1. Mentorship to Eliminate Horizontal Violence, Abuse, and Bullying Chloe Clark – BScN Student – Trent University Peterborough, ON Abstract: Nursing is a highly respected profession within Canada that over the past two decades has been plagued with the indecent behaviours of horizontal abuse, violence, and bullying. This poster addresses this issue as it effects new graduates with respects to retention, absenteeism, job satisfaction, and patient safety. A proposed 1-day workshop and mentorship program are provided as a solution to horizontal bullying within the workplace. The mentorship program aims to reduce behaviours that cause humiliation, depression, isolation, exhaustion, and fear felt by new nurses as a result of nurse-nurse harassment. By addressing both the individual and the environment, we hope to see retention rates and absenteeism decrease, and job satisfaction of new nurses increase. By reducing or eliminating horizontal violence in the workplace, we can provide safer care to our patients. Issue and Relevance: Within the profession of nursing, horizontal harassment, abuse, and bullying is a serious and increasingly prevalent issue that new graduates are subjected to 2, 6. Becher and Visovsky describe horizontal violence as hostility and/or unwanted abuse within the workplace 1. Cleary, Hunt, and Horsfall add that workplace bullying can include behaviour that could be considered humiliating, demeaning, intimidating, or threatening and occurring repeatedly 2. While most organizations have a zero-tolerance policy for harassment and abuse, 67% still admit to being verbal abused on the job; 36% have been the target of physical abuse; and 11% have been sexually abused 8. Generally, more experienced nurses are those who partake in these negative behaviours targeting new, unexperienced nurses 11. These behaviours can affect individuals on a physical, emotional, and psychological level drastically reducing their well-being 5. Nurses who are victim to horizontal harassment experience pain, demoralization, fear, sleeplessness, anxiety, depression and feelings of being devalued 5, 6. Workplace violence is directly related to increased levels of absenteeism, low retention rates, turnover rates, and low job satisfaction 5, 7. The minimum requirement from Ontario’s Occupational Health and Safety Legislation says an employer must have policies in place for both workplace violence and harassment and that they are to be reviewed annually 3. With current workplaces still experiencing unsettling levels of harassment and abuse, it is clear that the current legislation is not adequate enough to eliminate this issue. Strategy: The expectation of keeping patients safe can lead to an environment conducive to blaming others, which directly correlates with horizontal bullying 2. New, unexperienced nurses are an easy target to blame. I propose a mentorship program be put in place for new hires in order to help ease the transition into the workplace. Mentorship can reduce levels of burnout and turnover within new graduates and act as a tool for recruitment and retention 7. Experienced nurses chosen for mentoring new hires must incorporate values such as respect, honesty, trust, and cooperation in their daily practice in order to be suitable for the position 5. Mentors would begin by taking a one-day workshop modelled after the RNAO’s Preceptors for Nurses workshop that addresses training in proper communication skills, conflict, diversity, and motivation of learners 9. They would work to implement a blame-free environment by encouraging reporting of near misses and advocating for changes that promote patient safety when working with their new graduate. The mentors would provide new nurses with someone to rely on and help building their skill set. The formal mentorship program would last 6 months. In this time, monthly questionnaires would be completed to monitor the effectiveness of the partnerships. Mentors would encourage their new hire to reflect on their practice and focus on areas they could improve on with the help of the partnership. Mentors would be encouraged to set a good example for new hires by helping point out health and safety regulations on the unit. They would help their new graduate understand what is expected of them on the unit. Outcomes: The mentorship program aims to reduce horizontal harassment within the workplace, leading to better retention of new nurses, improved team morale, and an overall increase