Chapter 26: Workplace Violence and Incivility Flashcards
Your health care organization places a high value on workplace safety and integrates this into all aspects of administrative and patient care processes. As a unit manager, you thoroughly endorse this direction, and during the selection and hiring of new staff, you consistently:
a. Refuse to hire applicants who are pushy during interviews.
b. Thoroughly follow up with all references before offering a position.
c. Ask applicants during the interview whether drug or alcohol abuse is a problem.
d. Refuse to interview applicants with sporadic work histories.
ANS: B
Sporadic work histories and a “pushy” attitude may or may not be associated with aggression and violence. Thoroughly checking references helps to effectively confirm or rule out impressions obtained during the interview, and may yield useful information about issues related to violence and aggression in previous employment.
Jay, a newly graduated registered nurse (RN), has just begun work on an acute care nursing unit. As a nurse manager, you know that new graduates are most likely to experience:
a. Aggression.
b. Horizontal violence.
c. Physical violence.
d. Vertical violence
B
Studies indicate that new graduates were likely to experience horizontal violence, which resulted in high absentee rates and thoughts of leaving nursing after their first year.
In which of the following situations would you, as the head nurse, be concerned about potential safety issues?
a. Jordan comes to your office to complain about inadequate staffing on the unit. He
says that he is concerned because he attributes a recent incident to the staffing
levels.
b. Heinrich, a long-standing RN on the unit, has begun to miss work regularly. He
calls in but is vague about his reasons for the absences.
c. Carla, RN, has just ended a relationship with Jake, RN, and he will not leave her
alone. You are meeting with Jake today because colleagues on night shifts have
reported that Jake seems to have been intoxicated last night and the previous night.
d. Sarah is very quiet and says almost nothing in team meetings. Lately, she has been
much more animated since becoming friendly with a couple of other RNs on the unit
ANS: C
Jake seems at most risk for violence mainly because of his alcohol use and the end of what may be an obsessive relationship with Carla. In the other situations, Jordan is expressing a legitimate concern and is behaving assertively; Heinrich may have health concerns or other issues that are private and interfering with his work life; and Sarah’s change in behaviour is probably related to a higher level of comfort with work and colleagues.
Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively telling others that you are incompetent, you do not know what you are doing in relation to patient care, and that you lie to the staff about attempts to get more staffing. Through telephone calls and conversations during breaks, she is recruiting other staff to her position. Delaney confides that most staff members find you fair, honest, and knowledgeable. Marjorie’s behaviour can best be characterized as:
a. Political action.
b. Bullying.
c. Building alliances.
d. Disgruntlement.
ANS: B
Workplace bullying involves aggressive and destructive behaviours such as running a smear campaign and failing to support another nurse.
During coffee and other breaks, Rosalie, the new RN, is excluded from conversations with the other staff. When she approaches other staff on the unit to ask questions, they turn and walk off in the other direction. The behaviour of the staff is characteristic of:
a. Dislike.
b. Lack of trust in Rosalie’s abilities.
c. Horizontal violence.
d. Cultural incompetence
ANS: C
Horizontal or lateral violence and bullying are terms used to describe destructive behaviours towards coworkers, such as the “silent treatment,” and excluding others from socializing.
Sabotage is an example of which type of violence?
a. Threatening behaviour.
b. Written threat.
c. Harassment.
d. Verbal abuse.
ANS: C
Sabotage is harassment, which is any behaviour that demeans, embarrasses, humiliates, annoys, alarms or verbally abuses a person and that is known or would be expected to be unwelcome. Sabotage includes words, gestures, intimidation, bullying, or other inappropriate activities.
Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car accident. The father screams at her and tells her that she has no right to ask his family to leave, and that if she continues to do so, he will “throw her out of the room.” Caroline is shaken and tells her head nurse, who tells her that this kind of thing is just part of the job. The guidance of the head nurse:
a. Is reasonable. No physical violence was involved.
b. Is related to why incidents of violence in health care are probably underreported.
c. Acknowledges the deep distress and fear of the family.
d. Acknowledges the concern of the nurse.
ANS: B
A common perception is that incidents such as these, which involve threats rather than physical injury or harm, are part of the job. Because of underreporting, data related to violence and aggression in the workplace may not be reflective of their true incidence.
