The Bulletin - August 2015

The BulletinINFINDIANA NURSES FOUNDATIONVolume 41, No. 4Brought to you by the Indiana Nurses Foundation (INF) and the Indiana State Nurses Association (ISNA) whosedues paying memebers make it possible to advocate for nurses and nursing at the state and federal level.Quarterly publication direct mailed to approximately 100,000 RNs licensed in Indiana.August, September,October 2015.orgction.ust 1st, 2015tember 8th, 2015er ballot or haveontact ISNA Staff9-4575 ordiananurses.org.current resident orVoting:ISNAElectionsPage 3ANAReferenceProposalsSubmitted byISNAPage 7Policy PrimerPage 8Non-Profit Org.U.S. Postage PaidPrinceton, MNPermit No. 14Message from the PresidentProfessionalism: A Necessityfor NursesAs I reflect back on the last four years as theISNA president; I have many memories. Frommy first Meeting of the Members, as the newpresident, to the last ANA House of Delegates, Irecall much transformation. Change has includedpersonal, professional, nursing, health care, andorganizational adjustment. Thank you all forallowing me to have this unforgettable experience!The speed of change in nursing and our healthcare world has forced me to be more introspective,thoughtful, and mindful. I have always beengood at asking questions, and I still have manyuncertainties. I remember receiving StephenCovey’s book “The Speed of Trust” at a nationalconference several years ago. As I looked around atthe audience, I wondered how I would trust anyonein the audience without fear or concern.Being unable to trust others was really not aboutthe people around me. Mistrust was internal towhere I was personally. I was not in the right place.As I moved to a new place, I was still nervous.I had to prove my worth to strangers. How canothers not recognize our value from their visualperusal? Why does it always have to be about us? AsI reflected about having to prove worth, I realizedthat once again, I was looking through my own lensof concern about change.As the ISNA president, I share my doctoral workon nurse-to-nurse lateral violence. As I spread thisinformation throughout the state, I was hopeful thatsoon people would tire of hearing about how nursesmistreat each other and ask for other conversations,such as leadership development andorganizational membership. Did I really stillneed to raise the level of awareness aboutlateral violence?As I am still invited to speak frequentlyand I continue to share the message about howour nursing behavior can negatively affectour students, nurses, our interdisciplinarycollaborators and our patients, I know thatthe problem continues to exist in our state.As nursing professionals, we have to changeour behavior.With every presentation I provide, I goback to the early days of living in a less thanstellar relationship; feelingthat was where I deservedto reside. As I counseled the high school studentsI taught and encouraged them to leave undesirablerelationships, I realized I was in in the wrong place.(Are you seeing a pattern here?)Realizing you are out of place is not becauseyou selected the wrong place to reside. It is aboutgrowing and changing and the need to move along.The current work is finished and the adventuremust continue in another place. New colleagueswill become friends, old colleagues continue to befriends.Leaving the objectionable place behind allowsme to focus on my passion-developing, providingguidance and mentoring students and nursesand helping them change culture. As the ISNApresident, I have been blessed with opportunities,support, and expanded my network of colleaguesthroughout the state and the nation. Meeting manyIndiana nurses and students has provided me withmemorable experiences that I will not forget!I could talk about our great ISNA work, staff,presentations, educational offerings, legislativework, collaborations or membership growth. Icould talk about our strategic plan, our mission,our values or our pillars. But I will save thatinformation for my final meeting of the members“Staffing the Fort” on Friday, September 18th atFort Benjamin Harrison.As a connector, I have trouble letting go of thepast, people, and work. Sometimes we have to getthe goo remover out, or take off our shoes and startrunning, in another direction. I am not runningaway from the work of ISNA, the ISNA board, orthe wonderful membership, Executive Director,Director of Advocacy and Policy, Office Manager,or the ISNAP folks. I still want to be a resource toIndiana nurses, for any of you in need.As a nursing professional, at a different place, Iam walking slowly to the next adventure, turningaround to wave at the single most awesomeexperience that I have encountered-being thepresident of your Indiana State Nurses Association!

Page 2 • The Bulletin August, September, October 2015CEO NoteThe BulletinI am enjoying the ride as CEO of the IndianaState Nurses Association. Three years ago, I tookover the reins with the retirement of Ernie Klein.Together with the Board of Directors, we have beenworking on the implementation of ISNA’s strategicPlan. Pivotal to the plan is building membership. Todate, we have been very successful as membershipis up! With the current trend membership shouldcrest 1,500 maybe even 1,600 this year an increaseof more than 10% since January.ISNA is participating in a membership grant fromANA called “Member get a Member.” It rolled out inMay. If you are not engaged consider participating,for info go to our website www.indiananurses.org.As you know, the more members we have the moresuccessful we are with legislation. Please help usgrow!Financially ISNA is in a very strong position, theISNA/P grant has two more full years before it is upIT’S DIFFERENT HERE!!! Your SIGN-ON BONUS is waiting for YOU!Part-time or Full-time, we are currently seeking Adult and or Child & AdolescentAdvanced Practices Nurses to work in an outpatient setting.• If delivering superior care is important to you, please give us a call• If you would rather work in a team-based environment than a hierarchicalorganization, Cummins is your kind of organization• If being part of a learning organization appeals to you, get in touch with us.• If you seek an employer with ethical and performance standards as high as yourown, we’d love to hear from you.Salaries & benefits among the highest in local wage surveys, flexible hours, Sign-onBONUS, Health, vision, and dental insurance, PTO program, Nine paid holidays,attractive 401K plan, group life insurance, Health savings account and malpracticeinsurance all included.Must possess Indiana state licensure as a Registered Nurse with certification as a ClinicalNurse Specialist or Nurse Practitioner with prescriptive authority.WE INVITE YOU to join our MEDICAL STAFF TEAM – and we will work every day tomake sure that you will be GLAD YOU DID!!Learn more by visiting www.Cumminsbhs.org andapplying via careers@cumminsbhs.org. EOEfor bid, the headquartersbuilding thanks to Marla’shard work has been fullyrented, and our financialreserves are growing,thanks to a new investmentpolicy that the Board adopted. In the last twoyears, we have done some minor remodeling at theheadquarters property to help hold its value.On a national level, in June of 2014, I was electedTreasurer of ANA. As such, I was named chair ofthe Value pricing taskforce in April of 2015, whichis charged to advise the Membership Assembleon possible new dues structure(s) for ANA andthe states. More to come later as the work has justbegun.Remember decisions are made by those thatshow up. ISNA always shows up, do you?Indiana NursesFoundationThe Indiana Nurses Foundation(INF) is the Foundation of the IndianaState Nurses Association (ISNA).It exists to be the philanthropicarm of ISNA. The Foundation hasbeen dormant for a few years butISNA is committed to having arobust Foundation which providesadditional avenues to enrich thenursing profession of Indiana. If youare a member of ISNA and would beinterested in assisting in the rebirthof INF please contact the ISNA officeat 317-299-4575 orgingy@indiananurses.org.Gingy Harshey-Meade MSN, RN, CAE,NEA-BCChief Executive OfficerINFINDIANA NURSES FOUNDATIONAn official publication of the Indiana NursesFoundation and the Indiana State Nurses Association,2915 North High School Road, Indianapolis, IN 46224-2969. Tel: 317/299-4575. Fax: 317/297-3525. E-mail: info@indiananurses.org. Web site: www.indiananurses.orgMaterials may not be reproduced without writtenpermission from the Editor. Views stated may notnecessarily represent those of the Indiana NursesFoundation or the Indiana State Nurses Association.ISNA StaffGingy Harshey-Meade, MSN, RN, CAE, NEA-BC, CEOBlayne Miley, JD, Director of Policy and AdvocacyMarla Holbrook, BS, Office ManagerISNA Board of DirectorsOfficers: Jennifer Embree, President; Diana Sullivan,Vice-President; Michael Fights, Secretary; andElla Harmeyer, Treasurer.Directors: Emily Edwards, Angela Heckman,Vicki Poynter-Johnson.Recent Graduate Director: Heather Savage-MaierleISNA Mission StatementISNA works through its members to promote andinfluence quality nursing and health care.ISNA accomplishes its mission through unity,advocacy, professionalism, and leadership.ISNA is a multi-purpose professional associationserving registered nurses since 1903.ISNA is a constituent member of the American NursesAssociation.Bulletin Copy Deadline DatesAll ISNA members are encouraged to submitmaterial for publication that is of interest to nurses.The material will be reviewed and may be editedfor publication. To submit an article mail to TheBulletin, 2915 North High School Road, Indianapolis,IN. 46224-2969 or E-mail to info@indiananurses.org.The Bulletin is published quarterly every February,May, August and November. Copy deadline isDecember 15 for publication in the February/March/April The Bulletin; March 15 for May/June/Julypublication; June 15 for August/September/October,and September 15 for November/December/January.If you wish additional information or have questions,please contact ISNA headquarters.For advertising rates and information, pleasecontact Arthur L. Davis Publishing Agency, Inc., 517Washington Street, PO Box 216, Cedar Falls, Iowa50613, (800) 626-4081, sales@aldpub.com. ISNA andthe Arthur L. Davis Publishing Agency, Inc. reservethe right to reject any advertisement. Responsibilityfor errors in advertising is limited to corrections inthe next issue or refund of price of advertisement.Acceptance of advertising does not implyendorsement or approval by the Indiana NursesFoundation of products advertised, the advertisers,or the claims made. Rejection of an advertisementdoes not imply a product offered for advertisingis without merit, or that the manufacturer lacksintegrity, or that this association disapproves of theproduct or its use. ISNA and the Arthur L. DavisPublishing Agency, Inc. shall not be held liable forany consequences resulting from purchase or use ofan advertiser’s product. Articles appearing in thispublication express the opinions of the authors; theydo not necessarily reflect views of the staff, board, ormembership of ISNA or those of the national or localassociations.www.indiananurses.orgPublished by:Arthur L. DavisPublishing Agency, Inc.

