Workplace Violence, Decision Making

NRS3222
Leadership & Management
Theme 7
 Workplace Health & Safety
 Critical Thinking and Decision Making
Mohamad A. El Najm
Mohamad Mikkawi
1
Objectives
At the end of this session, you will be able to:
• Explain why violence can occur in healthcare setting

• Discuss how to prevent workplace violence
• Identify threats and threatening behaviors
• Differentiate between decision Making, problem
solving, & critical thinking
• Describe the managerial decision making process
• Discuss elements of problem solving & decision
making
2
Violence
3
Violence in Health Care
• Any violence act including

physical assaults &
threats of assault directed
towards people on duty.
• Attacks could be by
patients, family members,
coworkers, colleagues…
• Can cause physical
injuries, disability,
psychological trauma, or
death.
Marquis & Hustom (2003); Sullivan & Decker (2009) 4

Types Of Workplace Violence
 Threatening actions, such

as waving fists, throwing
objects…
 Verbal or written threats
 Physical attacks, slapping,
striking, pushing, stabbing,
shooting…
 Violent assaults, including
rape, homicide, weapons…
Risk Indicators
• Disorderly conduct, such as

shouting, pushing or throwing
objects, punching walls, or
slamming doors
• Fascination with guns or other
weapons, demonstrated by
discussions or bringing weapons to
workplace
• Verbal threats to inflict bodily harm
including vague or obvious threats
• Obscene phone calls
• Harassment of any nature

Incidence
• 35 - 80 % of hospital staff had been

victims of at least one assault during
their career.
• Nurses are more likely than others to

experience violence.
• Females report violence more often

than males.
OSHA (2010) 7
Who Is Affected?
• Those who work alone, late at

night.
• Persons going into inadequately

lighted parking areas.
• Persons ignoring the potential

for attack.

Consequences
 Affect staff morale

 Increase stress
 Administration mistrust
 Hostile environment
 Absenteeism & turnover
9
Factors Contributing
• Not restricted visiting hours.

• Patients with head trauma, alcoholics,
drug withdrawals, homeless…
• Family members stress and fear.
• Absence of well trained security
members
• Increasing abuse of illicit drugs.
• Overcrowded wards, public access…

Remember, you can’t always Tell who might commit violence.
However, There are basic precautions you can take.
11
Workplace Fatalities / California 2002
2%
10%
Exposure
12% Falls
Violence
43% Equipment
20% Transportation
Fire
13%
OSHA (2010) 12
How Can Violence be Prevented on the Job?
13
Violence Prevention
1. Management commitment
2. Employee involvement
3. Worksite analysis
4. Hazard prevention and control plan
5. Training and education
14
1. Management Commitment
Demonstrated by:
 Organizational concern for employee
physical & emotional safety & health.
 Equal commitment to employee &
visitor safety & health.

2. Employee Involvement
 Employee involvement & feedback

enable management to develop &
express their commitment to safety &
health.
 Should include the following:
 Understand & comply with the health
program and security measures.
 Participate in an employee input or
suggestion process covering safety,
health, & security concerns.
 Promptly & accurately report violent
incidents.
 Written Program

3. Worksite Analysis
•step-by-step common sense look at the workplace to

find existing or potential hazards
…..this entails reviewing specific procedures or operations
that contribute to hazards & specific locations where
hazards may develop.
• A “threat assessment team,” or similar task force, or

coordinator may assess the vulnerability to campus
violence & determine appropriate actions
…..the team should include representatives from

management, operations, security, occupational safety
& health, legal, & human resources.

Security Analysis
The Workplace security analysis
includes:
 Analyzing incidents & characteristics

of assailants & victims, & relevant
details.
 Identifying jobs, locations,
processes, & procedures with the
greatest risk of violence.
 Noting high-risk factors such as the
type of students, visitors, & physical
risk factors of the building.
 Evaluating the effectiveness of
existing security measures, including
engineering control measures.

4. Prevention and Control
• design measures to prevent or control

identified hazards through engineering or
administrative practices.
• If violence does occur, post-incidence

response can be an important tool in
preventing future incidents.

Administrative and work practice controls
…affect the way jobs or tasks are performed:
 State clearly to students, visitors, & employees

that violence is neither tolerated nor permitted.
 Establish liaison with local police.
 Require employees to report all assaults or
threats to a supervisor or manager.
 Set up trained response teams to respond to
emergencies.