in positive patient outcomes. Commitment from all employees within an organization would be needed for the success of this program. The programs success would be quantified by long-term measurements of retention rates, absenteeism, and job satisfaction of new nurses. Monthly questionnaires modeled after Jourdain and Chênevert’s (2010) study on job demands, burnout and intent to leave would help measure short-term outcomes such as self-confidence within the workplace, new nurses initial feelings of belonging and self-worth, and their intentions on staying within the organization and/or nursing profession 4. The program would help by allowing organizations to better understand why workplace harassment occurs and the feedback would then be used to implement better policies for reducing workplace violence. The encouragement of near-miss reporting would reduce errors leading to a decrease in blameful behaviours. This would in turn reduce the incidence of bullying related to errors in practice and create a safer, healthier environment to work in. In turn, costs associated with high turnover and absenteeism would be decreased. By reducing the incidence of horizontal bullying with a mentorship program, we would create a safer, healthier work environment for new graduates. Recommendations: 1)Strictly enforce a zero-tolerance policy for any type of harassment, violence, or bullying between faculty members as per the Ontario Occupational Health and Safety Act 3, 8 - Assign a mediator to monitor mentorship partnerships to address any possible issues that may arise 2)Encourage experienced nurses to complete the one-day workshop to enforce values such as respect, honesty, trust, and cooperation between faculty members 3)Create policies which encourage the reporting of near-misses and include follow-up proposals to address issues that arise with regards to health and safety violations 4)Ensure mentors complete month reviews with their new graduate to monitor progress and address issues related to expectations 5)Provide recognition and applaud achievements in visible ways 6 References: 1 Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. Medsurg nursing, 21(4), 210-214. Retrieved from https://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/resources/MSNJ-Becher-Visovsky-21-04.pdf 2 Cleary, M., Hunt, G. E., & Horsfall, J. (2010). Identifying and addressing bullying in nursing. Issues Mental Health Nursing, 31(5), 331-335. doi: 10.3109/01612840903308531 3 Government of Ontario. (2014). Occupational health and safety act, R.S.O. 1990, c. O.1. Retrieved from http://www.ontario.ca/laws/statute/90o01/v17#top 4 Jourdain, G., & Chênevert, D. (2010). Job demands–resources, burnout and intention to leave the nursing profession: A questionnaire survey. International Nursing Studies, 47(6), 709-722. doi:10.1016/j.ijnurstu.2009.11.007 5 Katrinli, A., Atabay, G., Gunay, G., & Cangarli, B. G. (2010). Nurses’ perceptions of individual and organizational political reasons for horizontal peer bullying. Nursing Ethics, 17(5), 614-627. doi: 10.1177/0969733010368748 6 Laschinger, H. K. S., Grau, A. L., Finegan, J., & Wilk, P. (2010). New graduate nurses’ experiences of bullying and burnout in hospital settings. Advanced Nursing, 66(12), 2732-2742. doi: 10.1111/j.1365-2648.2010.05420.x 7 Race, T. K., & Skees, J. (2010). Changing tides: improving outcomes through mentorship on all levels of nursing. Critical Care Nursing Quarterly, 33(2), 163-174. doi: 10.1097/CNQ.0b013e3181d91475 8 Registered Nurses Association of Ontario. (2008). Best practice guideline: Healthy work environments: Workplace health, safety and well-being of the nurse. Toronto, ON: Author.Retrieved from http://rnao.ca/sites/rnao-ca/files/Workplace_Health_Safety_and_Well-being_of_the_Nurse.pdf 9 Registered Nurses Association of Ontario. (2012). Preceptors for nurses workshop. Retrieved from http://rnao.ca/events/preceptorship-nurses-workshop 10 Wallen, G. R., Mitchell, S. A., Melnyk, B., Fineout‐Overholt, E., Miller‐Davis, C., Yates, J., & Hastings, C. (2010). Implementing evidence‐based practice: effectiveness of a structured multifaceted mentorship programme. Advanced Nursing, 66(12), 2761-2771. doi: 10.1111/j.1365-2648.2010.05442.x 11 Wilson, B. L., Diedrich, A., Phelps, C. L., & Choi, M. (2011). Bullies at work: the impact of horizontal hostility in the hospital setting and intent to leave. Nursing Administration, 41(11), 453-458. doi: 10.1097/NNA.0b013e3182346e90

