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Lateral Violence Among Nurses

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    Nurse-to-nurse violence, also called Lateral Violence, is a common problem in the medical profession. This issue affects not only the individuals involved but the entire profession. As a result, many areas are impacted. These include co-workers, staffing, cost- containment, and patients. Since the mid-1960s, the term “Nurses eat their young” has been a well-known but dark secret within the nursing profession (Hippeli, 2011).

    Although this problem has been recognized for years, it continues to be an issue that is poisoning the profession with its negative impact (Embree & White, 2010). Lateral Violence Lateral Violence can also be called “bullying, horizontal violence aggression or nurses eating their young” (Sheridan-Leos, 2008). With Lateral Violence, nurses will project their inner frustrations onto those that are less powerful, or have low self-esteem and mainly presents in non-verbal forms (Sheridan-Leos, 2008).

    These frustrations manifest in many different forms such as “non-verbal innuendo, verbal affront, undermining activities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy and broken confidences” (Embree & White, 2010). There are also covert behaviors that cause the most damage and include “unfair assignments, sarcasm, eye-rolling, ignoring, making faces behind someone’s back, refusing to help, sighing, whining, refusing to work with someone, isolation, exclusion, or fabrication” (Embree & White, 2010).

    These behaviors in the workplace have a negative impact on the profession, but most importantly patient safety. The focus of the nurse is placed on the infighting instead of the patient. The Impact of Lateral Violence on Nurses There is nothing positive about this behavior. This type of environment causes many forms of suffering. It is associated with “negative job satisfaction, retention problems, and adverse health effects on employees (Simons & Mawn, 2010). This has a major impact on new nurses. The new nurse is still learning and needs positive role models and support.

    However, this behavior impedes that growth. The stress caused increases absence from work and new nurses wanting to leave the nursing field (Sheridan-Leos, 2008). It has been reported that Lateral Violence has caused about 60% of new graduates to leave their first nursing job within the first 6 months of being hired (Embree & White, 2010). These numbers are high and should be sending a message to higher management personnel that something is wrong. Lateral Violence also affects individuals on an emotional, physical and psychological level.

    Nurses can have symptoms associated with post-traumatic stress disorder (PTSD), fluctuations in weight, high blood pressure, palpitations, gastric problems, depression, and anxiety (Sheridan-Leos, 2008). Lateral Violence can also cause nurses to develop low self-esteem, and have low morale, which can lead to excessive absenteeism from work and want to leave the nursing profession altogether (Sheridan-Leos, 2008). Lateral Violence Affecting Patient Care Patient safety and care is suffering from other stressors from the work environment.

    These include cost-containment, short staffing, and nurses being far too busy to spend adequate time with patients. The addition of Lateral Violence worsens the problem. The lack of communication and teamwork causes a breakdown that affects patient safety. The impaired working relationships among nurses can also cause accidents and poor work performance (Sheridan-Leos, 2008) The rate of medical errors increases due to this communication breakdown and is costly to the organizations (Nydia & Moody, 2010). Lateral Violence Effects on the Organization The organization is also affected by Lateral Violence in the workplace.

    Staff leaving units due to Lateral Violence causes retention and recruiting problems. This leads to staffing issues on the units, which causes more frustration and stress for the nurses who have to take on more responsibilities due to the nursing shortage. The remaining staff will also lack the initiative to want to do their job well (Sheridan-Leos, 2008). Cost to the organization is another problem. Nurses that leave need to be replaced. Recent studies show that the cost to replace these nurses is $22,000 to more than $64,000 for each nurse (Sheridan-Leos, 2008).

    The high cost for replacement has a direct effect on the budget. Cost-containment already has an impact on nurses and the care they provide. Money that has to be spent on new staff makes it harder to obtain needed supplies for the unit and raises for the staff.

    Lateral Violence Concerning Management/Leadership

    Lateral Violence can also occur between staff and higher authority figures. The oppressed-group model is the most cited theory used when describing the origins of Lateral Violence (Sheridan-Leos, 2008).

    It expresses that nurses are a “powerless and oppressed group dominated by others” and occurs when a “more dominant or powerful group exploits or controls a less powerful group” (Sheridan-Leos, 2008). Use of a strict hierarchy, intimidation, abuse of power, authoritative leadership, and broken confidences are examples of Lateral Violence from higher positions (Embree & White, 2010). The loss of trust and feeling insecure with management leaves the recipient feeling powerless in regards to reporting the problem. Therefore, the cycle continues or the nurse leaves. Stopping the Cycle

    Lateral Violence has become such a problem in the healthcare system that in 2008 The Joint Commission set a standard for all hospitals and organizations (Norris, 2010). Facilities “must determine what constitutes inappropriate behavior and develop a process to deal with this behavior” (Norris, 2010). Education opportunities for employees regarding Lateral Violence should become part of training. Nurses should be educated about this problem in nursing school as well. If new nurses know about Lateral Violence before entering the workplace they will be more prepared on ways to handle the situation.

