Workplace abuse: a glossary of violence.(Focus Nursing Issues)(Glossary)

Recently I attended a local meeting of Holistic Health Nurses held at a Bed and Breakfast in York Beach, ME. It was my first meeting with this group and we followed a brief welcome meditation with introductions around the room. When my turn came, I shared some of my work which included research on workplace violence for a book I am writing about communication and workplace dynamics for nurses. An immediate and intense discussion followed. Many terms were flying through the air and the energy was palpable.

"Is workplace violence about patients assaulting staff?"

"Part of the reason I left my last job was because of nurse to nurse bullying, isn't that workplace violence?"

"That sounds like horizontal violence."

"I read an article that talked about covert abuse and I think that is what nurse to nurse bullying is."

"What about belligerent docs? There is one physician in our clinic that yells at nurses all the time. We all hate to work with him."

"I think that is vertical abuse"

"I just read about physicians and something called 'disruptive behavior', isn't that what that is?"

This group, I realized was eager to share stories, ask questions and explore this issue! But, they were getting lost in the language! This is easy to understand. If you research the topic, you'll find lots of studies that address a particular angle of the problem based on the type of abuse, target or professional specialty. Some hypothetical examples:

* Patients assaulting nurses in the emergency room.

* Nurses who are bullies to new grads.

* Surgeons who are abusive to staff in the operating room.

The research I am doing and the above conversation made it clear to me that much needed discussions among nurses and others could easily become diluted with uncertainty about the language. This topic is so important and there is so much overlapping terminology it seems like a glossary would be a helpful resource. I have adapted the ones I have come across most frequently with cited references in specific cases. (see A Glossary of Violence)

Yet still there is reluctance to fully acknowledge the depth and breadth of this problem. In her recent article, "Hospital bullies take a toll on patient safety," health writer, JoNel Alecci quotes the president of the American Medical Association, Dr. Joseph Heyman, "I don't see it as a huge problem," he said, adding: "Having standards encourages hospitals to look for this kind of behavior and head it off at the pass." http://www.msnbc.msn.com/id/25594124,retrieved from web 07/ 11/08.

Talking about abusive behavior is an important process for identifying problems, validating each other's experiences, adopting new standards successfully and setting appropriate limits. Granted, this is trickier with patients who may have mental health issues and families with difficult dynamics however, a standard of respectful communication can and should be a priority for any organization striving to create a positive workplace.

There is no room for a double standard. As nurses we cannot make anyone respect us, but with organizational support we can insist on and expect enforcement of respectful treatment in the workplace.

REF: Hospital bullies take a toll on patient safety, Bad behavior by doctors and others undercuts morale, leads to errors, JoNel Aleccia, MSNBC, http://www.msnbc.msn.com/id/25594124, retrieved from web 07/11/08.

Beth Boynton, RN, MS is a nurse trainer/consultant/ speaker specializing in communication and conflict issues that impact nurses and other healthcare professionals. She is currently writing a nurse's guide for improving communication and workplace dynamics. She can be reached at bbbboynton@verizon.net

EDITOR'S NOTE: Additional resources may be found on the following websites: ANA website: www. nursingworld.org and Center for American Nurse: http://www.centerforamericannurses.org/

A Glossary of Violence

Abuse: the International Council of Nurses (ICN 2004) defines abuse as "behaviour that humiliates, degrades or otherwise indicates a lack of respect for the dignity and worth of an individual".

Bad Behavior: this news release from the Joint Commission addresses bad behavior and is has a related requirement for accreditation going into effect January 2009. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/ sea_40.htm

For more information about TJC's Sentinel Event Alert http:// www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

Bullying: abusive behavior towards another which often takes place repeatedly over time.

Covert Abuse: abusive behavior which is difficult to identify or prove and often more passive or passive-aggressive.

Disruptive Behavior: the American Medical Association (AMA) has written, "Personal conduct, whether verbal or physical, that affects or that potentially may affect patient care negatively constitutes disruptive behavior.

Horizontal Abuse: when a colleague is abusive to a peer or other at a similar level in the organizational or professional hierarchy.

Incivility: Any kind of rude or discourteous behavior.

Interactive Workplace Violence or Trauma (IWPV or IWPT): often used to describe abusive behavior taking place between peers or others at similar level.

Medical Intimidation:

Non-verbal Abuse: a wide range of belittling gestures or body language become abusive when used to disrespect another such as rolling eyes, smirking, whispering, ignoring, violating personal space or hands on hips. These are often insidious and passive or passive-aggressive power displays which may be hard identify.

Overt Abuse: abusive behavior which is obvious to all and typically more aggressive.

Psychological violence: intentional use of power, including threat of physical force, against another person or group, that can result in harm to physical, mental, spiritual, moral or social development. It includes verbal abuse, bullying/mobbing, harassment and threats. (Adapted from WHO definition of violence)

Toxic behavior: can range from the very serious aggression, bullying and sabotage of abusive colleagues to the annoying and hard to cope with behavior of negative co-workers.

Verbal Abuse: Any kind of tone or language used to intimidate another. Although not healthcare specific, Patricia Evans is a pioneer in studying and writing about verbal abuse and this link will take you to her website page with FAQs about this topic: http://www.verbalabuse.com/faq.shtml

Vertical Violence: used to describe abusive behavior towards those in less powerful positions such as physician to nurse or nurse to nurse's aide.

by Beth Boynton, RN, MS

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