5. Training and Education
 Ensures that all staff are aware of potential
security hazards & how to protect
themselves & their co-workers through
established policies & procedures.
 Every employee should understand the
concept of “universal precautions for
violence,” i.e., violence should be
expected, but can be avoided through
preparation.
 Staff should be instructed to limit physical
interventions in workplace altercations
whenever possible, unless there are
adequate number of staff or emergency
response teams & security personnel
available..
Know the Basic Rules of Violence Prevention
• Treat everyone with • Check patients’ records

respect. ahead of time, if possible.
• Safely store all objects • Vary your daily routine.
that could be used as • Trust your feelings.
weapons. • Always follow proper
• Report every incident. security procedures.
• Try to spot trouble before • Call for support at the 1st
it starts. sign of trouble, or if you
• Don’t try to be a “hero.” have any doubts.
22
Bullying
23
What is Workplace Bullying?
“Workplace bullying means any

behaviour that is repeated,
systematic, & directed towards an
employee or group of employees that
a reasonable person, having regard to
the circumstances, would expect to
victimise, humiliate, undermine, or
threaten & which creates a RISK to
health & safety.”
Stop Bullying in SA (2006); Sullivan & Decker (2009) 24

Bullying behaviour can be obvious & aggressive.
Examples could include:

 Abusive, insulting or offensive language
 Behaviour or language that frightens, humiliates,
belittles or degrades, including criticism that is
delivered with yelling and screaming
 Teasing or regularly making someone the brunt of
practical jokes
 Displaying material that is degrading or offending
 Spreading gossip, rumours & innuendo of a malicious
nature. Stop Bullying in SA (2006); Sullivan & Decker (2009) 25
Violence, assault, & stalking are extreme forms of

bullying that constitute a criminal offence. Such behaviour
should be reported directly to the police.
Examples:
 Harmful or offensive initiation practices
 Physical assault or unlawful threats.

Statistics
 1:6 people are bullied at work

(USA data)
 Women & Men are bullies –
58% women & 42% men.
 50% of all bullying incidents
are woman-on-woman
 80% women are the victims of
bullying

Damage Caused
 Severe Anxiety – 76%

 Disrupted Sleep – 71%
 Loss of Concentration – 71%
 Clinical Depression – 39%
 Panic Attacks – 32%
Left unresolved = Biological

effects

More…
Covert behaviour that undermines, treats less favourably,

or disempowers others, is also bullying, for example:
 Overloading a person with work

 Setting timelines that are very difficult to achieve, or
constantly changing deadlines
 Setting tasks that are unreasonably beyond a
person’s ability
 Ignoring or isolating a person
 Deliberately denying access to information,
consultation or resources
 Unfair treatment in relation to accessing workplace
entitlements, such as leave or training.
What is NOT Workplace Bullying?
Bullying behaviour does NOT include:

 Reasonable action taken in a reasonable manner by
an employer to transfer, demote, discipline, counsel,
retrench, or dismiss an employee
 A decision by an employer, based on reasonable
grounds, not to award or provide a promotion,
transfer, or benefit in connection with an employee’s
employment

Why do employers need to care?
 High prevalence of Workplace bullying is clear.

 It is costly – bullied targets are often the most talented
employees. Staff Turnover is expensive
 When staff “disappear” or publicly terminated, fear
dominates the workplace
 Fear driven workplaces have poor morale that
undermines employee commitment and productivity
 Recruitment & retention is made more difficult when
employers have bad reputation

Together…
 Support each other

 Always report workplace
bullying
 You deserve to be respected
 Name it – the unacceptable

behaviours
 Often giving the person
feedback will encourage
positive behaviour change

Critical Thinking
&
Decision Making
33
What is Critical Thinking?
• It is something you do every day

• It is a life skill you learned as you
developed into adulthood
• It is not a difficult task
• It is the way you make decisions
in your daily life
• It can also be called deductive
reasoning
• It is a system which allows nurses
to make choices which are best
for the patients
Tappan, Weiss & Whitehead (2007); Marquis & Hustom (2003); Sullivan & Decker (2009) 34
Critical Thinking
Critical thinking is integral to

decision-making & includes the
activities of organizing
assessment information,
recognizing patterns, & compiling
evidence to support the
conclusions drawn.
(Marquis & Huston, 2003)
The deliberate nonlinear process of

collecting, interpreting, analyzing,
drawing conclusions about
presenting & evaluating
information that is both factually &
belief based.
A Good Critical Thinker
 Is able to examine decisions from
all sides & takes into account
varying points of view, taking into
account research & the best
evidence.
 Does not say: ”We’ve always

done it this way,” & refuse to
consider alternate ways.
 Thinks “out of the box” &

generates new ideas & alternatives
when making decisions.
 Asks “Why” questions about a

situation to arrive at the best
decision.
Attributes of a Critical Thinker
 Seek the truth, nothing but the

truth
 Accept others ideas & beliefs
 Watch for problems & plan for
them ahead of time
 Be organized & work toward good
results
 Trust in your own abilities
 Look for opportunities for learning
 Realize that there may be other
ways besides yours
Aspects of Critical Thinking
 Reflection
 Review what you did & ways to

improve
 Did you follow the standards?
 Language
 Always communicate clearly to the
patient & staff
 Intuition
 Develop a “gut feeling” (not
rationality) based on your experience
& knowledge
 Realize what you do not know & then
find out
Tappan, Weiss & Whitehead (2007); Marquis & Hustom (2003); Sullivan & Decker (2009)
38
Decision Making
 complex process of choosing a

particular course of action.
 one of the criteria on which
management expertise is judged.
 Much of the manager’s time is
spent in solving problems &
decision making.
 These skills are learned &
improve with practice
40
Characteristics of Decision Making
 Decision making always triggered by

problems
 Decisions can solve or even made
but do nothing to the problem, e.g….
 Successful decision making can be
learned through experience.
 It is improved by using adequate
process model as a theoretical base
for understanding & applying critical
thinking skills.
Key to Successful Decision Making
 Set well defined goals

