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How Nurses Can Help End Horizontal Hostility in Three Easy Steps

How Nurses Can Help End Horizontal Hostility in Three Easy Steps

Cindy Mehallow / Monster Contributing Writer

Low satisfaction and morale lead to turnover, which triggers other negative outcomes: The remaining nurses become bitter and resentful, and facilities bear additional costs for orienting new nurses. A 2004 survey by the Association of Perioperative Registered Nurses estimates it costs $30,000 to $50,000 to orient a novice perioperative nurse. Other studies place the cost far higher — as much as twice a nurse’s annual salary.

Step 3: Take Action

Nurses can help defeat the culture of hostility on three levels: personal, unit and organizational. Here’s how:

Speak Up: When hostility becomes an issue in your work environment, “make yourself known,” urges Deborah Mills, BSN, chief nursing officer at Memorial Hospital in Martinsville, Virginia. “Speak to your manager, supervisor or an administrator — anyone who will listen.” In other words: “Speak your truth,” advises Bartholomew, author of a book by that title.

Confront the Offender: Don’t engage in the passive-aggressive behavior of complaining to or involving a third party who can’t resolve the situation. Ask your peer to step away from patients and talk about what’s going on, suggests Barbara Brown, RN, vice president of the Virginia Hospital and Healthcare Association. Acknowledge the behavior and note differences in skills, but agree that you’re working toward the same goals. Share strengths as a way to help each other gain missing skills.

Make Sure It’s Not You: Check your behavior to make sure you’re not party to the hostility in any way — either as victim, bystander or aggressor.

Arm Yourself: Learn to handle confrontation by reading books like Crucial Conversations: Tools for Talking When Stakes are High and others suggested by the American Association of Critical-Care Nurses’ (AACN) Healthy Work Environment Initiative.

Create Shared Values: Work with colleagues to create a unit philosophy that states shared values and defines acceptable and unacceptable behavior, suggests Bartholomew. Articulate consequences, and hold people accountable for their actions.

Enlist Management’s Support: “Creating a healthy organizational culture has to be a vision that comes from the top,” Mills says. If your hospital hasn’t done so already, encourage it to adopt the standards outlined in the AACN’s Healthy Work Environment Initiative and achieve the American Nursing Association’s Magnet hospital status, which recognizes excellence in nursing services.

Finally, be patient but persistent. Culture change can occur, but it happens slowly.

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