2. Abstract Nursing is a highly respected profession within Canada that over the past two decades has been plagued with the indecent behaviours of horizontal abuse, violence, and bullying. This poster addresses this issue with respects to its negative impact on retention, absenteeism, job satisfaction, and patient safety. A proposed workshop and mentorship program are looked at as a solution to horizontal bullying within the workplace. The mentorship program aims to reduce behaviours that cause humiliation, depression, isolation, exhaustion, and fear felt by new nurses as a result of nurse-nurse harassment. By addressing both the individual and the environment, we hope to see retention rates and absenteeism decrease, and job satisfaction of new nurses increase.

3. The Issue: Within the profession of nursing, horizontal harassment, abuse, and bullying is a serious and increasingly prevalent issue (Cleary, Hunt, and Horsfall, 2010). Becher and Visovsky (2012) describe horizontal violence as hostility and/or unwanted abuse within the workplace. Cleary, Hunt and Horsfall (2010) add that workplace bullying can include behaviour that could be considered humiliating, demeaning, intimidating, or threatening and occurring repeatedly. While most organizations have a zero-tolerance policy for harassment and abuse, 67% still admit to being verbal abused on the job; 36% have been the target of physical abuse; and 11% have been sexually abused (RNAO, 2008). Generally, more experienced nurses are those who partake in these negative behaviours targeting new, unexperienced nurses (Wilson, Diedrich, Phelps, & Choi, 2011). These behaviours can affect individuals on a physical, emotional, and psychological level drastically reducing their well-being (Katrinli, Atabay, Gunay, & Cangarli, 2010). Nurses who are victim to horizontal harassment experience pain, demoralization, fear, sleeplessness, anxiety, and depression (Katrinli et al., 2010). Workplace violence is directly related to increased levels of absenteeism, low retention rates, turnover rates, and low job satisfaction (RNAO, 2008). The minimum requirement from Ontario’s Occupational Health and Safety Legislation (2015) says an employer must have policies in place for both workplace violence and harassment and that they are to be reviewed annually. With current workplaces still experiencing unsettling levels of harassment and abuse, it is clear that the current legislation is not adequate enough to eliminate this issue.

4. Strategy: The expectation of keeping patients safe can lead to an environment conducive to blaming others, which directly correlates with horizontal bullying (Cleary, Hunt, and Horsfall, 2010). New and unexperienced nurses are an easy target to blame. I propose a mentorship program be put in place for new hires in order to help ease the transition into the workplace. Mentorship can reduce levels of burnout and turnover within new graduates and act as a tool for recruitment and retention (Race and Skees, 2010). Experienced nurses chosen for mentoring new hires must incorporate values such as respect, honesty, trust, and cooperation in their daily practice in order to be suitable for the position. Mentors would begin by taking a two-day workshop focused on these skills. They would work to implement a blame-free environment by encouraging reporting of near misses and advocating for changes that promote patient safety. The mentors would provide new nurses with someone to rely on for answering questions and helping to build their skill set. The formal mentorship program would last 6 months. In this time, monthly questionnaires would be completed to monitor the effectiveness of the partnerships. Mentors would encourage their new hire to reflect on their practice and focus on areas they could improve on with the help of the partnership.

5. Outcomes: The mentorship program aims to reduce horizontal harassment within the workplace, leading to better retention of new nurses, improved team morale, and an overall increase in positive patient outcomes. The programs success would be quantified by long-term measurements of retention rates, absenteeism, and job satisfaction by new nurses. Monthly questionnaires would help measure short-term outcomes such as self- confidence within the workplace and new nurses initial feelings of belonging and self- worth. The program would help by allowing organizations to better understand why workplace harassment occurs and the feedback would then be used to implement better policies for workplace violence. The encouragement of near-miss reporting would reduce errors leading to a decrease in blameful behaviours. This would in turn reduce the incidence of bullying related to errors in practice and create a safer, healthier environment to work in. In turn, costs associated with high turnover and absenteeism would decrease.

6. Recommendations: 1)Strictly enforce a zero-tolerance policy for any type of harassment, violence, or bullying between faculty members as per the Ontario Occupational Health and Safety Act (2014) 2)Keep managers/supervisors aware of each mentor partnership and have them monitor interactions with other nurses in order to identify possible harassment behaviours 3)Encourage experienced nurses to complete the two-day workshop to enforce values such as respect, honesty, trust, and cooperation between faculty members 4)Create policies which encourage the reporting of near-misses and include follow-up proposals to address issues that arise with regards to health and safety violations 5)Ensure mentors complete month reviews with their new graduate to monitor progress

