Horizontal Violence or Generational Conflict: Is Care-Fronting the Answer

Yvonne Wesley, RN, Ph.D., FAANIndependent Health Consultant

www.ywesleyconsulting.com

OverviewUpon completion of this session, participants will be able to:

Define Horizontal Violence and Generational Conflict

Compare and contrast HV and GC similarities and differences

Illustrate the effect of Care-Fronting on HV and GC

Horizontal ViolenceAntagonistic behaviors such as:

Gossiping, undue criticism,

Innuendo, scapegoating,

Undermining, passive aggression,

Bickering , blaming behaviors

Sabotage

Emotional dumping, indiscriminate venting

Weinand, M. R. (2010). Horizontal violence in

nursing: history, impact, and solution. JOCEPS: The

Journal Of Chi Eta Phi Sorority, 54(1), 23-26.

Weinand, M. R. (2010)

Why susceptibility among nurses• Antagonistic behaviors among oppressed people i.e.:

women• Nursing predominately women• Antagonistic behaviors, a form of self-hate• Demonstrated in the classroom with faculty

dominating student nurses.• Nurse managers and supervisors cited as frequent

users of bullying culture & top down style

Weinand, M. R. (2010)

End Product from HV• Overwhelming sense of negativity cultivated• Aggression breeds aggression• Low morale• High turnover• Increased absence• Low productivity

Weinand, M. R. (2010)

Solutions to the problemEmbrace transformational leadership

Inspire and challenge staff;

Utilize active listening,

Advise and coach staff;

Have a positive vision

Reward resolution vs. identification of problems

Formal training in teamwork, positive feedback, conflict

management and confrontation

skills

King-Jones, M. (2011)

•overt and covert nonphysical hostility,•criticism, sabotaging, undermining, infighting,

scapegoat, and bickering•unkindness, discourtesy, divisiveness, and

lack of cohesiveness•belittling gestures, verbal abuse, gossiping,

sarcastic comments, faultfinding, devaluing comments,

•disinterest and discouragement, and controlling behaviorsKing-Jones, M. (2011). Horizontal

Violence and the

Socialization of New Nurses. Creative Nursing,

17(2), 80-86.

King-Jones, M. (2011)

HV stems from oppression

HV is how oppressed people cope with powerlessness

HV, a display of powerlessness & negative emotions

Knowledge is power -- a cycle of power and resistance

To resolve HV, address the dynamics of power and conflict

Generational Conflict

•Increased numbers of generations working together creates more opportunity for misunderstanding•Veterans, [born before 1945]•Baby Boomers, [born 1946-1964]•Generation X, [1965-1976]•Gen Y/Millennials [1977-1997]

Hahn, J.A. (2011),

Managing Multiple

Generations: Scenarios From the Workplace. Nursing Forum, 46(3), 119-127.

Hahn, J.A. (2011)Veterans – before 1945

Grew up in times of political and economic uncertainty,

lived experience of the Great Depression and World War II

Nursing as a helping profession and unselfish

Expect rewards for hard work

Baby Boomers – ‘46 to ‘64

Strong sense of duty, called workaholics

Lived experience of prosperity

Look to empower

Arrive early to work

Hahn, J.A. (2011)

Generation X – ’65 to ‘76

Independent, self-directed, and techno-savvy

Latchkey kids

Grew-up quicker and stayed adolescents longer

Quality of life important their parents work long hours and experienced downsizing

Millennium/Gen Y – ’77 to ‘97

Technology and instant communication

Accepting multiculturalism

After-school activities, such as swimming, soccer, dance

Want work-life balance

Generation Generational styles

Veterans<1945

StableReliablePracticalLoyal

Baby Boomers1946–1964

InvolvementPersonal growth

OptimismMentors

Generation X1965–1976

Think globallyTechno-literacyPragmaticAsynchronous communicationSkeptical

Millennials1977–1997

MultitaskingTechnologically savvy

Outcome drivenDetermined

Carefronting

Kupperschmidt, B. (2006). Addressing multigenerational conflict: mutual respect and carefronting as strategy. Online Journal Of Issues In Nursing, 11(2), • Kupperschmidt argues that

professional nurses must care enough about their patients, profession, colleagues, and themselves to ‘carefront’ disrespectful behavior

Kupperschmidt, B. (2006).

