University of West Lateral Violence & Principles of Caring in Nursing Essay 1.Topic for the Assignment: Lateral Violence and Fundamental Principles of Cari

University of West Lateral Violence & Principles of Caring in Nursing Essay 1.Topic for the Assignment: Lateral Violence and Fundamental Principles of Caring in Nursing

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I am going to upload more materials needed for this assignment LATERAL VIOLENCE
IN NURSING: IMPLICATIONS AND
STRATEGIES FOR NURSE EDUCATORS
ERICKA SANNER-STIEHR, PHD, RN*
AND
PEGGY WARD-SMITH, PHD, RN†
Lateral violence among nurses persists as a prevalent problem, contributing to psychological
distress, staff turnover, and attrition. Newly graduated nurses are at particular risk for being targets
of lateral violence and experiencing its negative sequelae. Preparing student nurses to respond to
lateral violence prior to entering the nursing may alter this scenario. A review of the literature was
conducted to determine the potential for nursing faculty to change the cycle of lateral violence.
Based on this review, we recommend 3 main strategies, specifically for nursing faculty, aimed at
reducing incidences of lateral violence and preparing students to manage this phenomenon. First,
curricular content can address integrating lateral violence content into simulation experiences and
facilitating this knowledge into clinical experiences. Second, codes of conduct should guide behaviors
for both students and faculty. Finally, as role models, faculty should be aware of their own behaviors,
role model respectful communication, facilitate a courteous academic environment, and develop
nurses capable of identifying and appropriately responding to lateral violence. (Index words: Lateral
violence; Student nurses; Nursing education; Prelicensure; Faculty; Strategy) J Prof Nurs 33:113–
118, 2017. © 2016 Elsevier Inc. All rights reserved.
L
ATERAL VIOLENCE AMONG nurses is well documented as a persistent and ubiquitous problem. Also
known as horizontal violence, bullying, and incivilities, lateral
violence describes behaviors intended to demean, undermine, and/or belittle a targeted individual working at the
same professional level. Common examples of lateral
violence include verbal assaults (yelling, persistent criticism,
swearing, or belittling); nonverbal innuendo (eye rolling,
sighing, ignoring); undermining and sabotage (withholding
information, refusing to help); failure to respect privacy; and
broken confidences, gossiping and spreading rumors, and
scapegoating (Embree & White, 2010; Vagharseyyedin,
2015). Lateral violence contributes to a range of negative
consequences including depression, anxiety and sleep
disturbances (Vessey, Demarco, & DiFazio, 2010), a decreased
sense of well-being (Dehue, Bolman, Völlink, & Pouwelse,
2012), and physical illnesses (Kivimäki et al., 2003).
*Assistant Professor at University of Missouri-Saint Louis, College of
Nursing, St. Louis, MO.
†Associate Professor at University of Missouri, School of Nursing and
Health Studies, Kansas City, MO.
Address correspondence to Ericka Sanner-Stiehr: Assistant Professor,
College of Nursing, 1 University Drive Seton 220, University of
Missouri- St. Louis, St. Louis, MO 63141. E-mail: sannerstiehre@
umsl.edu
8755-7223
Employees who are dissatisfied with their work
environment may eventually leave if voicing their concerns
or ignoring offending parties does not solve the problem
(Sanner-Stiehr & Ward-Smith, 2014). Hospital staff turnover rates rose to a 5-year high at 17.2% in 2014, with
nursing turnover accounting for over 95% of that alarmingly
high number (NSI Nursing Solutions, Inc., 2015). High
turnover create financial burdens for institutions that spend
an estimated 20%–50% of an annual nurse salary to replace
those who leave (Boushey & Glynn, 2012; NSI Nursing
Solutions, Inc., 2015). In addition to the financial costs
associated with turnover rates, lateral violence has been
linked to attrition from the profession altogether (Johnson
& Rea, 2009; Lewis, 2006), exacerbating the already
concerning nursing shortage (American Association of the
Colleges of Nursing, 2014). Most alarmingly, dysfunctional
workplace communication and staff turnover also compromise patient care and safety (The Joint Commission,
2008), and Laschinger (2014) found that nurses perceived
a decrease in quality of patient care when uncivil behaviors
were present in their workplace.
