09 August 2016

Dr. Crude and the bystander effect

Before taking a faculty position, I was employed as a psychiatric nurse/therapist specializing in adolescent mental health, substance-abuse intervention and recovery, and violence prevention. I had the good fortune of working with an amazing team of mental health professionals who treated a variety of conditions and disorders. Many of our patients were violent, adjudicated youth with long histories of severe substance abuse and criminal activity.

Our work was challenging and sometimes dangerous. I have often been asked, “Were you or members of your team ever injured by one of your clients?” And the answer is no, although there were some close calls. Like the time a gang of violent youth drove onto the campus of our treatment center and circled the building while wielding a sawed-off shotgun and threatening to shoot one of our African-American counselors. It was terrifying, but, fortunately, the police responded, handled the situation without incident, and no one was hurt.

But if someone asked me if a co-worker ever harmed me, the answer would be yes. Unbelievably, the assault came from a psychiatrist. Here’s what happened.

Who do you think you are?
Years ago, as the nurse manager of an inpatient adolescent unit, one of my many responsibilities included organizing and facilitating treatment planning for our clients and their families. Each psychiatrist met individually with the team to review his or her clients’ treatment plans. The team consisted of the lead psychiatrist, psychologists, nurses, social workers, recreational therapists, teachers, occupational therapists, and nutritionists. My job was to organize each session so that the team was assembled and ready to go. They were busy and eventful days, with planning and coordination key.

Katarzyna Bialasiewicz/iStock
One particularly busy day, as I was preparing for our meeting, I noticed that one of our patients was struggling with what appeared to be symptoms from excessive dosage of her prescribed antidepressant. The patient—I will call her Anna, not her real name—was complaining of nausea, headache, agitation, and restlessness. She was clearly anxious and diaphoretic. Of course, we were concerned about her, but comforted by the fact that we planned to discuss her treatment plan later that morning. In the meantime, we withheld her morning dose of the medication, recorded her vital signs, and closely monitored her condition.

When her psychiatrist—I will call him Dr. Crude—arrived on the unit, I was relieved because Anna was still not feeling well. As Dr. Crude entered the treatment-planning room, I quietly mentioned that Anna might be experiencing symptoms related to heightened dosage of her antidepressant and expressed a need to discuss her condition first during morning rounds.

Imagine my shock—and fear—when he grabbed me forcibly by the shoulders, threw me angrily against the wall, jammed his finger into my chest, and, with spittle spraying from his mouth, accused me of “playing doctor,” chastised me for my audacity and impertinence, and asked in an enraged tone, “Who do you think you are?” He was beyond angry—furious, in fact—as he continued to berate me in front of my teammates.

I was certain one or more of them would come to my aid, but that did not happen. They sat stunned and silent, looking on with horrified expressions. After what seemed like forever, Dr. Crude let go of me and stormed out of the unit. Moments later, the tears came, and my teammates rushed to console me. When I asked what kept them from intervening, each one immediately apologized, stating that they were so stunned by what they observed they were completely immobilized.

Observers of violence
As I reflect on that experience and the lack of response from my teammates, I’m intrigued by their behavior. What kept a top-notch group of individuals, all highly trained, highly educated, and well-schooled in behavioral health and conflict de-escalation, from intervening on my behalf? There is a term used in psychology for people’s failure to help a person in distress. It’s called the bystander effect, a term coined by social psychologists to study if and how the presence of others discourages a person from intervening in an emergency situation. Researchers found that the greater the number of bystanders, the less likely any one of them will help.

There are various terms to describe bystanders. They are also called witnesses, accomplices, and indirect victims. I prefer the term “witness,” defined as someone who sees, hears, or knows about incivility, bullying and/or violence happening to someone else. Regardless of the term, actions of witnesses, whether intentional or not, contribute to the outcome of an uncivil or bullying event. The impact of bullying on witnesses is clear: Observing uncivil or bullying behavior, particularly over time, can have detrimental effects on one’s health, including mental health. Like targets of workplace bullying, witnesses of bullying may develop symptoms of guilt, anxiety, and depression. In some cases, they may disengage or leave unhealthy workplaces altogether.

