RN, MSN, CCRN
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% to 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 are 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.
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; and refusing to help.
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.
For much of the last century and a significant portion of this century, the public has viewed nurses as inferior to physicians. Physicians are viewed as heroes and adorned in praise, while the nurse, whose skill and attentiveness directly affects patient outcomes, 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 the theory of ethical relativism, which 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 profession.
The perpetrators of lateral violence see it as a rite of passage. The prevailing mentality is that 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.
The consequences of lateral violence can be somatic, emotional, and even organizational or structural. In 2017, Workplace Bullying Institute reported that 40% of nurses who experienced lateral violence also reported multiple adverse health conditions including:
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 have concluded that up to 60% of new hire registered nurses leave their positions within a few months due to experiencing lateral violence. 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 needs of a 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. Combined, this can lead to compromising a patient’s health and well-being, the very reason we are at the bedside.
Vanderbilt University Medical Center has said one noteworthy obstacle to eliminating lateral violence in healthcare 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:
Nurses have a responsibility to themselves and their co-workers to report lateral violence incidents, but leaders also 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,and encouraging team building.
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.
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