August, September, October 2015 The Bulletin • Page 5Excerpts from theISNA BylawsARTICLE IX ASSOCIATION MEETINGSSECTION 1. The ISNAshall hold an annualMeeting of the Membersin good standing, at suchtime and place as shall bedesignated by the Board ofDirectors and announcedin the official publication ofthe ISNA.SECTION 2. ANNUAL MEETINGa) The annual meeting shall be composed ofmembers present.b) Members shall:(1) Establish the order of business at the beginningof the annual meeting.(2) Adopt and maintain the Bylaws of the ISNA.(3) Take positions, determine policy, and setdirection on substantive issues of a broadnature necessitating the authority and backingof the official voting body of the ISNA exceptas otherwise provided for in these Bylaws.(4) Take action on Association business asrequired by law or these Bylaws.(5) Transact all other lawful business as may be inorder.SECTION 3. Special meetings of the ISNA may becalled by the Board of Directors, and they shall becalled by the President upon the written request ofa majority of the chapters at least one month prior tothe special meeting.ARTICLE X HONORARY RECOGNITIONSECTION 1. Honorary recognition may beconferred by a unanimous vote of the ISNA Board ofDirectors on a nurse or a person who is not a nursewho has rendered distinguished service or valuableassistance to the nursing profession.SECTION 2. Any ISNA member or structural unitmay recommend to the ISNA Board of Directors thename(s) of any individual(s) deserving recognition.The recognition shall be conferred at an annualMeeting of the Members at a time and place selectedby the Board of Directors.SECTION 3. Honorary Recognition confers socialprivileges only. One may be a member and also holdHonorary Recognition.ARTICLE XI QUORUMSSECTION 1. A majority of the Board of Directors,one of whom shall be the President or the Vice-President, shall constitute a quorum at any meetingof the Board.SECTION 2. A majority of the members shallconstitute a quorum for all committees.SECTION 3. Five (5) members of the Board ofDirectors, one of whom shall be the President orthe Vice-President, and three (3) percent of thecurrent membership shall constitute a quorum forthe transaction of business at any annual or specialmeeting.SECTION 4. These Bylaws except for Purposes,Functions, and Dues may be amended by the ISNABoard of Directors by a two-thirds vote, providednotice shall has been sent to all members at least sixty(60) days prior to the board meeting.Chuck Lindquist, Director of Indiana State NursesAssistance ProgramJune, 2015(For the months of June, 2014 – May, 2015)1) # of Intakes: 221 – 50 were re-enrollments (Averageof 18.4 a month. The average over the previous 8years was 284 a year)2) # of recovery monitoring agreements (RMA’s): 201(Average of 16.7 a month. The average over theprevious 8 years was 272 a year)a. Length in monitoring – 6 month RMA – 25(13%) ISNAP is moving away from the 6 monthRMA.b. Length in monitoring – 12 month RMA – 53(26%)c. Length in monitoring – 13-24 month RMA – 43(21%)d. Length in monitoring – 36 month RMA – 80(40%)3) # of Discharges: 304 (Average of 25.3) 67% weresuccessful completions4) Current # in active monitoring: 419 (48% have anencumbered nursing license).5) Current # in intake: 716) # closed out of intake without entering into anRMA: 105 (Average of 8.7). 42 or 40% did not meetcriteria for monitoring with ISNAP. They wereeither not given a substance use disorder (SUD)diagnosis or they had been clean and sober for asignificant period of time.7) Accomplishments:a. With the services of Briljent, ISNA created aprofessional video about the ISNAP program.ISNAP is promoting this video through ourcontacts. This is available on ISNAP’s websiteas well as you-tube.b. ISNAP sponsored a workshop, “Challengesof Prescription Drug Use/Abuse,” and raised$8,200 for the Needs Assistance Fund (NAF).c. ISNAP is developing an Alumni Resource Pool.These alumni will act as “mentors” to newparticipants coming into the program.ISNAP Annual ReportISNAP’s Annual Report to theISNA Board of Directorsd. ISNAP has been working with Affinity andWitham to re-evaluate the drug panels currentlyin use and the costs of the urine drug screens(UDS’s). This is in an attempt to lower the costsof the UDS’s to our nurses. The process shouldbe finalized by July 1st.e. ISNAP has a “memorandum of understanding”for professional services with Parkdale Center.Parkdale has created a state-wide networkof treatment programs, including facilitatedprofessional’s support groups, preferentialinpatient/outpatient treatment, aftercare and reentryprograms, education and advocacy. Thisshould strengthen the accountability of ISNAPparticipants to their monitoring program.f. ISNAP has reinstituted their Provider Meetings,bringing together those resources (treatmentproviders, Attorney General’s Office, Board ofNursing (BON), Professional Licensing Agency)supporting the ISNAP program. There isbeginning discussions of creating a “coalition”to better educate and meet the needs of thoseresources responding to the needs of theimpaired professional.g. ISNAP is asking the BON to begin doing moreface-to-face presentations again, as the lackthereof has seemed to affect the number orreferrals, etc. This would necessitate an increasein the budget for the next two years.• MSN Required• CNE Preferred• Teaching Experience RequiredFor more detailed information on this position, visit:www.ancilla.edu/contact/employmentopportunities/#position-nursing-facultyPlease submit a cover letter, curriculum vitaeor resume, a statement of teaching philosophy,transcripts and 3 references.Open until filled.Full-timeInstructorof NursingMail to:Vice Presidentof Academic AffairsPO Box 1, Donaldson, IN 46513Docments may be submittedelectronically to:Dr. Joanna Blountc/o erin.houser@ancilla.eduCall (866) 262-4552 Ext. 322for additional information.EOESECTION 5. These Bylaws may be amended withoutprevious notice at an annual or special meeting by aninetynine percent (99%) vote of those presentSearching for theperfect career?Find your future here.Search job listings in all 50 states, and filterby location & credentialsBrowse our online database of articles and contentFind events for nursing professionals in your areaGet started now!www.nursingALD.comKnowledge for LifeWith a degree from USI, you will be able to compete for select nursingjobs. Our programs focus on extensive clinical nursing experience whileproviding superior preparation for professional licensing / certificationexams. Our award-winning faculty provide personalized attention thatfosters supportive relationships with nursing students.We are currently offering the following degrees:• Bachelor of Science in Nursing • Post MSN Certificate• RN Completion (RN-BSN) • Doctor of Nursing Practice• Master of Science in NursingUSI promotes:• highly sought workplace skills • flexible course delivery• online education• varied clinical experiencesFor more information about these programs,please visit our website at http://USI.edu/healthCURRENT OPPORTUNITIES include anexperienced MANAGER for our Birthing Centerand experienced RNs in specialty care areassuch as ICU, ED, OB and PACU.Details and to apply go towww.dch.orgDearborn County Hospital is a communityhospital located in Southeast Indiana in theCincinnati area. Relocation assistance may beavailable depending on the applicant.Questions?Call or email Eva at 812-537-8487or ecarr@dch.org

Page 6 • The Bulletin August, September, October 2015ISNA Past Presidents and CEO’sISNA Presidents1904-1906 E. Gertrude Fournier, Fort Wayne1906-1908 Edna Humphrey, Crawfordsville1908-1010 Mary B. Sollers, Lafayette1910-1912 Maude W. McConnel, Sullivan1912-1914 Anna Rein, Springfield, IL1914-1916 Ida J. McCaslin, Lafayette1916-1918 Edith G. Wills, Vincennes1918-1919 Anna Lauman Driver, Fort Wayne1919-1921 Mary A. Meyers, Indianapolis1921-1922 June Gray, Indianapolis1922-1924 Ina Gaskill, Indianapolis1924-1926 Lizzie Goeppinger, Crawfordsville1926-1928 Anna M. Holtman, Fort Wayne1928-1929 Eugenia Spalding, Indianapolis1929-1931 Gertrude Upjohn, Indianapolis1931-1934 Lulu V. Cline, South Bend1934-1936 Nellie G. Brown, Muncie1936-1938 Marie Winkler, Indianapolis1938-1940 Edith Hunt Layer, Terre Haute1940-1942 Anne Dugab, Indianapolis1942-1946 Mary York, Bloomington1946-1947 Nancy Scramlin, Muncie1947-1950 Leonia Adams, Indianapolis1950-1952 Helen R. Johnson, Mooresville1952-1954 Helen J. Weber, Bloomington1954-1956 E. Lucille Wall, Indianapolis1956-1958 Genevieve Beghtel, Indianapolis1958-1960 Florence G. Young, South Bend1960-1962 Dorothy Damewood, Gary1962-1966 Marie D’Andrea Loftus,Indianapolis1966-1969 Richard O’Hakes, New CastleLooking foryour dream job?STOPsearching the hard way.www.nursingALD.comYour online resource for nursing jobs, research, & events.Arthur L. DavisPublishing Agency, Inc.1969-1973 Emily Holmquist, Indianapolis1973-1975 Jean Grimsley, Madison1975-1977 Kathryn Lawson George,Terre Haute1977-1981 Brenda L. Lyons, Indianapolis1981-1983 Sharon Isaac, Indianapolis1983-1985 Nadine A. Coudret, Evansville1985-1987 Janet S. Blossom, Lafayette1987-1989 Doris R. Blaney, Hobart1989-1991 Ann Marriner Tomey, Indianapolis1991-1994 A. Louise Hart, Indianapolis1994-1997 Esther Acree, Brazil1997-2001 Beverly S. Richards, Fishers2001-2003 Sandra D. Fights, Lafayette2003-2005 Joyce D. Darnell, Rushville2005-2007 Dorene Albright, Griffith2007-2009 Ella Sue Harmeyer, South Bend2009-2011 Barbara Kelly, Martinsville2011-2015 Jennifer Embree, CampbellsburgExecutive Directors/Chief Executive Officers1924-1929 Alma Scott1929-1930 Eugebia Kennedy Spalding1930-1931 Mary T. Walsh1931-1947 Helen Teal1947-1959 E. Nancy Scramlin1959-1960 Helen C. Randall1960-1970 Lucille Wall1970-1980 Lucretia Ann Saunders1980-1983 Linda J. Shinn1983-2000 Naomi R. Patchin2000-2012 Ernest Klein2013- Gingy Harshey-MeadeISNA Board ofDirectorsAll Terms Expire September 2015Officers:PRESIDENTJennifer EmbreeVICE-PRESIDENTDiana SullivanSECRETARYMichael FightsTREASURERElla HarmeyerDirectorsEmily EdwardsAngela HeckmanVicki Poynter-JohnsonRecent Graduate Director:Heather Savage-MaierleProposed StandingRules for the ISNAMeeting of theMembersRule 1.To be admitted to the meeting room, theindividual must be wearing the registration badge.Rule 2.To obtain the floor, a member shall rise, approachthe microphone, address the chairperson, give his/her name and region and, upon recognition by thechairperson, may speak.Rule 3.A member may speak no more than two times tothe same question and may not speak the secondtime until all others have been given an opportunityto speak. Each speech may be no longer than threeminutes. Non-members may speak when ISNAmembers has had the opportunity to speak.Rule 4.All main motions and amendments, except thoseof a routine nature, shall be in writing, signed bythe maker, and shall be sent at once to the chair.Members may propose or vote on motions.Rule 5.Any substantive resolution, not of an emergencynature, must receive an affirmative 3/4 vote forconsideration and a 2/3 vote for adoption by themembers attending the meeting.Rule 6.Debate on each proposed resolution, motion, orposition statement shall be limited to 20 minutes.Rule 7.Members shall act only on the resolve portionof a resolution and the recommendation portion ofreports. Clarification regarding intent and meaningof the resolution and recommendation shall behandled according to parliamentary procedure.Rule 8.Business interrupted by a recess of the meetingshall be resumed at the next business meeting atthe point where it was interrupted.Action Items from Meeting of the MembersSeptember 27, 2012Leading the way to a new model of healthcare in Alaska!Rehabilitation Hospital of Indiana opened in 1992 and we are proud of our many years ofoutstanding service. RHI is one of the largest freestanding inpatient physicalrehabilitation hospitals in the Midwest.REGISTERED NURSE OPPORTUNITIESCome talk with us about a specialty certification as CRRN.We offer competitive wages and excellent benefits.Please visit our website at www.rhin.com to see our current job listingand complete an online applicationREHABILITATION HOSPITAL OF INDIANA4141 Shore Drive | Indianapolis, IN 46254 | Or fax a resume to (317) 329-2238$10,000 Sign On Bonus &Relocation Assistance!Southcentral Foundation (SCF) is an Alaska Native owned, nonprofit healthcareorganization located on the Alaska Native Health Campus. Our award-winning “NukaSystem” of care is based on customer-ownership and relationships, integrated careteams and traditional Native values. SCF is seeking dynamic Registered Nurses to actas Case Managers in our Primary Care and Pediatric Clinics.• 401 K retirement plan • 12 paid holidays • Much Much More!If you are interested in becoming part of the nationally recognized AnchorageFacility, please visit our website and apply at www.scf.cc or contact Tess Johnson at907-729-5011/email tjohnson@scf.cc

