Week 11: Issues in the Workplace - Incivility, Violence, and Caregiver Rights

Burnout

psychological syndrome of exhaustion, cynicism, personal inefficacy in response to chronic job stressors

…66% of new grads mostly rt disempowerment

What decreases incidence of burnout in new grads?

structural empowerment

Emotional exhaustion

feeling completely drained/have nothing left to give emotionally or mentally 

Cynicism

detachment from your work, questioning whether your efforts even matter

Personal efficacy

feel like you’re not making a meaningful impact even when trying best to provide strong pt care

Moral distress

emotional + psychological pain when one knows the right thing to do but institutional constraints make it nearly impossible to pursue the right course of action

examples of when you might experience moral distress

short-staffing, inadequate support or mentorship → eg: unable to spend time w/ palliative pt in ER dt staffing issues

NGN supports

• unit-specific orientation

• experienced nurse mentorship

• progressive exposure to increasingly challenging situations

•Graduates require consistency, predictability, stability, and familiarity in their initial clinical practice situations for at least the first 4 months

What do NGNs require in the first 4 months of their initial clinical practice situations/job? (4)

consistency

predictability

stability

familiarity

Violence (2)

use/attempted use of physical force against a person that causes/could cause physical injury.

sexual aggression,verbal/nonverbal acts interpreted as threat of physical force that can lead to physical harm.

2 kinds of violence in workplace

violence, harassment, bullying directed at colleagues

1. at an equal level in the organization → HORIZONTAL/lateral violence
   …nurse to nurse (well-researched)
   

2. at unequal levels w/in the organization → VERTICAL violence
   …manager & NGN = power imbalance!(NOT well-researched but common)

why might horizontal violence happen in HC?

“nurses eat their young” = hierarchy culture, different management styles, insecure bullies

how might vertical violence appear?

unfair treatment, public criticism, intimidation, withholding opportunities

Classification of Violence (4)

Type 1: Criminal Intent = perp has no relationship to workplace

Type 2: Client or Customer = perp is pt at workplace → violent towards staff/another pt
…MOST COMMON IN HC

Type 3: Worker to Worker = perp is current/past employee of workplace
…horizontal + vertical violence

Type 4: Personal Relationships = perp has a relationship w/ an employee
…domestic violence in workplace
…personal relationship w/ staff OUTSIDE workplace + violent towards them INSIDE

harassment

comments/behaviours toward HCP that are unwelcome and persistent (including sexual)

eg: offensive jokes, name-calling

bullying

repeated + persistent behavior including social isolation, rumours, excessive criticism, intimidation, physical abuse, withholding job responsibilities

Incivility

deterioration in relationship b/w

…peers in workplace
…student + health workers
…student + faculty

Eg: impolite speech, neglect, disrespect, indifference → can esalate to bullying

Exposure to workplace incivility leads to (3)

poor mental health

emotional exhaustion + burnout

job dissatisfaction + turnover intention

impact of workplace violence on INDIVIDUAL (7)

physical injury
PTSD
anxiety
depression
burnout
fear/mistrust
sleep disturbances

impact of workplace violence on PT CARE (2)

decreased quality of care

decreased pt safety (increased errors)

impact of workplace violence on ORGANIZATION (4)

absenteeism

decreased recruitment + retention

decreased productivity

increased staff turnover

verbal de-escalation + tips (10)

used in potentially threatening situations to prevent harm to self/pt/others

1. Remain calm

2. Actively listen (to concerns/needs)

3. Avoid judgment and criticism

4. Re-focus on something positive

5. Empathize + validate their feelings

6. Give choices (help them feel in control)

7. Set limits

8. Be cognizant of your body language

9. Protect yourself (clear exit route)

10. Seek assistance

2 benefits of a healthy work environment

maximizes health + wellbeing of nurses/HCPs

improves organizational performance and pt/client/resident/societal outcomes

4 dimensions of a healthy work environment

1. psychological well-being: good communication, respect/valued, feedback + transparency welcomes

2. physical well-being: safety, env free from hazards

3. health and lifestyle practices: MH resources, work-life balance

4. corporate social responsibility: rt big picture; connection b/w workplace staff & the community

Recommendations for healthy work environments:
adequate _
rewards for _ + _
support for _ + _
Promote workplace _ & _

adequate staffing

rewards for effort & achievement

support nursing leadership + professional development

promote workplace health & safety

structural empowerment theory

work environment that provides access to

…information
…support
…resources
…opportunities

are empowering + enable employees to accomplish work in a meaningful way

workers are structurally empowered if they have access to resources that help them grow into stronger nurses (4)

ACCESS TO

1. information (knowledge & skills, understand role, org policies/procedures)

2. support from peers/preceptors/ leaders (constructive feedback, mentorship, space to ask Qs)

3. resources (equipment, supplies, time needed to adequately care for pts)

4. opportunities ( learn new skills, take on challenges)

new grad support
_ orientations
experienced _
progressive exposure to _
consistency, stability and _ in first four months

until specific orientation
experienced nurse mentorship
progressive exposure to increasingly challenging situations
consistency predictability and familiarity