Lateral Violence in EMS/ Public Safety

Running head: INCIVILITY IN PUBLIC SAFETY 1

Incivility in Public Safety Professions

Edward D. Struzinski

RN, CEN, CCRN, NR/CCEMT-P

August, 2014

INCIVILITY IN PUBLIC SAFETY 2

Who have we become? Why all this banter about one another and schoolgirl gossip while

relaxing at the station? Is it me? Or is there a whole lot more negative conversation going on,

talking about each other, rather than focusing positively about how we can be learning from our

mistakes? Let’s be better than we ever expected we could. Let’s be kind and considerate toward

one another. Give each other time to talk; listen to our extended family members – our brothers

and sisters of the public safety network, a large and socially diverse group of talented folks. As a

member of the public safety network, we are part of a special family of unique individuals. We

all work together under the most stressful of times. We strive for independence. As we age and

draw closer to retirement, we might actually become more dependent on others, in an ironic and

coincidental fashion to how we first started our careers. We evolve. And throughout our career in

public safety there is interaction among other humans: the building of relationships and

application of personal skills that helps us to generally get along, or be civil, with each other.

There are times, however, that we in the EMS field – providers of all levels – behave quite the

opposite, showing aggression, or otherwise acting in an uncivil manner toward each other. Call it

what you will. Some call it “giving someone what they deserve”. Still others call it “getting

disrespected”. But the bottom line is that the behavior is unbecoming of a true professional. It is

simply unnecessary to act in such a manner, and it is also unlawful to incite an atmosphere of

hostility. What is it? It is incivility. The subject has many sister names, varying in degrees and

along the spectrum from simple discourtesy to outright intimidation.

Incivility, more commonly known as lateral violence, is a major problem in the

healthcare field, especially in EMS and Nursing. In fact, it is reported that violence and other

forms of workplace aggression are increasingly being identified as an epidemic in the workplace;

with it being so great in the healthcare field that many providers, if not all, will experience it at


some point in their career (Marquis & Huston, 2012). It is so particularly prominent in health

care occupations that some estimates indicate as many as nine out of ten people reported

experiencing it at work (Guidroz, Burnfield-Geimer, Clark, Schwetschenau, & Jex, 2010).

What exactly is incivility?

Incivility can be defined in several ways or take on multiple forms. For example,

pertaining to the field of education, it is defined as any disruptive classroom behavior that is

showing disrespect or disregard to the instructor or classmates (Michigan State University,

2014). Another definition, as noted by sociologists who studied over five hundred events of bitter

behaviors, is that it is seen as the everyday rudeness and inconsiderate behavior of people

(Smith, Philips, and King, 2010). In business, it is described as general rudeness and impolite

behavior of not saying “thank you” or “please”; even questioning the competence of another

individual (Clay, 2013). The Joint Commission of Accreditation addressed the nature and cost of

incivility in a 2009 Sentinel Event Alert, reporting it as reluctance or refusal to answer questions,

not returning phone calls, condescending communication, uncooperative attitudes, and threats

being made (The Christ Hospital Health Network, 2014). Incivility has even managed to weave

itself into the World Wide Web. A study performed and discussing online behavior defines it as

that which ranges from name-calling and rude critiques or commentary to outrageous claims and

“flaming” discussion posts (Anderson, Brossard, Scheufele, Xenos, and Ladwig, 2013). This is

seen all of the time on the social media sites, is it not? And are we not all guilty of it at some

point in our net-surfing time on the job, too?

Finally, we come to the realm of public safety encompassing the triad of Police, Fire, and

EMS disciplines. Incivility is all too common, and extends to our international family as well.

Are we not guilty of any of these descriptions and/or actions that relate to workplace hostility?