Witnesses react to bad behaviors in various ways. Some take the side of the offender by doing nothing, laughing at the target, or encouraging the offender to mistreat the target. Others give silent approval by simply looking on and doing nothing. In my situation with Dr. Crude, the witnesses were so horrified and shocked by his behavior they were rendered helpless. As noted earlier, some social psychologists believe that the more observers there are to a bad situation, the less likely they are to intervene. That’s known as the “diffusion of responsibility” effect—believing someone else will step in and help.

Reward for silence
In some cases, the offender or bully is protected. That’s what happened with me. When I reported the incident to the medical director and the CEO of the facility, I was told to “let it go” because Dr. Crude topped the list of psychiatrists admitting patients to the facility and we “wouldn’t want to upset him.” Not only was I encouraged to let it go, I was offered a salary increase, which, to me, was hush money in return for my silence. Soon after, when my reports went unacknowledged, I left the organization knowing I could not be party to this type of behavior. Exposure to acts of incivility and bullying impacts everyone involved: the target, witnesses, patients, other co-workers, families of those being targeted, and, ultimately, the organization.

While there is no universal formula for effective intervention and being a supportive witness, here are some suggestions. Take a personal stand against incivility and bullying behavior. Make it clear to your friends and co-workers that you will not be a participant. Set a positive example. Do not tease, spread gossip and rumors about others, or laugh at off-color jokes or distasteful comments. Beware of offensive emails and/or social media postings. Do not forward them to others or respond to them in a conspiring manner.

In the workplace, witnesses may be useful and even compassionate when incivility or bullying occurs. They may listen to the victim and offer a sympathetic ear. However, it is the rare co-worker who puts his or her own well-being or job security on the line by giving an objective, detailed account of the incident to supervisors or HR representatives. Many co-workers—concerned about becoming a target themselves, or being identified as a complainer— are unwilling to address the situation. Also, many workplaces lack guidelines to deal with offenders as well as clear policies regarding confidentiality, so there is no roadmap and, sadly, a lack of support for reporting uncivil behavior. Even worse, rather than showing support, the person reporting the incident may be labeled a troublemaker or “whistle-blower,” a term that, for many, has a negative connotation.

Fortunately, there are witnesses who take immediate action to stop the offender and support the target by using words and/or actions to intervene. Evidence suggests that when witnesses take safe and effective action to support targets of incivility, there is greater likelihood that the behavior stops.

Practice, practice, practice
In an ideal world, witnesses intervene when each incident of incivility and bullying occurs. However, each situation is unique and complex, and stepping in to intervene is not as easy as some would like. Intervening on another’s behalf and, ultimately, mastering this type of intervention take courage, skill, and practice, practice, practice.

For instance, let’s imagine that you witness a colleague (Belle) berating another colleague (Alice) in the presence of a patient and his family. You determine that the incident calls for an immediate response, but what can you say? How comfortable do you feel saying something like, “Belle, it’s not OK to yell at Alice, especially in front of patients. If you have concerns, let’s discuss them in private.” In my experience, individuals often express a desire to intervene, but lack the appropriate skills.

Effective intervention requires practice and skill building, which may be accomplished through workshops, online modules, role-playing, and simulation. But most of all, successful intervention requires support from leadership at all levels of the organization.

Every organization must take a stand against negative and disruptive behavior by developing, implementing, and widely disseminating clear, confidential, and comprehensive policies and procedures that foster a healthy work environment. Supervisors and HR representatives must take reports of incivility and bullying seriously and conduct thorough, confidential investigation, protecting all identified parties. Implementing team charters that reinforce civility and norms for respectful interactions and protection of patient safety are crucial steps toward creating and sustaining healthy work environments.

Organizations must invest in educational programs that raise awareness about the negative impact of incivility on workplaces while simultaneously reinforcing and building upon existing organizational strengths. Positive role modeling at all levels of the organization is essential. For workers to intervene, leaders must model the way and reward others who bear active witness to bad behavior. The bottom line is, we can no longer stay silent.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

08 June 2016

Be humble and kind

Recently, I experienced a lengthy airport delay; it would be at least an 8-hour wait for my flight home to Boise, Idaho. So, I decided to grab some lunch in an airport restaurant and finish a bit of work. I was seated near the receptionist who was engaged in conversation with my waiter. I tried not to eavesdrop, but couldn’t help overhearing their exchange.

