Incivility & Horizontal Hostility in the Nursing Profession Keith Rischer, RN, MA, CEN, CCRN

Confronting Horizontal Hostility HH Defined Nurses covertly or overtly directing their dissatisfaction inward toward each other and those around them Unkind, aggressive, antagonistic behaviors Emotionally abusive “Professional” behavior that is… Demeaning Devaluing Disrespectful

Most Frequent Forms in Nursing Nonverbal innuendo Raising eyebrows-face making Verbal affront Snide remarks Undermining activities Not available to help Sabotoge Deliberately set up neg. situation Infighting Scapegoating Backstabbing

Who is at Highest Risk? New RN or nurse from another area Nurses who are different than the dominant group-Men in nursing or minorities HH is used to break new nurses into the “group” or acculturate them into the profession HH teaches the “unspoken rules” or status quo that must not be rocked

New Graduate Experiences Feeling neglected or isolated Too much responsibility without support 96% of new nurses experienced after 1 year-

Consequences of HH cont. Psychological Depression PTSD-50% suffer stress 5 years afterwards Burnout Lack of control Maladaptive responses: substance abuse, overeating Physical Decreased immune response Cardiac arrythmias/MI secondary to continuous circulating catecholamines

How does HH Survive & Thrive? Denial By both the perpetrator of HH and nurses who remain silent Normative Nobody questions it. Similar to dysfunctional co-dependant relationships Ineffective Supervisor Intervention Lack of Confrontation Skills Passive/aggressive communication style common with women and within nursing Aggression of HH Breeds Aggression in Victim Vicious cycle is perpetrated

Empowering Strategies:Carefronting Recognize what it is Carefronting uses biblical concepts of respect, forgiveness and courage to confront Caring enough to confront the “bully” in a responsible, respectful manner

Empowering Strategies Non-verbal innuendo “I sense from your facial expression that there may be something you wanted to say to me. It’s OK to speak directly to me…” Backstabbing “I don’t feel right talking about him/her situation when I wasn’t there or don’t know the facts. Have you spoken to them?” Verbal affront “Those I learn the most from are direct and clear in their feedback. What could you share with me to better understand this situation?” In this study of 26 brand new nurses who used these strategies 96% encountered HH in first year 100% confronted it directly though it was difficult Most common that these new nurses faced was setting up to fail with unreasonable assignment, sabotage, undermining and not being available

Principles to Transform the Profession Form meaningful relationships w/colleagues Recapture the dignity and value of the nursing profession Empowerment Embrace ability to change the situations that encourage oppression in health care Respect and value self and others Don’t engage in negative conversation about another co-worker Stand up for the “absent member

Closing Thoughts Need to respect our uniqueness and differences as a strength Nursing is a caring profession We have a professional responsibility to “care” for each other in addition to our patients