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New Nurses' Experiences in the Lateral Violence Zone

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New Nurses' Experiences in the Lateral Violence Zone NEW NURSES' EXPERIENCES IN THE LATERAL VIOLENCE ZONE: A GROUNDED THEORY by MARY LILLIAN HANKS NIRMALA EREVELLES, COMMITTEE CHAIR SUSAN APPEL BECKY ATKINSON KAREN MCCARTY ALAN WEBB A DISSERTATION Submitted in partial fulfillment of the requirements for the degree of Doctor of Education in the Department of Educational Leadership, Policy, and Technology Studies in the Graduate School of The University of Alabama TUSCALOOSA, ALABAMA 2017 Copyright Mary Lillian Hanks 2017 ALL RIGHTS RESERVED ABSTRACT The impact of lateral violence on nurses and the nursing profession contribute to the nursing shortage and has negative effects on patient care (Vessey, DeMarco, Gaffney, & Budin, 2009). According to the Center for American Nurses (CENTER, 2008), lateral violence and bullying are an everyday occurrence among health care professionals. Nurses must gain real world experiences to deliver quality, safe, and effective patient care (Benner, Surphen, Leonard, & Day, 2010). Unfortunately, there are experienced nurses who are unable or unwilling to help novice nurses transition into their new role. Impaired relationships among nurses can lead to absenteeism, medical errors, and poor work performance, including an unwillingness to ask questions for fear of humiliation or reprimand by a peer, and this, in turn has a negative impact on patient outcomes (The Joint Commission [TJC], 2012). Recognizing that incivility is associated with a lack of professionalism creates an opportunity for nursing academia and practice to forge a relationship to address this issue (Shephard, 2014). This qualitative study uses a grounded theory approach to examine the lateral violence encounters of 12 new nurse graduates and concludes with reflections on the role of nursing education in facilitating behaviors that support the creation and maintenance of healthy work environments for all nurses. Exploring the need to focus attention on affective-based practice methodologies to ease the burden of lateral violence in nursing can add to the science of nursing. ii DEDICATION This dissertation is dedicated to my parents, Larry Lee and Mary Catherine Wrenn. First, I honor my father, who passed away during my first semester of graduate school. His bravery, boldness, and strength has been instrumental in molding me into the woman I am today. Second, my mother’s love, patience, and unwavering belief in me made me believe that I could move mountains and heal the hearts and souls of those I would encounter. She was right. She taught me that every person I encountered deserved to be treated with respect and dignity. I love you both. I hope that I made you proud. I would also like to dedicate this dissertation to my children, Braxton and Briana Hanks, my two heartbeats. Thank you for being patient and traveling on this journey with me. I hope it has taught you, that with a little hard work and a whole lot of faith and endurance, all things are possible. iii LIST OF ABBREVIATIONS AACN American Association of Colleges of Nursing AACN American Association of Critical-Care Nurses ADN Associate Degree in Nursing ANA American Nurses Association BSN Bachelor of Science in Nursing IOM Institute of Medicine ISMP Institute of Safe Medication Practices LPN/LVN Licensed Practical/Licensed Vocational Nurse LV Lateral Violence MSN Master of Science in Nursing NCLEX-RN National Licensure Examination for Registered Nurses NCSBN National Council of State Boards of Nursing RN Registered Nurse TJC The Joint Commission iv ACKNOWLEDGMENTS A special thank you to Wallace and Virginia Hanks, my in-laws, for being there for my children when I could not, and to my aunts Lillie Granger and Ollie Giles for being there for my mother when I could not. Thank you also to my dissertation committee members: Dr. Susan Appel, Dr. Becky Atkinson, and Dr. Karen McCarty. A special thank you to Dr. Nirmala Erevelles, my dissertation chairperson, who met with me throughout this process and guided me on this journey of discovery. Her encouragement and guidance made the qualitative research experience a delight. And to Dr. Alan Webb, the qualitative methodolgist genius, thank you for your expert knowledge in qualitative methodology and graciousness in answering every question I had throughout this process. I could not have done this without you. I would like to thank the National League for Nurses Foundation for awarding me a Nursing Education Scholarship to help me complete my education and this dissertation. Finally, I want to acknowledge all of my students and every nurse who has ever felt the sting of lateral violence. I challenge each of you to remember what it means to be a nurse and find your voice. Your patients need you and I stand with each of you. v CONTENTS ABSTRACT .................................................................................................................................. ii DEDICATION ............................................................................................................................. iii LIST OF ABBREVIATIONS ...................................................................................................... iv ACKNOWLEDGMENTS ............................................................................................................ v LIST OF TABLES ....................................................................................................................... xi LIST OF FIGURES .................................................................................................................... xii CHAPTER ONE INTRODUCTION ............................................................................................ 1 Statement of the Problem .............................................................................................................. 3 Statement of Purpose .................................................................................................................... 4 Research Questions ....................................................................................................................... 4 Significance of Study .................................................................................................................... 5 Limitations of Study ..................................................................................................................... 5 Delimitations ................................................................................................................................. 6 Definition of Key Terms ............................................................................................................... 6 Overview of Literature .................................................................................................................. 8 Methodology ............................................................................................................................... 10 Chapter Summary ....................................................................................................................... 12 CHAPTER TWO REVIEW OF LITERATURE ........................................................................ 14 Lateral Violence: Workplace Violence and Bullying ................................................................. 15 The Prevalence of Lateral Violence in Nursing: What is Known .............................................. 16 vi Defining Professionalism and its Role in Nursing ...................................................................... 25 The Role of Professionalism and Caring in the Nursing Workforce ................................... 29 Promoting Professionalism in Nursing: Articulation and the Career Ladder ...................... 31 The Role of Care in Other Professions ................................................................................ 35 Professionalism and Caring in Non-nursing Professions .................................................... 37 Using an Ethics of Care as a Professional Model for Nurses ..................................................... 43 Nel Noddings’ Ethics of Care .............................................................................................. 44 Joan Tronto’s Ethic of Care ................................................................................................. 46 The Importance of an Ethics of Care in Nursing ................................................................. 48 Gaps in the Literature.................................................................................................................. 51 Chapter Summary ....................................................................................................................... 53 CHAPTER THREE METHODOLOGY .................................................................................... 54 Research Questions ..................................................................................................................... 54 Setting of Research ..................................................................................................................... 54 Participant Selection and Recruitment ........................................................................................ 55 Sample Selection ......................................................................................................................... 57 Methodology Selection ............................................................................................................... 58 Data Collection ..........................................................................................................................
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