oppressed group behavior and ways to improve empowerment
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Oppressed Group Behavior and Ways to Improve Empowerment. Jill A. Marsteller, PhD, MPP Associate Professor of Health Policy and Management Johns Hopkins Bloomberg School of Public Health and the Armstrong Institute for Patient Safety and Quality Johns Hopkins School of Medicine. - PowerPoint PPT PresentationTRANSCRIPT
JILL A. MARSTELLER, PHD, MPPASSOCIATE PROFESSOR OF HEALTH POLICY AND MANAGEMENT
JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
AND THE ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY
JOHNS HOPKINS SCHOOL OF MEDICINE
Oppressed Group Behavior and Ways to Improve
Empowerment
Learning Objectives
By the end of the presentation, you will be able to: Identify oppressed group behaviors Consider whether they are present among coworkers
at your institution Enumerate ideas for combating these behaviors in the
workplace
What is “Oppressed-Group Behavior” (OGB)?
A response of non-dominant groups to their lower position in the hierarchy, lack of autonomy in work, lack of control
Feelings of powerlessnessLack of pride, devaluing of self and own
group
Observed behaviors within oppressed groups
Silencing the self and passive-aggressivenessDefeatism or apathyBehaviors of insecurity
• e.g., aggressive communication; inflexibility; blaming; extreme sensitivity to slights; grudge holding; fear of/anger toward dominant group
Imitation of the dominant group to succeed• b/c leadership granted by the powerful, leaders in non-dominant
group more supportive of the powerful than their own group• Horizontal violence
• e.g., unwarranted criticism of peers and lower status groups;• bullying or hazing; • infighting and internal divisiveness; • disruptive behavior (violence, psychological aggression,
workplace incivility)
OGB in Nursing
Often found among nurses but not openly acknowledged (lit. dates to 70s)
Roots in historical female and male roles (female predominance in nursing and male predominance in medicine)
Lack of autonomy; obedience to physicianValue of nursing care poorly recognized (no
accounting available)Nurses not included in decision-making; little
control over own working conditions; expected to take on non-nursing tasks (e.g., cleaning the floor)
OGBs may exacerbate disempowered status
Hierarchical, competitive relationships amongst nurses; no cohesive action to increase power
Take sides with those outside nursing in cases of conflict
Indirect communication styles can be hard to follow or seem irresolute, indecisive
Sometimes talking about each other; complaining; holding grudges; acting in a petty fashion
Most common management styles used by nurses are avoiding and compromising (Valentine 2001).
Disempowering Nurse Behaviors
20 interviews with Canadian nurses 1998-1999 (17F, 3M; experienced & new; diploma through masters candidates)
Nurses value collaboration and acceptance outside nursing
Freq. failed to advocate for patient wishes and needs b/c of need to fit in with team values, other professionals’ opinions
Daiski 2004
Daiski 2004 Examples
“Nurses eat their young” Worst scheduling for new staff; ignoring requests Concentration on mistakes; lack of praise for
good work Holding back information and letting new nurses
flounder; seeing who is going to “make it;” Criticizing nurses who object to cleaning and
other non-nursing tasks Insistence on the same ways of doing things,
rejection of new approaches Shunning/ bullying those who are different or
breach “the rules”
Disruptive Behavior
10 Focus groups of 96 RNs (Hopkins)225 disruptive behavior events
Nurse instigators in 29% (n = 66)
“Gossiping is huge . . . [it] can be quite maligning and very vindictive.”
