The Toll of Lateral Violence & How to Handle It
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“Nurses Eat Their Young”,
An unfortunate, yet well understood statement that every new grad nurse and nursing student is familiar with.
I remember as a nursing student wanting to be invisible during my clinical rotations.
As a new grad nurse I would sneak off and cry in the bathroom, and pray no one would hear me.
Even as a more seasoned nurse there were many days I wondered if I made the wrong decision going into this field.
It wasn’t the 14 hour shifts, the exhaustion from working overnight or the disappointment of working on Christmas and Christmas Eve. It wasn’t the compiling emotional toll or compassion fatigue from seeing constant illness and sadness either.
It was other nurses.
The dirty look after you give report.
A demeaning comment after you ask a question.
Gossip in the breakroom.
An eye roll from a senior nurse.
Giving you an unfair assignment and refusing to help.
Unit cliques, scapegoating, intimidation, shaming, blaming, withholding information, hostility, sabotage, passive aggressive, rude, judgmental, sarcastic or disrespectful actions or comments.
It can leave you feeling anything from undermined, belittled or inadequate to straight-up humiliated.
This is not just nurses eating their young, it’s lateral violence (LV).
Lateral Violence
That’s right, there is an actual term for the bullying experienced in nursing culture, and it is well-documented in the literature in America and around the world. Lateral violence, AKA workplace aggression, bullying or peer incivility is a systemic, complex and pervasive problem .
93% of nurses report witnessing lateral violence in the workplace.
85% of nurses had experienced it, but 90% had difficulty confronting the perpetrator.
40% of nurses reported definite intent to leave their current position, or were considering leaving because of it.
Over a 6-month period, 88% of nursing students experienced bullying in the clinical setting.
So how is it that the most trusted profession, the most honest and ethical, has this devastating, hidden culture of bullying?
Explained
Theorists since the 1970s have believed that members of oppressed groups (nurses) feel powerless, inferior and devalued in a culture where power resides in a more dominant group (providers). Unable to take frustrations out on the dominant group, they develop disdain for members of their own group. This powerlessness is the foundation in a cycle that is perpetuated by aggression and anger towards each other. Over generations, it has affected nearly every specialty, academic setting and organizational level of nursing (ANA, 2015).
On top of that, nurses struggle with incredible physical, emotional and mentally exhaustive work conditions. There is a nursing shortage, hight patient-to-nurse ratios and unfair pay. Plus personal lives, relationships and families at home to balance…it’s not an excuse, but this stress definitely doesn’t help the situation.
So what?
Unless you have experienced it yourself, you may think this sounds a little dramatic. An eye roll here and there...really? It can’t be that bad...right?
Wrong.
LV has serious implications on the mental and emotional health of nurses and at the very worst, threatens patient’s safety. LV has been associated with:
nurse burnout
psychosomatic symptoms such as headaches, frequent illness, depression, PTSD & anxiety
poor quality of life
impaired relationships
fear of going to work/ absenteeism
decreased quality of care & collaboration
reduced productivity
dissatisfied patients
(ciocco, 2017)
This has become such an issue that in 2015 the American Nurses Association (ANA) convened a Professional Issues Panel on Incivility, Bullying, and Workplace Violence. In their released statement, they affirmed a zero tolerance policy for any kind of this violence.
The Joint Commission also issued a statement that bullying has no place in healthcare in 2016, and implemented a standard requiring accredited hospitals to define and address all forms of disruptive behavior in the workplace.
On a bigger scale, nurse’s disruptive and inappropriate behaviors towards our own keeps us from developing a sense of unity and gaining power in the ever so hierarchical structure of the healthcare system.
So WHAT TO DO??
Confront It.
As much as you don’t want to, you have to confront the perpetrator. Address it as soon as you can, in a firm but not accusatory manner. Here’s what I mean:
First, take a moment. Do not dismiss your feelings or blame yourself for what happened. Pause and take a deep breath, ten minutes or whatever you need to compose yourself. As hurt as you may feel, responding emotionally will only make you look unprofessional and make things worse.
Be the Bigger Person. When you have calmed down and have your thoughts together, I want you to come from a place of compassion. Why may they be acting like this? Are they overwhelmed with patients? Maybe they had an argument with their spouse this morning or their child is sick at home. Perhaps they were a victim of LV earlier that shift and now they are just taking it out on you. By starting from a place of empathy, you are setting the tone for a more constructive conversation.
Communicate your boundaries. You need to be clear about what behavior is and is not acceptable, and that you will not tolerate it.
Set goals. Be specific about your needs and expectations with this co-worker moving forward. Tell them how you would like to be treated in the future, and what you hope for the rest of the staff moving forward.
short, sweet(Ish) and to the point
Stand up Against It
If you witness LV, keep in mind that silence is complicity. All nurses must stand up against this behavior and advocate for a culture of respect, compassion and unity. If you see LV in any shape or form, diffuse the situation and appropriately stand-up for the nurse that needs your voice. Let the person know that their actions do not reflect the values of the unit culture or our profession.
