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