Nurturing Our Young
Jill Brogdon, R.N.
Submitted to Dr. Linda Campbell in partial
fulfillment of
NR601 Theoretical Frameworks
Regis University
24Aug2013
The purpose of
this paper is to examine lateral violence (LV) among nurses, how this hostility
from LV effects the nursing profession, how LV effects our patient care, and to
explore solutions to this phenomenon. I
would like to explore the option of nurturing, rather than berating our new
colleagues in nursing. As a nursing
student and a new nurse I often heard the phrase “nurses tend to eat their
young.” I pondered on this for a short
time before I became painfully aware of the meaning of this phrase, over and
over, in my career. As a veteran nurse, and charge nurse, I face this on a personal
level and with my staff. Even as a
leader on my floor I experience LV from a some of my peers. Early on in my career I made a vow to treat
my fellow nurse, as I would like them to treat me, and how they would most
likely want to be treated. I enrolled in a program through the University of
Colorado Health Science Center, where I was assigned to nursing students
finishing up their senior clinical, to be their mentor and preceptor. Through this clinical experience and my
experience as a charge nurse I have gained insight into the phenomenon of LV, and
far too many examples of how it affects my profession.
I discovered the term lateral
violence (LV), while researching, and found the best definition of lateral
violence from Kweykway Consulting, “Lateral
Violence occurs within marginalized groups where members strike out at each
other as a result of being oppressed. The oppressed become the oppressors of
themselves and each other. Common [behaviors] that prevent positive change from
occurring include gossiping, bullying, finger-pointing, backstabbing and
shunning.” LV is expressed amongst
nurses that are at the same hierarchical level.
LV may be overt, intentional aggression or covert, non-intentional
aggression. Covert aggression may be
more detrimental than overt aggression because hostility may be perceived
though body language and facial expressions of the aggressor, which would
otherwise not be expressed. A person who
exhibits covert behaviors may not even know they are being perceived as being
aggressive (Sheridan-Leos, 2008, p. 1)
By the
definition provided by Kweykway Consulting (Findlay, 2013,) LV stems from oppression of a group
of people. In the nursing profession
oppression occurs for several proposed reasons, such as, being a mostly female
profession, being victims of aggression from more domineering and power seeking
administration, and being victims of aggression from doctors who may think they
are more powerful and knowledgeable than nurses. People in more dominant and more powerful
roles, see the attributes that make nursing a unique and caring profession as
being weakness and an open avenue for treating nurses as less than equal to
themselves. With feeling power over
nurses, these more dominant people may act aggressively and cruelly toward the
nurse. The nurse that is being attacked then internalizes this aggression
leading to submissive-aggressive
syndrome. Submissive aggressive syndrome is defined as “nurses feel they have
lost their power (submissiveness), and react by overpowering others through aggressiveness”
(Sheridan-Leos, p 1.)
The less
experienced, new-graduate nurse may take the LV against themselves and redirect
hostility toward the less powerful patient, which creates a situation that
could impact a patients healing, mental and spiritual wellbeing, as well as,
their relationships with other around them.
An example of this would be when a physician behaves aggressively toward
a seasoned nurse, she then acts out in LV toward a new nurse, who then acts out
with aggression toward a patient, who may then act aggressively toward his or
her family. This chain of hostility has
a negative impact on the whole perception of health care and must be addressed
in order to maintain nurse retention, nursing job satisfaction and patient
satisfaction. Many federal and state
funding programs rely on data from patient satisfaction to allocate funding to
facilities. The facility I work at has
had cuts in reimbursement from Medicaid, due to patient satisfaction scores,
which has led to some staff reductions. The
LV phenomenon can be solved by teaching nurses to respect themselves and their
peers, and by giving them tools to channel their feelings of oppression. With these tools, nurses can gain a sense of
pride and power in their profession, which will also lead to an increase in
patient satisfaction and job security.
LV can be lessened or avoided by giving nurses the tools they need to
feel valued and find genuine value in their interactions with peers.
