Minimizing Toxicity in Minimizing Toxicity in the Work the Work EnvironmentEnvironment

Chelsye Bond, Monique Boutilier, Chelsye Bond, Monique Boutilier, Jennifer Fougere, & Jessica Jennifer Fougere, & Jessica MacLeanMacLean

““VViolence… begins long iolence… begins long before fists fly or lethal before fists fly or lethal weapons extinguish lives. weapons extinguish lives. Where resentment and Where resentment and aggression routinely displace aggression routinely displace cooperation and cooperation and communication, violence has communication, violence has occurred.”occurred.”

- Bernice Fields

ObjectivesObjectives

Describe toxic work environmentsDescribe toxic work environments Identify how workplace toxicity can Identify how workplace toxicity can

affect patients, staff & organizationsaffect patients, staff & organizations Explain 3 steps taken to combat Explain 3 steps taken to combat

workplace toxicityworkplace toxicity Summarize the nurses Summarize the nurses

responsibilities in helping to provide responsibilities in helping to provide effective solutions to workplace effective solutions to workplace toxicitytoxicity

Identifying Identifying Workplace Toxicity Workplace Toxicity

Toxic Work Toxic Work EnvironmentsEnvironments

An environment in which An environment in which individuals are the target of individuals are the target of offensive, intimidating, malicious offensive, intimidating, malicious or insulting behavior, and/or or insulting behavior, and/or experience an abuse or misuse of experience an abuse or misuse of power through means intended to power through means intended to undermine, humiliate, degrade or undermine, humiliate, degrade or injure the recipient. injure the recipient. (Randle et al., 2007)

Negative Workplace Negative Workplace BehaviorsBehaviors

Verbally abusive Verbally abusive languagelanguage

IntimidationIntimidation Constant criticismConstant criticism ThreatsThreats Spread of gossipSpread of gossip Physical abuse Physical abuse

(i.e. hurling (i.e. hurling charts)charts)

Undermining Undermining othersothers

Social exclusion Social exclusion Sexual commentsSexual comments Racial slursRacial slurs Delegation of Delegation of

unskilled tasksunskilled tasks Manipulation Manipulation

(Felblinger, 2008; Randle et al., 2007)

Workplace ToxicityWorkplace Toxicity

Two types:Two types:

1.1. HorizontalHorizontal

2.2. VerticalVertical

Video: http://www.youtube.com/watch?v=4MT8Wnb9ZY8&NR=1

Randle, J., a nurse at the University of Randle, J., a nurse at the University of Nottingham, led a study focusing on Nottingham, led a study focusing on bullying of nursing students. Findings bullying of nursing students. Findings suggested that more than half of all nursing suggested that more than half of all nursing students were bullied in their clinical students were bullied in their clinical placements. placements.

1/2

Anti-toxic CultureAnti-toxic Culture

A quality practice environment A quality practice environment creates a workplace culture that creates a workplace culture that values the wellbeing of clients values the wellbeing of clients and employees. and employees. (CNA, 2006)(CNA, 2006)

Policies that Policies that contribute to positive contribute to positive workplaceworkplacePolicies that address: Policies that address: Ethical issues Ethical issues Support safety Support safety Promote employee recognitionPromote employee recognition Ensure adequate resources Ensure adequate resources

(CNA, 2006)(CNA, 2006)

Effects of Workplace Effects of Workplace toxicitytoxicity

PatientPatientStaffStaffOrganizationOrganization

StaffStaff

IsolationIsolation FearFear Stress-related illnessesStress-related illnesses Physical & psychological effectsPhysical & psychological effects Increase in absence or sicknessIncrease in absence or sickness Intention to leave profession Intention to leave profession

(Brown, 2009; Randle et al., 2007; Rocker, 2008)

Patient Patient

A study by Rosenstein & O’Daniel A study by Rosenstein & O’Daniel (2005), reveals that (2005), reveals that 53 -75%53 -75% of of healthcare providers saw a strong link healthcare providers saw a strong link between disruptive behavior and between disruptive behavior and adverse clinical outcomes such as:adverse clinical outcomes such as:

Patient SafetyPatient Safety ErrorsErrors Adverse eventsAdverse events Quality of careQuality of care Patient SatisfactionPatient Satisfaction

OrganizationOrganization

UnderstaffingUnderstaffing Poor work relationsPoor work relations Low supervisor supportLow supervisor support Increased workloadIncreased workload Lack of resourcesLack of resources

(Cooper & Swanson, 2002; Salin, 2003)(Cooper & Swanson, 2002; Salin, 2003)

Combating Combating Workplace ToxicityWorkplace Toxicity

Assertiveness Assertiveness Conflict AssessmentConflict Assessment Conflict ManagementConflict Management

AssertivenessAssertiveness

Assertive behavior is standing up Assertive behavior is standing up for your rights while recognizing for your rights while recognizing the rights of others. the rights of others.