The waiter was lamenting the lack of gratuity he received from a party of eight patrons who had required a good deal of his time and attention. He had worked very hard to make their experience a positive one, given the busyness of the airport and their rush to catch a flight, but the gratuity they gave him was only about 5 percent of the bill. Then he added, “And to top it all off, my relief is late again. He is consistently 40 minutes late for his shift. It typically wouldn’t bother me, but I have another job to get to, and when he’s late I begin to get very nervous. I need both jobs to take care of my family.”

When the receptionist suggested that the waiter share his concerns with the manager, he responded: “No way, I can’t lose this job! I just need to deal with it.” At that point, the receptionist observed: “You know what, I’ve worked here a long time and I have a very good relationship with the manager. How about I mention it to him? I won’t let him know that the matter came from you.” Showing obvious relief, the waiter responded, “How very kind of you. That would be great. Thank you.” Given his unhappy experience with the previous guests, I made sure to leave a sizable tip.

A simple act of kindness
That simple act of kindness from the receptionist touched me. I hope that reaching out and offering a thoughtful gesture or act of kindness will never go out of style. Yet, so often, we fail to pause and acknowledge others amidst the hectic, fast-paced flurry of our lives.

Listen to this YouTube video of Tim McGraw singing “Humble and kind.” and really pay attention to the lyrics and images. He reminds us, “Hold the door, say please, say thank you. Don’t steal, don’t cheat, and don’t lie. … When you get where you’re goin’, don’t forget, turn back around, help the next one in line. Always stay humble and kind.” Tim’s goal is to spread the message of kindness and inspire others to do the same.

The Clarks on graduation day.
Make it a habit and a lifestyle
Last month, our youngest daughter graduated from the University of Idaho with her undergraduate degree. Brigadier General Erik C. Peterson, a highly decorated and distinguished commander of the U.S. Army Special Operations Aviation Command, delivered the commencement address. His military awards and decorations are many and impressive, and he, too, is a graduate of the University of Idaho. As a parent of one of the graduates, I found Gen. Peterson’s speech compelling, passionate, powerful, and deeply relevant to the ideals of service, advocacy, and civility. He challenged us to share our skills, talents, energy, and gifts to benefit others and contribute to the common good. He suggested we make service a habit and a lifestyle, not just a single act, and he strongly encouraged us to “endeavor to be kind.”

Quoting Albert Schweitzer, he stated, “Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate.” He further noted that, along his 30-year military journey, he has witnessed firsthand the very best and the very worst of humanity. He observed: “Nothing has had a more profound, sustained, positive impact on me than the occasional, conspicuous act of kindness of my fellow man, and the simple pleasure and reward of being able to extend the same. Kindness and civility with its inherent power are all too often overlooked. … Simple acts of kindness not only serve to counter the burdens and travails of the recipient, but are also known to improve the well-being of the giver. The impact of a [genuine act of kindness] can be profound, lasting, and positively viral.”

Pups in a truck. Four of our eight rescue pets.
This powerful, passionate, and brilliant speech touched me deeply. It was a rally cry to continue the path I am on—to be an avid advocate for civility, respect, and yes, kindness. And not only that, but to raise awareness and challenge myself and others to become “Civility Champions” dedicated to improving the lives of individuals, teams, organizations, and yes, maybe even society.

Kindness is a choice
Mary Wortley Montagu reminds us, “Civility costs nothing, and buys everything.” Think about ways you touch the lives of others. Perhaps you have rescued a pet, or, as in our family’s case, multiple pets. Maybe you hold the elevator for someone dashing to catch it, or pack an extra lunch for your child to share with a less fortunate friend or classmate. Maybe when others are gossiping about someone else, you are the first to jump in and speak well of that individual. Perhaps you’ve sent a letter to a relative or former teacher letting them know the positive impact they’ve had on your life.

