Break the Spell and End Lateral Violence in Nursing

By NT Contributor on Thu, Feb 07, 2013

nurse bullyingA nurse rolls her eyes at a co-worker as she picks up the assignment sheet that was created by a younger charge nurse. An ICU nurse pretends not to see her co-worker is drowning and ignores her request for help saying she is ‘too busy’. A newly hired RN who was previously a scrub tech finds she is now shunned by both groups. Is this just life as a nurse or a nurse’s right of passage? Or is it something more insidious? These behaviors go by several names: lateral or horizontal violence, incivility, nurse-to-nurse bullying, sabotage - “nurses eating their young.”

 

In general, bullying in the United States is a term used to describe uncivil behavior from someone who has power over you – vertical aggression. Rude behaviors from peers are referred to as horizontal or lateral hostility and are defined as: “A consistent pattern of behavior designed to control, diminish or devalue a peer (or group) which creates a risk to health or safety” (Farrell, 2005).

 

Some specific examples are:

  • Overt. Name calling, bickering, fault finding, criticism, intimidation, gossip, shouting, blaming, put-downs, raised eye brows; and
     
  • Covert. Unfair assignments, refusing to help someone, ignoring, making faces behind someone’s back, refusing to only work with certain people – or not work with others, whining, sabotage, exclusion, fabrication.

Estimates of lateral violence in the nursing workplace ranges from 46–100 percent (Stanley et al. 2007). Nursing literature abounds with examples of prevalence.

 

In one study, one-third of nurses perceived emotional abuse during their last five shifts worked (Roche). In another survey, 30 percent of respondents (n= 2,100) said disruptive behavior happened weekly, and 25 percent said monthly (Advisory.com).

 

A study of emergency room nurses found that 27.3 percent had experienced workplace bullying in the last six months with many staff bullied by their managers, charge nurses or directors as well as physicians and peers (Johnson, Rea). Bullying behaviors are like gangrene – when tolerated from a few physicians or nurses with strong personalities, the behaviors spread and infect the entire team – and eventually, the patient.

 

Lateral violence needs to stop. Bullying behaviors create a toxic work environment which not only harms nurses, but also our patients. Experts agree nursing communication breakdowns and lack of teamwork are a root cause of errors. If nurses are afraid to speak up because they are intimidated by fellow nurses and physicians, patients can be harmed. Research also shows that simply witnessing rude behavior "significantly impacts our ability to perform cognitive tasks" (Porath). From a very ethical perspective, tolerating bullying behaviors is wrong and violates our basic oath to keep patients safe.

 

But maybe we need another oath? Maybe it’s time we promise to keep each other safe; to nurture, support and protect each other because we understand and recognize how vulnerable we all are and the critical role we play in health care.

 

In April, after accidentally drawing up the lateral violence in nursingwrong medication which resulted in a child’s death, an experienced nurse took her own life. Her suicide is a result of our failure as a system, and as a profession, to provide a safe harbor for the delivery of patient care. Who knows what else was going on in her mind, or the details of the situation? All I know is that it could just as easily have been me who made the error.

 

Where do we start to stop nurse bullying? A Chinese magician once said, “If you want to take power away from anything, call it by its name”. The overt and covert behaviors listed above are not ‘normal.’ They are examples of lateral violence that cause serious and long lasting damage to our patients and to each other. They are wrong. Work your magic - say so!

 

References

 

Farrell, G. (2005). From tall poppies to squashed weeds: why don’t nurses pull together more? Journal of Advanced Nursing 35 (1): 26-33.

 

Johnson, S., Rea, R. (2009) Workplace bullying: concerns for nurse leaders. Journal of Nursing Administration Vol. 39, Nov. 2, pp. 84-90.

 

Pearson, C., Porath, C. (2009) The cost of bad behavior. Penguin Books

Roche, M. et al. (2009). Violence toward nurses, the work environment, and patient outcomes. Journal of Nursing Scholarship, Vol. 42:1, 13-22.

 

Stanley K., Martin M., Michel Y., Welton M. & Nemeth S. (2007) Examining lateral violence in the nursing workplace. Issues in Mental Health Nursing 28, 1247–1265.

 

Have you seen or experienced nurse bullying in the workplace? What was done about it?

Click here to join this contributor’s group page to connect with them and stay up to date with their latest articles, upcoming events, etc.



32 COMMENTS

Anonymous 1 year ago


I agree, bulling at the work place does need to stop. Some of the things mentioned about lateral violence I did not even think were bulling. I just experienced bulling at work last summer. I had to stand up for myself to stop it. It was not just me that said something to the bully, 3 other nurses did too. Now the bully treats me with respect as far as I know. How do we stop bulling from happening? It would be nice if they had a class on lateral violence, so we all know what it is.