August, September, October 2015 The Bulletin • Page 7ANA Reference Proposals Submitted by ISNADialogue Forum Topic ProposalTopic: Nurse TurnoverDialogue Forum Topic ProposalTopic: Emergency PreparednessStrategic Goal:Advance the quality and safety of patient care in atransforming health care system.Strategic Goal:Advance the quality and safety of patient care in atransforming health care system.Programmatic Pillar:Health Care Transformation pillar.Programmatic Pillar:Health Care Transformation pillar.Is the topic of nationalrelevance?YesIs the topic of nationalrelevance?YesIntroduced By:President/Chair(or Designee) Name:Second ContactPerson’s Information:Jeni Embree, Presidentof the Indiana StateNurses AssociationJennifer Embree DNP,RN, NE-BC, CCNSjembree8@iu.edu,812-583-1490Gingy Harshey-Meade gingy@indiananurses.org614-352-8595Description: 1. As nurses resign and retire their positons weare seeing a trend of slow replacement. Theopen positions create an environment of shortstaffing, required overtime, and nurse fatiguethat equate to an unsafe practice environment.2. Replacement of experienced nurses with lessexperienced nurses results in risks to nurses,patients, and the organization.3. This is not just happening in Indiana, it is anational problem. Short staffing is a nationalissue across the continuum of care. In June 2011,Wanted Analytics reported that employers andstaffing agencies posted more than 121,000 newjob ads for Registered Nurses in May, up 46% fromMay 2010. About 10% of that growth, or 12,700,were ads placed for positions at general andsurgical hospitals, where annual turnover ratesfor RNs average 14% according to a recent KPMGsurvey.4. ANA has published staffing standards, heldstaffing summits and conferences, assisted stateswith draft legislative language and still it persists.5. Many decisions made about nurse staffing aremade by non-nurses. Nursing needs to be at thetable for recruitment, retention, and positioncontrol planning. Improving recruitment,retention and position control planning candecrease costs without putting nurses and patientsin harm’s way.Introduced By:President/Chair(or Designee) Name:Second ContactPerson’s Information:Jeni Embree, President of the Indiana State NursesAssociationJennifer Embree DNP, RN, NE-BC, CCNSjembree8@iu.edu,812-583-1490Gingy Harshey-Meade gingy@indiananurses.org614-352-8595Description: 1. Description: When Ebola hit this last fallthe Health Care Industry was not ready. Puttingeveryone in jeopardy, patients and health careworkers. Two RNs were infected due to lack ofpreparedness and one individual lost his lifebecause his symptoms were not recognized.2. Nurses reported feeling unprepared. WashingtonState Nurses Association conducted a surveyshortly after the first cases in the US and found:a. 3% felt well preparedb. 11% felt preparedc. 35 % felt not well preparedd. 51% felt unprepared3. Worldwide outbreaks affect this country and allcountries as boarders can no longer be guardedfrom outbreaks in other countries due to theavailability and ease of worldwide travel.4. Nurses are often the first healthcare workers thepatient comes in contact with, making the nursevulnerable to any infection the patient is carrying.Nurses also are the primary care giver forhospitalized patients therefore: the preparednessof the organization for which the nurse works hasa direct impact on the health and wellbeing of theindividual nurse, the nurses, co-workers and thenurse’s patients.Underlying Issues:5. Preparedness on a nationwide scale so thatEmergency Departments are ready and individualinstitutions are identified and trained to receiveinfected patients.Underlying Issues: 6. The lack of understanding of Healthcareexecutives of adequate nurse staffing,recruitment, retention and position controlplanning and the impact on nurse sensitiveand patient outcomes.Interested in JoiningOur Company?DSI Renal is a leading provider ofdialysis services in the United Statesto patients suffering from chronic kidney failure. Wecontinue to grow through acquisition, development of newclinics, and organic growth.Persons with renal (kidney) disease who are in need ofdialysis treatments will find state-of-the-art treatmentwith personalized care at DSI Renal’s dialysis facilities.Together with our physician partners, DSI Renal owns andoperates over 100 dialysis clinics in 22 states.For more information on DSI Renal or for available nursingpositions visit our website at www.DSI-Corp.com

Page 8 • The Bulletin August, September, October 2015Policy Primerby Blayne Miley, JDDirector of Policy & Advocacybmiley@indiananurses.orgIt’s been an active summer in nursing policy. TheIndiana General Assembly interim study committeesare giving us a preview of the 2016 legislative session.The Supreme Court issued its third opinion on theAffordable Care Act, deciding in King v. Burwell thatfederally-run exchanges (like Indiana’s) may continueto provide tax credits to help people buy healthinsurance. The Indiana State Board of Nursing has fivenew members. Finally, next month Pamela Cipriano,President of the American Nurses Association, willkeynote the 2015 ISNA Annual Meeting to discussstaffing issues.Indiana Legislature Interim Study TopicsThe Indiana General Assembly interim studycommittees are holding hearings on issues that arelikely to be the subject of introduced bills for the 2016legislative session, which begins in January. Here arethe health-related topics selected for study and thecommittees to which they are assigned:• Medical Malpractice Act, including whether thecap on damages should be increased and anypotential changes or improvements to the medicalreview panel process that may improve andstreamline it - Committee on Courts and Judiciary.• Needle distribution and collection programs aspart of a comprehensive response to reducingdisease transmission due to intravenous drug use.The study must include a review of the appropriatecriminal penalties for drug offenses and drugparaphernalia related offenses and the use ofproblem solving courts - Committee on PublicHealth, Behavioral Health, and Human Services.• Department of Insurance accident and sicknessinsurance or health maintenance organizationconsumer complaint process & accident andsickness health insurance and HMO denialsof claims, especially because a procedure wasdeemed experimental or investigatory - Committeeon Public Health, Behavioral Health, and HumanServices.• Production and use of hemp oil that is producedfrom industrial hemp - Committee on Agriculture& Natural Resources.• Whether smoking should be prohibited in bars,casinos, and private clubs, including fiscalimpact. Whether e-cigarettes should be definedas tobacco products and subject to smoking bans.E-cigarette taxation. Fiscal impact of an increasein the cigarette tax. Possible funding sources fortobacco use prevention and cessation programs.The impact of the tobacco tax on smoking ratesand health living ratings relative to other states.The impact of smoking upon families andpregnancy. The costs incurred by the state as aresult of smoking during pregnancy and smokingwithin families. The fiscal impact of changingexisting laws regarding cigarette tax distribution- Committee on Public Policy.You can view the members of the committees,meeting dates, and webcasts here: http://iga.in.gov/legislative/2015/committees/interim. Now is the timeIndiana legislators are deciding what bills they willintroduce in the 2016 legislative session, so now is anopportune time to reach out to your state legislatorswith changes you want to see in Indiana law. If youhave questions, I am happy to provide support andassistance.Pending Federal Legislation Impacts NursesMultiple pieces of legislation that impact nursesare being debated in Congress. Current issues includesafe staffing, veterans health, safe patient handling,and home health. In July, a delegation of ISNA leadersparticipated in the American Nurses Association’sLobby Day, taking to Capitol Hill to advocate for you.To get the latest updates and find out how you canparticipate, visit www.rnaction.org.ISNA-Endorsed Candidates Appointed to theIndiana State Board of NursingGovernor Pence has appointed new members to theIndiana State Board of Nursing who will all serve fouryear terms through June 30, 2019:• India Owens, RN, MSN,CEN, NE-BC, FAEN(endorsed by ISNA)• Mary Rock, RN, MSN,JD (endorsed by ISNA)• Ayana Russell, LPN• Andrew Morrison - consumer memberCongratulations to the new appointees!ISNAbler Student Subscription is the Perfect Back toSchool GiftAs we gear up for the start of another school year,Indiana’s undergraduate nursing students will have anew resource to stay informed on nursing issues. TheISNAbler, our weekly e-newsletter now is availableto update students on policy, research, events, andnews. For just $25, students will receive the ISNAbleruntil they obtain their RN license or for five years,whichever occurs first. To be eligible, students mustbe enrolled in an undergraduate nursing programthat prepares them for RN licensure. Subscribetoday at www.indiananurses.org/isnabler-studentsubscription!Health Workforce Studies Publishes NursingWorkforce ReportsYou know all those survey questions you answerwhen you renew your nursing license? HealthWorkforce Studies within the IU Department of FamilyMedicine compiles the answers into a data report anda policy report on Indiana’s nursing workforce. Theseprovide valuable information on education, diversity,and specialty issues. You can check out the reports,here: http://family.medicine.iu.edu/hws/resources/nursing-resources/. Speaking of the survey questions,the RN license renewal window is open now throughHalloween. Don’t forget to renew your license!ISNA is Here For YouISNA is committed to getting more nurses andnursing students involved in policy. I am your advocate,and also a resource to amplify your advocacy. I amhappy to travel anywhere in the state to speak to anynursing group about how and why to be engaged inpolicy. All you have to do is ask.I am excited to announce this fall I am joiningthe ranks of nurse educators as an adjunct facultymember at Indiana State University. I will be coteachinga graduate-level Health Policy Leadershipcourse utilizing a distance learning platform. I lookforward to reaching more nurses, raising ISNA’s brandawareness, and sharpening my skills in conveyingpolicy issues. I welcome any do’s and don’ts fromeducators or students reading this!