You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your health care organization. This team has been established in response to increases in reports of violence and aggression. You begin designing the safety plan by:
a. Surveying staff about levels of satisfaction with the workplace and management,
collegial, and patient relations.
b. Offering training sessions in self-defence.
c. Developing a policy that outlines zero tolerance for bullying.
d. Offering education sessions on recognizing behaviours with potential for violence.
ANS: A
Violence and aggression and a toxic workplace can lead to staff dissatisfaction and high staff turnover rates. Surveying staff provides a useful starting place in identifying problems such as employee dissatisfaction, bullying, and other forms of violence.
In the emergency department waiting room, you notice a patient sitting, with his head in his hands, who has been waiting for about 5 hours for relief of his headache. When you approach him to ask him how he is doing, he says, “I can’t believe that I have to wait this long for help! Do you know what it is like to be in pain for 10 hours?” Your response to him would be:
a. “It is frustrating to wait when you are in pain and when you are expecting to receive relief right away.”
b. “Don’t talk to me. If you are going to be rude, then you will not receive treatment
here.”
c. “We are very busy and don’t have enough staff to deal with problems such as
yours.”
d. “Perhaps you should go elsewhere. We do not have time for you here, as many
more sick patients are waiting.”
ANS: A
Empathizing helps the other person to know and feel that he has been understood and is powerful in deescalating a situation that has potential for aggression and violence. Communication techniques and body language skills were used to try to deescalate the situation.
At 3 a.m., a man walks into your emergency department. He paces back and forth in the waiting area before he approaches staff to ask if he can see his wife, who is a patient on another floor. He speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his jacket pocket. A best initial response would be to:
a. Assess your situation and your surroundings.
b. Ask two or three staff to assist in confronting the individual.
c. Ask what floor his wife is on and remind him that visiting hours are over.
d. Remain calm as there is no potential for violence here.
A
The Canadian Nurses Association (CNA) cites studies that suggest that intimidating and disruptive behaviours in the nursing profession contribute to:
a. Low morale.
b. Preventable adverse outcomes.
c. An increase in power for leaders.
d. Citations of leaders for not addressing workplace violence.
ANS: B
The CNA cites studies that suggest that intimidating and disruptive behaviours in the nursing profession contribute to low patient satisfaction and an increase in preventable adverse outcomes. Although intimidating and disruptive behaviours may contribute to low morale, these were not identified as contributors by the CNA.
Residents in a new long-term care facility attend meals in a large dining hall. In reviewing reports of aggression and violence, you note that behaviours such as hitting or attempts to hit staff are increasing. Further investigation suggests that this behaviour occurs most often at mealtimes. A possible intervention would be to:
a. Seat residents with the highest potential for violence next to those with the lowest potential for aggression.
b. Feed residents earlier in the day.
c. Restrain residents who are violent or aggressive during meal times.
d. Establish a smaller dining area that is away from the main area that is for residents
who have potential for aggression/violence.
ANS: D
Working during periods of understaffing, especially during visiting hours and meal times, is a risk situation for violence and aggression. Reducing activity levels through interventions such as a separate dining area may reduce incidents of violence and aggression.
Many inaccurately believe workplace violence to be related specifically to:
a. Verbal abuse.
b. Physical injury.
c. Incivility.
d. Harassment.
B
As indicated by Shield and Wilkins for Statistics Canada (2014), abuse in the health care setting is most often perpetrated by someone who:
a. Is male.
b. Has more experience.
c. Consistently works day shifts.
d. Has high coworker support.
ANS: A
Shield and Wilkins noted that abuse was related to being male, having less experience, usually working non-day shifts, and perceiving staffing or resources as inadequate, nurse-physician relations as poor, and coworker and supervisor support as low.
In addressing a high staff turnover rate that results from violence on a nursing unit, you are: a. Confirming the high correlation between managerial incompetence and violence.
b. Demonstrating awareness that workplace violence, if present, has significant costs.
c. Aware that staff and manager experiences contribute to high turnover.
d. Aware that violence is a rare but present factor in the workplace.
ANS: B
Workplace violence and aggression contribute to staff turnover and toxic work environments. Loss of the organizational investment required to train new staff and departure of experienced staff can increase operating costs and reduce the quality of care.
