Conflict and Work Place Violence

What are examples of bullying or incivility?

What are responses to bullying or incivility?

Don't allow them? Address them? Report them?

What are approaches to conflict resolution?

Lose Lose

1. Avoidance

2. Smoothing

Win/Lose

3. Accommodating (sacrificial)

4. Competing (telling and no other option)

Win

5. Compromise

6. Collaboration

What are types of conflict and are they all bad?

• Conflict is not always bad

  • some conflict allows for the growth of an organization

• Internal Discord (intra-personal)

  • A nurse wants to move up on the career ladder, but is finding time with family is compromised

• External Discord (inter -personal and -group)

  • interpersonal: A new nurse is given a heavier client assignment than the others and is denied when asks for help

  • intergroup: There is confusion whose responsibility it is to make sure patients receive meal trays: nursing or dietary

What are negotiation tactics?

• Before

  • Doing homework

  • Trade offs and Bottom line

• During

  • Assertive

  • Speaking and listening

• After

  • Restate agreement verbally and written

What are additional negotiation tactics?

1. Discuss conflict

2. Be honest

3. Never use the bottom line first

What are legal considerations related to violence toward nurses?

You will fill out an incident report

Class D felony if assault a nurse

What are de escalation scenarios?

• Establish Verbal Contact

• Provide orientation and reassurance

• Orient the patient as to where they are and what to expect

• Explain: "I'm here to care for you and keep you and everyone else safe"

• Be polite, respectful & allow them time to respond

• Help patient manage their emotions, manage what the patient may want

What are Dos and Donts of de escalation tactics?

• DO

  • Maintain control by controlling your emotions

  • Leave an unobstructed exit

  • Remove loose items from your person

  • Be aware of movable furniture/objects

  • Be alert to the presence of facial tension

• DONTS

  • Ignore an aggressor's warning signs

    • Perhaps pacing, restlessness, kicking things

  • Begin shouting or arguing

  • Become hostile or punitive

  • Ask for explanations of their behavior

  • Make dares or threats

  • Use false reassurance

What are Provider / RN disagreement?

• Poor nurse - physician communication contributes to increased patient harm and decreased job satisfaction for nurses

• Scenario: Medical team rounds and leaves unit, you review orders in chart and find them unclear, what action should you take?

  • call physician and clarify order

• Scenario: A patient has numerous questions following their surgical procedure, so you encourage them to ask the questions of the surgical team when they round. You are in the room when the team rounds and the patient nods and says "Doing great, no questions" when the surgeon asks. What action should you take?

  • say something like "hey didn't you have a question about x, y, and z"

• Scenario: You call the resident about a change in patient status and the physician yells at you, "What were you thinking?! You should have called me about this hours ago!" What action should you take?

  • stay calm and use assertive language

How to improve Provider / RN communication?

• Physicians were most dissatisfied when nurses were unprepared with required information when communicating with them

• When nurses used assertive and purposeful communication styles during emergency situations, physicians responded promptly

• In non-emergent times, develop a rapport when possible

• Factors that were found to enhance communication: common understanding, trust& respect, and collaborative attitudes

• Where are you during rounds?

What are nurse manager actions regarding patient violence?

fill out incident report

Abusive conduct to others in variety of forms

A. Bullying

B. Incivility

3. Mobbing

A. Bullying

can overlap with bullying, but may look less severe: passive-aggressive actions, gossiping, eye-rolling, rude..

A. Bullying

B. Incivility

3. Mobbing

B. Incivility

can be either bullying or incivility, but with group mob mentality

A. Bullying

B. Incivility

3. Mobbing

C. Mobbing

W7Q1. A nurse delegates a vital signs re-check on the patient in room 208 to a very busy PCA/NA. The PCA/NA disagrees that it is an urgent task as they are already too busy to go re-check the VS. They have a discussion after the PCA/NA said they can't do any other tasks right now. The nurse decides to do the VS recheck because she has medications to give in that room anyway but asks if the PCA/NA could get the 11am vitals instead. The PCA/NA decides this is more manageable for her schedule. This is an example of what conflict resolution strategy?

1. Avoidance

2. Comforting

3. Accommodating

4. Negotiation

3. Accommodating

W7Q2. Which of the following behaviors should the nurse-manager identify as work place violence, incivility, or bullying? Select all that apply.

1. A group of nurses consistently refuse to help a nurse when that nurse has a heavy workload, despite having time to do so

2. Staff members assign an unwanted nickname to a colleague

3. A nurse's specific vacation request is denied by the manager

4. A nurse asks a colleague to assess a known verbally abusive client without warning to see how the colleague will respond

5. A nurse tells a nursing student to rush to room 311, knowing that the unit has no room 311

1. A group of nurses consistently refuse to help a nurse when that nurse has a heavy workload, despite having time to do so

2. Staff members assign an unwanted nickname to a colleague

4. A nurse asks a colleague to assess a known verbally abusive client without warning to see how the colleague will respond

5. A nurse tells a nursing student to rush to room 311, knowing that the unit has no room 311

W7Q3. A recent graduate has begun working at a health center and finds the behaviors of colleagues stressful and intimidating. The nurse's colleagues whisper around the nurse, roll their eyes at the nurse, and laughs when the nurse asks for assistance or clarification. What is this recent graduate's best initial action?

1. Organize a meeting to confront the colleagues about their behavior

2. Avoid the offending colleagues whenever possible

3. Report these behaviors to the nurse manager

4. Seek assistance from the organization's ombudsperson

3. Report these behaviors to the nurse manager

W7Q4. The newly hired nurse has questioned the physician's order to administer a dangerously high dose of a medication. The nurse recognizes the dose is unsafe and not within the common dosing range. The physician insists the order is safe and orders the nurse to administer it. Which of the following statements is the best response by the nurse?

1. Say nothing and administer the medication

2. Do not administer the medication and state, "I am concerned about the order, I am uncomfortable administering it, and I think this is a safety issue."

3. Do not administer the medication and state, "Can you ask someone else to do it?"

4. Administer the medication and request for a meeting with the physician and the nurse manager

2. Do not administer the medication and state, "I am concerned about the order, I am uncomfortable administering it, and I think this is a safety issue."

W7Q5. As the nurse manager, you are negotiating for increased staffing for your unit with hospital administration. What tactics will you employ? (Select all that apply.)

1. Provide written documentation of agreed upon compromise at end of negotiation

2. Hold feedback session for all participants at end of negotiation

3. Begin negotiation by each party stating the bottom line

4. Provide exaggerated data on staff call-outs to enhance the seriousness of the situation

5. Mention personal connection with hospital administrator

6. Wear sunglasses so they cannot see the expression in your eyes

1. Provide written documentation of agreed upon compromise at end of negotiation

W7Q6. A client has been brought into the ED via ambulance with a bleeding injury and they are visibly intoxicated and threw an empty water pitcher at a staff member. Which of the following are appropriate actions?

1. Approach the client alone and close curtain to provide privacy. Speak in calm,reassuring manner.

2. Notify provider of client's condition.

3. Ask unit secretary to call police for assistance.

4. Tie wrist restraints to bedrail in preparation of use.

2. Notify provider of client's condition.

W7Q7. A client has pushed a nurse on the unit, causing the nurse to fall and hit their head against the wall. The nurse goes to the nurse manager for assistance. What action should the nurse manager take first?

1. Notify provider of client's condition

2. Go to client's room to check on situation

3. Fill out incident report with nurse

4. Escort nurse down to emergency department to be seen for the head injury

2. Go to client's room to check on situation