August, September, October 2015 The Bulletin • Page 9

Page 10 • The Bulletin August, September, October 2015Public Policy PlatformIndiana State Nurses Association Public Policy PlatformAmended September 13, 2013One purpose of the Indiana State Nurses Association(ISNA) is to influence public policy consistent withthe goals of the membership. ISNA members at theannual Meeting of the Members and the ISNA Board ofDirectors establish goals and policies. These goals andpolicies serve as the foundation for a variety of programactivities, including ISNA’s legislative efforts. ISNAprioritizes issues for action based on potential impact,availability of Association resources, and existence ofcoalition or alternative advocacy group efforts.The headers under which ISNA’s positions have beenorganized are the American Nurses Association Codeof Ethics.1. The nurse, in all professional relationships,practices with compassion and respect for the it dignity,work and uniqueness of every individual, unrestrictedby considerations of social or economic state, personalattributes, or the nature of health problems. ISNAsupports:A health care system that is universal, affordable,comprehensive, accessible and provides high-qualityhealth care.That a person’s advance directive choices berespected by all health care providers.2. The nurse’s primary commitment is to the patient,whether an individual, family, group or community.ISNA supports:Direct access by consumers to services of registerednurses.3. The nurse promotes, advocates for, and strivesto protect the health, safety, and rights of the patient.ISNA supports:The use of the documents, position statements,and publications by professional nursing associationssuch as the American Nurses Association’s Principlesfor Nurse Staffing, ANA Code of Ethics for Nurses,and Standards of Care in health care institutions andagencies.Efforts to eliminate adult and child abuse.Individual professional licensure, registration orcertification for any type of health care personnel.The implementation and integration of electronichealth records to improve the quality, safety andefficiency of patient care.Delivering safe, cost efficient, and quality patient carewith compassion is the number one priority for nurses.That when errors in patient care do occur, nursesand other healthcare providers should be encouraged toreport those errors without fear of punishment.That causes of errors should be analyzed so thatappropriate system/organizational corrections can thenbe made.Legislation that would enact a state-wide ban onsmoking in public places.That registered nurses include a military healthhistory assessment in the provision of care.4. The nurse is responsible and accountable forindividual nursing practice and determines theappropriate delegation of tasks consistent with thenurse’s obligation to provide optimum patient care.ISNA supports:The use of quality indicators such as the NationalData-Base of Nursing Quality Indicators to evaluatenursing care.5. The nurse owes the same duties to self as to others,including the responsibility to preserve integrityand safety, to maintain competence, and to continuepersonal and professional growth. ISNA supports:Voluntary continuing nursing education for relicensureas a cooperative effort between individualnurses, schools of nursing, providers of continuingnursing education and employers of professional nurses.That, while it is the ultimate responsibility of eachnurse to maintain competence and professional growth,all organizations employing nurses are encouragedto budget sufficient resources (equal to a definedpercentage of nursing payroll and benchmarked to otherindustry standards) to support ongoing acquisition andmaintenance of knowledge and skills.The Ohio Nurses Association as the preferredapprover of continuing nursing education activities andproviders6. The nurse participates in establishing,maintaining, and improving health care environmentsand conditions of employment conducive to theprovision of quality health care and consistent withthe values of the profession through individual andcollective action. ISNA supports:Examination and analysis by nurses of their own workplace grievance procedures and assignment policiesand practices in terms of ethical, legal, regulatory, andeconomic considerations.Nurse retention strategies to include factors such aspractice autonomy, inclusion of staff nurses in decisionmaking,management’s respect of nurses, recognizingnurses work load, shift length, and total number ofhours worked per week.Initiatives of health care providers and regulatorybodies that cultivate a culture of patient safety, includingthe use of technology, the un-prejudicial investigation oflatent systematic sources of errors, and staff education.The use of adjustable nurse/patient ratios based onnurses’ assessment of patients’ acuity.The right of nurses to organize and bargaincollectively and enforcement of laws that protect therights of nurses to be represented as a separate group ofhealth care professionals.The Indiana State Department of Health, that requiresagencies to adopt policies and procedures to reduce therisk of injury and violence to nurses, which may includeestablishing a security policy, intended to prevent actsof workplace violence toward nurses. ISNA condemnsacts of violence toward nurses in all environments inwhich nurse’s practice.7. The nurse participates in the advancement of theprofession through contributions to practice, education,administration, and knowledge development. ISNAsupports:The promotion and funding for nursing researchprojects/programs that expand the scientific base ofnursing practice and that maximize nursing contributionin the promotion of health and wellness.Funding for accredited nursing programs that prepareadequate numbers and diversity of appropriately skilledregistered nurses to assure the delivery of and access tosafe quality nursing care.An ongoing and consistent method of data collection,analysis and projections regarding the demand andsupply of Indiana nurses workforces.Specialty certification as a means to enhance patientsafety and improve patient care outcomes.In addition to formal education in an academicsetting, certification in the nurse’s clinical specialty isanother avenue for professional growth. Certificationis a nationally recognized credential reflecting thenurse’s proficiency in care delivery to specific patientpopulations. The certification process is administeredby ANCC and other professional nursing organizations.Environments that encourage certification becausethe facility benefits through increased nurse retentionand job satisfaction.Legislative and other initiatives that removerestrictions that prevent the maximum utilization ofAdvanced Practice Registered Nurses (APRNs).Working with nursing and non-nursing stakeholdersto promote effective utilization of APRNs in improvingaccess to health care in Indiana.The role of APRNs and all registered nurses as fullmembers of health care teams.Nursing programs that offer seamless pathways fromASN-to-BSN programs to achieve the 80 percent of BSNproportion by 2020.8. The nurse collaborates with other healthprofessionals and the public in promoting community,national, and international efforts to meet health needs.ISNA supports:Funding to support prevention, education, research,and access to safe quality care to address major healthconditions.The expansion of non-institutional health careservices such as home and community-based nursingservices consistent with identified health care needs.Daily availability of registered nurses to studentsenrolled in primary and secondary schools.The participation of registered nurses in emergencypreparedness planning and response.Continued participation in the Indiana Center forNurses and willingness to assist in educating Indiananurses about the severity and nature of the facultyshortage.Participation by members in AHEC (Area HealthEducation Centers), both at state and regional levels.Health care reform that incorporates the keycontributions of nurses in addressing access, cost andquality.And encourages collaboration with other stakeholdersin the design of health care reform.Providing information to nurses throughout the stateon health care reform.The development of a comprehensive, inclusive statewidetrauma system.The appointment of nurses as voting members ofhospital and other governing boards.Advocating for trauma system funding in theupcoming state (2013) budget and promote nursingas a stakeholder in the ongoing development of acomprehensive, inclusive state-wide trauma system.9. The profession of nursing, as represented byassociation and their members, is responsible forarticulating nursing values, for maintaining theintegrity of the profession and its practice, and forshaping social policy. ISNA supports:That the federal, state, and local governmentswork to provide a stable source of funding to meet thepublic’s health care needs, including recognition of andremuneration for services rendered by nurses.Accredited baccalaureate nursing programs asthe preferred educational preparation for a licensedregistered nurse.Active opposition to legislative or regulatory actionthat would reduce standards for nursing education inIndiana.Active opposition to legislative or regulatory actionthat would restrict nursing practice.Mechanisms which would recognize and expandnursing practice.The Indiana State Board of Nursing as the approvingbody for nursing education programs leading tolicensure.Accreditation of all nursing school educationprograms by nursing discipline specific accreditingagencies.That the Indiana State Board of Nursing is responsibleto regulate the practice of nursing as defined in Indianastatute.Opposition to prosecution of health care providersand facilities under the criminal neglect statute insteadof through state licensing boards or state regulatoryagencies.Public Policy continued on page 11

August, September, October 2015 The Bulletin • Page 11ISNA Welcomes Our New and ReinstatedMembersPamela Adams Bloomington, INChristy Akin Seymour, INMonica Almy-Boylan Lowell, INHeather Anderson Mooresville, INCaroline Asava Indianapolis, INTamika Banks Hammond, INConnie Barton Fishers, INMaria Berger Jasper, INCynthia Bone Indianapolis, INKelli Cardwell Jeffersonville, INLeanna Cartwright Crown Point, INRichard Cigler Munster, INSheila Clark Syracuse, INTabetha Clarke Crown Point, INMelanie Cline Indianapolis, INSteven Cook Newburgh, INCynthia Coyne Fort Wayne, INDeborah Cragen Indianapolis, INDonna Craig Huntingburg, INPatti CrislerGreenwood, INMegan Curran Indianapolis, INSara Darnell Porter, INAnnamaria Davis Muncie, INKate DellWest Lafayette, INElizabeth DePew Leo, INTammy Dieterle Zionsville, INGloria Dillman Munster, INVicki DotyNewburgh, INAnnette Drook Carmel, INSuzette Eliopoulos Fort Wayne, INLynn Fentress Valparaiso, INLetitia Finnie Indianapolis, INCourtney Fouche Greenwood, INJennifer Gale Colfax, INGretchen Gibbs Richmond, INSarah Grcich Winamac, INSherry Griepenstroh Santa Claus, INCheryl Griffith Brownsburg, INKrista Gulczynski Noblesville, INSusan Gunn Brownsburg, INCorrine Harleman Terre Haute, INJoy HartIndianapolis, INJulie Hatfield Muncie, INHeather Hazen Columbia City, INMarcia Herzog Brownsburg, INCaroline Hill Rockville, INKelley HillNoblesville, INTroy HillNorth Manchester, INKimberly Hodge Greenfield, INStephanie Hull Westport, INMargaret Hultman Porter, INStacey Johnson Elkhart, INRenae Kendall Jasper, INDeborah Kinney Evansville, INJoanne Komari Indianapolis, INMary Kosinski Bloomington, INStephanie Kramer Garrett, INTammy Lawson South Bend, INBrandon Lee Fishers, INNatalie Lentz Lowell, INBrianna Little Indianapolis, INKimberly Locke Dunkirk, INMarissa Malenkos Indianapolis, INCarmen Masterson Indianapolis, INMary Moore Indianapolis, INBrenda Mostrog Anderson, INSylvia Oudhuis LA Porte, INSara ParrisBrownsburg, INJeanette Pickett Frankfort, INKiana Player Merrillville, INChristina Poe Bedford, INTanya Popper Abell Shelbyville, INVelissa Price Franklin, INDonna Purdy Wabash, INJustin Roelofs South Bend, INKalyn Roessner Daleville, INHelena Rosencrans Indianapolis, INCarol Rozelle Merrillville, INSherri Russell Terre Haute, INKelsey Schooley New Haven, INKimberly Schramm Winamac, INTracy ScottWashington, INCraig Shuman Anderson, INMary Grace Sierra Marion, INChristina Signorino Indianapolis, INCarrie