2013 Western Governors University MSN Thesis
Workplace Hostility and Nurses’ Perceptions of the Value of Interventions and Supportive Structures (A Non-Geographic Pilot Study)
Abstract
Workplace and nurse-to-nurse hostility are now well-known phenomena in healthcare organizations. While costs and consequences are well defined in the literature, nurses’ perceptions of interventions and supportive structures are lacking. Lack of supportive structures and ineffective interventions by managers have been cited by nurses as being primary concerns. This qualitative pilot study attempted to present a representative panel of active and passive supportive structures, as well as authoritative and collaborative interventions for nurses to evaluate as being valuable or controversial. This work was conducted to inform on reasonable next steps in policy development and staff support as the interventions and structures deemed most valuable by nurses are likely to be both well-received and effective.
Workplace and nurse-to-nurse hostility are now well-known phenomena in healthcare organizations. While costs and consequences are well defined in the literature, nurses’ perceptions of interventions and supportive structures are lacking. Lack of supportive structures and ineffective interventions by managers have been cited by nurses as being primary concerns. This qualitative pilot study attempted to present a representative panel of active and passive supportive structures, as well as authoritative and collaborative interventions for nurses to evaluate as being valuable or controversial. This work was conducted to inform on reasonable next steps in policy development and staff support as the interventions and structures deemed most valuable by nurses are likely to be both well-received and effective.
Research Questions
Primary Question
Of the presented set, which interventions and supportive structures to hostilities do nurses perceive as being the most valuable and why? (Thesis page 56)
Secondary Question
What trends in the data, if any, correlate participant characteristics with perceptions of value? (Thesis page 59)
See page 28 in the PDF file below for an explanation of Value Analysis and page 94 for the Value Tables as listed below.
Primary Question
Of the presented set, which interventions and supportive structures to hostilities do nurses perceive as being the most valuable and why? (Thesis page 56)
Secondary Question
What trends in the data, if any, correlate participant characteristics with perceptions of value? (Thesis page 59)
See page 28 in the PDF file below for an explanation of Value Analysis and page 94 for the Value Tables as listed below.
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Survey Results (N = 90)
Narrative Analysis
Beyond the diversity and trending data, the researcher reviewed each open-ended question for descriptive information. These narratives were essential for exploring themes underlying perceptions of value or possible assumptions that may have been made by nurses participants based on the wording of specific questions. Each question presented has been presented as it was on the survey in the exact order as viewed by nurse participants. Results focus on key words and repeating phrases and offer insight into why nurses perceived structures and interventions as being more or less valuable.
Passively Supportive Structures
These structures and interventions to workplace hostility focus on organizational support and have a cultural focus.
Please briefly explain why a zero-tolerance policy to hostility with clear process, protocol, and consequences may or may not be valuable. Key words in these responses included “accountability,” “consequences,” and “standardized.” Narratives focused on defining behavior that was acceptable as well as what was not acceptable. Additional recurring commentary focused on decreasing gray areas and possibly reducing retaliation against reporting employees. Had this question not included “clear process, protocol, and consequences” it would likely have scored lower in the Value Index. This is important information to consider when developing a zero-tolerance policy.
Please briefly explain why having an integrity line or clear pathway for reporting hostilities may or may not be valuable. Key words in these responses included “confidential,” “anonymous,” “protection,” and “standardized.” Narratives continued to express value in reducing gray areas of policy and protocol as well as reducing the likelihood of retaliation when reporting hostilities. This question was deliberately not defined as being anonymous or confidential in order to solicit perceptions. It appears from the data that many nurses assume it is anonymous, while others perceive it as being confidential. While confidentiality is likely in a reporting system, anonymity would make it difficult to investigate concerns. This is important information to consider when developing a clear pathway for reporting hostilities.
Please briefly explain why having administrative teams in place dedicated to assessing and addressing workplace hostility may or may not be valuable. Key words in these responses included “team,” “peer,” “mediation,” “authority,” “enforce,” and “administration.” Many respondents expressed value for team interventions, while expressing reservations about the team being composed of administration. Mediation of reported events and enforcement of the zero-tolerance policy were mentioned repeatedly, though several nurses articulated a desire to have teams that were broadly representative of the nursing staff. The published recommendations for such administrative teams are consistent with these preferences. This structure may have scored higher if the question was worded to include peer review and support.