In response to the mounting evidence of negative
consequences, the Joint Commission for Healthcare
Accreditation (2008) appealed to all health care organizations to take measures to decrease behaviors that undermine
safety culture. Health care organizations subsequently
implemented zero-tolerance policies, blueprints for reporting
Journal of Professional Nursing, Vol 33, No. 2 (March/April), 2017: pp 113–118
© 2016 Elsevier Inc. All rights reserved.
113
http://dx.doi.org/10.1016/j.profnurs.2016.08.007
114
SANNER-STIEHR AND WARD-SMITH
and managing instances of lateral violence and other
disruptive behaviors. Unfortunately, these measures only
address instances once they have occurred, and reporting is
deterred by fear of retribution (Jackson et al., 2010; Peters
et al., 2011) and perceived lack of managerial/administrative
support for targets (Lindy & Schaeffer, 2010).
Approximately 17.2% of nurses either change jobs or
leave the profession annually, an increase from 13.5% in
2011 (NSI Nursing Solutions, Inc., 2015). Among newly
licensed nurses, these rates are even higher, between an
estimated 25% and 33% (Booth, 2011; MacKusick &
Minick, 2010). Throughout the past decade, hostile work
environment and incivilities have been cited as significant
reasons for these alarmingly high rates (Booth, 2011;
Chachula, Myrick, & Yonge, 2015; Gaynor, Gallasch,
Yorkston, Stewart, & Turner, 2006; MacKusick & Minick,
2010; Read & Laschinger, 2013). With an imminent and
potentially serious nursing shortage (American Association
of the Colleges of Nursing, 2014; NSI Nursing Solutions,
Inc., 2015), retention of newly licensed nurses will be
critical to maintaining an adequate and sustainable nursing
workforce (Laschinger, Grau, Finegan, & Wilk, 2010).
Most recently, the American Nurses Association (2015)
issued a position statement on the unacceptability of lateral
violence. Communication between members of the health
care team, including nurses, is imperative to the delivery of
safe patient care. Intraprofessional education is increasingly
common in prelicensure education in accordance with
Standard IV of the American Association of Colleges of
Nursing Essentials for baccalaureate nursing education
(American Association of the Colleges of Nursing, 2008).
Despite nurses constituting the largest profession in health
care, intraprofessional communication remains conspicuously absent from prelicensure nursing curriculum standards.
In the past, lateral violence may have been tolerated as an
unappealing but unavoidable facet of nursing, but that
conversation is changing. Student nurses are aware of the
lateral violence they are likely to encounter and have begun
appealing to nurse educators in print, asking nursing
educators to include training specific to lateral violence
in curricula (Brox, 2015; Lissade, 2015; National Student
Nurses’ Association, 2015). Nurse educators must respond
by providing this student-centered education (Figure 1).
Methods
A literature review was conducted utilizing the following
databases: Academic Search Complete, MedLine, PubMed,
CINAHL, and PsycInfo. Search terms included lateral
violence, horizontal violence, workplace bullying, nurs*,
nursing, faculty, educator*, student nurses, nursing students,
attrition, turnover, new grad*, education, financial, cost,
communication, manager*, reporting, prelicensure, and
nursing school. Years searched included in the search
ranged from 2005 to 2015 to describe the historical context
and evolution of attempts at solutions over the last decade.
Criteria for inclusion in this review included those with a
focus on background, student experiences with lateral
violence, the scope of incivility in the nursing academic
setting, and interventions for students and faculty
incivilities. This article focuses on implications for nurse
educators rather than hospital administrators; thus, articles
focused on interventions aimed at registered nurses at the
hospital level were excluded. In addition, professional
documents such as the American Association of Colleges of
Nursing’s, 2008 Essentials for Baccalaureate Education
(2008) and The Joint Commission’s, (2008) report on
Safety Alerts were included as background context of
lateral violence in nursing. In all, a total of 40 relevant
references including articles, reports, and documents were
identified through this review.