Simcox Akron, INDiane Spain Hobart, INJanice Stover Evansville, INSteele Summers Indianapolis, INJessica Sumner New Albany, INMary Swartz Evansville, INBernadette Taylor Merrillville, INAmy TaylorEvansville, INKerry TeskaFort Wayne, INLucy Tormoehlen Kokomo, INCary-Lynn Troutman North Vernon, INKathryn Twibell Muncie, INKate Uebelhack Mount Vernon, INTiffany Wallace Saint John, INErin Watson Middletown, INJudy Weaver Indianapolis, INAnika Wedel Goshen, INAmy Whistler Salem, INKathy Whitmore Shirley, INAnn-Katrin Williamson Camby, INMarjorie Wolfe Indianapolis, INKristi WrayValparaiso, INChristian Wright Indianapolis, INMichelle Wright Carmel, INMargaret Yeisley Indianapolis, INGET YOUR PROFESSIONAL TOOLKIT LICENSE – BOARD OF NURSING MEMBERSHIP – INDIANA STATE NURSES ASSOCIATION (ISNA)ISNA IS CARING FOR YOU WHILE YOU PRACTICEWWW.INDIANANURSES.ORGThe ISNA is a Constituent Member of the American Nurses AssociationAPPLICATION FOR RN MEMBERSHIP in ANA / ISNAOr complete online at www.NursingWorld.orgPLEASE PRINT OR TYPE_____________________________________________________________________________ _____________________________________Last Name, First Name, Middle InitialName of Basic School of Nursing______________________________________ ____________________________________ ____________________________________Street or P.O. Box Home phone number & area code Graduation Month & Year______________________________________ ____________________________________ ____________________________________County of Residence Work phone number & area code RN License Number State______________________________________ ____________________________________ ____________________________________City, State, Zip+4 Preferred email address Name of membership sponsor1. SELECT PAY CATEGORY_________ Full Dues – 100%Employed full or part time.Annual – $281Monthly (EDPP) – $23.92_________ Reduced Dues – 50%Not employed; full-time student, or 62 years or older.Annual – $140.50Monthly (EDPP) – $12.39_________ Special Dues – 25%62 years or older and not employed or permanently disabled.Annual – $70.25Monthly (EDPP) $6.852. select payment type_________ FULL PAY – Check_________ FULL PAY – BANKCARD_________________________________________________________Card Number_________________________________________________________VISA/Master card Exp. Date_________________________________________________________Signature for Bankcard Payment_________ ELECTRONIC DUES PAYMENT PLAN, MONTHLYThe Electronic Dues Payment Plan (EDPP) provides for convenientmonthly payment of dues through automatic monthly electronic transferfrom your checking account.To authorize this method of monthly payment of dues, please read,sign the authorization below, and enclose a check for the first month (fullreduced $12.38).This authorizes ANA to withdraw 1/12 of my annual dues and thespecified service fee of $0.50 each month from my checking account. It isto be withdrawn on/after the 15th day of each month. The checking accountdesignated and maintained is as shown on the enclosed check.The amount to be withdrawn is $________________ each month. ANA isauthorized to change the amount by giving me (the under-signed) thirty (30)days written notice.To cancel the authorization, I will provide ANA written notificationthirty (30) days prior to the deduction date._________________________________________________________________Signature for Electronic Dues Payment Plan3. SEND COMPLETED FORM ANDPAYMENT TO:Customer and Member BillingAmerican Nurses AssociationP.O. Box 504345St. Louis, MO 63150-4345✁✁Public Policy continued from page 10Legislative action to protect nurses who report unsafe, incompetent, or illegalpractices from harassment or retaliation by employers, including, but not limited to,termination of employment.The title “birth attendant” for non-nurse midwives and regulation by theProfessional Licensing Agency and the Indiana State Medical Licensing Board.Legislation that must cover accepted practices, training requirements, supervisoryand referral issues and have clear methods for disciplining and removal from anapproved list of birth attendants.That the Indiana tobacco settlement monies should be used only for the improvedhealth of the citizens of Indiana.That elimination of significant waste and inefficiency must first occur beforenursing salaries and/or positions are affected when cost containment initiatives areundertaken.Direct third-party reimbursement for nurses to include advanced practice nursesand certified registered nurse anesthetists by all payers.Competitive salaries for all nurses.Pay equity.OTHERISNA will educate Indiana nurses about important health care reform measures;and encourages nurses to advocate for health care reform measures to include butnot limited to:Patient-centered medical home as an enhanced model of primary care.Health information technology to share interoperability among health systems.Payment reforms to slow spending for health care growth while improving quality.Redesign of a public health system that speaks to health of the nation.Revamping the US food and drug safety system.Improving access to health care that is appropriate convenient and cost effective.Insurance reform to allow for reasonable expense and coverage for all citizens.Tort reform to address unreasonable claims against health institutions andproviders.Portability for health insurance.ISNA supports that registered nurses include a military health history assessmentin the provision of care.

Page 12 • The Bulletin August, September, October 2015CE Independent StudyBreaking the Cycle of Horizontal ViolenceINDEPENDENT STUDYThis independent study has been developedto enable nurses to recognize and deal withhorizontal violence.1.0 contact hour will be awarded for successfulcompletion of this independent study.The Ohio Nurses Association (OBN-001-91) isaccredited as a provider of continuing nursingeducation by the American Nurses CredentialingCenter’s Commission on Accreditation.Expires 4/2017DIRECTIONS1. Please read carefully the enclosed article“Breaking the Cycle of Horizontal Violence.”2. Complete the post-test, evaluation form andthe registration form.3. When you have completed all of the information,return the following to the Indiana StateNurses Association, 2915 N. High School Road,Indianapolis, IN 46224A. The post-test; completed registration form;and evaluation form.The post-test will be reviewed. If a score of 70percent or better is achieved, a certificate will besent to you. If a score of 70 percent is not achieved, aletter of notification of the final score and a secondpost-test will be sent to you. We recommend that thisindependent study be reviewed prior to taking thesecond post-test. If a score of 70 percent is achievedon the second post-test, a certificate will be issued.If you have any questions, please feel free tocall Marla Holbrook, 317-299-4574, or emailmholbrook@indiananurses.orgOBJECTIVES1. Describe horizontal violence in healthcare.2. Describe strategies to deal with horizontalviolence.This independent study was developed by:Barbara Brunt, MA, MN, RN-BC, NE-BC, Director,Nursing Education and Staff Development,Summa Health System. The author and planningcommittee members have declared no conflict ofinterest.Disclaimer: Information in this study isintended for educational purposes only. It is notintended to provide legal and/or medical advice.Horizontal violence and bullying has beenextensively reported and documented in healthcare,with serious negative outcomes for registered nurses,their patients, and health care employers. In thisarticle horizontal violence (HV) will be definedand some of the theories behind it will be reviewed.Behaviors exhibited with horizontal violence will bediscussed and various strategies to deal with it willbe described. There has been quite a bit of researchdone on this topic and several studies will behighlighted. The Joint Commission (TJC) standardson maintaining a culture of safety will also bereviewed.On the international level, one out of everythree nurses plan to leave his or her position dueto HV. In the United States, 90 - 97% of nursesreport experiencing verbal abuse from physicians(Bartholomew, 2014). The effects of HV are reflectedin poor patient and employee satisfaction scoresand ultimately in the reputation of the hospital orsetting. Hutchinson, Vickers, Jackson, and Wilkes(2006) suggested that violent behavior amongnurses is “accepted” within the profession, and, asa result, bullying is considered an under-reportedphenomenon. According to a survey conducted bythe Workplace Bulllying Institute, 27% of Americanshave suffered abusive conduct or incivility at work(Griffin & Clark, 2014).There are several terms used to describe thisphenomenon: interactive workplace trauma,bullying, horizontal hostility, bullying, incivility,and horizontal or lateral violence (Bartholomew,2014). Bullying is defined as “repeated offensive,abusive, intimidating, or insulting behaviors; abuseof power, or unfair sanctions that make recipientsfeel, humiliated, vulnerable, or threatened,thus creating stress and undermining their selfconfidence”(Townsend, 2012. p. 1).Lateral Violence, horizontal violence, andhorizontal hostility are used to portray aggressivebehavior between individuals on the same powerlevel, such as nurse-to-nurse and manager-tomanager.Definitions of bullying share three elementsthat come from racial and sexual harassment law:1. Bullying is defined in terms of its effect of therecipient, not the intention of the bully2. There must be a negative effect on the victim3. The bullying behavior must be persistent(Bartholomew, 2014)Both overt and covert behaviors are included. Overtbehaviors would include name-calling, bickering,fault-finding, backstabbing, criticism, intimidation,gossip, shouting, blaming, using put-downs, raisingeyebrows, ignoring someone’s greeting, nicknames,and failing to give credit when due. Covert behaviorswould include unfair assignments, sarcasm, ignoring,eye rolling or making faces behind someone’s back,refusing to help, sighing, whining, refusing to workwith someone, sabotage, isolation, exclusion, andfabrication (Bartholomew, 2014).Another definition of HV is unwanted behavior,whether physical or verbal, which is offensive,humiliating, and viewed as unacceptable to therecipient. Both intrinsic and extrinsic factors playa role in perpetuating HV. Intrinsic factors includeemotional sate (e.g. anger, burnout), personality style,beliefs and expectations, inadequate communication/conflict management skills, generational differences,diversity, and racioethnic differences. Extrinsicfactors include violent workplace, poor nursephysicianrelationships, task and time imperatives,culture, and demands for efficiency/productivity.