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WHY, WHEN WE ARE DEEMED TO BE CARERS, ARE WE SO MEAN TO OUR COLLEAGUES?

Canadian Operating Room Nursing Journal, Dec 2006 by Fudge, Lesley

Horizontal and vertical violence in the workplace

ABSTRACT

The author discusses horizontal and vertical violence as they have existed in nursing for many years but are only recently beginning to be discussed and dealt with.

Horizontal violence - across peer groups and similar levels of staff

Vertical violence - from senior to junior colleagues usually downwards but possible upwards

The article will consider some of the issues from examples around the world and how they impact on perioperative nurses.

INTRODUCTION:

More Articles of Interest: Nurses 'Eating Our Young'-It Has a Name: Lateral Violence; A message from the president; MENTORING: THE MAGIC PARTNERSHIP; Hostile Intentions; Violence in the workplace

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Horizontal violence in the workplace was a relatively unknown phrase around five years ago when Dr Lois Hamlin, a Senior Lecturer at Northern Sydney Health and University of Technology in Sydney Australia, presented a paper on the topic1. As she spoke, attendees were able to reflect on the many times the behaviours she described had been experienced, witnessed, or even conducted.

THE EVIDENCE:

Lack of morale or positive attitudes to the working environment may have a negative impact on patient care because it leads to a loss of trust and a decrease in communication. It may also increase staff sickness rates2.

Hamlin described nurses as often functioning within a hierarchy where they are deemed to be second-class health care workers, or the "Cinderellas" of health care, and that, despite the changing role of women in society, nurses continue to be oppressed3. Certainly some things have changed as we now have Nurse Consultants in the United Kingdom with (in the OR) their own surgical caseload, taking referrals directly from family doctors in the community, and working under the indirect supervision of a Consultant Surgeon. Nurse Consultants also teach junior doctors so perhaps, at some levels, nurses are less subordinate than in the past. This change has empowered these nurses, placed them on a similar level with their doctor colleagues and removed the 'hand-maiden' perception of the past.

However, further change is required as staff are still experiencing horizontal and vertical violence. New staff and students entering the OR are less likely to remain in this specialty if their initial experience includes working with inappropriate team members. With the world wide nursing shortage and an aging workforce, it is important that new recruits be treated well from day one. It is also crucial that we retain experienced team members by ensuring they are being treated well. During the author's research a colleague shared the story of a young, new, enthusiastic staff nurse being brought to tears by an Health Care Assistant who had been in the department for years and wanted to make sure that the staff nurse understood who knew more about the job!

In order to understand violence toward staff it is necessary to understand the types of violence, how to recognise it, what causes it, and how it can be effectively addressed and eliminated.

TYPES OF VIOLENCE:

Horizontal and vertical violence can be overt or covert, physical or psychological. They can take place from a senior to junior staff member or within peer groups. Hamlin and Gilmour3 (2003) describe the work of Rene Michael4,5, who wrote two papers in 2001 entitled "Survive or Thrive? The Impact of workplace trauma on peri-operative nurses" and "When speciality becomes a nightmare." Michael showed that perioperative workplace traumas included verbal abuse, sexual harassment, sexual intimidation and physical assault from peers and those in authority.

Overt violence is "in your face" and obvious for everyone else to see. It can be either physical or psychological.

Covert, or hidden, violence is mainly psychological and would range from unkind behaviour to extreme cruelty.

How to Recognise It;

Overt violence can take many forms. Examples include a team member being constantly criticised in front of others. The critic may be doing so either through lack of consideration or in order to deliberately humiliate. Either way, this behaviour needs to be considered to be entirely unacceptable. If not handled properly, overt violence might be driven underground and result in covert violence.

Covert violence can include abuse of power such as ensuring certain staff members always work with the unpleasant surgeon or receive the difficult, long operating list. Denial of requests for time off or providing preferential scheduling to other nurses can allow an abuser to take advantage of the 'power of the rota'.

Michael's studies4'5 demonstrated that the majority of physical violence in the workplace involved doctors and these perpetrators are mainly, according to the author, surgeons and anaesthetists. Among the more worrying stories was one nurse relating her story that a surgeon stapled her shoulder with a used skin staple gun. The violence can also often be of a sexual nature.

During the author's first week as a junior Sister in cardio-thoracic surgery she experienced two events that have remained strong in her memory.

During a cavity closure swab check it was discovered that a swab was missing and this fact was reported to the surgeon. Swabs were recounted and the circulator searched the theatre, bags, boots, under the table etc. It was reported back to the surgeon that the swab could not be located. The surgeon then opened his hand and said, "Is it this that you are looking for?"

Health Care Industry

WHY, WHEN WE ARE DEEMED TO BE CARERS, ARE WE SO MEAN TO OUR COLLEAGUES?

Canadian Operating Room Nursing Journal, Dec 2006 by Fudge, Lesley

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