7. Within the practice of nursing, horizontal harassment, abuse, and bullying is a serious and increasingly prevalent issue that needs to be addressed (Cleary, Hunt, and Horsfall, 2010). Becher and Visovsky (2012) describe horizontal violence as hostility and or unwanted abuse within the workplace. Cleary, Hunt and Horsfall (2010) add that workplace bullying can include behaviour that could be considered humiliating, demeaning, intimidating, or threatening and that are typically repeated. Generally, more experienced nurses are those who partake in these negative behaviour targeting new, unexperienced nurses (Wilson, Diedrich, Phelps, & Choi, 2011). These behaviours can affect individuals on a physical, emotional, and psychological level drastically reducing their well-being (Katrinli, Atabay, Gunay, & Cangarli, 2010). Nurses who are victim to horizontal harassment experience pain, demoralization, fear, sleeplessness, anxiety, and depression (Katrinli et al., 2010). Negative environments within the nursing field can lead to increased incidence of burnout, sick leave, and poor retention of new nurses— which ultimately leads to poor patient outcomes (Becher and Visovsky, 2012; Registered Nurses Association of Ontario, 2008). Horizontal harassment is not new to the nursing profession, it has been described well over the last two decades, yet it still has not changed. Mitchell, Ahmed, and Szabo (2014) explain that this type of negative behaviour continues to be described as a “rite of passage” for new nurses, yet we have seen that this contributes to such negative outcomes for both nurses and patients. This phenomenon is quantified by the lack of retention on new nurse graduates, their lack of success, low self-esteem, absenteeism, and diminished patient care. While the exact prevalence of horizontal violence is unknown due to being underreported, it is suggested that approximately 65- 80% of nurses experience this behaviour and about 50% of nurses experience this on a daily-weekly basis (Becher and Visovsky, 2012). The expectation of keeping patients safe can lead to an environment conducive to blaming others which is associated with horizontal bullying (Cleary, Hunt, and Horsfall, 2010). Horizontal violence demeans the nursing profession and needs to be dealt with. The entity of nursing revolves around fundamental values such as individuality, autonomy, dignity, worth, uniqueness, privacy, persons, policy, human rights, cultural rights (Gallagher, 2007). If we want to better patient outcomes, increase retention, and reduce absenteeism and turnover rates, then we need to find a solution to horizontal violence that brings nursing back to its fundamental values.

8. References: 1 Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. Medsurg nursing, 21(4), 210-214. Retrieved from https://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work- environment/resources/MSNJ-Becher-Visovsky-21-04.pdf 2 Cleary, M., Hunt, G. E., & Horsfall, J. (2010). Identifying and addressing bullying in nursing. Issues Mental Health Nursing, 31(5), 331-335. doi: 10.3109/01612840903308531 3 Government of Ontario. (2014). Occupational Health and Safety Act, R.S.O. 1990, c. O.1. Retrieved from http://www.ontario.ca/laws/statute/90o01/v17#top http://www.ontario.ca/laws/statute/90o01/v17#top 4 Jourdain, G., & Chênevert, D. (2010). Job demands–resources, burnout and intention to leave the nursing profession: A questionnaire survey. International Journal of Nursing Studies, 47(6), 709-722. doi:10.1016/j.ijnurstu.2009.11.007 5 Katrinli, A., Atabay, G., Gunay, G., & Cangarli, B. G. (2010). Nurses’ perceptions of individual and organizational political reasons for horizontal peer bullying. Nursing Ethics, 17(5), 614-627. doi: 10.1177/0969733010368748 6 Laschinger, H. K. S., Grau, A. L., Finegan, J., & Wilk, P. (2010). New graduate nurses’ experiences of bullying and burnout in hospital settings. Journal of Advanced Nursing, 66(12), 2732-2742. doi: 10.1111/j.1365- 2648.2010.05420.x 7 Race, T. K., & Skees, J. (2010). Changing tides: improving outcomes through mentorship on all levels of nursing. Critical care nursing quarterly, 33(2), 163-174. 8 Registered Nurses Association of Ontario. (2008). Best Practice Guideline: Healthy Work Environments: Workplace Health, Safety and Well-being of the Nurse. Toronto, ON: Author. Retrieved from http://rnao.ca/bpg/guidelines/workplace-health-safety-and- wellbeing-nurse-guideline 9 Registered Nurses Association of Ontario. (2012). Preceptors for Nurses Workshop. Retrieved from http://rnao.ca/events/preceptorship-nurses-workshop http://rnao.ca/events/preceptorship-nurses-workshop 10 Wallen, G. R., Mitchell, S. A., Melnyk, B., Fineout‐Overholt, E., Miller‐Davis, C., Yates, J., & Hastings, C. (2010). Implementing evidence‐based practice: effectiveness of a structured multifaceted mentorship programme. Journal of advanced nursing, 66(12), 2761-2771. 11 Wilson, B. L., Diedrich, A., Phelps, C. L., & Choi, M. (2011). Bullies at work: the impact of horizontal hostility in the hospital setting and intent to leave. Journal of Nursing Administration, 41(11), 453-458.