(Bartholomew, 2014). Can you think of a time youeither observed or experienced HV?A number of nursing organizations have issuestatements regarding the detrimental effect ofdisruptive behavior on both patients and nursesand have called for solutions to address theproblem (American Association of Critical CareNurses (AACN), 2004; Association of PerioperativeRegistered Nurses (AORN), 2011; American NursesAssociation (2011) International Council of Nurses(ICN), 2006; National Student Nurses Association(NSNA), 2010). It is imperative that definitive actionbe taken to address the problem of HV and its impacton health professionals and patients.Raynor and Keashly (2005) identified commonelements seen in HV. These included experience ofnegative behaviors, many of which are nonphysical,passive and indirect and are patterns of behaviorsthat show a set of negative effect. Persistency isanother element with HV, which occurs over time.The damage from HV is largely stress-related,resulting in anxiety, sleeplessness, and dread ofgoing to work. Also the victims of HV often identifythemselves as being bullied.Oakley (2009) identified typical behaviors of adisruptive person as blame-shifting, gas lighting(denying obvious reality), black-and-white thinking(seeing things as all back or all white, with no shadesof gray), and situational competence (being verycompetent in one role but not in another setting).According to Hague (2010) chronic anger is prominentin healthcare today. Research indicates that nursesoften see their work environment as hostile, feelthat disrespect is common, and restructuring hascompromised patient safety. Nurses feel they havebeen excluded from decision-making which hasresulted in a feeling of powerlessness expressed inthe form of HV. This atmosphere has the potential tohave a negative impact on patient care.Often the theory of oppression is used to explainHV. Oppression exists when a power prestigiousgroup controls and exploits a less powerful group.Nursing characteristics, such as being warm,nurturing, sensitive, passive and submissivecaregivers, are viewed as less important or negativecharacteristics when compared with those of medicalpractitioners, who are often seen as the dominantculture. The image of the nurse is frequently seenas a handmaiden. The result is that nurses oftenlack autonomy, accountability, control over theirpractice, and are excluded from the power structure.Characteristics of an oppressed group are low selfesteem,self-hatred, feelings of powerlessness, anda weakened sense of identity. Women are oftenconsidered to be a subordinate group within societyin general, and the health care arena in particular,because women comprise at least 90% of the nursingprofession (Bartholomew, 2014).Disenfranchising work practices can alsocontribute to HV. This would include task and timeimperatives, where patients are seen as tasks ratherthan people. Generational and hierarchical abuse isoften exhibited when nurses eat their young becausethey were treated badly when they started. Otherfactors are clique formation and low self-esteem.Nurses who are the most vulnerable to HV are newlyhired nurses, temporarily assigned nurses suchas floats, newly licensed nurses, and nurses froma different group or culture, such as male nurses(Griffin, 2006).Education and increased awareness is the keyto dealing with HV. The incidence of abuse andintimidating behaviors are not isolated events in thehealthcare setting. Studies have shown that verbalabuse and disrespectful behavior significantly impactthe workplace by decreasing morale, increasing jobdissatisfaction and creating a hostile work climate.When nurses are intimidated about communicatingwith other team members, quality care is endangered.Current literature and data suggest that abusivenesswill continue unless education program for skilldevelopment are instituted and actions to establish,enforce and measure zero-tolerance policies areimplemented. (AACN, 2004).Not only do people need to understand was HV is,but also what it IS NOT. Serantes and Suarez (2006)identified myths about violence, harassment, andbullying.• Physical violence or harassment at work is onlycarried out by colleagues within the organization.• The level of physical violence at work has notchanged (it actually increased by 1/3 of itsprevious rates from 1996 to 2000).• Workplace violence is only physical (a lot ofworkplace violence is psychological)• All workplace violence is reported by the victims(in 1996 the US Dept of Justice found that morethan 50% of acts of violence in the workplace gounreported).• Victims of workplace violence have onlythemselves to blame. (In general 50% ofindividuals blame themselves for their mishap).• Violence is not destructive• Workplace violence is inevitable• Prevention is more expensive than repairing thedamage.• Victims of workplace violence believe in justiceand its supportThe ten most frequent forms of HV as described byBartholonew (2014) include the following behaviors,listed in order from the most to the least frequentlyencountered: nonverbal innuendos, (raising ofeyebrows, making faces) verbal affronts (snideremarks, lack of openness, and abrupt responses)and undermining activities (turning away or notbeing available). Withholding information, sabotage(deliberately setting up a negative situation),infighting (bickering) and scapegoating (attributingALL that goes wrong to one individual) are otherforms of HV. Backbiting (complaining to others aboutan individuals and not speaking directly to thatindividual), failure to respect privacy, and brokenconfidences are the last three forms of HV identified.CE continued on page 13

August, September, October 2015 The Bulletin • Page 13CE continued from page 12Impact of Horizontal ViolenceHV has individual, organizational, and financialimpacts. Individual impact includes emotionalaspects, such as anger, decreased self-esteem andlack of motivation. Social impact includes strainedrelationships and low interpersonal support.Depression, stress and burnout create a psychologicalimpact, which can result in physical manifestationsof illness (Bartholomew, 2014). Patient safety is alsoat risk. Bullying reduces patient safety by interferingwith teamwork, communication, and collaboration.Nurses who have been bullied feel isolated from thecoworkers; they’re reluctant to ask questions andafraid to speak up to advocate for patients. Highnurse turnover jeopardizes continuity on the unit,and may leave nurses without adequate experienceor knowledge to recognize or act quickly on potentialpatient problems. (Townsend, 2012).Nursing leaders are becoming more aware of thecosts and consequences of hostility among nursesin the healthcare system. Some economic effects,such as high turnover rates are obvious. Significantliterature also validates the effects of stress andburnout on nurses. For example, when positions needto be filled due to sick calls, compensations claims,and family medical leaves of absence, overtime andagency costs accrue. An Australian study showedthat 34% of nurses who experienced bullying tookoff more than 50 sick days in a year. (Bartholomew,2014).Horizontal violence takes a toll on the individualaffected. The victim may experience physicalproblems that include dry throat, frequentheadaches, gastrointestinal problems, and a changein body weight, sleep disturbances, and decreasedenergy. Psychological effects may include stress,fear, anxiety, sadness, depression, frustration, andmistrust, loss of self-esteem and confidence, andnervousness. (Longo, 2012)There are also costs to the organization related toHV. These would include the mental and physicalhealth problems of those individuals targeted, takingtime off work, leaving the organization or profession,decreased productivity, high turnover rates, anddecreased morale.The number one strategy to deal with HV is toincrease awareness of the problem. This would includeeducation of staff, development and communicationof policies/procedures, etc. Individuals need to takeresponsibility for their own professional behavior,and become an individual change agent. Seeking outhelp and creating an action plan are other strategies.Organizational StrategiesManagers have an important role to play inidentifying and responding to any problems.According to Bartholomew (2014), managers needto be able to identify indications of HV, such aspoor employee satisfaction scores, high turnoverrates, dueling shifts, cliques, and absenteeism.There are questionnaires that are available toassess the cohesiveness of the group. Managersalso need to create an environment where staffmembers feel comfortable coming to the managerswith concerns. To deal with HV, managers need todecrease negativity, gossip, and a culture of blame bymaintaining zero tolerance for any communicationthat is unhealthy, disrespectful or spoken to peopleother than the person(s) directly involved. Theyalso need to create a climate of safety and healthycommunication by role modeling and using as manyopportunities as possible to teach interpersonal andconfrontational skills.Strategies to stop the cycle of HV at theorganizational level include adopting a zero tolerancepolicy, embracing transformational leadership,developing a strong policy to deal with incidentsof hostility, developing institutional policies thatare proactive, not reactive, and empowering staff tospeak without fear of reprisal (Longo, 2012).Suggestions for increasing a healthy culture arelisted below:• Firmly establish board and senior leadershipteam commitment• Make harm visible: frame disruptive behavioras a safety issues, and create infrastructure tosupport managers and staff• Shift the power structure from a hierarchyto a team/tribe by providing a constructivefeedback system, providing leadership/conflictmanagement training for managers, providingassertiveness training and crucial conversationstraining for staff, monitoring the organizationalclimate, and increasing social capital by buildinga strong internal network. (Bartholomew, 2014)In addition to the institution adopting a zerotolerance policy for HV, other strategies identifiedby the International Council of Nurses (ICN) includesensitizing the public and the nursing communityto the various manifestations of violence againstnursing personnel, supporting nurses, includingfacilitating access to legal aid when appropriate,ensuring awareness of and access to existentresources available to nurses to deal with workplaceabuse, and providing improved education and ongoingtraining in the recognition and management ofworkplace abuse and violence (ICN, 2004).Some institutions have instituted a code pink,which is a technique nurses employ to addressunacceptable behavior in hospitals and othersettings. It works like this: RNs go to a locationwhere their nurse colleague is being verbally abusedand stand in support of their peer and against thebullying that is taking place. (Trossman, 2014).Individual StrategiesIndividual strategies include courageousleadership. Every nurse must lead this culturalchange. Working cooperatively despite feelings ofdislike, not speaking negatively about superiors,addressing co-workers by the first name andasking for help as necessary, and looking people inthe eye when having conversation with them areother strategies that can be used. Not being overlyinquisitive about each other’s lives, repaying favorsand complements, not engaging in a conversationabout a co-worker w another co-worker, standingup for the “absent member” in a conversation wherethey are not present, and not criticizing publicallyare other effective strategies (Bartholomew, 2014).Strategies identified by the Center for AmericanNurses (2008) included: nurses adopting andmodeling professional ethical behavior, recognizingand addressing bullying and disruptive behaviorsin the workplace, reflecting on own behavior andcommunicating respectfully, participating incollaborative interdisciplinary initiative to preventabuse, and working to ensure the mission, visionand values of their workplaces are reflective of theCode of Ethics for Nurses and standards set by theprofession in order to eliminate disruptive behavior.Evinrude (2008) shared how journaling helpedher deal with a personal case of bullying in theworkplace. Journaling helps the individual reflecton the situation and think of ways to deal withissues over time. It also is helpful to keep track of thenature, time, date, place and names of all individualswho were present.Strategies to stop the cycle at the individual levelinclude:• Gain control and recognize that the aggressor isat fault not you• Get help from your employer – read yourworkplace policy on HV or harassment tounderstand your options• Make an action plan, after seeking advicefrom others with similar experiences, talk toyour manager, and take advantage of employeeassistance programs.• Implement the plan• Confront the aggressor – make it clear that thebehavior is offensive and must stop using “I”messages and describing the behavior and how itmade you feel.• Make a formal written conflict, following thegrievance policy• As a last resort, seek out legal advice if thesituation warrants (Leiper, 2005).Additional suggestions offered by Bartholomew(2009b) when confronting a bully, include:• Don’t wait – the sooner you confront the behavior,the better• Always ask to speak to the person in private• Take a few deep, centering breaths before youbegin the conversation• If you are setting down, sit at right angles insteadof across from each other• Remember the goal: speak your truth.• Remember when someone is loud, aggressive,or mean they are angry or afraid. Anger is thesecondary emotion; try to get to the primaryemotion, which is hurt.