Anonymous 2 years ago


I think change starts very small. It is scary to step out and be a voice especially when you are already a victim. What if we changed the culture? What if we refused to participate? What if we refused to tolerate? i.e. When a bullying nurse looks to you for a snicker, say "That's not cool." What if we came side by side those who are being bullied. Change won't happen overnight, but workplace culture can be changed. I've seen it done. Briana C



Anonymous 2 years ago
Reading all of your comments has been insightful. I'm a 29 yr nurse who has been a nursing supervisor for the past 5 yrs. I'm thankful that keeping an attitude of focusing on the patients helped me survive any criticism of others. Striving to learn more & be better also always helped.
As a supervisor, I try to be alert to negative vibs & comments; to keep us all focused on our mission; to include staff in decisions; to make sure the work load is balanced & that we are helping each other (self included); & that staffing is adequate to maintain quality outcomes. This week, however, I'm witnessing the eating of an elder (her retirement got delayed). It was her quietness that caught my attention. I will work with her manager to address the problem because I don't want her to retire on a negative note. I've already made a comment of awareness within the hearing of some of her co-workers, & have faith that they can help turn it around. We have so many compassionate nurses, & we must strive to preserve it!

Anonymous 2 years ago
I agree that lateral violence is a growing problem in the nursing workplace. This article does a good job of defining it and shining a spotlight on it. However, where are the authour's solutions? We know it's there, what can we do about it?

Anonymous 3 years ago
who would think ...the doctors at the MHMR I worked at enjoyed the entertainment of the bullier bulling. sad. I finally quit, should have sued.

Anonymous 3 years ago
Did my job, as I should. I was told by an aid "leave it alone. It is not worth it." She was right! I got the ax. The co worker not doing his job stayed! Got fired. Managment is a big problem! Who is left to report it to?

Anonymous 3 years ago
I am considering getting out of nursing as I have been bullied numerous times by peers as well as those I supervised. Then I was basically called a liar by the DON after reporting it at one place. The problem is that many nurses are raising children (many alone)and need their jobs. I ended up leaving that position, as it only made matters worse. (people yelling threats down the hallway, cursing out loud (directed toward me)in front of other staff and patients).

Anonymous 3 years ago
As a psychiatric liaison nurse who has worked with med-surg nurses and their managers, I am familiar with the issues of "shark" nurses and managers who are too timid to articulate and enforce a professional standard of interpersonal behavior on their units. "Shark" nurses need to be called out on their behavior by everyone who witnesses it. The quality of your workplace environment has a major influence on your overall mental and physical health. It is worth fighting for a supportive, nurturing workplace. Remember, power is what you take!!

Anonymous 3 years ago
I believe it's getting much worse than it was when I started. A lot of it is the fact that nurses no longer have ANY power in management, because they see out their peers. It's all about bean counters and it's way too stressful to stand. It used to be fun to go to work.. I left and went into homecare. At least there I can work alone and just see patients.

Anonymous 3 years ago
I decided tto change careersto become a nurse to help people. I started off as a new nurse on a med/surg floor. The bullying behavior of both nurses and MD's was horrible, yet totally tolerated. Speak up? Really? Management was part of the problem and there was no one to go to. No wonder so many nurses leave the profession. I will probably return to my first career which was much more rewarding and people friendly. And, both experienced and new nurses propagate the bullying.

Anonymous 3 years ago
Bullying exists everywhere. I left nursing for 4 years and thought that the stress of being picked on would be gone,however ours is not a polite society. I have been a healthcare worker since the early 70's. I think that prople are not taught kindness and patience, and if co-workers are bullying the staff, they are probably, also, mistreating tne medical consumer (patients.)

Anonymous 3 years ago
Nurses can be as evil to their co-workers as they can their patients. The problem with lateral bulling can be stopped by showing your strength.Bullies and haters are in all professions.You must demonstrate a determination to carry on inspite of the obstacles before you.Do not allow sabotage of your career to satisfy another.You will only meet this same personality on your next job. Stand up and be strong !

Anonymous 3 years ago
I find it gets pretty bad at report time...the most criticism, avoiding eye contact, arguing...bickering after I have taken the train for over 1 hour to get to the patients at my job for the 12 hour night shift...then taking the train back home in the morning...no body is running out me though...I stand my ground....I'll see to it..the bully's will go....and I will be staying...this article goes to my boss tomorrow morning...

Anonymous 3 years ago
I was a new nurse and basically lynched. When I spoke to my supervisor, I was accused of calling the other staffers liars. I will never go back to floor nursing because of this

Anonymous 3 years ago
I worked with an assistant that was the bullier in my unit. It was like working with a bad behaved child all day. I finally retired and will not return to hospital nursing! My manager knew how awful and disrespectful this person was and didn't do anything about her. I was a practicing nurse for 30 years before this person caused me to have enough and leave it all behind.

Anonymous 3 years ago
If the nursing profession concentrated their energies on superb patient care there would be no lateral nurse bashing. unfortunately the newest nurses don't see it that way.

Anonymous 3 years ago
Although I'm not a new nurse, I decided to change to L&D. One of the OBs screamed at me all of the time. When I finally complained to managment they talked to him. Now the other nurses tell me I should never have complained. I should have just "sucked it up" until he got bored and stoppedl

Anonymous 3 years ago
Bullying happened so rampantly at the VA Hosp., Kaiser Hosp., and in private work places, it is the main reason I left those places: administration tacitly supported it.
Having grown up bullied in home life, I lacked words to even describe it, much less identify it.
If we fail to stop bullying that affects early childhood development, it grows into larger issues later. We live in an extremely bully-prone culture;
What's wrong with our culture, that we have spawned such a high rate of bullying in the population? It is not just in nursing!

