Horizontal Violence or Generational Conflict: Is CareFronting the Answer Yvonne Wesley, RN, Ph.D., FAAN Independent Health Consultant www.ywesleyconsulting.com Overview Upon completion of this session, participants will be able to: Define Horizontal Violence and Generational Conflict Compare and contrast HV and GC similarities and differences Illustrate the effect of Care-Fronting on HV and GC Horizontal Violence Antagonistic behaviors such as: Gossiping, undue criticism, Innuendo, scapegoating, Weinand, M. R. (2010). Horizontal violence in nursing: history, impact, and solution. JOCEPS: The Journal Of Chi Eta Phi Sorority, 54(1), 23-26. Undermining, passive aggression, Bickering , blaming behaviors Sabotage Emotional dumping, indiscriminate venting
Weinand, M. R. (2010) Why susceptibility among nurses Antagonistic behaviors among oppressed people i.e.: women Nursing predominately women Antagonistic behaviors, a form of self-hate Demonstrated in the classroom with faculty dominating student nurses. Nurse managers and supervisors cited as frequent users of bullying culture & top down style Weinand, M. R. (2010) End Product from HV Overwhelming sense of negativity cultivated Aggression breeds aggression Low morale High turnover Increased absence Low productivity
training in teamwork, Weinand, M. Formal R.positive feedback, conflict management and confrontation (2010) skills Solutions to the problem Embrace transformational leadership Inspire and challenge staff; Utilize active listening, Advise and coach staff; Have a positive vision Reward resolution vs. identification of problems overt and covert nonphysical hostility, criticism, sabotaging, undermining, infighting, scapegoat, and bickering unkindness, discourtesy, divisiveness, and lack of cohesiveness
belittling gestures, verbal abuse, gossiping, sarcastic comments, faultfinding, devaluing comments, disinterest and discouragement, and controlling behaviors King-Jones, M. (2011). Horizontal Violence and the Socialization of New Nurses. Creative Nursing, 17(2), 80-86. King-Jones, M. (2011) King-Jones, M. (2011) HV stems from oppression HV is how oppressed people cope with powerlessness HV, a display of powerlessness & negative emotions Knowledge is power -- a cycle of power and resistance To resolve HV, address the dynamics of power and conflict
Increased numbers of generations working together creates more opportunity for misunderstanding Veterans, [born before 1945] Baby Boomers, [born 1946-1964] Generation X, [1965-1976] Gen Y/Millennials [1977-1997] Hahn, J.A. (2011), Managing Multiple Generations: Scenarios From the Workplace. Nursing Forum, 46(3), 119-127. Generational Conflict Hahn, J.A. (2011) Veterans before 1945 Grew up in times of political and economic uncertainty, lived experience of the Great Depression and World War II Nursing as a helping
profession and unselfish Expect rewards for hard work Baby Baby Boomers Boomers 46 46 to to 64 64 Strong Strong sense sense of of duty, duty, called called workaholics workaholics Lived Lived experience experience of of prosperity prosperity Look Look to to empower empower Arrive Arrive early
early to to work work Hahn, J.A. (2011) Generation X 65 to 76 Millennium/Gen Y 77 to 97 Independent, Independent, self-directed, self-directed, and and techno-savvy techno-savvy Technology and instant communication Latchkey Latchkey kids kids Accepting multiculturalism Grew-up Grew-up quicker quicker and and stayed stayed
adolescents adolescents longer longer After-school activities, such as swimming, soccer, dance Quality Quality of of life life important important their their parents parents work work long long hours hours and and experienced experienced downsizing downsizing Want work-life balance Generation Veterans <1945 Generational styles
Stable Reliable Practical Loyal Baby Boomers 19461964 Generation X 19651976 Millennials 19771997 Involvement Personal growth Optimism Mentors Think globally Techno-literacy Pragmatic Asynchronous communication Skeptical Multitasking Technologically savvy Outcome driven Determined Carefronting Kupperschmidt,
Kupperschmidt, B. B. (2006). (2006). Addressing Addressing multigenerational multigenerational conflict: conflict: mutual mutual respect respect and and carefronting carefronting as as strategy. strategy. Online Online Journal Journal Of Of Issues Issues In In Nursing, Nursing, 11(2), 11(2), Kupperschmidt Kupperschmidt argues argues that that professional professional nurses nurses must