Inclinations
toward nurse on nurse aggression can be addressed and corrected by adopting
differing ways of thinking and knowing, in order to change one’s perspective on
why they may be feeling and acting aggressively. I believe aggression can be diffused by
changing thought patterns in prospective with one’s perceived or actual
problem. Problem solving by being able
to think about solutions and know how one’s actions affect other people is a
monumentally necessary skill needed to avoid LV.
Predictive
thinking is useful in redirecting aggressive feelings and thoughts by
introducing consequence and reward associated with the act of being
aggressive. For instance, thinking “if I
belittle Jenny, then I may have a negative peer evaluation from her, which may
lead to me not getting a raise.” This
ability to foresee consequence from action makes it easier to redirect negative
thoughts and feelings. The act of being
more cognizant and predictive of how a behavior influences an outcome, allows
for more control and intention when interacting with peers.
Reflective
thinking can be introduced as a tool for an aggressive nurse, which allows her
to personally evaluate her interactions with others. Reflective thinking incorporates self-talk
and can involve speaking to one’s self in a mirror. By speaking in front of a mirror to one’s
self, an aggressive nurse may evaluate how her speech patterns and body
language may come across to the person on the receiving end. She can see her body language as she speaks
to herself, and practice body language that may portray more kindness and
sincerity. She can also practice
speaking to herself with more kind words, which will most likely give her a
better sense of self-worth. Through this
self-reflection, a nurse who comes across with aggressiveness can learn to
speak with greater kindness and sincerity when interacting with younger, less
experienced peers, which will in turn, give them more confidence in their
practice. The less experienced nurse
will not be the receptor for LV and will be less likely to adopt LV behaviors
in their interactions with peers. An
article by Curtis Baker (2012) discusses how the behaviors of LV are learned
and passed on from generation to generation amongst nurses. We, as nurses, are teaching our young to “eat
their young.”
Thinking
creatively is a great way to explore alternatives to aggression, in which all
parties involved in an interaction can benefit. The best example I have of
creative thinking that solved a potential aggressive problem is from when I was
a new graduate nurse. I was paired with
a veteran nurse, who was also a veteran American soldier, to train me on the
night shift. It became apparent to me
right away that he was not terribly pleased to train me. He went out of his way to ask me questions
that he felt I should know about orthopedic nursing, but did not yet have the
answer to. He was quite aggressive in
his speech and body language. My previous trainer had not given me the tools to
answer his questions, so I asked him to pretend like I was a blank slate and to
please share with me all of the tools he had to be a such great orthopedic
nurse. By giving him the permission to
share his wealth of knowledge and help mold me into his vision of a competent
orthopedic nurse, we forged a fantastic working relationship. To this day I credit him with teaching me to
be the nurse I am, and take pride in being.
Knowledge of and
practice of Carper’s ethical way of knowing is very useful when trying to
resolve tendencies toward LV. Ethical
knowing incorporates being aware of moral and ethical considerations when
interacting with other people. Using
ethical thinking when making choices about one’s actions toward others will add
an aspect of morality that will be more likely to divert negative tendencies,
and steer one toward empathetic and positive interactions with peers. Implementing ethical knowledge allows a nurse
to ask herself “is this behavior right?” or “is this the responsible way to
act?” (Carper, 1978.) Having the skill of ethical knowing allows a nurse to step
outside of her immediate negative situation and be able to make responsible
choices when interacting with peers and patients. Peers and patients that are treated with
kindness and respect tend to be less irritating, which would lead an aggressor
to wish to treat them more kindly. LV and aggression are a vicious cycle that
can be broken. I would like to challenge
all nurses to adopt ethical thinking in order to bring harmony to our
profession.
