Читать книгу Toxic Nursing, 2nd Ed - Cheryl Dellasega - Страница 48

In their 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) committee on the Quality of Healthcare in America noted that improving our health system depends in very large part on trust. In particular, the IOM indicated that healthcare professionals must feel that their team members, leaders, and organizations are trustworthy (Institute of Medicine, 2001). LoCurto and Berg (2016) define trust as “an expectation that the other person will behave in a way that is beneficial, or at least not harmful, and allows for risks to be taken based on this expectation” (para. 1). Happily, emerging evidence indicates a moderate to high level of trust among healthcare providers, although Sangaleti et al. (2017) note that it is perceived as a process rather than an outcome.

One threat to the development and maintenance of trust in a clinical setting is gossip. Waddington (2016) cautions administrators not to dismiss gossip as idle talk but rather to consider it a harbinger of deeper discord. Buldik, Ozel, and Dincer (2016) concur after surveying 268 nurses from four different acute care hospitals. They call gossip a “social virus” that has the potential to negatively impact patient care.

So what makes us gossip? Traditionally, researchers have thought that rumors spread because of the “three Cs”: conflict, crisis, and catastrophe. But marketing professor Jonah Berger has another idea: What about mere physiological arousal? Berger designed a study in which he placed people into two groups. One group experienced heightened levels of physiological arousal (their autonomic nervous system was activated, which affected bodily functions such as heart rate and perspiration), and the second group did not.

He found that situations that increase arousal spark information sharing—even if the arousal is entirely unrelated to the content of the information being shared (Beilock, 2011; Berger, 2011). That means after you take a jog around the neighborhood, you probably shouldn’t stop to chat with your neighbor because you might accidentally share the news of a friend’s pending divorce. It also means that as a nurse, after you’ve just participated in a code, you’re more likely to mention that piece of office gossip you had been keeping to yourself. More recently, Brondino, Fusar-Poli, and Politi (2017) discovered a connection between biologic measures and gossip, with oxytocin but not cortisol levels increasing in 22 females randomly assigned to gossip vs. non-gossip conversations and then a follow-up neutral conversation.

A situation that may promote gossip is institutional change. Commentator Donna Kandsberger notes,

When communication is not provided until decisions are finalized, unofficial information will certainly spread and fill in any gaps. Typically, due to the anxiety associated with change and unknown outcomes, the scenarios that staff imagine and circulate through the ‘grapevine’ tend to be more negative and alarming than the actual situation.

Sharing gossip may not always be a bad thing, especially since there is more than one type of gossip. In fact, authors distinguish between what they call “positive gossip,” which serves a bonding/sharing purpose, and “negative gossip” (the latter sometimes referred to colloquially as “trash talk”). Jolly and Chang (2018) suggest that there may be benefits to gossip, such as when one coworker tells another coworker that a third party had a really hard patient, prompting others to provide more support. But of course, the bottom line is that when most folks think of gossip, they think of the negative exchange of sometimes-false information about someone else.

In a healthcare setting, there are clearly a number of different professional groups: nurses versus physicians, day shift versus night shift, leadership versus bedside nurses, full-time versus part-time, men versus women, junior versus experienced—the list goes. Gossip can occur between groups—where, for example, workers on the day shift gossip about those on the night shift. Or, it can happen within groups—for example, one bedside nurse talking about another bedside nurse. The gossip that occurs between groups may serve to reinforce dividing lines that separate one group of people from another. As these battle lines become more entrenched, it can become harder and harder for groups to work together. Although gossiping about someone outside your group with a member of your group can reinforce your group bond, the net effect is negative because it alienates you further from out-of-group colleagues. Too often, the latter is the case—and make no mistake, gossip is often a source of verbal abuse (Dellasega, 2009).

Almost everyone reports experiencing some negative gossip, or peer verbal abuse, at work. Diane Ceravolo and her colleagues did a study on the frequency of verbal abuse for nurses before and after an intervention workshop series (2012). At baseline, they found—in line with other studies—that 90% of nurses reported experiencing peer verbal abuse in their workplace. After their workshop intervention, the level of verbal abuse decreased to 76%—still quite high.

A 2019 survey published by American Nurse Today showed that of the 35% of respondents who experienced verbal assault by a healthcare provider in the last two years, two thirds reported the incident to a manager (Spader, 2019). This number has increased from a study conducted in 2012, which stated that less than one-third of those who had experienced verbal abuse reported their concerns (Ceravolo, Schwartz, Foltz-Ramos, & Castner, 2012). However, although more nurses reported the incident in the 2019 survey, 75% of those who did were dissatisfied with how the situation was resolved.

This is significant. If the vast majority of nurses experience verbal abuse, and the vast majority also believe that talking with their manager won’t help resolve the problem, the obvious question is, what now? What should nurses do when they experience verbal abuse? What should managers do when their nurses report that they have experienced verbal abuse, or that gossip is getting out of control?

Because it doesn’t seem realistic to try to change the foundational sociology of human relations by asking employees not to talk about third parties, managers must find another way of dealing with this problem. One approach might be an in-service event to educate nurses about the IOM report on errors, which indicates that many medical mistakes occur due to breakdowns in communication (Institute of Medicine, 1999). Another might be to maintain an open-door policy so that employees can talk to you easily—and to let them know that the conversation will be treated with respect and not held against them. Since several of the studies reviewed suggest gossip can be connected to wanting more information about an individual or institution, yet another option would be to schedule open Q&A forums where uncertainties and fears about hospital issues can be openly addressed. Times of transition and insecurity (such as a proposed merger or expansion) can often lead to a gossip volcano.

If you’re dealing with gossip about institutional change, commentator Donna Kandsberger suggests the following:

Initiating communication early along with regular updates can help staff feel included in the overall goals and mission of the work unit or organization and thus increase their feeling of being respected members of the organization. It must be clearly communicated and understood, in order to avoid the perception of indecision or confusion on the part of the organization’s leaders, that early information will be accurate at the time of presentation but is subject to revision over time as plans and decisions evolve. With early and ongoing communication, opportunities for staff to comment or ask questions can increase their feelings of inclusion and empowerment as well as give leaders valuable insights into the ‘word on the street’ or ‘grapevine’ of information and perception that is circulating among the staff.

The bottom line is that it’s unlikely that gossip and trash talk is going to vanish from our workplace, so we need to find constructive ways of managing its negative consequences.

Commentator Melissa Snyder articulates three approaches a nurse manager can take to address this type of inappropriate communication:

First, the nurse manager must consistently work at establishing professional relationships between all employees based on trust and integrity. Without these core values, relationships cannot grow and mature, and the cohesiveness of the work team is constantly challenged. In a busy, stressful healthcare environment, nurses must feel supported by and confident in the abilities of their colleagues. Each of these scenarios betrays this sense of trust and support in both personal and professional ways. To establish trust, nurses must be empowered to share their thoughts and feelings regarding situations in a professional way.

The second approach in dealing with gossip and trash talk is to foster a professional work environment that extends beyond the boundaries of a particular unit. Professionalism must be modeled consistently by the nurse manager and other expert nurses. In addition, all nurses should be supported in their socialization to the professional role with frequent opportunities to practice these skills and to gain new knowledge through professional development programs. Over time, this combination creates an expectation of professional behavior that guides how nurses behave at the bedside but also permeates all other aspects of their lives.

The final approach is the need to address the role of technology and social media with all nurses. Nurses need to know that these technologies can be very useful but can also be very detrimental if not used with caution and consideration. Nurses need to know what the expectations are for their use of social media, and, if possible, there should be a clear policy indicating how these technologies can be used.