“I Have to VENT!” Am I Letting off Steam or Fueling Horizontal Violence? by Beth Boynton, RN, MS Revised from 2009 Confident Voices  No matter how many times I discuss the topic of venting, I never end up with a definitive answer as to whether or not it is an appropriate tool for communicating in our all-too-often-stressful clinical environments. I generally discourage venting, however, realizlng that, like many other communication strategies, there are probably exceptions to the rule.   I think if we are mindful of some contraindications regarding venting, we can minimize inappropriate occurrences or some problems that can arise from them. Let’s consider this hypothetical situation involving three staff nurses, Mary, Annie and Jen. Jen is 10 minutes late getting back from lunch, and it is the second time in the past few days that Annie has covered for her. Jen was a few minutes late that time, too.   “Mary, OK if I vent?” asks Annie.  “Sure,” says Mary.  “Where is Jen? She should have been back by now! I am so sick of her taking her sweet time at lunch. I end up taking care of her patients, and I get backed up and don’t have time for my own lunch. UGH, I could just scream. I hate covering for her!”  Just then, Jen steps out of the elevator. Annie gives her a dirty look and a brief report using an angry tone. Annie gives report to Mary and takes a short lunch to try to catch up with her work. Jen shrugs her shoulders and goes about her business.   Here are the concerns I have with this kind of communication:  First, Annie’s venting enabled her, (at least to some extent) to avoid offering direct, and perhaps, constructive feedback to Jen. Annie gets some validation for her feelings and an opportunity to discharge some emotional energy. Jen gets a cold shoulder and little opportunity to learn how her behavior is impacting Annie.  Second, venting has the potential to create alliances. Annie is really irritated at Jen and shares her frustrations with Mary. Annie and Mary now have a secret connection that involves Jen, but Jen doesn’t know it. This gets woven into the relationships of the team and can lead to presumptions, ganging up, or other unhealthy dynamics.  Third, if Mary allows Annie to vent about Jen, then Annie may be off the hook for considering any part that she plays in the conflict. Annie is giving up her full meal break and blaming Jen. This may be part of a deeper issue for Annie to reflect on in terms of asking for help, setting limits, or even some secondary gain related to being a martyr. It may be easier for her to avoid reflecting on her own behavior, but she is not showing any ownership.  Fourth, in this scenario, Jen’s side of the story doesn’t surface. Perhaps her watch is slow, the nurse who oriented her told her that it was acceptable to take a 30-40 minute lunch if she missed her morning break, or she wasn’t paying close attention to the time she left. Granted, Jen could offer an apology and explanation on her return and this, too, would contribute to a more collaborative culture.  Last, the learning opportunities lost by not having a dialogue about this issue may keep the team and organization from identifying and addressing underlying issues, such as staffing, quality and safety. Maybe a longer lunch option would make more sense on this unit, perhaps Annie and/or Mary will hesitate to talk with Jen about another issue, or maybe an opportunity for an improvement in the cafeteria’s workflow will be missed.  These concerns are contributing factors to horizontal violence and keep us in a stuck in a cycle of negativity. This reflects back on individuals, organizations and our profession! They also keep us from collaborating effectively and providing safest care. Giving feedback requires skill and courage and is critical to effective teamwork and collaborative efforts. Maybe there are times when a patient or colleague is driving you crazy and you just need to let off steam, or maybe the organizational culture doesn’t feel safe for giving direct feedback or maybe the level of communication you have is so healthy that the above are not concerns. Still, we may be loosing more than we gain by allowing venting.   What are your thoughts? Feel free to challenge my thinking. Communication is often filled with gray areas! bbbboynton@earthink.net. Beth bethboynton.com More Popular Articles Here

“I Have to VENT!” Am I Letting off Steam or Fueling Horizontal Violence?

by Beth Boynton, RN, MS

Revised from 2009 Confident Voices

No matter how many times I discuss the topic of venting, I never end up with a definitive answer as to whether or not it is an appropriate tool for communicating in our all-too-often-stressful clinical environments. I generally discourage venting, however, realizlng that, like many other communication strategies, there are probably exceptions to the rule.

I think if we are mindful of some contraindications regarding venting, we can minimize inappropriate occurrences or some problems that can arise from them. Let’s consider this hypothetical situation involving three staff nurses, Mary, Annie and Jen. Jen is 10 minutes late getting back from lunch, and it is the second time in the past few days that Annie has covered for her. Jen was a few minutes late that time, too.

“Mary, OK if I vent?” asks Annie.

“Sure,” says Mary.

“Where is Jen? She should have been back by now! I am so sick of her taking her sweet time at lunch. I end up taking care of her patients, and I get backed up and don’t have time for my own lunch. UGH, I could just scream. I hate covering for her!”

Just then, Jen steps out of the elevator. Annie gives her a dirty look and a brief report using an angry tone. Annie gives report to Mary and takes a short lunch to try to catch up with her work. Jen shrugs her shoulders and goes about her business.

Here are the concerns I have with this kind of communication:

First, Annie’s venting enabled her, (at least to some extent) to avoid offering direct, and perhaps, constructive feedback to Jen. Annie gets some validation for her feelings and an opportunity to discharge some emotional energy. Jen gets a cold shoulder and little opportunity to learn how her behavior is impacting Annie.

Second, venting has the potential to create alliances. Annie is really irritated at Jen and shares her frustrations with Mary. Annie and Mary now have a secret connection that involves Jen, but Jen doesn’t know it. This gets woven into the relationships of the team and can lead to presumptions, ganging up, or other unhealthy dynamics.

Third, if Mary allows Annie to vent about Jen, then Annie may be off the hook for considering any part that she plays in the conflict. Annie is giving up her full meal break and blaming Jen. This may be part of a deeper issue for Annie to reflect on in terms of asking for help, setting limits, or even some secondary gain related to being a martyr. It may be easier for her to avoid reflecting on her own behavior, but she is not showing any ownership.

Fourth, in this scenario, Jen’s side of the story doesn’t surface. Perhaps her watch is slow, the nurse who oriented her told her that it was acceptable to take a 30-40 minute lunch if she missed her morning break, or she wasn’t paying close attention to the time she left. Granted, Jen could offer an apology and explanation on her return and this, too, would contribute to a more collaborative culture.

Last, the learning opportunities lost by not having a dialogue about this issue may keep the team and organization from identifying and addressing underlying issues, such as staffing, quality and safety. Maybe a longer lunch option would make more sense on this unit, perhaps Annie and/or Mary will hesitate to talk with Jen about another issue, or maybe an opportunity for an improvement in the cafeteria’s workflow will be missed.

These concerns are contributing factors to horizontal violence and keep us in a stuck in a cycle of negativity. This reflects back on individuals, organizations and our profession! They also keep us from collaborating effectively and providing safest care.

Giving feedback requires skill and courage and is critical to effective teamwork and collaborative efforts. Maybe there are times when a patient or colleague is driving you crazy and you just need to let off steam, or maybe the organizational culture doesn’t feel safe for giving direct feedback or maybe the level of communication you have is so healthy that the above are not concerns. Still, we may be loosing more than we gain by allowing venting.

What are your thoughts? Feel free to challenge my thinking. Communication is often filled with gray areas! bbbboynton@earthink.net.

Beth

bethboynton.com