Compliment others. Smile and greet them. At the bank or grocery store, offer your place in line to someone with fewer items or who seems to be in a hurry—or do it just because. If you see litter, pick it up and throw it away. Bring your partner coffee in bed. Include others in conversation, especially those who tend to be shy or quiet. At the Starbucks drive-thru, pay for the order of the person behind you.

These are just a few ideas. I’m sure many of you have countless ways to say thank you or extend a kind gesture to another. As Gen. Peterson and Tim McGraw remind us, endeavor to be humble and kind. It really can make a difference in the lives of others. Maybe even our own.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

04 April 2016

When people behave badly: How to recover if you're the target

For well over a decade, I have studied and contributed to the body of science on fostering civility, and creating and sustaining healthy workplaces. The utter cruelty of certain individuals never ceases to amaze me. Fortunately, the vast majority of people are respectful and civil. Yet, sadly, others treat people with disdain and contempt. I am often asked what motivates people to behave badly. It’s not a simple question to answer. Although there are reasons behind negative and harmful acts, some of which make sense, others simply fail to explain disrespectful human interaction.

For example, do you consider yourself a reasonably respectful or civil person? Most of us would say yes. If this is true for you, here’s another question: Have you ever been rude or disrespectful to someone? If you are like every other human being, the answer to the second question is also yes. So then the question becomes, why would an otherwise civil or respectful person behave rudely or badly?

Stressed out
Very often, the answer is, “Because I’m stressed out.” I agree; heightened levels of stress brought on by any number of life’s demands often account for much incivility. Stress may be caused by the challenges of managing the myriad roles and responsibilities associated with family, work, and life in general. Being overworked, underpaid, and sometimes unappreciated also may contribute to increased stress. While not acceptable, responding rudely in highly stressful situations is more easily understood than other forms of incivility.

–  People Images
In the workplace, incivility can add tension to an already highly stressed environment, and its potential impact cannot be overestimated. Being treated badly or in an uncivil manner, particularly over time, can have devastating results. In a practice-based discipline, such as nursing, this is especially troubling, because incivility can weaken confidence and moral courage, impair clinical judgment and reasoning, create vulnerability and self-doubt, and cause anxiety, resentment, and anger. Ultimately, it can negatively impact patient care.

Stress is not the only contributor to incivility. I’m reminded of a story told to me by a nursing instructor in her mid-50s. She was so excited because she had finally, after much soul-searching and research, decided to pursue a doctoral degree. She could hardly wait to share her excitement and ideas with her program director. When she had an opportunity to meet with the director and disclose her scholarly intentions, the director laughed and said: ‘‘Are you kidding, at your age? You can’t be serious. By the time you finish your degree, you’ll be ready to retire. We prefer to invest in younger faculty.”

The exchange left the instructor feeling demoralized and diminished, and she decided to forgo pursuing the doctoral degree. Whether the director’s comments were intentionally or unintentionally delivered, the result was the same. A talented and energetic faculty member was left to feel devalued and unimportant.

Rank rankism
This example illustrates the negative impact that low emotional intelligence, ineffective communication skills, and an attitude of superiority—a sense of power over—can have. The instructor in this story is the target of rankism, a term coined by Robert W. Fuller, PhD, former president of Oberlin University. In his book, Somebodies and Nobodies: Overcoming the Abuse of Rank, Fuller tells us that "rankism" lies at the heart of discriminatory behavior, is evident in nearly every institution in society, and occurs when people abuse their power to demean and disadvantage those they outrank.

Intended or not, disrespectful and rude behavior toward others may indicate prejudice and rise to the level of discrimination—in some cases, outright abuse. The antidote to rankism is to foster work environments based on human dignity for all. It is abuse of power and rank—not power and rank per se—that damages relationships and puts people at a disadvantage.

Those who are targets of rankism and other forms of incivility often describe their experiences in vividly emotional ways. Many are still negatively impacted by their uncivil experiences, even when the encounters occurred years before. Some people describe intense psychological symptoms, such as feeling traumatized, helpless, and powerless. Many feel caught in a no-win situation, with little possibility of successful resolution. The lingering effects of incivility can cause serious and sometimes lasting psychological and physiological effects.

