Incivility & Horizontal Hostility in the Nursing Profession

1. Incivility & Horizontal Hostility in the Nursing Profession Keith Rischer, RN, MA, CEN, CCRN

2. Confronting Horizontal Hostility • HH Defined • Nurses covertly or overtly directing their dissatisfaction inward toward each other and those around them • Unkind, aggressive, antagonistic behaviors • Emotionally abusive • “Professional” behavior that is… • Demeaning • Devaluing • Disrespectful

3. Most Frequent Forms in Nursing • Nonverbal innuendo • Raising eyebrows-face making • Verbal affront • Snide remarks • Undermining activities • Not available to help • Sabotoge • Deliberately set up neg. situation • Infighting • Scapegoating • Backstabbing

4. Who is at Highest Risk? • New RN or nurse from another area • Nurses who are different than the dominant group-Men in nursing or minorities • HH is used to break new nurses into the “group” or acculturate them into the profession • HH teaches the “unspoken rules” or status quo that must not be rocked

5. New Graduate Experiences • Feeling neglected or isolated • Too much responsibility without support

6. Psychological Depression PTSD-50% suffer stress 5 years afterwards Burnout Lack of control Maladaptive responses: substance abuse, overeating Physical Decreased immune response Cardiac arrythmias/MI secondary to continuous circulating catecholamines Consequences of HH cont.

7. How does HH Survive & Thrive? • Denial • By both the perpetrator of HH and nurses who remain silent • Normative • Nobody questions it. Similar to dysfunctional co-dependant relationships • Ineffective Supervisor Intervention • Lack of Confrontation Skills • Passive/aggressive communication style common with women and within nursing • Aggression of HH Breeds Aggression in Victim • Vicious cycle is perpetrated

8. Empowering Strategies:Carefronting • Recognize what it is • Carefronting uses biblical concepts of respect, forgiveness and courage to confront • Caring enough to confront the “bully” in a responsible, respectful manner

9. Empowering Strategies • Non-verbal innuendo • “I sense from your facial expression that there may be something you wanted to say to me. It’s OK to speak directly to me…” • Backstabbing • “I don’t feel right talking about him/her situation when I wasn’t there or don’t know the facts. Have you spoken to them?” • Verbal affront • “Those I learn the most from are direct and clear in their feedback. What could you share with me to better understand this situation?”

10. Principles to Transform the Profession • Form meaningful relationships w/colleagues • Recapture the dignity and value of the nursing profession • Empowerment • Embrace ability to change the situations that encourage oppression in health care • Respect and value self and others • Don’t engage in negative conversation about another co-worker • Stand up for the “absent member

11. Closing Thoughts • Need to respect our uniqueness and differences as a strength • Nursing is a caring profession • We have a professional responsibility to “care” for each other in addition to our patients