must care care enough enough about about their their patients, patients, profession, profession, colleagues, colleagues, and and themselves themselves to to carefront carefront disrespectful disrespectful behavior behavior Kupperschmidt, B. (2006). Treating Treating each each other other with with respect respect is is aa nurse's nurse's ethical
ethical responsibility responsibility Carefronting, a model of communication used when professional nurses care enough about themselves and their patients to confront disrespectful behavior face-to-face Kupperschmidt, B. (2006) to e r u l i a F is t n o r f con st e
n o h dis io n t a c i n u comm Carefronting embodie s forgiveness, caring and valuing, w hile addressing the anger in the disresp ectful behavior, and focuses on the h ere and now Kupperschmidt, B. (2006) The goal is the ability to work together to provide safe patient care in an environment
based upon mutual respect Kean Univ e rsity Grad uates Bivins & Pr imus 2012 Developed the: Perceived Carefront ing Ability Questionn aire AA newly newlyregistered registerednurse nurse Renee Reneeis is working working alongside alongsideJeanette, Jeanette,aa nurse
nurse of of twenty twentyfive five years yearsin inaabusy busytrauma trauma emergency emergencyroom. room. Patient Patient Glendale, Glendale,aa frequent frequent flyer, flyer,presents presentscomplaining complainingof of chest chest pain painradiating radiating to to his his right rightarm, arm, his hishistory
historyincludes includeshypertension hypertension managed managed with withaa beta beta blocker blocker and and drug drug seeking seeking behavior. behavior. Jeanette Jeanette blurts blurtsout, out,Back Back so so soon. soon. Ran Ranout out of ofyour your Percocets Percocetsin inthree three days daysdid
did you? you? Renee Renee goes goesto to his his bedside bedside places placeshim him on onthe the cardiac cardiac monitor, monitor,performs performs and and EKG EKGand andtells tells the thephysician physicianthe the patient patient may maybe be experiencing experiencing aaheart heart attack.
attack. Jeanette Jeanette waltzes waltzesover, over, rolls rollsher hereyes, eyes, sighs sighsand andsarcastically sarcasticallysays, says,This This rookie rookieneeds needsto to go go back backover over there there and and complete complete his hishistory historyand and physical physical before
beforejumping jumping to to conclusions. conclusions. Embarrassed EmbarrassedRenee Renee walks walksaway. away. Later Later she she seeks seeksout out Jeanette Jeanette and and asks asks to to speak speak to to her herin inaa private private area. area. Yvonne Bivins MSN RN Nadia Primus MSN RN Carefronting Techniques based on Kupperschmidt (2006) When you called me a rookie and said I jumped to a conclusion (what was
the action). I felt humiliated (your reaction). Because it portrays me as someone in a rush (what does it look, sound or feel like). Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response) In the future talk to me in private (what behavior you want to see). Are you committed to treating me as respected colleague? (What you want them to do?) If there isnt a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence). 16 16 14 12 10 8 6 7 5 4 2 0 Number of Participants Pre-test
Post-test Baby Boomer RNs 7 4 Generation X RNs 17 8 Yvonne Bivins MSN RN Nadia Primus MSN RN A paired t test compared pre and post mean scores of the participants perceived ability to utilize Carefronting pre-test M= 40. 75, SD=4.15 post-test M= 43.08, SD=3.08
Highest possible score being 50 and the lowest 10 Alpha set at p<0.05 There was no significant difference t(11) = -2.17, p = 0.053. The 95% confidence interval for the mean difference between the two means was -4.70 to 0.03. Yvonne Bivins MSN RN Nadia Primus MSN RN An independent t test compared Baby Boomer to Gen X mean scores on perceived ability to utilize Carefronting No significance difference in the Baby Boomer & Generation X mean scores pre-test t(24) = .992, p = .33 post-test t(11) = .154, p = .88 Carefronting Techniques based on Kupperschmidt (2006) When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction). Because it portrays me as someone in a rush (what does it look, sound or feel like).
Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response) In the future talk to me in private (what behavior you want to see). Are you committed to treating me as respected colleague? (What you want them to do?) If there isnt a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence). Take home Message 1. Horizontal Violence and Generational Conflict are a problem within nursing 2. Both are highly detrimental to the body of Black nurses Caring enough to confront may help Carefronting comes from a place of love, not bitterness or hate
