Thursday, February 21, 2013

Spreading Kindness One at a Time

Nurses Eating Their Young.

This week in our Nursing Leadership class we are presenting our version of a "TEDtalks" or “MSBtalks” to our school's nursing forum.  As the target audience is nursing students and future nurses I decided to speak about horizontal violence or "nurse bullying".    

"Bullying in the workplace is epidemic in health care settings. Nurses and other members of health care teams can face bullying and other disruptive behavior that can negatively affect communication and collaboration among health care professionals, interfere with the quality of care, and compromise patient safety" (American Nurses Association, 2012, N.D).

I am a third year nursing student. As I end my college career here at MSB I find myself searching for that perfect place where I will work and I always envisioned myself working for children’s. However, Lately there has been a lot of tension and hostility between the staff on our unit because of short staffing and high patient volumes during this surge period.  Nurses and nursing assistants are all working extra long hours and everyone is beginning to become extremely short with each other, the idea of the team has some how been lost and I can only image that this same thing is happening everywhere.  I find myself worrying and nervous about when its my time to start orienting for my first nursing position will I be treated with this same almost snapping attitude where the learning environment is not nurturing.  We all know that it is not always going to be a perfect situation but how can we as future nurse overcome this and become prepared.  I say… 



Let's Call a CODE and stop nurse bullying.  We've all heard about nurses eating they're young, but there's a solution to be found in the acronym C-O-D-E.  First let's talk about the problem.  Nursing bulling also called horizontal violence is a reality that nursing students and new nurses face through public criticism, lack of support, exclusion and pure rudeness. Leading to avoidance, transfers, and mistakes that threaten patient safety because the novice nurse is afraid to ask for help and doesn’t receive the help they need. Bullying damages individuals, organizations, and the nursing profession!  “Healthcare centers should be a safe haven for patients, not places where unprofessional behavior, such as intimidation lead to mistakes.  The joint commission mandated that health care organizations need to implement codes of conduct specifically addressing work bullying and requires educating staff regarding professional behavior and instituting “zero tolerance” for disruptive behavior.” (Thompson, 2012, N.P)

“What would Florence Nightingale say if she saw how horribly nurses treat each other? Would she say, “”well that’s just the way it has always been?
No. She would say that we need to do something about the way nurses treat each other and that our duty, our ethical responsibility, is to eradicate this bad behavior as Nightingale eradicated death from poor hygiene”.  (Thompson, 2012, N.P) Author Rene Thompson suggests that we should present with moral courage when faced with horizontal violence. Vicki Lachman, a coauthor article Doing the right thing: Pathways to moral courage, has presented the perfect solution:

"Let's call a C-O-D-E by using moral courage.  Moral courage is the willingness to stand up for and act according to one’s ethical beliefs when moral principles are threatened, regardless of the perceived or actual
Risks”.  The acronym: CODE was developed to help nurses to develop steps to demonstrate strength and self confidence.  

C-O-D-E: An aid to demonstrating moral courage
C: Courage
The first step is to critically evaluate the situation to determine whether moral courage is needed to address it. Morally courageous people know how to use affective and objective information to determine whether a situation warrants further exploration.

O: Obligation to honor
When caught in a moral dilemma, you should self-impose a purposeful time-out for reflection to help determine what moral values and ethical principles are at risk or are being compromised.  Look at all the alternatives that present with each dilemma and ask your self, what’s the right thing to do?

D: Danger management
What do you need to do to manage your fear of being morally courageous? This step requires the use of cognitive approaches for emotional control and risk-aversion management. During this step, explore possible actions and consider adverse consequences associated with those actions. The cognitive re-framing method helps a person learn to stop negative thought processes that interfere with effective analysis of a situation.  Examples include positive talk and self-soothing techniques such as deep breathing,

E: Expression
Represents expression and action through assertiveness and negotiation skills. Knowing one’s obligations and demonstrating specific behaviors can enable you to move past your fear and serve as an effective patient advocate.
To avoid the blocks to exercising moral courage, nurses need to develop moral courage through education and practice.” (Lachman, 2012, N.P)

If you are feeling overwhelmed don’t worry, after practice, like many things in nursing, you will be able to demonstrate moral courage will confidence.  Imagine a world where bullying doesn’t exist. Where nurses go out of their way to support each other.  Where everyone works well together.  This is the ideal workplace for the nursing world.  Life’s most persistent and urgent question is what are you doing for others?-Martin Luther King Jr.  We can apply this question to the nursing field by asking ourselves, “what are we doing for our co-workers?” We should be treating our co-workers with the same compassion and empathy as our patients; with up most respect.

All nurses should:
• Communicate respectfully, honestly and openly.
• Hold self and each other accountable for unacceptable behavior.
• Seek solutions as a team – investigate and analyze occurrences of abuse just like other medication errors.
• Develop a mentoring system among peers, supervisors, physicians and other providers to build on strengths and enhance personal skills.
• Change negative cultures –- establish a standard for collaboration and communication in their unit, develop strategies and skills and share their best practices. (AACN, 2004, pg.2)

Finally, the Call of Action is for us, the future of nursing, is to develop relationships in which individuals hold themselves and others accountable to professional behavioral and practice standards.

Free pod casts from ANA  


"ANA Now Offers Free Pod casts on Bullying in the Workplace.  The ANA podcast series on bulling will help nurses recognize acts of bullying, identify the causes and consequences of bullying, and learn more about the expected actions and responsibilities of individual nurses, nurse managers, and health care organizations to prevent and respond to bullying in the workplace" (American Nurses Association, 2012, N.P.).

Click HERE to view the four pod casts on nurse bullying from ANA. 

 Additional Resources
Avoiding the Nursing Tit for Tat: The key to a supportive environment 

References

Thompson, R. (2012).  Do no harm applies to nurses too.  Pittsburgh, PA, InCredible Messages Press, LP.

American Association of Colleges of Nursing. (2004).  Zero tolerance for abuse.  Retrieved from http://www.aacn.org/wd/practice/docs/publicpolicy/zero_tolerance_for_abuse.pdf

American Nurses Association.  (2013).  NursingWorld: ANA Now Offers Free Podcasts on Bullying in the Workplace.  Retrieved from http://nursingworld.org/HomepageCategory/NursingInsider/ANA-Offers-Podcasts-on-Bullying.html

Lachman, V.D., Murray, J.S., Iseminger, K., Ganske, K.M., ( 2012) Doing the right thing: Pathways to moral courage.  Retrieved from http://www.americannursetoday.com/article.aspx?id=9110&fid=9022
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