Identification of Strategies
Lateral violence as a self-perpetuating cycle in nursing
emerged as the overarching theme from this literature
review, revealing three ways in which nurse educators can
intervene to interrupt the cycle. First, exposure to lateral
violence often occurs during clinical rotations and interactions with fellow students and faculty (Bowllan, 2015;
Cooper, Walker, Askew, Robinson, & McNair, 2011;
Hinchberger, 2009). Student nurses are particularly vulnerable to being targets of lateral violence (King-Jones,
2011); unfortunately, effective response strategies may not
be addressed in nursing education. Lacking the ability to
identify and appropriately respond can lead to formation of
maladaptive coping mechanisms, negative personal consequences, and attrition and staff turnover (Sanner-Stiehr &
Recommendations for Nurse Educators
•
Address instances of lateral violence in clinical rotations
•
Include education about lateral violence and the opportunity to rehearse
appropriate communication strategies within the curriculum
•
State expectations for professionalism explicitly in Codes of Conduct and
enforce consistently
•
Role model professional and respectful communication
Figure 1. Recommendations for nurse educators.
LATERAL VIOLENCE IN NURSING
Ward-Smith, 2013; Sanner-Stiehr & Ward-Smith, 2014).
Education specifically focused on preventing, identifying,
and responding to lateral violence while in an academic
setting can increase student nurses’ ability to respond to
lateral violence once graduated. Second, students may be
exposed to lateral violence and other hostilities in the
academic environment. Nurse educators must take care to
ensure that the academic atmosphere does not send the
message that lateral violence is acceptable. Enforcing codes
of conduct and providing counseling for students who
breach those rules through incivilities can help to break the
cycle. Third, as the hierarchical leaders in an academic
environment, faculty serve as role-models, setting standards for professional conduct. Because faculty–faculty
incivilities can translate into role-modeling of an unsupportive and antagonistic environment, faculty behavior
issues should be identified and resolved. This article
discusses each of these three main strategies in further
detail, as the most promising approach to breaking the
cycle of lateral violence.
Implications and
Strategies for Nurse Educators
Strategy #1: Curricular Content
As health care employees, nurses encounter mentally,
emotionally, and physically stressful situations on a daily
basis. The ability to identify inappropriate communication
and knowledge of how to respond can prevent escalation,
restore an atmosphere of respect, and maintain focus on the
crucial mutual goal: patient care delivery. Education about
lateral violence should provide the opportunity to develop
and practice communication skills specific to the professional nursing work environment. Furthermore, specific
training related to responding to lateral violence is essential
because the line between assertiveness and incivility can
often become blurred without proper guidance (Rad,
Mirhaghi, & Shomoossi, 2015).
Simulation. Simulation, as an instructional modality, has
gained increasing popularity in contemporary nursing
education for its applicability to a variety of clinical
scenarios (Jeffries, 2014). The ability to rehearse responses
in a controlled environment alleviates the pressure of
stressful situations and facilitates skill mastery (Bandura,
1997). Incorporating lateral violence situations into
simulation experiences can provide a nonthreatening
environment in which student nurses can develop effective
response strategies to common lateral violence situations
(Sanner-Stiehr & Ward-Smith, 2015).
Simulations typically include three main steps: (a)
prebriefing, (2b) simulated experience, and (c) debriefing
(Jeffries, 2014). Prebriefing for lateral violence response
training simulations should include defining lateral violence behaviors and a discussion of the goals of effective
responses. Whether covert or overt, lateral violence
behaviors disrupt respectful communication and/or
threaten safe patient care delivery. As a result, simulated
response training should focus on restoring respect and
ensuring that patients receive high-quality care. These
115
goals should be followed by role-modeling of effective
response strategies that address these goals. Following
prebriefing, students should have the opportunity to practice
responding to lateral violence behaviors, applying knowledge acquired during prebriefing. Students should be
allowed to phrase responses in their own words to create a
more organic experience. Although facilitators typically do
not provide feedback during simulated scenarios, feedback
to correct ineffective response strategies and provide
additional coaching may be crucial. If students practice
ineffective responses that do not address the overall goals,
they will not benefit from the exercise.
The final step, debriefing, allows students the opportunity to reflect on the experience, discuss alternative
responses for situations and, most importantly, generalize
response strategies to alternate situations. Facilitators
should guide debriefing discussions with semiopen-ended
questions such as “How did you feel about this experience?”
and narrow the focus gradually to generalizing. For
example, asking students, “Have any of you experienced
similar situations” can encourage students to share previous
experiences and provide the opportunity to discuss how
response strategy techniques and goals can be applied to
different situations. Although other members of the health
care team such as physicians and managers may engage in
disruptive behaviors, these relationships inherently involve
authority gradients. Because of the innate power inequality
present in these situations, we recommend that training
specific to responding to nonlateral disruption in communication should be provided separately.