Treating each other with respect is a nurse's ethical responsibility

Carefronting, a model of communication used when professional nurses care enough about themselves and their patients to confront disrespectful behavior face-to-face

Kupperschmidt, B. (2006)

Failure to

confront is

dishonest

communicationCarefronting embodies forgiveness, caring and valuing, while addressing the anger in the disrespectful behavior, and focuses on the here and now

Kupperschmidt, B. (2006)

The goal is the ability to work together to provide safe patient care in an environment based upon mutual respect

Kean University GraduatesBivins & Primus 2012 Developed the:Perceived Carefronting Ability Questionnaire

A newly registered nurse Renee is working alongside Jeanette, a nurse of twenty five years in a busy trauma emergency room. Patient Glendale, a frequent flyer, presents complaining of chest pain radiating to his right arm, his history includes hypertension managed with a beta blocker and drug seeking behavior.

Jeanette blurts out, “Back so soon. Ran out of your Percocets in three days did you?” Renee goes to his bedside places him on the cardiac monitor, performs and EKG and tells the physician the patient may be experiencing a heart attack.

Jeanette waltzes over, rolls her eyes, sighs and sarcastically says, “This rookie needs to go back over there and complete his history and physical before jumping to conclusions. Embarrassed Renee walks away. Later she seeks out Jeanette and asks to speak to her in a private area.

Yvonne Bivins MSN RNNadia Primus MSN RN

Carefronting Techniques based on Kupperschmidt (2006)

When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction).

Because it portrays me as someone in a rush (what does it look, sound or feel like).

Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response)

In the future talk to me in private (what behavior you want to see).

Are you committed to treating me as respected colleague? (What you want them to do?)

If there isn’t a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence).

Number of Participants Pre-test Post-test

Baby Boomer RNs 7 4

Generation X RNs 17 8

Associate Degree

Bachelor's Degree

Graduate Degree

0

2

4

6

8

10

12

14

16

5

16

7

Yvonne Bivins MSN RNNadia Primus MSN RN

• A paired t test compared pre and post mean scores of the participants’ perceived ability to utilize Carefronting

• pre-test M= 40. 75, SD=4.15

• post-test M= 43.08, SD=3.08

• Highest possible score being 50 and the lowest 10

• Alpha set at p<0.05

• There was no significant difference t(11) = -2.17, p = 0.053. The 95% confidence interval for the mean difference between the two means was -4.70 to 0.03.

• An independent t test compared Baby Boomer to Gen X mean scores on perceived ability to utilize Carefronting

• No significance difference in the Baby Boomer & Generation X mean scores • pre-test t(24) = .992, p = .33

• post-test t(11) = .154, p = .88

Yvonne Bivins MSN RNNadia Primus MSN RN

Carefronting Techniques based on Kupperschmidt (2006) When you called me a rookie and said I jumped to a conclusion

(what was the action). I felt humiliated (your reaction). Because it portrays me as someone in a rush (what does it look,

sound or feel like). Was it your intention to embarrass or humiliate me? (repeat what

the action was, STOP! wait for a response) In the future talk to me in private (what behavior you want to

see). Are you committed to treating me as respected colleague? (What

you want them to do?) If there isn’t a change, I will arrange a meeting with the supervisor

to discuss your actions (what is the consequence).

Take homeMessage

Caring enough to confront may help

Carefronting comes from a place of love, not bitterness or hate

1. Horizontal Violence and Generational Conflict are a problem within nursing

2. Both are highly detrimental to the body of Black nurses