Although each of us deserves to be treated with dignity and respect, people report varying degrees of discomfort when addressing conflict and incivility. For further discussion of this topic, read my two-part series on conflict negotiation.

If you have been the target of repeated incivility or bullying, attending to your physical, emotional, and spiritual health is a critical first step. It may be necessary to see your healthcare provider or seek counsel from a mental health expert. Getting yourself physically and emotionally prepared to deal with the problem will require you to be in a healthy state. When reporting a problem, it’s important to follow confidential policies, procedures, and guidelines (assuming they exist). In any case, inform your employer or supervisor about the problem, and request institutional support. Be sure that human resource and employee-assistance program personnel have your best interest in mind and are poised to assist you in following healthy workplace policies and procedures.

10 tips for recovery
For anyone who experiences incivility, either inside or outside the workplace, it is imperative to reverse the negative effects it can have on his or her physical, emotional, and spiritual well-being. If you have been the target of bad behavior, here are 10 tips for successful recovery.

1. Share your story with a good friend, family member, mentor, counselor, or member of the clergy. Avoid sharing your experience with co-workers. Instead, seek support from those who can offer a more objective perspective, such as an ombudsperson, conflict negotiator, or civility coach. Relating the experience and sharing it with others can provide healing. However, avoid dwelling on it too long. Tell your story, validate that it occurred, and make a plan to move forward.

2. Journal about your experience. For many people, writing their story and reflecting on it can be therapeutic and may help provide insight.

3. Engage in activities you enjoy, and don’t retreat from relationships that matter to you. Continue to make time for exercise, friends, family, pets, and social activities.

4. Enjoy a massage, meditation, yoga, deep breathing exercises, and other relaxation techniques.

5. Get plenty of sleep, stay hydrated, and eat a well-balanced diet.

6. Get (or stay) involved by helping a friend, neighbor, or co-worker. Volunteer in the community, or champion one of your favorite causes.

7. Focus on building resiliency. No one size fits all, so find the plan that works for you. Surround yourself with positive people and with those who bring you joy.

8. Try to find meaning in stressful or traumatic events and experiences, and incorporate this meaning into moving forward.

9. Recognize what makes you uniquely strong, and own it! Don’t let others define you. Memorize and practice reciting a positive script, such as: “I am poised, balanced, and in control of my life. I am talented, courageous, and confident in my ability to succeed.”

10. Remember, symptoms of distress can last from a few days to many months, and recovery takes time and progresses at varying paces and degrees. If symptoms are persistent, you may need to talk with an expert. Don’t hesitate to reach out for support if you need it.

Clark, C.M. (2008). Student perspectives on incivility in nursing education: An application of the concept of rankism. Nursing Outlook, 56(1), 4-8.

Fuller, R.W. (2003). Somebodies and nobodies: Overcoming the abuse of rank. British Columbia, Canada: New Society Publishers.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

11 February 2016

Conflict negotiation, Part 2

Most people recognize that direct communication may be the most effective approach to resolving conflict, but are reluctant to address issues head-on. If you do decide to address a conflict, be sure to plan wisely. Create emotional and physical safety by selecting a proper setting for your conversation. Both parties need to agree on a mutually beneficial time and place to meet. Select a quiet venue conducive to conversation and problem-solving. You should be well rested, and the encounter should take place in a private area away from other people, where you’ll be free of interruptions. If desired, a third person can be invited by either side to listen in or mediate.

Goals and ground rules
Be sure to co-create goals and ground rules (i.e., speaking one at a time; addressing one another directly; using a calm, respectful voice; avoiding personal attacks; sticking to objective information, etc.). Also, be sure to test your assumptions since they may be wrong. This can be accomplished by asking clarifying questions, such as: “I’m gathering from our conversation that you’re concerned about my performance. Is that the case?” Or, “I’m inferring from this exchange that you question my intention. Is that correct?” Asking clarifying questions helps clear the air and establish mutual understanding.

Conversations that involve criticism can be stressful, so prepare by being well-hydrated, rested, and as stress-free as possible. Do some deep breathing exercises or yoga stretches before the meeting. When the meeting starts, listen carefully, and show compassion and genuine interest in the other person. Stay focused on your purpose, maintain eye contact, and avoid being judgmental.