We recommend including response strategy simulation
at least twice during prelicensure education. Because most
programs are two years in length, including it as a
stand-alone scenario during the first year can introduce
concepts early while students become adjusted to the
simulation process and core coursework. Subsequently in
the second year, we suggest including elements of lateral
violence or disruptive behaviors into simulations focused
on management of physiological problems to increase the
realistic presentation of how these situations manifest.
Simulated response training provides student nurses with
the intraprofessional development education solicited by
the National Student Nurses’ Association (2015) and can
ultimately lessen the negative effects of lateral violence in
the workplace. Nurse educators interested in learning more
about specific lateral violence response training for
simulation may contact the primary author for details.
Clinical Experiences. Student nurses often either experience or witness lateral violence during their clinical
rotations (Levett-Jones, Pitt, Courtney-Pratt, Harbrow, &
Rossiter, 2015). Leaving these situations unaddressed
can lead to the formation of maladaptive coping mechanisms or worse, the impression that lateral violence is a
routine and expected aspect of nursing (Sanner-Stiehr &
Ward-Smith, 2013). Integrating education into postclinical
debriefings, especially when lateral violence has been
experienced or observed, provides an opportunity to learn
from those incidents and immediately reinforces appropriate
116
SANNER-STIEHR AND WARD-SMITH
communication strategies. Student placement for clinical
experiences should utilize clinical settings that are
supportive of student nurses and with individuals who
role-model appropriate and professional behavior. Designated education units address this need by providing
partnerships between educators and clinicians, training
nurses in their role as preceptors (McVey, Vessey, Kenner, &
Pressler, 2014), and ensuring that professionalism is
emphasized and that students gain experiences on units
where they are welcomed (Galuska, 2015). As often as
possible, designated education units should be utilized for
clinical placements.
Strategy #2: Codes of Conduct
learning environment, one in which the behavior of faculty
aligns with the mission statement of the institution.
The results of an Internet review of universities and
the presence of faculty honor codes indicate that many
institutions have or are developing these documents
(American Association of University Professors, n.d.). In
addition, Clark (2015) provides that interventions faculty
can implement to avoid incivility in educational settings.
Prevention is preferred, and careful attention to developing
behavioral norms that do not include any type of lateral
violence or incivility, and adhering to these norms,
according to Clark (2015) avoids inappropriate situations,
which enhance learning.
Strategy #3: Faculty Role and Responsibility
Students. Prelicensure nursing programs should include
appropriate behavior statements within their code of
conduct statements, extending beyond academic dishonesty
to social behaviors and communication policies. Clearly
delineating expectations for student behavior and consequences for breaches not only lets students know what is
expected of them while in school but can also help develop
professional habits upon entry to the workforce. Common
disruptive student behaviors that should be addressed
include tardiness, sleeping during class, uncivil or sarcastic
comments during class, bullying peers, challenging
professors’ competence and credibility, and academic
dishonesty (Clark & Springer, 2007a, 2007b). If breaches
of codes of conduct are unaddressed or tolerated during
nursing school, unacceptable behaviors are likely to continue
and escalate in professional practice. Unprofessional and
inappropriate behaviors reflect poorly on the individuals
behaving in a disruptive manner, the colleges/schools of
nursing they attended, and the profession of nursing as
a whole.
Kolanko et al. (2006) notes that if students are identified
as at-risk, the behaviors can be counseled and corrected as
part of their educational process. Cooper et al. (2009)
found that using profanity, belittling remarks, and
inappropriate, rude, and hostile language were the most
common forms of lateral violence among student nurses
surveyed. When these types of behaviors are witnessed,
students must be held consistently accountable to the
standards set for acceptable behaviors.
Faculty. Although most academic settings have codes of
conduct for students, faculty codes of conduct and
disciplinary procedures may not be a part of the academic
policies or may be ineffectively implemented. The American
Association of University Professors Statement on Professional Ethics (2014) state that faculty are expected to “seek
and state the truth as they see it (Nagel, 2014, para 18).”
Codes of conduct are separate and not overlapping of
academic freedom and tenure issues. In 2012, International
Association of Universities adopted a guideline articulating a
code of ethics in higher education. This document describes
values and principles and provides procedures and practices
useful to identify inappropriate behavior and sanctions,
should they be required. These guidelines are aimed at
assuring that institutions of higher education provide a
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