Please briefly explain why having one or more standardized immediate verbal or non-verbal responses (such as a phrase or tapping on one's own badge) for all nursing staff may or may not be valuable. Key words in these responses included “immediate,” “annoying,” “ineffective,” and “standardized.” While many nurses did acknowledge this intervention as having value for instances in which the hostile party was unaware of their hostility, a greater focus was paid to hostile parties that were fully aware. This intervention seems to have scored poorly as it was not an effective crisis management tool, nor was it designed as such. A theme was observed, however, in which this technique could be used to attract the attention of others who might come to the aid of the victim or target of hostilities.
Collaborative Interventions
These structures and interventions to workplace hostility focus on organizational and individual awareness and have a preventive focus.
Please briefly explain why offering staff virtual simulations of hostility with appropriate responses may or may not be valuable. Key words in these responses included “visual,” “examples,” “practice,” “preparedness,” “defining,” and “awareness.” Recurring phrases included “practice makes perfect” and “a picture is worth 1,000 words.” A few respondents stated that this should be taught in nursing school and that modeling acceptable behavior contrasted with what was not acceptable was valuable.
Please briefly explain why offering staff classes in conflict management skills may or may not be valuable. Key words in these responses included “education,” “empower,” “practice,” “safety,” “skill,” and “expensive.” A few participants commented that this could provide a venue to debrief as well as share experiences with others. Several nurses pondered the cost-to-benefit ratio. As this intervention was noted in the top four most valued by nurses, the cost-to-benefit ratio was likely worthwhile by nurses’ perceptions.
Please briefly explain why incorporating hostility awareness into new hire orientation may or may not be valuable. Key words in these responses included “fair,” “expectations,” “consequences,” “foundation,” “termination,” and “awareness.” The general narrative focused on “a level playing field” and increasing awareness for what would constitute “grounds for termination.” Considerable concern was expressed about overloading new hires with negative information, which was balanced by others insisting that the problem had to be acknowledged and awareness of behavioral expectations had to begin at day one of orientation.
Please briefly explain why incorporating hostility awareness into regularly occurring meetings may or may not be valuable. Key words in these responses included “support,” “repetition,” “tedious,” “awareness,” “monthly,” “quarterly,” and “annually.” The general consensus was that nurses attend too many meetings and that meetings indicate time away from the bedside. Many respondents, however, stated that quarterly or annual reminders would be preferable and valued over discussions at every monthly staff meeting.
Actively Supportive Structures
These structures and interventions to workplace hostility focus on training and skills and have an educational focus.
Please briefly explain why requiring that staff participate in virtual simulations of hostility with appropriate responses may or may not be valuable. Key words in these responses included “mandate,” “requiring,” “readiness,” “practice,” “consistent,” and “expensive.” This intervention differed from offering virtual simulations of hostility and appropriate responses in that it required participants to attend. It was interesting to note that nurses did not want to be mandated to attend another class, meeting, or intervention. It is also worth noting that “expense” was not a key word when this intervention was offered and not required. Requiring this intervention reduced the Consensus of Value from 88.64% to 73.5%.
Please briefly explain why requiring employees involved in reported hostilities participate together in classes teaching conflict management skills may or may not be valuable. Key words in these responses included “reporting,” “punishment,” “punitive,” “teambuilding,” and “closure.” This was the lowest scoring intervention by both CV and VI. General consensus was split between perceiving value in having the two adversaries work out their differences with perceiving this as needless additional punishment for the target or hostilities. Many respondents stated they would not report hostilities if this were the intervention. Clearly, this was the most controversial option, though it did maintain a slight positive trend.
Please briefly explain why requiring employees involved in reported hostilities participate separately in classes teaching conflict management skills may or may not be valuable. Key words in these responses included “mandating,” “reporting,” and “confidentiality.” While this intervention was more popular than requiring a class with the antagonist, statements such as “would decrease reporting” and “together or separate” predominated the narrative. Several respondents noted that separating the adversaries would allow more confidential disclosures, though other nurses felt there to be value in keeping the parties together to work out their differences. Most thought it should not be mandated.