-What must be achieved by decisions
-Goals set inline with philosophy &
purpose
 Gather all relevant information

-Ensure clear, accurate, & concise
-Clear understanding of data collected
-Generate many possible solutions
 Be creative and sensitive

-Remember the needs of the
organization, members, & clients
Tappan, Weiss & Whitehead (2007) 42
Limitations to Effective Decision Making
Actions that may negatively affect the
decision making process:
 Jumping into conclusions without
examining the situation thoroughly
 Failing to obtain all the necessary
information
 Choosing decisions that are too
broad, too complicated , or lack
definition
 Failing to choose and communicate a
rational solution
 Failing to intervene and evaluate the
decisions or solution appropriately
(Delaune and Lander, 2006 in Kelly,
2008)
Tappan, Weiss & Whitehead (2007) 43
Good Nurse Managers and Leaders Know
 When to ask for help

 Give credit to others where possible
 Accept that wrong decisions can be
made
 Take responsibility for their decision
 Learn from mistakes
 Part of being a professional
44
References
Marquis, B.L. & Hustom C.J. (2003). Leadership Roles and
Management Functions in Nursing: Theory & Application
(4th ed.). Philadelphia: Lippincott.
OSHA (2010). Data and Statistics. Retriened on 5th

December 2010 from:
www.osha.gov/pls/odi/establishment_search.html
Stop Bullying in SA (2006). Workplace Bullying. Retrieved

in 5th December 2010 from: www.stopbullyingsa.com.au
Sullivan, E.J. & Decker, P.J. (2009). Effective Leadership &

Management in Nursing (7th ed.). London: Pearson
Prentice-Hall.
Whitehead, D.K., Weiss, S.A., & Tappan, R.M. (2007),

Essentials of Nursing Leadership and Management (4th
ed.). Philadelphia: F. A. Davis Company. 45

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NRS3222

Leadership & Management

 Critical Thinking and Decision Making

At the end of this session, you will be able to:

• Explain why violence can occur in healthcare setting

• Any violence act including

Marquis & Hustom (2003); Sullivan & Decker (2009) 4

 Threatening actions, such

• Disorderly conduct, such as

Marquis & Hustom (2003); Sullivan & Decker (2009) 6

• 35 - 80 % of hospital staff had been

• Nurses are more likely than others to

• Females report violence more often

• Those who work alone, late at

• Persons going into inadequately

• Persons ignoring the potential

Marquis & Hustom (2003); Sullivan & Decker (2009) 8

 Affect staff morale

• Not restricted visiting hours.

Marquis & Hustom (2003); Sullivan & Decker (2009) 10

Marquis & Hustom (2003); Sullivan & Decker (2009) 15

 Employee involvement & feedback

Marquis & Hustom (2003); Sullivan & Decker (2009) 16

•step-by-step common sense look at the workplace to

• A “threat assessment team,” or similar task force, or

…..the team should include representatives from

Marquis & Hustom (2003); Sullivan & Decker (2009) 17

 Analyzing incidents & characteristics

Marquis & Hustom (2003); Sullivan & Decker (2009) 18

• design measures to prevent or control

• If violence does occur, post-incidence

Marquis & Hustom (2003); Sullivan & Decker (2009) 19

…affect the way jobs or tasks are performed:

 State clearly to students, visitors, & employees

Marquis & Hustom (2003); Sullivan & Decker (2009) 20

• Treat everyone with • Check patients’ records

“Workplace bullying means any

Stop Bullying in SA (2006); Sullivan & Decker (2009) 24

Bullying behaviour can be obvious & aggressive.

Examples could include:

Violence, assault, & stalking are extreme forms of

Stop Bullying in SA (2006); Sullivan & Decker (2009) 26

 1:6 people are bullied at work

Stop Bullying in SA (2006); Sullivan & Decker (2009) 27

 Severe Anxiety – 76%

Left unresolved = Biological

Stop Bullying in SA (2006); Sullivan & Decker (2009) 28

Covert behaviour that undermines, treats less favourably,

 Overloading a person with work

Bullying behaviour does NOT include:

Stop Bullying in SA (2006); Sullivan & Decker (2009) 30

 High prevalence of Workplace bullying is clear.

Stop Bullying in SA (2006); Sullivan & Decker (2009) 31

 Support each other

 Name it – the unacceptable

Stop Bullying in SA (2006); Sullivan & Decker (2009) 32

• It is something you do every day

Critical thinking is integral to

The deliberate nonlinear process of

 Does not say: ”We’ve always

 Thinks “out of the box” &

 Asks “Why” questions about a

 Seek the truth, nothing but the

 Review what you did & ways to