I also suggest using evidence-based models for framing conversations that address conflict. Below, I have provided two common workplace scenarios using two different approaches to conflict negotiation. The first scenario, based on a framework suggested by Casperson (2014), demonstrates addressing conflict “in the moment.” The second scenario, which uses the DESC model offered by TeamSTEPPS, demonstrates a more planned approach.

Casperson’s framework
Dana Casperson suggests the following approach for opening a conversation in which you address conflict: When (identify the triggering event) happened, I felt (identify the negative emotion you experienced) because my (identify your specific need or interest) is really important to me.

Workplace scenario: You are a member of a work team in a health care organization. Some team members engage in negative gossip and spreading rumors. You believe you have been the target of these behaviors and, one day, when you approach the lounge, you hear your name mentioned in a derogatory way. As you enter, the room falls silent. You decide to address the situation.

A Casperson response: When I approached the lounge, I heard my name mentioned in a negative light. It concerns me because being accepted as a valued member of the team is important to me. In the future, please speak with me directly if you have something to say about me.

The DESC model
DESC stands for: 1) Describe the specific situation. 2) Express your concerns. 3) Suggest other alternatives. 4) Consequences stated.

Workplace scenario: You and a colleague, Professor Grey (referred to as Terri in the response below), are team-teaching a nursing course. The two of you become engaged in passionate disagreement over specific content to include in or exclude from the course. As a result, working together has become very stressful. You are actively avoiding Terri, and you notice she does not reach out to you as often as before. To make matters worse, students are beginning to suffer the consequences of this alienation and are becoming confused and frustrated. You realize something needs to be done to resolve the situation.

A DESC response: Describe: Terri, thank you for meeting with me. I’d like to share an observation with you about the course we are co-teaching. Explain: I realize we have differences about our course content, and I’m concerned that this disagreement has begun to impact our relationship as well as our students’ ability to learn. Suggest: Because we both genuinely care about our students, it’s best if we can work out our differences. Consequence: Let’s use our course outcomes and objectives as criteria to address the situation. That way, we’re more likely to be successful in reaching agreement.

These conversations are not for the faint of heart. They require courage, preparation, and follow-through. If you feel that taking a direct approach with your co-worker is just too difficult, enlist the support of a trained expert or your supervisor in reconciling the problem. After discussing it, ask him or her to practice addressing the situation with you.

Either way—the Casperson approach or the DESC approach—taking action to address a conflict is not an easy or stress-free decision to make.

Caspersen, D. (2014). Changing the conversation: The 17 principles of conflict resolution, New York: Penguin Books.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

25 January 2016

Conflict negotiation, Part 1

Twenty years ago, I read an excellent book authored by scholars from the Higher Education Research Institute (HERI, 1996) at UCLA. In describing a social change model of leadership development, they identified ability to engage in “controversy with civility” as an essential element. Conflict, they suggested, often implies competition or disagreement that involves potential aggression, and the term frequently conjures up the notion of winners and losers. Controversy, on the other hand, implies disagreement that has potential for positive outcome resulting in a solution that is beneficial to all.

For controversy with civility to occur, observed the scholars, parties to the disagreement must accept two fundamental premises: 1) Differences of viewpoint are inevitable, and 2) resolution of opposing points of view requires that both positions be aired honestly but with civility and openness. Whether one uses “conflict” or “controversy with civility” when referring to disagreement, both terms, it should be noted, describe natural and normal processes which, when managed well, can lead to creative problem solving. This is particularly true when problem solving occurs in an atmosphere of civility, collaboration, and with intent to achieve common purpose. Successful negotiation of either conflict or controversy requires listening well and setting ground rules—rules of engagement—that provide a platform for acceptable conduct and interaction.

You don’t have to be mean to be a leader!
The relevance of the HERI publication I refer to above resonates even more for me today as I consider the political rhetoric surrounding the 2016 U.S. presidential campaign. I passionately believe that positive and effective leadership only occurs in a context of civility, ethical conduct, and professionalism. Some years ago, I developed the acronym PEAK—Principled, Ethical, Authentic, and Kind—to describe that kind of leadership.

