Creating and Sustaining a Healthy Work Environment / Leading Change & Managing Conflict
workplace violence
-any act of threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the work site -ranges from threats to verbal abuse to physical assaults
change
-constantly evolving -inevitable and unpredictable, can create uncertainty -affects staff, patients, and the organization overall -can result in conflict
emerging theories
-cyclical rather than linear -require organizations to react with speed and flexibility -systems approach to change -innovation that results in a comprehensive view and a realization that systems are complex -include new theories based on complexity science -new theories based on systems theory and complexity science: chaos theory, learning organization theory
nurse leader's role in change
-develop empowered teams to implement change -instrumental in change at both the unit and organizational levels -serve as change agents -understand change theories and models -embrace change and innovation to ensure that safe and quality nursing care -recognize that conflict is always present in the workplace
barriers to safe pt handling
-lack of reporting -lack of proper equipment -decrease staffing ratios -retaliation
types of violence
-lateral (peer to peer): "nurses eating their young" -vertical (higher to lower): management to staff nurse or vice versa -third party violence -nurse to patient violence -patient to nurse violence -organizational violence -external violence -sexual harassment -mass trauma
role of leaders and nurse managers
-open communication -active listening -engage all members -positive interactions -mutual respect -needs versus wants -compassion and empathy -use 'I' statement
nurse leaders and managers supporting change
-position themselves to be in the forefront of change and innovation -coaches, encouragers, and positive role models for change -committed to and exhibit an attitude that supports the change/innovation -emphasize relationships among staff -build mutual trust and confidence -manage conflict effectively -anticipate and reward change -provide predictability and stability -"can-do" attitude -promote teamwork and process improvement
laggards
5 Adopter Categories: -final group to adopt the change -stuck in past traditions -"We always did it that way, why do we need to change?"
innovators
5 Adopter Categories: -first people to adopt the change -venturesome and willing to take risks
early adopters
5 Adopter Categories: -next in line to adopt the change -more discerning when choosing to adopt an innovation
early majority
5 Adopter Categories: skeptical and reluctant to adopt an innovation
change agent
A __________ must: -lead and manage the change process -gather data necessary to identify a problem that needs to be changed -set goals and objectives for the change and develop a plan -identify those who will be affected by the change and include them in the process -implement the change, and communicate throughout the process -evaluate the change and make modifications to the plan as necessary
change
Competencies for Facilitating _______: -personal knowledge and accountability for one's own strengths and limitations specific to change and innovation -understanding the essence of change and innovation concepts as well as the tools of innovation -the ability to collaborate and fully engage team members -competence in embracing vulnerability and risk taking
compromising
Conflict Management Strategies: -everyone giving something up and everyone getting something they want in return -usually effective
collaborating
Conflict Management Strategies: -involving a shared approach to resolve conflict **time-consuming but most effective
competing
Conflict Management Strategies: -pursuing one's own needs, desires, or goals at the expense of others -can result in aggression
accommodating
Conflict Management Strategies: -sacrificing one's own needs or goals and trying to satisfy another's desires, needs, or goals -not usually effective
avoiding
Conflict Management Strategies: -withdrawing or hiding from the conflict -not always effective -may just postpone the conflict
on the organization
Consequences of Workplace Violence: -creates a culture of fear and diminishes staff morale -impacts patient safety and job satisfaction -results in disrupted work relationships, miscommunication, and an unhealthy work environment -results in negative patient and nurse outcomes
on individuals
Consequences of Workplace Violence: -may result in physical effects such as frequent headaches and decreased energy -results in psychological effects such as stress, anxiety, and depression, frustration
learning organization theory
Emerging Theories: -leaders move away from traditional authoritarian view to facilitate change and collaboration -members are continuously learning, and that learning facilitates an awareness that remains to be learned -bring change to the whole, and not just fixing parts of the whole
chaos theory
Emerging Theories: -unpredictable and explains why a small change in one area can have a large effect across the organization -nurse leaders need to understand the decisions made can result in unintended changes
strategies to prevent workplace violence
Examine the workplace for the presence of elements of an unhealthy environment. Increase awareness of workplace violence by providing information. Model and promote positive and professional behaviors to foster a healthy environment. Support the development of organizational "zero tolerance" of workplace violence programs and policies. Ensure communication is open, non-biased, and respectful at all times. Deal directly with all reported incidents of workplace violence.
