Will the nursing staff of an Emergency Department benefit from a comprehensive morale program versus the singular MAGIC program by experiencing a decrease in unexplained absences and nursing staff turnover?
Mitigating Lateral Violence: Design for Change in Practice Stacy Lacaillade Chamberlain College of Nursing NR451 Capstone Course 28 November, 2010 Design for Change in Practice Evidenced based practice (EBP) is an empowering process for improvement in the health care professions. Rosswurm and Larrabee (1999) credit the research studies which used meta – analysis, randomized clinical trials and systematic studies of patient outcomes over the last few decades as having started this shift from the tradition of intuition driven practiceto the new paradigm of evidenced based practice (p.318). However, evidence has encountered a certain amount of difficulty being implemented into practice, thereby necessitating the use of a model when implementing a change based on evidence into practice. This paper will discuss the six steps in the Rosswurm and Larrabee (1999) model for implementing change as they apply to the necessary change of mitigating lateral violence in the nursing work place. Step 1: Assess This step of the change process begins with the identification of a problem. For the purposes of this paper the problem identified is lateral violence in the workplace. Rosswurm and Larrabee (1999) discuss this process to include comparing the internal data with external data and involving the shareholders. There is much evidence to support the fact that lateral violence is a real and troubling problem in the nursing profession. The external data of evidence spans over twenty years worth of documented research that describes and proves the presence of lateral violence in the world of professional healthcare particularly as it pertains to nurses (Griffin, 2004). Lateral violence is known by many names; psychological terrorism, nurse to nurse aggression, and bullying (Griffin, 2004; Jennings, 2008; Embree & White, 2010); however, the essence is the same. This author was interested in assessing the relevance and importance of this evidence due to an overwhelmingly evident trend in the emergency department in question. The internal data suggested that the high turn over rate and many unexplained absences that plagued the ED were due in part to factors outside of the short staff and long hours. The shareholders gathered to discuss the problem and initiate a positive change, included all levels of emergency room management, a select group of staff members, and hospital administrators. Step 2: Link Problem with Interventions and Outcomes During the second step in the Rosswurm and Larrabee (1999) model for change, the shareholders are directed to define their problem in standardized language for the purpose of identifying relevant research, and linking the problem with outcomes. This part of the process resulted in the formation of a PICO formatted question: Will the nursing staff of an Emergency Department benefit from a comprehensive morale program versus the singular MAGIC program by experiencing a decrease in unexplained absences and nursing staff turnover? This question was developed because the shareholders had identified lateral violence as a problem in the work place directly related to the high level of unexplained absences and nursing staff turnover. The comprehensive morale program present in the PICO question was the intervention decided upon by the shareholders. This program would include education for both management and staff about lateral violence and conflict management, because comprehensive educational initiatives for both management and staff have proven effective in the mitigation of lateral violence (Griffin, 2004; Apker et al., 2009; Embree & White, 2010). The program would also include a multi- level mentorship program including mentorships for new hires and coaching for staff of all experience levels. New nurses are particularly vulnerable to lateral violence (Griffin, 2004) and mentorship has been a proven improvement technique for enabling and…;Mitigating Lateral Violence: Design for Change in Practice Stacy Lacaillade Chamberlain College of Nursing NR451 Capstone Course 28 November, 2010 Design for Change in Practice Evidenced based practice (EBP) is an empowering process for improvement in the health care professions. Rosswurm and Larrabee (1999) credit the research studies which used meta – analysis, randomized clinical trials and systematic studies of patient outcomes over the last few decades as having started this shift from the tradition of intuition driven practiceto the new paradigm of evidenced based practice (p.318). However, evidence has encountered a certain amount of difficulty being implemented into practice, thereby necessitating the use of a model when implementing a change based on evidence into practice. This paper will discuss the six steps in the Rosswurm and Larrabee (1999) model for implementing change as they apply to the necessary change of mitigating lateral violence in the nursing work place. Step 1: Assess This step of the change process begins with the identification of a problem. For the purposes of this paper the problem identified is lateral violence in the workplace. Rosswurm and Larrabee (1999) discuss this process to include comparing the internal data with external data and involving the shareholders. There is much evidence to support the fact that lateral violence is a real and troubling problem in the nursing profession. The external data of evidence spans over twenty years worth of documented research that describes and proves the presence of lateral violence in the world of professional healthcare particularly as it pertains to nurses (Griffin, 2004). Lateral violence is known by many names; psychological terrorism, nurse to nurse aggression, and bullying (Griffin, 2004; Jennings, 2008; Embree & White, 2010); however, the essence is the same. This author was interested in assessing the relevance and importance of this evidence due to an overwhelmingly evident trend in the emergency department in question. The internal data suggested that the high turn over rate and many unexplained absences that plagued the ED were due in part to factors outside of the short staff and long hours. The shareholders gathered to discuss the problem and initiate a positive change, included all levels of emergency room management, a select group of staff members, and hospital administrators. Step 2: Link Problem with Interventions and Outcomes During the second step in the Rosswurm and Larrabee (1999) model for change, the shareholders are directed to define their problem in standardized language for the purpose of identifying relevant research, and linking the problem with outcomes. This part of the process resulted in the formation of a PICO formatted question: Will the nursing staff of an Emergency Department benefit from a comprehensive morale program versus the singular MAGIC program by experiencing a decrease in unexplained absences and nursing staff turnover? This question was developed because the shareholders had identified lateral violence as a problem in the work place directly related to the high level of unexplained absences and nursing staff turnover. The comprehensive morale program present in the PICO question was the intervention decided upon by the shareholders. This program would include education for both management and staff about lateral violence and conflict management, because comprehensive educational initiatives for both management and staff have proven effective in the mitigation of lateral violence (Griffin, 2004; Apker et al., 2009; Embree & White, 2010). The program would also include a multi- level mentorship program including mentorships for new hires and coaching for staff of all experience levels. New nurses are particularly vulnerable to lateral violence (Griffin, 2004) and mentorship has been a proven improvement technique for enabling and…