Leading with civility and kindness is not a sign of weakness, nor is it a philosophical abstraction. Rather, it is living and leading by a durable code of moral and principled behavior that is applied in everyday life. True leadership calls for strong commitment to ethical conduct and ability to empathize with others. As I reflect on some of the comments made during the current campaign season, I am reminded of a quote by Eric Hoffer, who said, “Rudeness is the weak man’s imitation of strength,” and another quote by Tennessee Williams, who quipped, “All cruel people describe themselves as paragons of frankness.”

Not all conflicts are created equal.
In my work as a consultant, mastering the skills of conflict negotiation often tops the list of skill-building requests. While many of us recognize that conflict can be a positive experience when it is addressed directly, we often avoid it, especially if a situation has evolved over time and bad feelings have built up, resulting in a breakdown of communication and damaged relationships. In some cases, individuals avoid dealing with conflict because they lack the requisite skills or are unable to create the emotional “safe space” needed for effective dialogue and conflict resolution.

Other reasons for avoiding conflict include believing that mentioning the conflict or attempting to resolve it may put one’s position or job at risk. Not all conflicts are created equal. Some may be resolved with a brief conversation that clears up misunderstandings, but others require work, energy, and willingness to revisit a painful issue. It is important, therefore, to decide which conflicts to address and which ones to let go.

Effective conflict negotiation requires that you carefully analyze your level of interest in the other party, and how important it is to you to resolve the conflict. For example, if the issue is not of high interest to you or you are not deeply vested in the other party, the effort required to resolve the conflict may not be worth it. However, if the issue is of high interest to you and you are also highly vested in your relationship with the other party, it is probably in your best interest to attempt to resolve the problem, especially if both parties care about the results. It’s important to realize that some problems or issues may never be resolved.

Ask yourself these questions.
Before engaging in conflict negotiation, ask yourself the following questions: How important is your relationship with the other person? If you are able to resolve the conflict, how much will it affect your working relationship now and in the future? If you don’t address the conflict, will it negatively affect your ability to work with this person now and in the future? How likely is it that the conflict will be resolved and the relationship improved? What are the potential costs and benefits of addressing the situation?

Once you have carefully considered these questions and have decided to address the conflict, it is important to reflect and consider how you may have contributed to the situation. Many times, people will say, “I had nothing to do with this conflict, and the other person is to blame for the problem.” In most cases, this is not a true assessment. Even when it might be true, it’s still important to consider the other person’s point of view regarding your role. Doing so will help you develop an understanding of that person’s perspective.

Higher Education Research Institute (1996). A social change model of leadership development guidebook. Version III. Los Angeles, CA: Author.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be published.

13 November 2015

Beating the burden of burnout

It’s amazing to me that, not long after the start of a new academic year, many nursing faculty members are overwhelmed by stress with some nearing a state of burnout. During a lunch break at a recent nursing conference, I chatted with nurse educators from around the country. The conversation centered on their myriad work responsibilities and heightened levels of stress. Seated around the table, they described how each minute of every day seems to be filled with an endless list of family, life, and work responsibilities. They lamented the long work hours invested in preparing for classes, grading assignments and exams, meeting with students, engaging in committee work, working on scholarly activities, providing service, teaching—both classroom and clinical—and fulfilling a number of other responsibilities.

Manuel Faba Ortega
One professor commented: “It’s only the first month of classes, and I am completely exhausted. I’m teaching two 12-hour clinical days and an extra class as an overload assignment because we have unfilled faculty positions, and there is no one else to teach the class. I’m also enrolled in a DNP program, because our university requires all faculty members to obtain a doctoral degree. We have a new director, and she has asked me to take on some of the school’s administrative responsibilities, which I have agreed to do. On top of everything, our current cohort of students is more challenging than ever, and I am completely drained.”

Too busy for self-nurturing
Concerned for her, I asked: “What are you doing for yourself? How are you nurturing your body and spirit?” She looked at me with a perplexed expression and said, “To be perfectly honest, I am doing very little, if anything, to nurture myself. I’m just too busy.”

