Turning it Upside down-Relational Aggression

Karen A Paulosky RN, BSN, MSN
Clinical Manager
Munson Medical Center
Differentiate between relational aggression
(RA), workplace bullying (WPB) & incivility (IC).
Evaluate the long term effects of being exposed
to a “Chronic Mary”
Explain the theme, “Why me? What have I
done wrong?”
Define the role of a “middler”.
Explore employer’s response to claims of
bullying in the workplace. Describe an Individual
Develop an action plan for a given scenario
Relational Aggression ( RA)Using words as weapons- hypercritical,
depreciating or severe
Linked to adverse physical and psychological
Female bullying
Work Place Bullying (WPB)Workplace Bullying Institute – “repeated healthharming, mistreatment of one or more persons
(the targets) by one or more perpetrators.”
Verbal, Offensive conduct/behaviors (including
nonverbal)which are threatening, humiliating or
Deliberate, Disrespectful and Repeated
3. Incivility- 3 parts
Rude or discourteous speech or behavior that is
disruptive, i.e. eye rolling, arm-crossing, walking
away, bullying, taunting, intimidation. Joy stealing:
Setting up, devaluing, misrepresenting, lying,
shaming, breaking boundaries, splitting,
mandating, blaming, silencing
Resulting: Psychological or physiological distress
Minor encounters can escalate into more
threatening situations.
 37% of US Workforce or 54 million Americans
report repeated abusive behavior at work
 41% say they have been psychologically harassed at
 50% of all workers have missed time from work
because of harassing behavior directed at them
 70-80% report recurring rudeness and incivility at
 82% of individuals targeted for workplace
harassment leave their jobs
Novice Nurse Studies*- Novice Nurse Productivity
Following Workplace Bullying and Turnover of New
Graduate Nurses in Their First Job Using Survival Analysis
Link to increased intent to leave
Poor Patient Outcomes
Dissatisfaction with Interpersonal Relationships
Negative affect on Novice Nurse Productivity and handling
*Berry, P., Gillespie, G., Gates ,D. & Schafer, J. Journal of Nursing Scholarship , 2012,,44:1,
*Cho, S-H., Lee, J., Mark, B., Yun, S-C, Journal of Nursing Scholarship, 2012 44:1, 63-70.
Sigma Theta Tau
Pair up with a partner
Share one example of relational aggression,
bullying or incivility that you have seen or
experienced in your career
Toxic gossip
Big HIM – humiliation, intimidation, and
manipulative behaviors
Increased stress, body weight, heart disease,
Increased cost of recruiting, onboarding and
Decreased production, motivation, morale,
engagement, customer service, image, patient
loyalty and referrals
One word answer – nothing!
What to do:
Collecting and recording data
1. credible list – 4 or 5 behaviors
2. meet in neutral place
Those who watch RA but don’t act
Who are your friends?
Caring and nurturing relational behaviors are
more frequently observed.
Circumvent the real problem
Cost on morale, productivity, business, patient
return and safety
Individual who bears witness or is affected by
Emphasis on using assertive behavioral terms to
address the disruptive behaviors
File a report, met with supervisor or mediator
Each person alternates detailing his or her view of
the situation
Adhere to civility rules
Goal to find an interest-based resolution, clear
expectations and agreement on who is doing what by
Seek common ground and pursue compromise
Follow-up meeting to evaluate progress to resolve issue
The individual displaying uncivil behaviors
Emphasis for corrective actions will be placed on
the behavior not the person
Verbal warning
Performance Improvement Plan (PIP)
Education on financial, human, organizational costs that
result from disruptive behavior and specific behavioral
requirements ( i.e. self-control classes, stress
management etc.) and associated time frames for
Individual- Data on RA/WPB person
Peer-Commitment to My Co-Workers- Card
from Relationship-based care
CorporateEmployee Handbook, Polices and how you are
supported if you are a target
Nursing Transition to Practice Series
I will accept responsibility for establishing and
maintaining healthy interpersonal relationships
with you and every other member of this team.
I will talk with you promptly if I am having a
problem with you. The only time I will discuss it
with another person is when I need advise or
help in deciding how to communicate with you
I will establish and maintain a relationship of
functional trust with you and every other
member of this team. My relationships with
each of you will be equally respectful,
regardless of job titles or levels of educational
I will not engage in the “3B’s” ( Bickering,
Back0biting, Blaming). I will practice the
“3C’s” ( Caring, Committing, Collaborating) in
my relationship with you and ask you do the
same with me.
I will not complain about another team member
and ask you not to as well. If I hear you doing
so, I will ask you to talk to that person.
I will accept you as you are today, forgiving the
past problems and ask you to do the same with
I will be committed to finding solutions to
problems rather than complaining about them
or blaming someone for them, and ask you to
do the same.
I will affirm your contribution to the quality of
our service.
I will remember that neither of us is perfect,
and that human errors are opportunities, not
for shame or guilt but for forgiveness and
- Complied by Marie Manthey
Review who will be the “target” and “bully”
based on the previous discussed scenario
Third person is the manager/facilitator and
forth person is the observer
Role play a meeting and then discuss the roles
and how it played out
Bully Free at Work- Valarie Cade
Book and Free E course
Crucial Conversation Tools- K Patterson, J
Grenny, R McCMillan, A Switzler
Toxic Nursing: Managing Bullying, Bad Attitudes
and Total Turmoil Cheryl Dellasega & Rebecca L
Volpe Sigma Theta Tau 2013
Creating & sustaining civility in nursing
education Cynthia Clark Sigma Theta Tau 2013

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