    Attitudes, the best management styles, and conflict resolution should be emphasized in the teachings. Group work and compromising to help lessen the stress need to be utilized by staff as well. Managers and leaders need to be easy to approach, trustworthy, and have a good rapport with their staff. Nurses would be more likely to speak with their superiors about issues of Lateral Violence happening if this type of healthy relationship is in place. Management would need to be educated about what to look for in regards to Lateral Violence to intervene.

    Management should not ignore the problem. When signs of Lateral Violence are noticed, the manager should bring it up in a staff meeting and let the staff talk about the occurrences as well (Sheridan-Leos, 2008). Nurses should know the signs of Lateral Violence and what to do if it occurs. Recognizing abuse, recognizing if it is affecting the nurse, knowing existing policies and procedures for reporting abuse, the nurse knowing their rights, documenting the problem, and seeking help are examples (Brothers, Condon, Cross, Ganske, & Lewis, 2010).

    Management needs to provide a healthy work environment. There are several ways to foster this. According to the American Association of Critical-Care Nurses (AACN), there should be “skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership” (Brothers et al., 2010). Nurses, leaders, and educators should also be educated early on about the legal and ethical aspects of Lateral Violence.

    There are guidelines for nurses provided by the American Nurses Association (ANA) The Code of Ethics for Nurses. The Code states that “all individuals with whom the nurse comes into contact are to be treated with respect for their inherent worth, dignity, and human rights and that nurses take into account the needs and values of all persons in all professional relationships” (Brothers et al., 2010). Secondly, “the nurse is responsible for collaborating with colleagues to provide optimal healthcare for patients” (Brothers et al., 2010).

    A third part of the Code “requires that the nurse recognized, establishes and maintains boundaries that support appropriate limits to relationships and uses them to support professional practice” (Brothers et al., 2010). Therefore, any form of Lateral Violence breaches the Code and all nursing professionals need to know this. Conclusion Lateral Violence is toxic to nursing and the organizations where they work. For years, it has been a problem and remains to be. Sadly, it has become part of the nursing culture and is viewed as a “right of passage” (Sheridan-Leos, 2008). The vicious cycle just keeps going.

    The oppressed nurse directs Lateral Violence to a weaker nurse. The weaker nurse is now a victim and as time moves on will become oppressed. They will then find a weaker nurse and do the same thing. Like a revolving door it just keeps going. New nurses come to the unit and think that is the norm and they become part of the cycle. Retention, recruitment, turnover rates, patient safety, and budget problems are negatively affected by Lateral Violence. The vicious cycle will continue, as it has for years until facilities and personnel learn to recognize Lateral Violence and deal with it.

    Managers and leaders need to be educated on what to look for regarding Lateral Violence and need to be positive role models to foster eliminating the problem. Nurses need to be educated early in their careers about the growing problem and know that it is not acceptable behavior and needs to be reported when it occurs. It is also very important that all nurses know the Code and recognize that Lateral Violence breaches the Code. Conflict resolution, a healthy work environment, the trustworthiness of peers, and victims of Lateral Violence reporting the issue instead of becoming an abuser could help end the cycle of Lateral Violence.


    1. Brothers, D., Condon, E., Cross, B., Ganske K., Lewis, E. (2010). Taming the beast of lateral violence among nurses. Virginia Nurses Today, 18(4), 7-11. Embree J., White A. (2010).
    2. Concept Analysis: Nurse to nurse lateral violence. Nursing Forum, 45(3), 166-173. Hippeli F. (2011, May 20).
    3. Nursing: Does it still eat its young, or have we progressed beyond this? Nursing Forum. Norris T. (2010). Lateral Violence: Is nursing at risk? Tennessee Nurse, 73(2), 1-7. Nydia H., Moody C. (2010, January-February-march).
    4. The Cost of Lateral Violence: All pain and no gain. The South Carolina Nurse, 17(1), Saleem, T. (2011, March 25). Current Nursing. Retrieved March 25, 2011, from Sheridan-Leos N. (2008).
    5. Understanding lateral violence in nursing. Clinical Journal of Oncology Nursing, 12(3), 399-403. Simons S., Mawn B. (2010).
    6. Bullying In the Workplace: A qualitative study of newly licensed registered nurses. American Association of Occupational Health Nurses, 58(7), 305-311.

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