Next time you arrive for your shift, take a moment to clear your brain of all those ACLS

algorithms and make room for that which you probably have automatically tuned out. Pay close

attention. Does the morning ritual not seem to be discussing each other? People bashing the

reputations of others behind their backs (sometimes even straight to them), critically questioning

a colleague’s competence or slamming someone over the way they handled a crash scene or

medical call? What about your co-workers intentionally showing a generally sour attitude to

someone, causing more unrest between each other? According to the U.S. Department of Labor

(2014), workplace hostility is any conduct rendering the atmosphere as intimidating, hostile, or

offensive. Examples include threatening behavior, crude language, forms of sabotage, and

demeaning or belittling other employees (U.S. Dept. of Labor, 2014).

Hazing rituals and “traditional” learning

For those of us with significant longevity in public safety, consider the “early” ways of

teaching new EMTs and rookie firefighters the ropes of the job. Do you recall using, or

receiving, the tactics of intimidation during scenarios and belittling of efforts? How often is this

still experienced among EMS workers as a form of hazing or other way of “earning respect

within the group”, “earning your stripes in EMS”? Or to validate the usual statement “if you

cannot take it here, then what good are you going to be on a scene?” … as if psychologically

beating someone into submission is somehow a valid indicator of their skill level and predicator

of proficiency to perform tasks, such as applying Oxygen, inserting an IV, immobilizing a

patient on a backboard, or wrestling with a confused diabetic to provide an amp of D50.

Time after time these statements are spoken from educated and often very experienced

veterans of the field, yet the ignorance of their words somehow blinds them to only see the EMS

of the past and not moving it forward to the brighter future lying ahead for our newest members.


Somehow some of these folks feel they are better providers in the field because of the demeaning

nature of how they were trained back in the day, and that everyone needs to go through it as a

form of basic training to the profession. This delusional idea for molding new and

impressionable EMTs is damaging to the individual, the profession, and ultimately patient care.

It is well known and supported today that these forms of aggressive behavior (incivility, hostility,

bullying, hazing, etc.) creates a hostile environment built on fear and disrespect that has a

negative impact on learning. It undermines the learning environment that green EMTs need in

order to achieve their maximum potential and be successful (National Association of State

Boards of Education, 2014). Research shows this sort of behavior only serves to be destructive,

not constructive, to individuals and learning. Continuing to perform these actions only breeds

more ancient philosophy for “learning”. As the department training officer or other preceptor

position, ask yourself to honestly answer the following question: to whose benefit it is when you

demand that new team member to wash the station floor over and over again because it does not

meet your satisfaction criteria? Is it to their benefit to empower them? Or is it to serve your own

selfish desire to express your “power” over them?

On the other hand, these techniques are a determining factor for causing employees to

frequently use their sick time unnecessarily, have habitual lateness habits, feel distressed, express

negativity, or suddenly need to leave work due to an “illness” or “back injury” sustained on the

job. These incidents raise the frequency of being held at work, further inciting negativity and

ultimately breaks the budget with overtime costs. We see this in the EMS field every day.

So, have you ever asked yourself why you think it’s okay to perform your inconsiderate

actions and spread this disease of unprofessional behavior? To the very people whom you entrust

with your life while driving to the call, or to the hospital, but you refuse to extend a genuine


suggestion to drive safely after work? Incivility is a malignant tumor on the profession of EMS

and society in general; one that requires daily and continuous treatments to suppress it, in the

form of polite behavior, showing concern, smiling, handshake greetings, saying “please” and

“I appreciate it” at every opportunity of every day, and performing random acts of kindness, like

maybe surprising your EMS partner with their coffee or treating them to lunch.