Anonymous 3 years ago
Report the problem? Vow to support each other. Wow, that's what was needed: a fresh perspective. Look, there are all kinds of reasons nurses can get fired, from chronic lateness to medical errors to you name it.l And if you want to keep your job, you don't do those things, right? There are also all kinds of reasons nurses can lose their licenses - & we strive not to do those things. My question: if the nursing higher ups can penalize you for various infractions as I've listed, why do they allow, nurture, and reward bullying behavior? I have some theories, but the question is enough. In the meantime, I too am planning my escape route out of nursing.

Anonymous 3 years ago
I'm in a typical situation after suffering an injury in the workplace 2 years ago returning to work last Sept. and now with diminished health and ongoing pain have to deal with bitter staff in who complain I am betlittling and condescending and they don't like to work with me...

Anonymous 3 years ago
a new trend I am seeing is younger in years of practice nurses throwing more experienced nurses under the bus

Anonymous 3 years ago
Great article that popped into my mailbox today. I work at my new job, in a brand new 400 million dollar hospital. Myself, a seasoned year nurse along with great co-workers have been called "the creme de la creme" picked to open the new hospital. We are saddened and disappointed that the management finds it their strategy to ignore our input on ideas for flow and growth by maintaining an attitude disempowering and disregarding our professional input. For that, your "creme de la creme staff staff" will dwindle away and your hospital will be no better than the rest who subscribe to lateral passive-aggressive moves to be the best.

Anonymous 3 years ago
I've just been fired for the same thing. I'm actually done with nursing. You should not be obsessed with work, its not healthy.

Anonymous 3 years ago
i;m tired of being thrown under the bus but younger nurses who are threatened by my experience

Anonymous 3 years ago
I solved the problem. I quit nursing! There was no other way after seeing and feeling abuse in many settings across the country as a travel nurse. It is not just in the hospital, it is everywhere and many of us have no recourse especially when you have a contract. So if there is a shortage I hope you all have to work every second so you cannot have time to slice others.

Anonymous 3 years ago
This behavior happens on my unit on a daily basis. The younger nurses are always put in charge and always take the lighter assignments. It is not unusual to see these nurses walking around texting, being on facebook, or just chit chatting at the desk while the rest of us are working ourt butts off. I have often complained about an assignment that needed to be broken up but to no avail. Management is well aware of what goes on but chooses to ignore.

Anonymous 3 years ago
As usual, and article that states a problem, however offers no resolution. I work "agency" therefore am on the front lines at every assignment for this. Given the hardest clients, even if it is every other room on the whole unit. You don't dare question the assignment, you just have to do the best you can to keep your patients safe running up and down the unit all night, while your co workers sit at the desk and enjoy a nice chat, or sit and text all shift. If you dare say one word, you are labeled a troublemaker and not allowed to work again. Sad, I started 20+ years ago with a place that was ALL about helping each other. I am sorry I ever moved to a large city and tried to help where there was such a need. I guess I understand now why the need exists. Almost sick of it all.

Anonymous 3 years ago
I recently left a job and have vowed not to go back in
a hospital setting because of the bullying. I am not a new nurse,and I believe the toxicity in most hospitals is getting worse. The last situation was probably the most damaging to all including the ones doing the bullying.

Anonymous 3 years ago

This is a common problem in our field. The "older, more experienced" nurses complain and don't help the "new" nurses, and put obstacles in the way, or demean the newer nurses until they break. It may not be this way everywhere, but it has been where I have worked. It is very difficult to ignore the behavior, but management doesn't want to hear about it, or just say, "stay away from nurse so and so"


Anonymous 3 years ago
lorem ipsum

Anonymous 3 years ago
I sometimes believe we enter the profession to heal our own wounds; and when faced with obsticals- attact those who are a challange for use- as irrelavent and ineffectual as it is- we go into this profession to heal ourselves- and it isn't fun....

Anonymous 3 years ago
If everyone takes a moment to acknowledge that yes, this indeed is a problem..but not just "their" problem... ask yourself, have I been a part of the issue? If you think you are not to blame because you haven't bullied anyone, think again. Have you witnessed it and just let it happen because it isn't happening to you? Let's do the right thing for all of us. Don't just stand by the sidelines--if you see someone needing help or not getting the support from another peer. Be the help that the person needs. I have been that person-- the new traveler who was picked on because I was just new...I was resented because everyone thought I made more money working as a traveler. Well, maybe I did..a little, but it was my choice to leave my home town and think of this career as an adventure. I didn't have the luxury of knowing everyone that small town...that unit, and I didn't feel welcomed. I promised myself that I would not be like that to anyone. As a traveler, I was there to help that unit, to do my job, to give patient care--yes, being rude to travelers is also being a bully.