Please briefly explain why requiring manager/supervisor training in conflict resolution, mediation, and prevention may or may not be valuable. Key words in these responses included “mentor,” “front line,” “modeling,” “non-punitive,” and “confidence.” General consensus by narrative focused on the manager as being the “first responder,” “needing to lead by example,” and “requiring a skill set in conflict management.” This appears to be a critical characteristic by the perception of nursing staff when evaluating a manager or supervisor for adequacy in their leadership role. Commentary overall was very supportive and respectful of nurse managers. A few nurse managers who identified themselves as such in the narratives expressed a desire for greater confidence when dealing with staff in conflict, while other participants desired greater confidence that their leaders could support them through hostilities.
Authoritative Interventions
These structures and interventions to workplace hostility focus on organizational support and have a crisis management focus.
Please briefly explain why utilizing direct manager/supervisor intervention as a standardized authoritative response to hostility may or may not be valuable. Key words in these responses included “chain of command,” “awareness,” “first responder,” “politics,” and “trained.” Many respondents valued that the manager knew his or her direct reports, while several also expressed concern about their manager’s lack of training in identifying and resolving conflict as well as possible political agendas. A few nurses expressed that their managers were the hostile parties and therefore recommended third party mediation.
Please briefly explain why utilizing direct manager/supervisor intervention with human resource personnel present as a standardized authoritative response to hostility may or may not be valuable. Key words in these responses included “distrust,” “awareness,” and “administration.” This intervention was the most favored of the four least preferred options. Adding HR was valued by many as increasing the awareness of the problem and making it more difficult for any specific manager to ignore or allow hostilities to continue without intervention. Beyond, that concerns were cited about administration and HR acting on behalf of the facility and not in support of the staff.
Please briefly explain why utilizing a third party mediator or direct human resource intervention without manager/supervisor mediation as a standardized authoritative response to hostility may or may not be valuable. Key words in these responses included “objectivity,” “knowledge,” “decreased bias,” “expertise,” and “expense.” Respondents communicated that this should be either a first or last resort. Many stated they would prefer their manager to intervene as long as they had the appropriate skill set for conflict resolution. While third party mediation was generally acknowledged as being less biased and meriting less fear of retaliation, it was also cited as being more expensive and less available.
Please briefly explain why utilizing an executive mandate for contractual authoritative mediation with clear consequences such as monetary fines for ongoing patterns of hostility may or may not be valuable. Key words in these responses included “court [of law],” “doctors,” “excessive,” “[law] enforcement,” “fear,” “counseling,” and “ticket.” Respondents indicated general support while also offering that if this was being considered, then someone should probably simply be terminated. Concerns were also expressed that doctors or others with higher perceived incomes might be able to buy their way out of trouble and continue hostilities. A general theme emerged that “counseling” would be valued over “fear tactics.” However, several respondents also noted that this intervention could pay for third party mediation or some of the other supportive structures deemed “expensive.”
Beyond the diversity and trending data, the researcher reviewed each open-ended question for descriptive information. These narratives were essential for exploring themes underlying perceptions of value or possible assumptions that may have been made by nurses participants based on the wording of specific questions. Each question presented has been presented as it was on the survey in the exact order as viewed by nurse participants. Results focus on key words and repeating phrases and offer insight into why nurses perceived structures and interventions as being more or less valuable.
Passively Supportive Structures
These structures and interventions to workplace hostility focus on organizational support and have a cultural focus.
Please briefly explain why a zero-tolerance policy to hostility with clear process, protocol, and consequences may or may not be valuable. Key words in these responses included “accountability,” “consequences,” and “standardized.” Narratives focused on defining behavior that was acceptable as well as what was not acceptable. Additional recurring commentary focused on decreasing gray areas and possibly reducing retaliation against reporting employees. Had this question not included “clear process, protocol, and consequences” it would likely have scored lower in the Value Index. This is important information to consider when developing a zero-tolerance policy.