• Whenever you don’t know what to do, repeat whatthe other person said: Let me get this straight.You are saying that . . . “ (p. 3)The American Nurses Association has a publicationtitled Bullying in the Workplace: Reversing aCulture (Longo, 2012) to help nurses increase theirprofessional awareness and knowledge to developthe skills needed to create a safe workplace. There isa checklist which outlines common acts of bullying,contributing factors that increase the risk for bullyingbehaviors, and strategies to eliminate bullying in theworkplace.Research StudiesThere have been numerous research studieslooking at HV. Griffin described a research study in2004 on cognitive rehearsal she conducted with 26newly registered nurses hired for their first positionat a Boston tertiary hospital. Ten years later, Griffinand Clark (2014) reviewed the literature on cognitiverehearsal as an evidence-based strategy to addressincivility and bullying behaviors in nursing. Inthe initial study, nurses spent two hours learningto recognize HV and then practiced techniques toconfront it. Participants were given cue cards to usewhen they were experiencing the various types ofHV. Examples of constructive responses on the cardsfor each of the behaviors seen in HV are listed below:Nonverbal innuendo – I sense (I see) from yourfacial expressions that there may be something youwanted to say to me. It’s OK to speak directly to me.Verbal affront – The individuals I learn the mostfrom are clearer in their directions and feedback.Is there some way we can structure this type ofsituation?Undermining activities – When somethinghappens that is “different” or “contrary” to what Iunderstood, it leave me with questions. Help meunderstand how this situation may have happened.Withholding information – It is my understandingthat there was (is) more information availableregarding the situation, and I believe if I had knownthat (more), it would (will) affect how I learnSabotage – There is more to this situation thanmeets the eye. Could “you and I’ (whatever, whoever)meet in private and explore what happened?Infighting – Always avoid unprofessionaldiscussion in nonprivate places. This is not the timeor place. Please stop (physically walk away or moveto a neutral spot)Scapegoating – I don’t think that is the rightconnectionBackstabbing – I don’t feel right talking abouthim/her/the situation when I wasn’t there or don’tknow the facts. Have you spoken to him/her?Failure to respect privacy – It bothers me to talkabout that without his/her permission or I onlyoverheard that – it shouldn’t be repeated.Broken confidences – Wasn’t that said inconfidence? Or that sounds like information thatshould remain confidential (Griffin & Clark, 2014).Johnson (2009) examined the literature onworkplace bullying among nurses with the aim ofreaching a better understanding of the phenomenon.Workplace bullying occurs in many occupationsand workplaces, including nursing. It is more thana simple conflict between two individuals. It is acomplex phenomenon that can only be understoodthrough an examination of social, individual andorganizational factors. Workplace bulling has beenshown to impact the physical and psychologicalhealth of victims, as well as their performance atwork. Workplace bullying impacts the organizationthrough decreased productivity, increased sicktime and employee attrition. More nurse-specificresearch is needed. Research needs to be conductedin a systematic and uniform manner so thatgeneralizations across studies can be made.Bigony et al. (2009) further discussed the issueof lateral violence in the perioperative setting andconcluded that support from administration andcontinuing education with the aim of increasingawareness, together with a zero tolerance policy,should be the standard for all health careorganizations. HV threatens the health and wellbeingof all nurses and becomes a patient safety issue.Thomas and Burk (2009) did a content analysisof stories written by junior nursing students aboutincidents of injustice perpetrated by staff RNs duringtheir clinical experiences. Four levels of injusticewere described: “we were unwanted and ignored,”‘our assessments were distrusted and disbelieved,”“we were unfairly blamed,” and “I was publiclyhumiliated.” Nursing leadership, both in hospitalsand educational institutions, must become engagedin efforts to eradicate HV towards students.CE continued on page 14

Page 14 • The Bulletin August, September, October 2015CE continued from page 13Purpora, Blegen, and Stotts (2012) studied theincidence of horizontal violence among hospitalRNs and looked at the effects on patient care. Theytested two hypotheses about the social origins of thisbehavior. A randomized sample of 175 hospital staffRNs drawn from the California Boar of RegisteredNursing’s mailing list was surveyed. Horizontalviolence was reported by 21% (n=37) of participatingnurses. Findings suggested a positive relationshipbetween beliefs consistent with an oppressedself and horizontal violence and also a positiverelationship between beliefs consistent with thoseof an oppressed group and horizontal violence. Achange in the oppressive social structure in hospitalsmay be needed to address horizontal violence.Recent research supports earlier findings. A 2012study of the psychological consequences of bullyingin Australia found that impact varied dependingon whether the nurses worked in the hospital oraged care, and full- or part-time. Full time agedcare nurses reported higher psychological distressthan part-timers. Hospital nurses reported higherpsychological distress, while aged care nursesreported higher depression. More than half of thosepeople who experienced hostility at work reportedthat they lost time worrying about the uncivil incidentand its future consequences. After three studiesinvestigating the objective consequences of bothdirect and indirect rude experiences, researchersfound that both were harmful to task performance.Even a one-time event can affect objective cognitivefunctioning and creativity. (Bartholomew, 2014)Woelfle and McCaffrey (2007) reviewed fiveresearch studies published in 2003 and 2004 tobetter understand the reasons for impaired personalrelationships among nurses and to provide evidencefor change in the nursing environment. Based onthat review, they concluded that HV is prevalent innursing and it is experienced by student nurses aswell as novice and veteran nurses. There should bepolicies in organizations relating to HV, protectingstaff from and holding staff accountable for workplaceviolence. It is impossible to deliver compassionate,high-quality patient care when staff memberswork in an atmosphere of fear and intimidation.Management must take action to fight HV.Establishing a culture that fosters a sense ofcohesiveness among staff is a critical link inimproving patient satisfaction and decreasing HV.Barrett, Piatek, Korber, and Padula (2009) completed astudy that included both quantitative and qualitativecomponents. A pre-post design was used, with atargeted intervention that focused on teambuilding.Six to eight nurses from 4 different units in a privatenot-for-profit teaching hospital participated. Twotwo-hour sessions were presented by a trained groupfacilitator. The first session included informationon HV, as well as a discussion of their personalexperiences with it. Participants completed theMyer-Briggs Type Indicator (MBTI) and there wasa skill-building session on giving and receivingfeedback and managing conflict. The qualitativecomponent focused on the impact of the interventionof overall group dynamics and processes. RN scoreson the Group Cohesion Scale (p=.037) and the RN/LPN interaction scores improved post-intervention.Bally (2007) described the role of nursingleadership in creating a mentoring culture in acutecare environments. High rates of retirement amongolder nurses and HV among younger nurses heightensthe importance of mentoring in the context of overallorganizational stability and performance. If this is along-term commitment and solution, it will lead toimprove staff retention, satisfaction and better patientoutcomes. Mentoring cultures depend upon elementsof a stable infrastructure such as managerial andexecutive support, scheduling flexibility, incentives,and recognition. Transformational leadershippractices are critical to achieving the sustainableeffect of mentoring programs that are rooted deeplyin organizational culture.The Joint Commission Culture of SafetyThe Joint Commission [TJC] (2014) has recognizedthe impact of poor interpersonal relationshipson patient safety and quality and created severalstandards relating to this. They have a chapteron Patient Safety Systems. The quality of careand the safety of patients are core values of TheJoint Commission accreditation process. This is acommitment The Joint Commission has made topatients, families, health care practitioners, staff,and health care organization leaders. The intentof this “Patient Safety Systems” (PS) chapter is toprovide health care organizations with a proactiveapproach to designing or re-designing a patientcenteredsystem that aims to improve quality of careand patient safety, an approach that aligns with TheJoint Commission’s mission and its standards.The ultimate purpose of The Joint Commission’saccreditation process is to enhance quality of careand patient safety. Each requirement or standard,the survey process, the Sentinel Event Policy, andother Joint Commission initiatives are designed tohelp organizations reduce variation, reduce risk, andimprove quality. Hospitals should have an integratedapproach to patient safety so that high levels of safepatient care can be rovided for every patient in everycare setting and service. (TJC, 2014)A culture of safety is characterized by open andrespectful communication among all members ofthe healthcare team in order to provide safe patientcare. It is a culture that supports organizationalcommitment to continually seeking to improvesafety. Verbal abuse is communication perceived bya person to be a harsh, condemnatory attack, eitherprofessional or personal, or language intended tocause distress to a target (Bartholomew, 2014).Ignoring bad behavior has potentially seriousconsequences for patients. Aleccia (2008) statedabout 70 percent of nurses studied believe there’sa link between disruptive behavior and adverseoutcomes, and nearly 25 percent said there was adirect tie between the bad acts and patient mortality.In an Institute for Safe Medication Practices studyof about 2,000 clinicians more than 90 percent saidthey’d experienced condescending language orvoice intonation; nearly 60 percent had experiencedstrong verbal abuse and nearly half had encounterednegative or threatening body language (Institute ofMedicine, 2007).Bartholomew (2009a) discussed how nursemanagers can create collaborative relationships ontheir unit with physicians. Research shows that1-3% of physicians are disruptive, yet this groupcauses exponentially devastating effects on morale,retention, and patient safety. Managers must takethe necessary actions to demonstrate to nurses andphysicians the standard of acceptable behavior andset the tone for collegiality on the unit. Nothing ismore powerful than staff witnessing a managerapproaching a disruptive physician and saying, “CanI speak to you for a minute in my office?”Suggestions given by Lindeke (2008) to developcollaborative relationships grouped strategiesinto three categories: self-development, teamdevelopment, and communication development.Self development strategies included developingemotional maturity, understanding the perspectivesof others, and avoiding compassion fatigue. Teamdevelopment strategies included building the team,negotiating respectfully, managing conflict wisely,avoiding negative behaviors, and designing facilitiesfor collaboration. Communication developmentstrategies included communicating effectively inemergencies, and using electronic communicationthoughtfully.Horizontal violence is a phenomenon that isdetrimental to patient safety and should not beallowed to continue. This is a serious problem andit is imperative that the profession addresses thisproblem. Various organizational and individualstrategies were outlined to combat HV and minimizeits impact on staff. Organizations need to create aculture where HV is not tolerated. Nurses and studentsneed to be given tools that provide information onhow to address conflicts and change disruptivebehavior in the workplace. Nurses, individuallyand collectively, must enhance their knowledge andskills in managing conflicts and promote workplacepolicies to eliminate HV.ReferencesAleccia, J. (2008). Hospital bullies take a toll on patientsafety-Health care. MSNBC. Retrieved fromhttp://msnbc.msn.com/id/25594124/AmericanAssociation of Critical Care Nurses. (2004). Zerotolerance for abuse. Retrieved from: http://www.aacn.org/wd/practice/docs/publicpolicy/zero_tolerance_for_abuse.pdfAmerican Nurses Association. (2011). Lateral violenceand bullying in nursing fact sheet. Retrieved fromhttp://www.nursingworld.org/Mobile/Nursing-Factsheets/lateral-violence-and-bullying-innursing.htmlAssociation of periOperative Registered Nurses. (2011).Patient Safety. Retrieved from: http://www.aorn.org/Clinical_Practice/Position_Statements/Position_statements.aspxBally, J. M. (2007). The role of nursing leadershipin creating a mentoring culture in acute careenvironments. Nursing Economics, 25(3), 143-149.Barrett, A., Piatek, C., Korber, S., & Padula, C. (2009).Lessons learned from a lateral violence and teambuildingintervention. Nursing AdministrationQuarterly, 33(4), 342-351.Bartholomew, K. (2009a). Blog spotlight: Set the tonefor nurse-physician collegiality. Nurse ManagerWeekly, 9(12), 2-3.Bartholomew, K. (2009b). Expert spotlight: Help staff riseabove horizontal hostility. Nurse Manager Weekly,9(6), 2-3.Bartholomew, K. (2014). Ending nurse to nurse hostility:Why nurses eat their young and each other. 