ANA
Guidelines for a Healthy Work Environment: -Nurses' Bill of Rights, 2001 -help nurses improve work environment and ensure safe quality patient care
AACN (American Association of Critical Care Nurses)
Guidelines for a Healthy Work Environment: -Standards for Establishing and Sustaining Healthy Work Environments, 2005 6 standards: -communication -effective decision making -appropriate staffing -recognizing staff for accomplishments -leadership
AACN (American Association of Colleges of Nursing)
Guidelines for a Healthy Work Environment: -hallmarks of a professional nursing practice -allows nurses to practice to full potential
AONE (American Organization of Nurse Executives)
Guidelines for a Healthy Work Environment: Guiding Principles: -Mitigating Violence in the Workplace -8 principles developed to reduce lateral and patient violence in the workplace
healthy
Healthy vs Non-Healthy Work Environment: -effective organizational performance -improved patient outcomes -safe patient care -work satisfaction -meaningful work -enjoyable -increased retention and recruitment
non-healthy
Healthy vs Non-Healthy Work Environment: -stressful -lack civility and respect -ineffective interpersonal relationships -workplace violence
why
Making Change and Innovation: -a reasonable rationale for the change -lack of understanding can lead to resistance to change
what
Making Change and Innovation: the actual change or innovation being implemented
who
Making Change and Innovation: the key stakeholders (e.g., pts/families, employees, communities) r/t the work to be changed
when
Making Change and Innovation: the point at which to start the change process and how long it will take to achieve the change
how
Making Change and Innovation: the techniques or processes needed for successful and sustainable change
incivility
Nonphysical Workplace Violence: disrespect, rudeness and a general distain for others i.e. eye rolling
bullying
Nonphysical Workplace Violence: repeated, unwanted actions intended to humiliate, offend, and cause distress in the recipients
ANA
Resources to Create a Safe Work Environment: Code of Ethics for Nurses With Interpretive Statements; Nursing: Scope and Standards of Practice; Incivility, Bullying, and Workplace Violence
OSHA
Resources to Create a Safe Work Environment: Guidelines for Preventing Workplace Violence for Healthcare and Social Services Workers
The Joint Commission
Resources to Create a Safe Work Environment: standards for addressing workplace violence or behaviors that undermine culture of safety
power-coercive strategy
Strategies for Dealing with Resistance to Change: -based on power and authority and assumes that staff will respond to authority and threats of job loss -used when resistance is expected, but the change will occur no matter how the majority feel -staff must accept the change or find a new job
normative-reeducative strategy
Strategies for Dealing with Resistance to Change: -focuses on the relationship needs of staff, utilizes peer pressure, and relies on the staff's desires to have satisfactory work relationships -used when some resistance is expected, however, there is a belief that the staff will succumb to peer pressure
empirical-rational strategy
Strategies for Dealing with Resistance to Change: strategy assumes staff are generally self-interested and believes that providing information and education will assist staff in changing behavior and adopting the change or innovation
Lewin's Force-Field Model
Theories and Models of Change: -change results from 2 field or environmental forces -driving forces (helping forces) facilitate the change and move it forward -restraining forces (hindering forces) impede change and maintain the status quo 3 steps 1. unfreezing the status quo 2. moving toward the new way 3. refreezing or stabilizing the change for sustainability
Kotter's Eight-Stage Process of Creating Major Change
Theories and Models of Change: -involves a multistep process that overcomes all sources of resistance -must be directed by high-quality leadership Includes 8 Stages: 1. establishing a sense of urgency 2. creating the guiding coalition 3. developing a vision and strategy 4. communicating the change vision 5. empowering broad-based action 6. generating short-term wins 7. consolidating gains and producing more change 8. anchoring new approaches in the culture
Rogers's Innovation-Decision Process
Theories and Models of Change: -recognizes behavior in response to change 5 stages of action and choices: 1. knowledge 2. persuasion 3. decision 4. implementation 5. confirmation **everyone involved with or affected by the change be committed to the change
Lippitt's Phases of Change Model
Theories and Models of Change: 7 steps: 1. diagnose the problem 2. assess the motivation and capacity for change 3. assess the change agent's motivation and resources 4. select progressive change objectives 5. choose an appropriate role for the change agent 6. maintain the change after it has started 7. terminate the helping relationship **focus on people involved in change process, rather than change process itself **stresses communication and rapport with those involved
planned change
Types of Change: -purposeful -calculated -collaborative -utilizes change theories -well received
unplanned change
Types of Change: -sudden and necessary -causes anxiety and stress
intrapersonal
Types of Conflict: from within the person
intergroup
Types of Conflict: occurs between groups of people i.e. physicians and nurses
organizational
Types of Conflict: occurs when there's a disagreement between staff and organization policies, procedures, standards, or the changes being made; causes conflict within the organization
interpersonal
Types of Conflict: occurs when there's a disagreement between two or more people
conflict
a state of disharmony among people and occurs when people have different views
physical harm
avoid _______ through implementation of safety programs and establishing policies that prevent nurse/patient injuries
nurse fatigue
impaired function resulting from physical labor, or mental exertion Causes: -extended shifts of > 12.5 hrs -results in higher chance to make errors as well as slow reaction times, lapses of attention to detail, reduced communication and motivation, and compromised problem solving -lack of rest breaks during working hrs—not mandated by federal regulations and only by fewer than 25 states Ways to Improve: -seek balance, arrive well-rested, use strategies to reduce fatigue -support from nurse leaders
physical harm
improper pt handling and mobility, musculoskeletal injury
skilled communication model
model to promote a healthy and safe work environment -becoming aware of self-deception -becoming reflective -becoming authentic -becoming mindful -becoming candid
psychological harm
workplace violence, emotional abuse, bullying, and disrespectful treatment