Please briefly explain why having an integrity line or clear pathway for reporting hostilities may or may not be valuable. Key words in these responses included “confidential,” “anonymous,” “protection,” and “standardized.” Narratives continued to express value in reducing gray areas of policy and protocol as well as reducing the likelihood of retaliation when reporting hostilities. This question was deliberately not defined as being anonymous or confidential in order to solicit perceptions. It appears from the data that many nurses assume it is anonymous, while others perceive it as being confidential. While confidentiality is likely in a reporting system, anonymity would make it difficult to investigate concerns. This is important information to consider when developing a clear pathway for reporting hostilities.
Please briefly explain why having administrative teams in place dedicated to assessing and addressing workplace hostility may or may not be valuable. Key words in these responses included “team,” “peer,” “mediation,” “authority,” “enforce,” and “administration.” Many respondents expressed value for team interventions, while expressing reservations about the team being composed of administration. Mediation of reported events and enforcement of the zero-tolerance policy were mentioned repeatedly, though several nurses articulated a desire to have teams that were broadly representative of the nursing staff. The published recommendations for such administrative teams are consistent with these preferences. This structure may have scored higher if the question was worded to include peer review and support.
Please briefly explain why having one or more standardized immediate verbal or non-verbal responses (such as a phrase or tapping on one's own badge) for all nursing staff may or may not be valuable. Key words in these responses included “immediate,” “annoying,” “ineffective,” and “standardized.” While many nurses did acknowledge this intervention as having value for instances in which the hostile party was unaware of their hostility, a greater focus was paid to hostile parties that were fully aware. This intervention seems to have scored poorly as it was not an effective crisis management tool, nor was it designed as such. A theme was observed, however, in which this technique could be used to attract the attention of others who might come to the aid of the victim or target of hostilities.
Collaborative Interventions
These structures and interventions to workplace hostility focus on organizational and individual awareness and have a preventive focus.
Please briefly explain why offering staff virtual simulations of hostility with appropriate responses may or may not be valuable. Key words in these responses included “visual,” “examples,” “practice,” “preparedness,” “defining,” and “awareness.” Recurring phrases included “practice makes perfect” and “a picture is worth 1,000 words.” A few respondents stated that this should be taught in nursing school and that modeling acceptable behavior contrasted with what was not acceptable was valuable.
Please briefly explain why offering staff classes in conflict management skills may or may not be valuable. Key words in these responses included “education,” “empower,” “practice,” “safety,” “skill,” and “expensive.” A few participants commented that this could provide a venue to debrief as well as share experiences with others. Several nurses pondered the cost-to-benefit ratio. As this intervention was noted in the top four most valued by nurses, the cost-to-benefit ratio was likely worthwhile by nurses’ perceptions.
Please briefly explain why incorporating hostility awareness into new hire orientation may or may not be valuable. Key words in these responses included “fair,” “expectations,” “consequences,” “foundation,” “termination,” and “awareness.” The general narrative focused on “a level playing field” and increasing awareness for what would constitute “grounds for termination.” Considerable concern was expressed about overloading new hires with negative information, which was balanced by others insisting that the problem had to be acknowledged and awareness of behavioral expectations had to begin at day one of orientation.
Please briefly explain why incorporating hostility awareness into regularly occurring meetings may or may not be valuable. Key words in these responses included “support,” “repetition,” “tedious,” “awareness,” “monthly,” “quarterly,” and “annually.” The general consensus was that nurses attend too many meetings and that meetings indicate time away from the bedside. Many respondents, however, stated that quarterly or annual reminders would be preferable and valued over discussions at every monthly staff meeting.
Actively Supportive Structures
These structures and interventions to workplace hostility focus on training and skills and have an educational focus.
Please briefly explain why requiring that staff participate in virtual simulations of hostility with appropriate responses may or may not be valuable. Key words in these responses included “mandate,” “requiring,” “readiness,” “practice,” “consistent,” and “expensive.” This intervention differed from offering virtual simulations of hostility and appropriate responses in that it required participants to attend. It was interesting to note that nurses did not want to be mandated to attend another class, meeting, or intervention. It is also worth noting that “expense” was not a key word when this intervention was offered and not required. Requiring this intervention reduced the Consensus of Value from 88.64% to 73.5%.
