Burnout | Leadership | Stress & Self-Care

Nurses Eat Their Young

  • The truth is many healthcare professionals fail to show kindness or respect to their coworkers.   
  • Bullying, also called horizontal or lateral violence, is defined as non-physical, harmful, or hostile behavior between coworkers. 
  • Lateral violence in nursing not only directly affects the nurse’s mental and emotional health, but further leads to poor job satisfaction, decreased productivity, which in turn means quality of patient care will suffer. 

Catherine Glynn

RN, MSN, CCRN

September 28, 2022
Simmons University

Lateral Violence in Nursing

You would think by the time one becomes a professional, their maturity level would be too high for the playground, but the truth is many healthcare professionals fail to show kindness or respect to their coworkers.   

Bullying, also called horizontal or lateral violence, is defined as non-physical, harmful, or hostile behavior between coworkers.  Multiple studies over the previous decade estimate 44-85% of registered nurses have been the target of lateral violence in nursing with up to 93% reporting having witnessed, in silence, bullying of another coworker.  This workplace bullying is typically found in one of three forms:  verbal assault, threatening, humiliating, or intimidating behaviors, and/or sabotage or interference in work  

The result of bullying – a toxic work environment, low employee morale, high turnover rates and diminished productivity.  The aggressors in lateral violence focus on those without strong support systems, particularly novice nurses.   

Some examples of this type of cloaked violence include the manager who consistently denigrates the performance of a coworker. Gossiping, intentional exclusion of one nurse from group meetings, refusing to help are additional examples of bullying. 

The prevalence of lateral violence is significantly higher in healthcare than any other profession.  While there is not one definitive explanation, there are some relatively interesting phenomena attached to the industry.   

 

lateral violence in nursing bullying

Causes of Lateral Violence in Nursing

For much of the last century and a significant portion of this century, the public has viewed nurses as inferior to physicians.   Physicians are revealed as heroes and adorned in praise, while the nurse and all her skill, attentiveness and industry that directly affects patient outcome is disregarded often.  

While this marginalized treatment is beginning to diminish, old habits die hard.  This leaves many bedside providers feeling undervalued.  These fertile grounds for the buds of frustration have some academics correlating bullying to the outward expression of this frustration.   

Another plausible explanation of lateral violence in nursing is known as the theory of ethical relativism.  This theory contends that the morality of a deed is the result of the culture in which it occurs.  “Nurses have eaten their young” for as long as anyone can remember so it stands to reason that this behavior has become enmeshed in the nursing profession. 

The perpetrators of lateral violence see it as a rite of passage.  The prevailing mentality – this hazing has always taken place so it always should.  These  facilities where lateral violence in nursing is tolerated foster a culture that normalizes bullying making it more difficult to report and nearly impossible to reverse.

Consequences of Lateral Violence in Nursing

The consequences of lateral violence can be somatic, emotional, and even organizational or structural.  The 2017 Workplace Bullying Institute reported that 40% of nurses who experienced lateral violence also reported multiple adverse health conditions including: 

  • Weight gain/loss 
  • Arrhythmias 
  • Difficulty sleeping 
  • Upset stomach/nausea 
  • Headaches 

Many nurses subjected to lateral violence complain of mental challenges associated with their experiences.  Commonly referenced complaints include diminished feeling of well-being, negative self-image, and an unfortunate worldview.  Some signs and symptoms reported include PTSD, anxiety/depression, difficulty falling asleep or staying asleep, and even suicidal ideation or behaviors. 

Lateral violence impacts job satisfaction to the core and influences one’s commitment to the organization.  These factors combine to increase the turnover rate in an industry already desperately short-staffed.  Several studies recently concluded that up to 60% of new hire registered nurses leave their positions within a few months related to lateral violence experienced.  These lost resources represent a significant expenditure in initial training that will not be recouped by the organization. 

Quality of care is another causality of lateral violence in healthcare.  As nurses detach from their jobs, teamwork and collaboration suffer.  The product of this equation is a failure to meet the varied needs of the diverse patient population.  Communication is impaired in the arena of lateral violence and organizations see an increase in medication errors, charting omissions, and administrative errors.  All these influences combine in a manner that can be responsible for a compromise of a patient’s health and well-being, the very reason we are at the bedside.  

lateral violence in nursing consequences

Overcoming Lateral Violence in Nursing

Vanderbilt University Medical Center has asserted that one noteworthy obstacle to the elimination of lateral violence in the healthcare field is addressing the under-reporting of incidents.  Some research suggests that as few as 20% of bullying incidents are reported. 

Reasons given for not reporting a bullying incident include a culture that views workplace violence as “part of the job”, an overall perception the violent events are the norm, discrepancies in definitions of “bullying”, lateral violence, & harassment, concern of being blamed for the incident/fear of retaliation and being unaware of reporting protocol. 

Nurses have a responsibility to themselves and their co-workers to report lateral violence incidents, however leaders have an obligation to develop a safe, healthy, positive work environment and culture.  Leaders must lead by example.  

This lofty goal can be reached by developing a “Zero Tolerance” policy including expectations and consequences, leading through example by role modeling positive behaviors, endorsing conflict management strategies, generating awareness, encouraging team building. 

The Bottom Line

In summary, bullying in nursing is harmful to the targets of violence, their co-workers, and ultimately their patients.  Bullying magnifies the marginalization of nursing and can be responsible for further injury and additional stress.  Exposing nurses to a hostile workplace increases the likelihood of mistakes, errors, and omissions in care delivery.   

Nurses must draw on more than their knowledge base or skill proficiencies to combat bullying.  They must be schooled in leadership and conflict resolution.  They need training in communication and problem solving.  Every nurse and particularly those in leadership should be afforded appropriate training to challenge disruptive behaviors and foster a workspace that is positive, inclusive, and professional.   

Communication, collaboration, respect, trust, and teamwork are the building blocks of a safe, effective work environment.  Leaders that value these building blocks can have a hand in banishing bullying in nursing. 

lateral violence in nursing incidence

Love what you read?
Share our insider knowledge and tips!

Read More

Work-Life Balance For Nurses

Work-Life Balance For Nurses

Stress & Self-Care Work-Life Balance For Nurses Ubderstand the importance of work life balance for nurses to help avoid burnout and protect your personal life. Learn work-life balance skills such as making self-care a priority, managing work time effectively, and...