Presence of intimidating cliques on the nursing unit that “police” other nurses’ practice
Passive-aggressive emailActual or perceived lack of competency in a new
RN as justifying “being harsh and critical” toward the new nurse
Walrath, Dang and Nyberg 2010
Disruptive Behavior
Survey of 1559/5710 respondents (27.3%)RNs experienced higher frequency of disruptive
behaviors and triggers than MDs Unlike MDs, RNs experienced almost monthly
occurrence of malicious gossip, self-centeredness, and inappropriate use of communication technology
Both MDs (45% of 295) and RNs (37% of 689) reported that the disruptive behavior of a member of their own discipline affected them most negatively
189 incidences of harm to patients as a result of disruptive behavior were reported
Walrath, Dang and Nyberg 2013
Bigger than OGBs: The Bullying Organizational Context
Workplace bullying--repeated, intentional, masked negative behaviors or actions in imbalanced power relationships
Wider environmental/organizational issues may help normalize bullying (not just within-group OGBs) (Hutchinson et al. 2006)
Increasingly complex systems of control within organizations can be co-opted by bullies
Bullying may be condoned/rewarded as appropriate use of power when bullied person is cast as the problem
OGBs can be addressed
Interventions can decrease OGBsDecrease in OGBs has been found to be
related to increased work force performance, satisfaction and retention (Roberts, DeMarco and Griffin 2009)
Combating OGBs/ Bullying
Recognize and expose oppressed group behavior “For many focus group participants, these
sessions served as a catharsis for pent-up emotions resulting not only from personally observing or experiencing disruptive behavior but also from the fact that when such behavior did occur, the instigators were not consistently and equitably addressed across professional disciplines. –Walrath et al. 2010
Combating OGBs/ Bullying
Encourage staff to appreciate and compliment each other
Create an avenue for complaints/ positive criticism of system; encourage them to make a solid case with data and documentation
Combating OGBs/ Bullying
Advocate for collaboration among staff; create joint projects and opportunities for positive interactions (e.g., writing group)
Create a buddy system/mentorship systemReward helping behaviors and promote
solidarity, esprit de corpsCreate opportunities for communication
across shifts and units (validates views and builds consensus within group)
Combating OGBs/ Bullying
Address issues raised by non-dominant groupsRecognize good work and those working to
improve qualityEncourage involvement on hospital
committees and decision-making bodiesEmphasize group’s contributions to hospitalTrain on appropriate assertion and conflict
resolutionDeal with negative/ bullying coworkers
consistently and equitably
Combating Oppressed Group Behaviors/ Bullying
Train on structured communication strategiesOffer scripted responses to most common
instances of horizontal violence or bullying
Measure OGBs to Intervene
Silencing the Self Scale Workplace Scale (STSS-W) for nurses (DeMarco et al. 2007)
Lateral Violence in Nursing Survey (Stanley et al. 2007)
Nurse Workplace Behavior Scale (NWS) (DeMarco et al. 2008)
Disruptive Clinician Behavior Survey for Hospital Settings (Walrath et al. 2013) for nurses and physicians
Relational Coordination
Measure between-group relationships (Gittell et al. 2008): Frequency, timeliness, accuracy of communication Shared knowledge Shared goals Mutual respect Joint problem solving behavior
On your own
List non-dominant/ low autonomy groups in your organization and any OGBs you notice
Describe roots of the OGBs, ideas for improvement
Generate 3 actions that could support the improvement plans
References
Daiski, Isolde. ”Changing nurses’ dis-empowering relationship patterns,” Journal of Advanced Nursing, 2004, 48(1), 43–50.
DeMarco R. F. & Roberts S. J. (2003) Negative behaviors in nursing: looking in the mirror and beyond. American Journal of Nursing 103(3), 113–116.
DeMarco R., Roberts S. & Chandler G. (2005) The use of a writing group to enhance voice and connection among staff nurses. Journal for Nurses in Staff Development 21 (3), 85–90.
DeMarco R., Roberts S., Norris A. & McCurry M. (2007) Developing of the silencing the self scale (work) (STSS-W) for nurses. Journal of Nursing Scholarship 39 (4), 375–378.
References
DeMarco R., Roberts S., Norris A. & McCurry M. (2008) The development of the Nurse Workplace Scale (NWS): self-advocating behaviors and beliefs in the professional workplace. Journal of Professional Nursing 24, 196–301.
Gittell, J.H., Weinberg, D., Pfefferle, S., Bishop, C. (2008). “Impact of relational coordination on job satisfaction and quality of care: A study of nursing homes,” Human Resource Management Journal, 18(2): 154-170.
Hutchinson M, Jackson D, Vickers M and Wilkes L. “Workplace bullying in nursing: towards a more critical organisational perspective,” Nursing Inquiry 2006; 13 : 118–126.
References
Roberts S . J . , Demarco R. & Griffin M. (2009) The effect of oppressed group behaviours on the culture of the nursing workplace: a review of the evidence and interventions for change. Journal of Nursing Management 17, 288–293.
Sieloff, Christina Liebold. “Staying Power,” Recruitment and Retention Report, Nursing Management, November 1999.
Stanley K., Martin M., Michel Y., Welton M. & Nemeth S. (2007) Examining lateral violence in the nursing workplace. Issues in Mental Health Nursing 28, 1247–1265.
References
Walrath JM, Dang D, Nyberg D. An organizational assessment of disruptive clinician behavior: findings and implications. J Nurs Care Qual. 2013 Apr;28(2):110-21.
Walrath JM, Dang D, Nyberg D. Hospital RNs' experiences with disruptive behavior: a qualitative study. J Nurs Care Qual. 2010 Apr-Jun;25(2):105-16.
Valentine P. (2001) Gender perspectives on conflict management strategies of nurses. Journal of Nursing Scholarship 33 (1), 69–74.