Please briefly explain why requiring employees involved in reported hostilities participate together in classes teaching conflict management skills may or may not be valuable. Key words in these responses included “reporting,” “punishment,” “punitive,” “teambuilding,” and “closure.” This was the lowest scoring intervention by both CV and VI. General consensus was split between perceiving value in having the two adversaries work out their differences with perceiving this as needless additional punishment for the target or hostilities. Many respondents stated they would not report hostilities if this were the intervention. Clearly, this was the most controversial option, though it did maintain a slight positive trend.
Please briefly explain why requiring employees involved in reported hostilities participate separately in classes teaching conflict management skills may or may not be valuable. Key words in these responses included “mandating,” “reporting,” and “confidentiality.” While this intervention was more popular than requiring a class with the antagonist, statements such as “would decrease reporting” and “together or separate” predominated the narrative. Several respondents noted that separating the adversaries would allow more confidential disclosures, though other nurses felt there to be value in keeping the parties together to work out their differences. Most thought it should not be mandated.
Please briefly explain why requiring manager/supervisor training in conflict resolution, mediation, and prevention may or may not be valuable. Key words in these responses included “mentor,” “front line,” “modeling,” “non-punitive,” and “confidence.” General consensus by narrative focused on the manager as being the “first responder,” “needing to lead by example,” and “requiring a skill set in conflict management.” This appears to be a critical characteristic by the perception of nursing staff when evaluating a manager or supervisor for adequacy in their leadership role. Commentary overall was very supportive and respectful of nurse managers. A few nurse managers who identified themselves as such in the narratives expressed a desire for greater confidence when dealing with staff in conflict, while other participants desired greater confidence that their leaders could support them through hostilities.
Authoritative Interventions
These structures and interventions to workplace hostility focus on organizational support and have a crisis management focus.
Please briefly explain why utilizing direct manager/supervisor intervention as a standardized authoritative response to hostility may or may not be valuable. Key words in these responses included “chain of command,” “awareness,” “first responder,” “politics,” and “trained.” Many respondents valued that the manager knew his or her direct reports, while several also expressed concern about their manager’s lack of training in identifying and resolving conflict as well as possible political agendas. A few nurses expressed that their managers were the hostile parties and therefore recommended third party mediation.
Please briefly explain why utilizing direct manager/supervisor intervention with human resource personnel present as a standardized authoritative response to hostility may or may not be valuable. Key words in these responses included “distrust,” “awareness,” and “administration.” This intervention was the most favored of the four least preferred options. Adding HR was valued by many as increasing the awareness of the problem and making it more difficult for any specific manager to ignore or allow hostilities to continue without intervention. Beyond, that concerns were cited about administration and HR acting on behalf of the facility and not in support of the staff.
Please briefly explain why utilizing a third party mediator or direct human resource intervention without manager/supervisor mediation as a standardized authoritative response to hostility may or may not be valuable. Key words in these responses included “objectivity,” “knowledge,” “decreased bias,” “expertise,” and “expense.” Respondents communicated that this should be either a first or last resort. Many stated they would prefer their manager to intervene as long as they had the appropriate skill set for conflict resolution. While third party mediation was generally acknowledged as being less biased and meriting less fear of retaliation, it was also cited as being more expensive and less available.
Please briefly explain why utilizing an executive mandate for contractual authoritative mediation with clear consequences such as monetary fines for ongoing patterns of hostility may or may not be valuable. Key words in these responses included “court [of law],” “doctors,” “excessive,” “[law] enforcement,” “fear,” “counseling,” and “ticket.” Respondents indicated general support while also offering that if this was being considered, then someone should probably simply be terminated. Concerns were also expressed that doctors or others with higher perceived incomes might be able to buy their way out of trouble and continue hostilities. A general theme emerged that “counseling” would be valued over “fear tactics.” However, several respondents also noted that this intervention could pay for third party mediation or some of the other supportive structures deemed “expensive.”