Carper’s aesthetic
knowing allows a nurse to explore questions, such as, “what does this mean and
how is it significant?” Having
aesthetical knowledge about a moment in time allows a nurse to take into
perspective, the unique qualities and gifts a particular peer or patient has to
offer. Even a less than ideal encounter
can have many positive lessons associated with it. Aesthetic knowledge allows a nurse to make
appropriate decisions on interacting with peers and helps her to derive
positive interventions that are unique to her patient. If everyone in a relationship
appreciates the value of the interaction, there will be less inclination to
turn to hostility. (Carper, 1978)
Jean Watson is a
nursing theorist who has a grand theory revolving around caring. This theory is not particularly useful to
solve smaller problems in nursing but is monumentally useful in attempting to
solve LV. Jean Watson is the nursing
theorist in which the facility I work for has adopted in our mission toward
magnate status. Jean Watson has ten
caritas that she proposes to create a Science of Caring. The caritas in the Science
of Caring are a set of rules that incorporate many ideas, which are useful in
solving the phenomenon of LV. The
caritas are as follows.
1. Embrace altruistic values and
Practice loving kindness with self and others.
2. Instill faith and hope and honor
others.
3. Be sensitive to self and others
by nurturing individual beliefs and practices.
4. Develop helping – trusting--
caring relationships.
5. Promote and accept positive and
negative feelings as you authentically listen to another’s story.
6. Use creative scientific
problem--solving methods for caring decision making.
7. Share teaching and learning that
addresses the individual needs and comprehension styles.
8. Create a healing environment for
the physical and spiritual self, which respects human dignity.
9. Assist with basic physical,
emotional, and spiritual human needs.
10. Open to mystery and Allow
miracles to enter.
I
have a great respect for Jean Watson and believe that adopting these caritas
into our nursing practice brings us a wealth of tools to maintain the nursing
profession as a caring and loving profession while preserving love and
dignity. She teaches a nurse to value
each individual and to look for positive aspects in each situation. Using the
caritas in interacting with others is the greatest tool in avoiding LV.
In
conclusion I believe that all nursing facilities should develop or offer a course,
which gives their staff members tools to handle feelings of hostility and to
redirect LV. The tools provided in this
paper are exceptional tools that can be used to construct
a harmonious and nurturing environment in the workplace. Predictive thinking
allows a nurse to foresee consequences and rewards of actions, pushing them to
strive toward actions with more rewarding outcomes. Reflective thinking teaches
the nurse to be able to self evaluate their interactions with peers and
patients. Creative thinking is a tool that can be used to explore solutions to
a problem that incorporates each participant’s needs and values in to the
solution. Ethical knowing provides moral
and ethical ways of evaluating a situation and with these values a nurse is
more likely to choose and kind and patient way to interact with patient and
peers. Training in aesthetic knowing
teaches the nurse to be able to creatively come up with ways to interact with
peers and ways to develop interventions that provide a unique experience that
is mutually beneficial to all involved.
Jean
Watson’s theory incorporates all of these ways of thinking and ways of knowing
in a caring science that explores, in depth ways to care about those around
us. A positive outcome from writing this
paper is that I feel inclined to take these tools and help create a course,
which teaches these ideas to new nurses and seasoned nurses. Everyone deserves to be able to work in a
place devoid of hostility, where they can truly care for one another and care
for the outcomes and well being of their patients. Through nurturing our young, we can help them
grow and learn to grow in a more positive way.
References
Baker, C. (2012). Nurses eating their young: are we teaching
students more than nursing skills?.
Oklahoma Nurse, 57(1), 9.—
Campbell, L. (2011.) The Ways of Thinking. (PowerPoint
Presentation.) Denver: Regis
University.
Carper, B. (1978). The Ways Of Knowing. (PowerPoint Presentation.) Denver: Regis University.
Findlay,
Denise (2013) Lateral violence in First Nations Communities. Retrieved
from http://www.kweykway.ca/lateral-violence-in-first-nations-communities
Parker,
M. E., & Smith, M. C. (2010). Nursing
theories & nursing practice (3rd ed.). Philadelphia: Davis.
Sheridan-Leos, N. (2008). Understanding Lateral Violence in
Nursing. Clinical Journal
Of Oncology Nursing, 12(3), 399-403. doi:10.1188/08.CJON.399- 403
The Writers at Inova Health, (2007.) Dr. Jean Watson’s Human
Caring Theory: Ten Caritas
Factors, retrieved from http://watsoncaringscience.org/images/features/library/Watson10_caritas%20fact ors%20colored%20list.pdf
