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How Nurses Can Help End Horizontal Hostility

How Nurses Can Help End Horizontal Hostility

Nurses are supposed to be compassionate caregivers. So why are so many scarred emotionally from the gossip, backstabbing, second-guessing and other abusive, demoralizing or hostile acts nurses inflict on one another?

If you've had enough of the fighting, read on. Veteran nurses explain why such horizontal hostility occurs, revealing the true price it exacts, and share tips for creating a more collegial workplace.

Step 1: Know Why It Happens

Hospitals make stressful workplaces. Patients are sicker than ever, nurses are in short supply, and many nurses are getting older. Plus, many groups and individuals often care for one patient, setting up power struggles and an "us-versus-them" mentality, says Melissa Fitzpatrick, RN, MSN, FAAN, chief healthcare strategist with business intelligence software provider SAS Institute and former chief nurse executive at Duke University Medical Center.

Hostility among nurses resembles that of other oppressed groups, says Kathleen Bartholomew, RN, MN, whose pre-nursing background was in sociology. After doctors yell at them, nurses may take it out on coworkers. And when people work harder and faster without time to debrief, they act out, says Bartholomew, author of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other.

Generational differences can also create strife when values, communication styles and skill sets clash. In addition, conflict can arise when nurses and institutional practices mishandle the integration of new nurses -- an unfortunately common occurrence given the nursing shortage.

Step 2: Realize the Cost

"Nurses who are doing the negative talking, putting others down, don't realize the damage they are doing," Bartholomew says. Negativity leads to a sense of isolation and torpedoes teamwork. "You end up with a life-preserver attitude instead of a lifeboat mentality," she says. "It becomes ‘every man for himself' rather than ‘we're all in this together.'"

Poor teamwork and communication can also spell trouble for patients, Bartholomew says. She almost lost a patient herself when a coworker, upset by a colleague's comments, programmed the pain machine incorrectly, dispensing the wrong dose.

Low satisfaction and morale lead to turnover, which triggers other negative outcomes: The remaining nurses become bitter and resentful, and facilities bear additional costs for orienting new nurses. A 2004 survey by the Association of Perioperative Registered Nurses estimates it costs $30,000 to $50,000 to orient a novice perioperative nurse. Other studies place the cost far higher -- as much as twice a nurse's annual salary.

Step 3: Take Action

Nurses can help defeat the culture of hostility on three levels: personal, unit and organizational. Here's how:

  • Speak Up: When hostility becomes an issue in your work environment, "make yourself known," urges Deborah Mills, BSN, chief nursing officer at Memorial Hospital in Martinsville, Virginia. Bartholomew, who also authored Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication, agrees. "Speak to your manager, supervisor or an administrator -- anyone who will listen," she says.
  • Confront the Offender: Don't engage in the passive-aggressive behavior of complaining to or involving a third party who can't resolve the situation. Ask your peer to step away from patients and talk about what's going on, suggests Barbara Brown, RN, vice president of the Virginia Hospital and Healthcare Association. Acknowledge the behavior and note differences in skills, but agree that you're working toward the same goals. Share strengths as a way to help each other gain missing skills.
  • Make Sure It's Not You: Check your behavior to make sure you're not party to the hostility in any way -- either as victim, bystander or aggressor.
  • Arm Yourself: Learn to handle confrontation by reading books like Crucial Conversations: Tools for Talking When Stakes are High and others suggested by the American Association of Critical-Care Nurses' (AACN) Healthy Work Environment Initiative.
  • Create Shared Values: Work with colleagues to create a unit philosophy that states shared values and defines acceptable and unacceptable behavior, suggests Bartholomew. Articulate consequences, and hold people accountable for their actions.
  • Enlist Management's Support: "Creating a healthy organizational culture has to be a vision that comes from the top," Mills says. If your hospital hasn't done so already, encourage it to adopt the standards outlined in the AACN's Healthy Work Environment Initiative and achieve the American Nursing Association's Magnet hospital status, which recognizes excellence in nursing services.

Finally, be patient but persistent. Culture change can occur, but it happens slowly.

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