Talk to Your Manager
Per recommendations from the ANA, your managers need to adopt a zero-tolerance policy in the workplace. Express your concerns and experiences. They should also be responsible for cultivating an environment where nurses feel safe and comfortable reporting acts LV and bullying. They should take these reports seriously and respond timely.
Keep Record
Gather all details of these incidences with dates, times, witnesses and specifics. Bringing bullying to HR may seem dramatic but it’s not. That is what HR is there for, so include them early and often.
For Nursing Student:
You especially will feel hesitant to speak up but I absolutely encourage you to practice doing so now. At the very least, tell your clinical instructor, preceptor or take it up the faculty chain.
For New Grads:
Look for hospitals with New Grad Nurse Residency Programs that may teach you further skills necessary to deal with LV and prepare you to confront these issues.
If your Manager Doesn’t Listen
Direct them to the ANA’s zero tolerance policy and remind them they are expected to hold nurses accountable to the ANA’s Code of Ethics for Nurses. You can also direct them to the resources at the end of this post.
Know Your Limits
If you feel like you have exhausted all options, consider if this position is worth it. I have known plenty of nurses that have left their jobs for more positive work environments. There is no room for this behavior in nursing, and if it’s not being addressed, chances are that won’t change any time soon. Empower yourself by finding a new job that respects your boundaries and provides the kindness, dignity and respect you deserve.
If Needed,
seek behavioral health services or therapy. Workplace bullying is not a joke. It can seriously impact your long term mental, physical and emotional health.
Educate Yourself & Take Collective Action
While managers can create and enforce policies, real change can start with you. You can educate yourself and create a culture that is safe and supportive for nurses. Use this as an opportunity to join a unit committee or start a quality project to address bullying.
More than anything, remember that lateral violence is not a right of passage. It is not normal. For any nursing student, new grad or seasoned nurse, it is 100% unacceptable and it needs to stop.
I hope this gives you the confidence to step up for yourself in the workplace, but more so I hope this reminds you that you are not alone. Your mental, emotional and physical health is just at important as the patients you care for. Continue to advocate for yourself, and reach out if you have any specific questions, thoughts or ideas.
Drop me a line in the comments or find me on social media, I would love to hear from you!
Resources
Nurses Eat Their Young: Inside The Nurse Bullying Crisis by Olivia Thompson
ANA Podcast Series on Bullying
Nurses Inspire Nurses who provide bimonthly classes teaching you all the things you didn’t learn in nursing school-confidence, handling emotions and the workplace environment. They also have the cutests NIN Apparel!
ANA on Violence, Incivility and Bullying
Joint Commission Workplace Violence Resources
Mental Health Resources
SAMHSA Treatment Referral Helpline: 1-877-SAMHSA7 (1-877-726-4727). Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8 a.m. to 8 p.m. EST.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
References
Bartholomew, K. (2006). Ending Nurse to Nurse Hostility: Why Nurses eat their young and each other. Marblehead, MA: CiHCPro, Inc.
Budin, W.C., Brewer, C.S., Chao, Y., & Kovner, C. (2013). Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of Nursing Scholarship, 45(3), 308-316.
Clarke CM, Kane DJ, Rajacich DL, Lafreniere KD. Bullying in undergraduate clinical nursingeducation. J Nurs Educ. 2018;51(5):269–276.
Ciocco, Maggie MS RN BC. (2017). Combating Bulling, Incivility and Workplace Violence: What Nurses Need to Know in a Nutshell
Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An Intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257- 262.ed
Jacobs, D., & Kyzer, S. (2010). Upstate AHEC lateral violence among nurses project. South Carolina Nurse, 17(1), 1.
McKenna, B., Smith, N., Poole, S., & Coverdale, J. (2003). Horizontal violence: Experiences of Registered Nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96.
Laschinger HK, Wong CA, Cummings GG, Grau AL. Resonant leadership and workplace empowerment: the value of positive organizational cultures in reducing workplace incivility. Nurs Econ. 2014;32(1):5–18.
Read, E., & Laschinger, H. K. S. (2013). Correlates of new gradu- ate nurses’ experiences of workplace maltreatment. Journal of Nursing Administration, 43(4), 221-228.
Rowell P. Being a ‘‘target’’ at work: or William Tell and how the apple felt. JONA. 2005;35(9):377-379. 1995;4:5-9.
Stanley, K., Martin, M., Michel, Y., Welton, M., & Nemeth, S. (2007). Examining lateral violence in the Nursing workplace. Issues in Mental Health Nursing, 28(11), 1247-1265.
Thomas S. Horizontal hostility nurses against themselves: how to resolve this threat to retention. Adv J Nurs. 2003; 103(10): 87-88,90-91.
Wilson, B.L., Diedrich, A., Phelps, C.L, & Choi, M. (2011). Bullies at work: The impact of horizontal hostility in the hospital setting and
