, Violated Expectations, and Bad Behavior

--Patterson, Grenny, McMillan, & Switzler--Patterson, Grenny, McMillan, & Switzler ““Developmental sequence in small groups,” Developmental sequence in small groups,” Psychological Psychological

BulletinBulletin--Bruce Tuckman, Ph.D.--Bruce Tuckman, Ph.D.

Coaching for ResultsCoaching for Results----Berry, Cadwell & FehrmannBerry, Cadwell & Fehrmann

““Aggression in clinical settings: Nurses’ views,” Aggression in clinical settings: Nurses’ views,” Journal of Journal of Advanced NursingAdvanced Nursing

--Gerald A. Farrell, RN, PhD--Gerald A. Farrell, RN, PhD ©Linda Mueller, Lee Memorial Health System 2010

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Evaluations, please:Evaluations, please:

All feedback is positiveAll feedback is positive What went wellWhat went well What should be changed next timeWhat should be changed next time Suggestions for making the course Suggestions for making the course

betterbetter



welcome to becoming sabotage-savvy: things they dont teach in nursing school ©linda mueller, lee...

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