It is communicating accurately and It is communicating accurately and honestly with others on an equal honestly with others on an equal basis. basis.

Assertive behavior has Assertive behavior has 3 components: 3 components:1.1. The non-judgmental statementThe non-judgmental statement2.2. The emotional consequenceThe emotional consequence3.3. The effect of the behavior on the victim and The effect of the behavior on the victim and

service providedservice provided

““WWhen you called me stupid in front of my hen you called me stupid in front of my patientpatient

I felt angry and embarrassed because it made meI felt angry and embarrassed because it made meseem unprofessional and undermines my patient’sseem unprofessional and undermines my patient’sconfidence in my ability to care for them”.confidence in my ability to care for them”.

Conflict AssessmentConflict Assessment

1.1. What is the issue?What is the issue?

2.2. Who is involved?Who is involved?

3.3. Where is/was the conflict taking Where is/was the conflict taking place?place?

4.4. Which is the best conflict Which is the best conflict management style to activate?management style to activate?

““IIt is well known that the t is well known that the

empowering behaviors of nurse empowering behaviors of nurse leaders can be paramount leaders can be paramount importance in the way staff nurses importance in the way staff nurses react to their work environment”.react to their work environment”.

(Pangman & Pangman, 2010)

Conflict Management Conflict Management StrategiesStrategies

AvoidingAvoiding AccommodatingAccommodating CompetingCompeting CompromisingCompromising CollaborationCollaboration

(Valentine, 2001 as cited in Pangman & Pangman, 2010)

SolutionsSolutions

Quality practice environmentQuality practice environment CNA ModelCNA Model CRNNS complaint submissionCRNNS complaint submission CREWCREW

Quality Practice Quality Practice EnvironmentsEnvironments

A quality professional practice A quality professional practice environmentenvironment

Primary valuePrimary value Central to ethical nursing Central to ethical nursing Decreases moral or ethical Decreases moral or ethical

distressdistress

(CNA, 2003)

#1

CNA ModelCNA Model

1.1. Control over workloadControl over workload

2.2. Nursing leadershipNursing leadership

3.3. Control over practiceControl over practice

4.4. Support and recognitionSupport and recognition

5.5. Professional developmentProfessional development

6.6. Innovation & CreativityInnovation & Creativity

What actions would you take What actions would you take if the CRNNS Standards for if the CRNNS Standards for Nursing Practice were not Nursing Practice were not followed in the workplace?followed in the workplace?

How to submit a How to submit a complaint complaint 1.1. Address your letter of complaint to the Executive Address your letter of complaint to the Executive

Director of the College of Registered Nurses of Nova Director of the College of Registered Nurses of Nova Scotia. Scotia.

2.2. State that you are submitting a complaintState that you are submitting a complaint3.3. Provide name and employment information about Provide name and employment information about

nurse involvednurse involved4.4. List and number the incidents about which you are List and number the incidents about which you are

complaining. Give detailscomplaining. Give details5.5. Letters of complaint should be marked Letters of complaint should be marked

“CONFIDENTIAL’ and addressed to: Executive “CONFIDENTIAL’ and addressed to: Executive Director, College of Registered Nurses of Nova Director, College of Registered Nurses of Nova Scotia, 4005-7071 Bayers Road, Halifax, NS B3L 2C2Scotia, 4005-7071 Bayers Road, Halifax, NS B3L 2C2

*For more detailed information please refer to pamphlet*For more detailed information please refer to pamphlet

(CRNNS, 2009).(CRNNS, 2009). TO: CRNNS

CREWCREW

CCivilitity, ivilitity, RRespect, espect, EEngagement in ngagement in the the wworkplace is a program orkplace is a program designed to improve workplace designed to improve workplace relationships within a teamrelationships within a team

CivilityCivility RespectRespect EngagementEngagement

DiscussionDiscussion

Can anyone provide an example of Can anyone provide an example of a strategy used to a strategy used to promotepromote a a positive work environment? positive work environment?

QuestionsQuestions