Lateral Violence: The Real Nurse Curse

Abstract

<h2>Poster Presentation</h2><h3>Objective</h3> Lateral violence (LV) or workplace bullying is a longstanding problem within the healthcare field, so much so that the Joint Commission addressed the subject in 2008. Nurses consider bullying a normal rite of passage, <i>just how it has always been</i>. The current practice of enabling bullying among peers, allowing incivility to go unchecked, and having no accountability needed to be addressed. Thus, an LV workgroup was developed to decrease the incidences of LV and measure its effect on nurse retention. <h3>Design</h3> Plan-do-check-act (PDCA) cycles were used to isolate perceived LV behaviors and develop strategies to reduce their occurrence of or enhance the ability to manage them. <h3>Sample</h3> Registered nurses (more than 400) from the following units: labor & delivery, postpartum, nursery, neonatal intensive care, antepartum, gynecologic surgery/post anesthesia care. <h3>Methods</h3> One metric used to measure our efficacy was a monthly/quarterly anonymous survey to track the perception how often LV behaviors occurred. This survey was used after the implementation of each educational piece. The human resources department tracked LV complaints and job loss/resignation due to LV. <h3>Implementation Strategies</h3> The PDCA cycles involved educating staff, supervisors, and managers through PowerPoint presentations, posters, e-mails, tip sheets, and meetings. Administrators sent a clear message to the staff in support of this initiative; we were now a <i>no bully zone</i>. Recognizing and appropriately handling LV in conjunction with accountability was a top priority especially for supervisors/managers. Another cycle included a questionnaire asking charge nurses how they made patient/nurse assignments. This led to the creation of a unit-specific tip sheet that showed how assignments were made. Staff could now see the complexities involved in making assignments. <h3>Results</h3> By the end of our second PDCA cycle, we were seeing a decrease in LV on the units. The end result of this project was an impressive decrease in LV and an increase in nurse retention. <h3>Conclusion/Implications for Nursing Practice</h3> Education and accountability are paramount when tackling LV. The education must equip supervisors and managers with tools to effectively deal with bullies, witnesses, and victims of LV. This project is being reproduced in our hospital and will spread system wide. The benefits of reducing LV are far reaching and include patient safety and satisfaction, job retention, effective communication, decreased stress, healthy work environments, and better Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.