Unfortunately, this story is not uncommon. I often ask nurses, nurse faculty members, and nursing students the same question, “What are you doing to nurture yourself?” Sadly, the vast majority of respondents say they are working so hard and moving in so many directions that self care has taken a back seat to responsibilities that often overwhelm them.

This is deeply concerning, because lack of self care takes a significant toll on personal, physical, emotional, and spiritual well-being, and it can have a potentially negative impact on our ability to care for others, including patients. The pressure created by competing demands from family, work, and life responsibilities can cause stress and maybe even burnout.

Obviously, stress will always be a part of our lives, and mild stress levels can actually give us an edge and help us mobilize for action and achievement. However, too much stress, especially if prolonged and coupled with poor coping habits, can cause physical, emotional, and spiritual fatigue as well as ill health. Common signs and symptoms of stress overload include accumulation of belly fat, interrupted sleep, fatigue, irritability and anger, and lack of interest. Mental health problems, such as increased anxiety and depression, may result, and it’s not uncommon for stomachaches, headaches, intestinal problems, and cardiac changes to manifest when stress levels are heightened and prolonged.

A few questions to ask
For some, burnout may also occur. Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. When we are burned out, we feel overwhelmed, depleted, unproductive, unhappy, unappreciated, and too tired to function. To determine if you might be experiencing burnout, ask yourself a few questions:
  • Do you have difficulty getting out of bed and feeling excited about your day?
  • Do you become irritable or impatient with students, coworkers, or patients?
  • Do you lack energy and feel disillusioned about your work?
  • Are you using unhealthy coping strategies, such as spending hours watching TV or browsing the Internet, or using drugs, food, or alcohol to feel better?
If so, you may be experiencing or approaching a state of burnout.

While eliminating stress is impossible, minimizing it and engaging in self-care techniques can be extremely helpful and ultimately important in achieving an overall state of wellness. So, take a minute to jot down your favorite stress busters and most effective stress-reducing techniques. Some of us benefit from physical exercise and activities, such as yoga, meditation, progressive relaxation, deep breathing, and enjoying music or the outdoors. Spending time with family, friends, and pets, eating nutritious foods, and getting enough rest also help reduce stress.

While these stress-management techniques can be helpful—and I certainly recommend them—real and lasting change comes from identifying the sources of our stress and creating an intentional plan to deal with them. It may be helpful to carry a small notebook or make a note using your smartphone to record events or situations that cause you stress. After a week or two, you will likely gain a clear picture of where your stress is coming from and how you might address it.

Putting yourself first essential
After reviewing your personal list of stressors, identify those that you can do something about and those that are out of your control. For example, you may be stressed by your work commute. Is there a way to change the method, timing, or route of your commute to reduce your stress? If so, this is something within your control. If you identify a stressor that you cannot effectively eliminate—caring for a child with a disability, for example—perhaps there are ways to reduce the stress involved. In the case of a child with a disability, are there other people or community resources available that can share your care responsibilities and thereby lessen your stress?

Regardless of the sources of your stress—whether you can change them or not change them—putting yourself first is essential. This is not a selfish endeavor. By taking care of yourself, you can better attend to the needs of others. Enter “me time” into your calendar and regard that time as important as any other work meeting or event. Resist the urge to cancel “me time,” because the healthiest way to cope with stress and burnout is to take excellent care of yourself.

Managing your time well and staying organized can also be stress-reducing. Start each day with a “to-do” list and arrange them by priority—from high to low. Consider dropping low priority tasks altogether by rescheduling them for completion sometime in the future, or better yet, when possible, delegate those tasks to someone else. Resist multitasking and the urge to immediately respond to every text or email message you receive. Prioritize the messages, and, if possible, save them to a folder to be addressed when you have more time.

“Unplug” from your phone, television, computer, and other distractions to enjoy a moment of peace and quiet. Take a deep breath, and clear your mind. When life is busy, we often get distracted and lose connection with those we care about most. Schedule a date night with your partner, enjoy lunch or a power walk with a friend, or spend time with your furry friends. Avoid negative people as much as possible, and surround yourself with those who bring fun and laughter into your life. Take time off, or schedule a mini-vacation. Whatever you decide to do to de-stress, remember, you deserve it!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not b posted.