2ndEd. Danvers, MA: HCPro.Bigony, L., Lipke, T. G., Lundberg, A., McGraw, C. A.,Pagac, G. L., & Rogers, A., (2009). Lateral violencein the perioperative setting. AORN Journal, (89)4,688-700.Center for American Nurses, (2008). Lateral violence andbullying in the workplace. Retrieved from: http://www.centerforamericannurses.org/positions/lateralviolence.pdfEvinrude, D. J. (2008). Surviving bullying in theworkplace: A personal account. Nurses First, 1(3),15-16.Griffin, M., (2006, July). Professional accountability:Addressing lateral/horizontal violence in nursingpractice. Paper presented at the annual conventionof the National Nursing Staff DevelopmentOrganization. Orlando, FL.Griffin, M., & Clark. C. M. (2014). Revisiting cognitiverehearsal as an intervention against incivilityand lateral violence in nursing: 10 years later. TheJournal of Continuing Education in Nursing. Nov.22: 1-8. Doi:10.3928/00220124-20141122-02. Epubahead of print.Hague, D. (2010). Tips for managing anger constructively.Ohio Nurse, 3(2), 12-14.Hutchinson, M., Vickers, M., Jackson, D., & Wilkes, L.(2006). Workplace bullying in nursing: towards amore critical organizational perspective. NursingInquiry, 13(2), 118-126.Institute of Medicine. (2007). Preventing medicationerrors. Washington DC: The National AcademiesPress.International Council of Nurses. (2006). PositionStatement on abuse and violence against nursingpersonnel. Retrieved from: http://www.icn.ch/images/stories/documents/publications/position_statements/C01_Abuse_Violence_Nsg_Personnel.pdfJohnson, S. L. (2009). International perspectives ofworkplace bullying among nurses: A review.International Nursing Review, 56(1), 34-40.Doi: 10.1111/j.1466-7657.2008.00679.x.Leiper, J., (2005), Nurse against nurse: How to stophorizontal violence. Nursing 2005 35(3), 44-45.Lindeke, L. L. (2008). Nurse-physician workplacecollaboration. Retrieved from: http://nursingworld.org/mods/mod775/nrsdrfull.htmLongo, J. (2012). Bullying in the workplace: Reversinga culture. Silver Spring, MD: American NursesAssociation.National Student Nurses Association. (2010). Resolutionin support of policy development and increasedfunding for research on lateral violence in nursing.Retrieved from: http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Final%20Resolutions%202010_revised%205-05-10.pdfOakley, B. (2009). Hardwired to bully. Reflections onNursing Leadership. 35(1), Retrieved from: http://www.nursingsociety.org/pub/rnl/pages/vol35_1_oakley.aspxPurpora, C., Blegen, M. A., & Stotts, N. A. (2012).Horizontal violence among hospital staff nursesrelated to oppressed self or oppressed group.Journal of Professional Nursing, 28(5), 306-314.Doi:10.1016/j.profnurs.2012.01.001Raynor, C., & Keashly, L. (2005). Bullying at work: Aperspective from Britain and North America. InSD. Fox and P. E. Spector (EDs). Counterproductivework behavior: Investigations of actors andtargets. pp. 27-296). Washington, DC: AmericanPsychological Association.Serantes, N. P. & Suarez, A. (2006). Myths about workplaceviolence, harassment and bullying. InternationalJournal of Sociology and Law, 34, 229-238.The Joint Commission (2014). Patient Safety Systems (PS).Retrieved from: http://www.jointcommission.org/assets/1/6/PSC_for_Web.pdfThomas, S. P. & Burk, R. (2009). Junior nursing students’experiences of vertical violence during clinicalrotations. Nursing Outlook, 57 (4), 226-231.Townsend, T. (2012). Break the bullying cycle. AmericanNurse Today, 7(1), 1-9. Retrieved from http://www.americannursetoday.com/break-the-bullyingcycle/Trossman, S. (2014). Toward civility: ANA, nursespromote strategies to prevent disruptive behaviors.The American Nurse, 46(1), 1, 6.Woelfle, C. Y. & McCaffrey, R. (2007). Nurse on nurse.Nursing Forum, 42(3) 123-131.CE Post Test and Evaluation Form continued on page 15

August, September, October 2015 The Bulletin • Page 15DIRECTIONS: Please complete the post-test andevaluation form. There is only one answer per question.The evaluation questions must be completed and returnedwith the post-test to receive a certificate.Name:_______________________________________________Final Score:__________________Please circle one answer.1. Bullying is behavior which is generally persistent,systematic, and ongoing.a. Trueb. False2. Name-calling, backstabbing, and gossip are threeexamples of what type of hostility?a. Overtb. Covertc. Severed. Illegal3. Which of the following is an example of covertbehavior?a. Fault-findingb. Criticismc. Sabotaged. Shouting4. Associations that have issued statements regardinghorizontal violence include all of the followingEXCEPT:a. American Nurses Associationb. American Nurses Credentialing Centerc. American Association of Critical Care Nursesd. International Council of Nurses5. Characteristics of an oppressed group include:a. High self-esteemb. Self-hatredc. Heightened sense of identityd. Sense of power and control6. Nurses who are most vulnerable to horizontalviolence are newly hired or licensed nurses, floatnurses, and male nurses.a. Trueb. False7. There are numerous myths about horizontal violence.Which of the following statements is true and is not amyth?a. Workplace violence is only physicalb. Workplace violence is inevitablec. Prevention is more expensive than repairing thedamaged. The level of physical violence at work has changedBreaking the Cycle of Horizontal ViolencePost Test and Evaluation Form8. According to Bartholomew, the most frequent form ofhorizontal violence is:a. Backbitingb. Broken confidencesc. Non-verbal innuendosd. Withholding information9. The number one strategy to deal with horizontalviolence is to:a. Increase awareness of the problemb. Report incidences to managementc. Monitor employee satisfaction scoresd. Maintain culture of blame10. Individual impacts of horizontal violence include:a. Increased self-esteemb. Increased motivationc. Angerd. Decreased absenteeism11. Organizational strategies to deal with horizontalviolence include all of the following EXCEPT:a. Adopting a zero tolerance policyb. Embracing transformational leadershipc. Promoting a culture of safetyd. Developing reactive institutional policies12. Individual strategies to deal with horizontal violence,as identified by the Center for American Nurses,include:a. Keeping a journalb. Adopting and modeling professional ethicalbehaviorc. Accepting a fair share of the workloadd. Reflecting on the behavior of others13. In the study by Baily a mentoring culture includedall of the following EXCEPT:,a. Management and executive supportb. Incentives and recognitionc. Inflexible schedulesd. Transformation leadership14. The organization that recognized the impact of poorinterpersonal relationships on patient safety andquality and created several standards relating to thiswas:a. The American Hospital Associationb. The Occupational Safety and HealthAdministrationc. The Joint Commissiond. The American Medical Association15. Suggestions given by Lindeke to developcollaborative relationships included all of thefollowing EXCEPT:a. Self-developmentb. Team developmentc. Communication developmentd. Organizational developmentEvaluation:1. We you able to achieve thefollowing objectives? Yes Noa. Describe horizontal violence inhealthcare. Yes Nob. Describe strategies to deal withhorizontal violence. Yes No2. Was this independent study an effectivemethod of learning? Yes NoIf no, please comment:3. What one idea will you take from this study andapply to your setting?4. How long did it take you to complete the study, thepost-test, and the evaluation form?______________________5. What other topics would you like to see addressed inan independent study?Registration FormName:________________________________________________(Please print clearly)Address:______________________________________________Street______________________________________________________City/State/ZipDaytime phone number:________________________________________________ RN _____________ LPNPlease email my certificate to:Email address:_________________________________________Fee:______________ ($20)ISNA OFFICE USE ONLYDate Received:_______Amount:______ Check No.__________MAKE CHECK PAYABLE TO THEINDIANA STATE NURSES ASSOCIATION (ISNA).Enclose this form with the post-test, your check,and the evaluation and send to:Indiana State Nurses Association2915 N. High School Road, Indianapolis, IN 46224American Nurses AssociationIntroduce 10 RN Friends and Colleagues to ISNA-ANAMembership and You’ll Earn a $25 Amazon Gift Card!Ready, set, go – ISNA and ANA’s Member-Get-a-Member program is here! Start referring your RNfriends and colleagues for ISNA -ANA membership.You’ll earn a free ANA webinar and a $25 Amazongift card. Refer more RNs; you could earn two or eventhree $25 Amazon gift cards. It’s a win/win for you,your friends and the nursing profession. It’s easy toget involved! There is no commitment, no quota andabsolutely no selling. You can participate as much asyou like. Here’s how:1. Visit www.nursingworld.com/MGM-ISNA andprovide ISNA with the name and valid emailaddresses of your coworkers, nursing schoolchums, neighbors – every RN you know whoshould join. You can enter one name and emailaddress today, another tomorrow and even morenext week. We’ll keep track and send you rewardsas you’ve earned them!2. Check-out the online Volunteer Recruiter Toolkitat www.nursingworld.org/MGM-ISNA whereyou’ll find details on:• Frequently asked questions• Recruitment• Finding future members• ISNA-ANA member benefits flyer• Sample email you can share with yourcolleagues3. That’s it. Once you enter the names and validemail addresses online we’ll take it from there!And, if you’re not sure whether a nurse is alreadya member, we’ll verify their membership status -and reach out if they are not one.Plus, you’ll be richly rewarded for your efforts!Earn…• A free Stepping into Your Spotlight: BuildingYour Professional Brand webinar when yousubmit 9 or fewer names and email addresses offuture members. This eye-opening presentationwill show you how creating, developing andpromoting your personal brand as a nurse cantruly set you apart.• A $25 Amazon gift card for every 10 futuremember names and email addresses that youprovide. Supply 10 emails and names; you’llreceive one $25 Amazon gift card. Supply 10 moreand you’ll receive another $25 Amazon gift card.• Special recognition on the ISNA website.We hope you enjoy sharing the value you receive asa member – letting colleagues know about ISNA andMEMBER GET MEMBERALET’S GROW MEMBERSHIP!Refer RNs, Earn Great Rewards.Start today!ANA’s efforts to support nurses’ scope of practice or atimely article you read in American Nurse Today.This is a great opportunity for you to help ISNAand ANA grow. Every nurse should have professionaldevelopment resources that will help them meettoday’s ever-changing practice and career needs.And when we speak for nurses, in Indianapolis orWashington, we want to speak out on behalf of everynurse in Indiana.Get started today at www.nursingworld.org/MGM-ISNA!Questions? Contact membergetamember@ana.org.

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