Transformational-style leadership and empowerment

Instead of applying power over an individual, as found in authoritarian-style leadership

(dictators who command and demand), it is best to provide power to the individual, so they may

grow into being a true leader for the next generation. This can be achieved by being a

transformational-type leader, one who inspires others. Developed by James MacGregor Burns in

1978, this style of leadership focuses on motivation and enhancing performance by connecting

with an individual’s identity and self-goals, and challenging the individuals to take greater

ownership of their work and efforts (Langston University, 2014). This is an effective means of

leadership that drives productivity by empowering others, the most important action we can

make toward each other in the public safety field. Empowerment is a process. It challenges our

ideas and views about the way things are now and how they can be later (Page & Czuba, 1999)

and challenges us to achieve and succeed. Empowerment strengthens relationships and

encourages us to work as a unified team and employ a collaborative-style approach to

performing patient care and handling confusion on scenes. Collaboration between EMS

providers and all of public safety is essential to team performance and effectiveness on every call

and in every situation. It is also co-dependent on having and expressing the concept of mutual

respect, something we all want to receive and nothing short of it. Research shows that teams

using a collaborative approach have advantages over the ones who do not (Northouse, 2010).


Conclusion

Incivility, more commonly known as lateral violence, is a growing problem in every

workplace and in every career interest. The effects from incivility are as widespread as the

problem itself. With time, effort, and continued education spotlighting the issue, hopefully this

cancer that causes a hostile work environment will be eradicated from EMS. What we need in

our field is for all of us to join together in union for the creation of a powerfully motivating and

constructive environment that fosters good will and good times. We need to not allow or stand

for others who use destructive power and negativity, for it is only associated with promoting a

hostile environment through actions of incivility, intimidation, bullying, etc. Support each other.

Take care and be kind to each other. Be generous and spontaneous to your fellow EMS partners.

Offer instead of demand, especially toward our newest family members, as they are the most

impressionable and will be more likely to demonstrate that same behavior in their future.

We’re all in this together, and should be for the same purpose: patient care.


References

Anderson, A., Brossard, D., Scheufele, D.A., Xenos, M.A., & Ladwig, P. (2013). The “nasty

effect”: Online incivility and risk perceptions of emerging technologies. Journal

of Computer-Mediated Communication, 19(3). doi:10.1111/jcc4.12009

Clay, R. (2013). That’s just rude. American Psychological Association, 44(10). Retrieved from

http://www.apa.org/monitor/2013/11/rude.aspx

Guidroz, A. M., Burnfield-Geimer, J.L., Clark, O., Schwetschenau, H.M., & Jex, S. M. (2010).

The Nursing Incivility Scale: Development and validation of an occupation-

specific measure. Journal of Nursing Measurement, 18(3), 176-200.

doi: 10.1891/1061-3749.18.3.176

Langston University. (2014). Transformational leadership. Retrieved from

http://www.langston.edu/sites/default/files/basic-content-files/

TransformationalLeadership.pdf

Marquis, B., Huston, C. (2012). Leadership roles and management functions in nursing (7th

ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Michigan State University. (2014). Civility/incivility in the college classroom. Retrieved from

http://fod.msu.edu/oir/civilityincivility-college-classroom

National Association of State Boards of Education. (2014). Bullying, harassment, and hazing.

Rhode Island Statewide Bullying Policy, 2011. Retrieved from

http://www.nasbe.org/healthy_schools/hs/bytopics.php?topicid=3131

Northhouse, P. (2010) Leadership theory and practice (5th ed.). Thousand Oaks, CA:

Sage.

http://dx.doi.org/10.1891/1061-3749.18.3.176


Page, N., Czuba, C. (1999). Empowerment: What is it? Journal of Extension, 37(5). Retrieved

from http://www.joe.org/joe/1999october/comm1.php

Smith, P., Philips, T., King, R. (2010). Incivility, the rude stranger in everyday life.

Cambridge, UK: Cambridge University Press. doi: 10.1017/CBO9780511781803

The Christ Hospital Health Network. (2014). Incivility in the workplace. Examiner, A

Physician’s Publication. April/May, 2013. Retrieved from

http://www.thechristhospital.com/?id=2443&sid=1

U.S. Department of Labor. (2014). Hostile work environment harassment. Retrieved from

http://www.dol.gov/oasam/programs/crc/2011-workplace-harassment.htm

http://dx.doi.org/10.1017/CBO9780511781803

Lateral Violence in EMS/ Public Safety

Healthcare

Transcript of Lateral Violence in EMS/ Public Safety