Lateral violence, also known as workplace bullying or horizontal violence has been a prevalent issue in the profession of nursing. Chu & Evans address the problem in their article “Lateral Violence in Nursing”. Lateral violence is a disruptive behavior between employees in the health care system. In nursing, this behavior can be presented as verbal or nonverbal aggression causing emotional, psychological, and even behavioral effects on the victim . Lateral violence can also have a negative effect on patient care quality by jeopardizing patient safety due to lack of teamwork, communication failure, and organizational chaos. Bullying has become endemic in the nursing environment, raising concerns in the past decades. Many people are aware that nurses experience abuse from patients; however, nurse-to-nurse is one of the highest forms of violence, followed by physician-to-nurse. As Chu argues, bullying includes “backstabbing, being ignored, invasion of privacy, physical intimidation, and physical abuse” .
In the culture of nursing, the phrase nurses “eat their young” is pretty common. This means that experienced nurses do not help or provide enough support to the novice nurse in the workplace. The new nurses may perceive this aggressive behavior as a “rite of passage”, and eventually, they adopt it because of the bad experienced they had during the first year. When new nurses don’t receive the support and cooperation from the most experienced nurses, they tend to become stress, and as Chu explains, their level of stress has a tremendous impact on their performance, which usually declines . Dealing with a bully colleague or physician by just accepting their “difficult temper” is not ideal. Novice nurses may prefer to avoid situations or certain nurses because they are afraid of confronting or reporting them. This only increases a room for potential errors because they feel isolated and are afraid of asking questions. Moreover, a stressful and toxic environment not only affects the patient, but also affects the organization as a whole.
Whether bullying is direct or indirect, it can cause a series of psychological effects on the victim. Nurses experiencing prolongued bullying may develop negative mental health problems such as post-traumatic stress disorder. This repeated behavior increases the chance of depression, decreases nurse morale, and gives the nurse a sense of powerlessness. Furthermore, bullying leads to burnout resulting in a high turnover, abseenteism, and lower productivity. Exposure to this negative environment frequently causes nurses to lose their passion towards their career, and even leave the nursing profession. Every time a nurse resigns their position due to bullying, it has a direct impact on the organization by causing a huge amount of cost to the health care system. Chu discusses that, “it costs approximately $92,000 to recruit and orient nurses hired in the medical surgical-units, and $145,000 for nurses in other specialized areas. It is of extreme importance that everyone in the healthcare system becomes aware and learn how to be accountable for the behavior they display.
As discussed earlier, lateral violence causes a detrimental effect in teamwork by promoting an uncivil environment, thus diminishing patient care outcome. To decrease this issue, it is imperative that everybody in the healthcare system addresses it. Whether reporting them or whistleblowing if one notice these kind of hostile behaviors, enforcing policies, making awareness of available resources to break lateral violence. Training the staff and providing educating to the staff is a step further in dealing with the problem. Preventative strategies and promoting a healthy teamwork can make a difference in the workplace environment. way Through programs, nurses will be taught techniques on how to handle undesired situations. Lastly, implementing preceptor programs to enhance the experience for the novice nurses will have a positive impact during their transition from student to nurse.
Analysis of the Issue
The phenomenom of lateral violence has created a negative impact in the work setting. Nursing is the primary occupation at risk when it comes to bullying; this ongoing issue has been prevalent for decades, and it often goes unreported. Incivility can occur in a numerous ways, whether it is subtle as micromanagement or overt behavior such as physical abuse.
Incivility is a barrier when it comes to working in interdisciplinary teams. As the author Anita Finkelman discusses in the book “Professional Nursing Concepts”, incivility can interfere with working in interdisciplinary teams. Some key elements to working in interprofessional teams involve good communication, collaboration, and coordination. If a nurse is afraid to ask questions because she or he is afraid of a physician or another collegue there will be poor communication, which might affect patient care outcome.
Chapter 10 mentions that abuse from physician-to-nurse, and nurse-to-nurse has received attention. However, not only is this epidemic occurring in the workplace, but it has also been found in academic settings. As Finkelman states, “incivility is found among students and faculty, in both student-faculty and student-student interactions” . It is unfortunate that bullying might take roots in the academic setting where the faculty is suppossed to set an example, and students should be learning how to communicate and work in teams effectively.
As noted earlier, incivility, violence, and bullying is affecting nursing and the healthcare system. Lateral violence affects an individual’s dignity and interferes with career development. There has been cases where nurses become so vulnerable and end up taking their lives as a consequence of bullying. In the academic setting, students may even drop out because they can’t cope with the stress caused by the faculty or other students.
Recommendations to End LV
Although bullying or workplace violence is a prevalent problem that nurses face on a daily basis, we must come up with strategies to eliminate this negative culture in the nursing field. From my perspective, as an individual one must start by acknowledging this matter and the effects that may result from it. One must try to be a role model in the profession, avoiding hostile and inappropriate behaviors towards colleagues, coworkers, or even classmates. We need to evaluate ourselves when it comes to incivility, it is not difficult to treat others with civility and kindness. Proper communication and collaboration has to begin in the academic setting. It is also significantly important that we become as educated as possible on the issue and share the knowledge with others about all the available resources to help those who are victims of lateral violence. Learning how to be assertive and being comfortable using the word “I” when talking can also make a difference, bullies often attack those who are not as confident. Lastly, I consider that if someone is being abused at the workplace or school setting, one must take action by whistleblowing or exposing the perpetrator. Lateral violence has to come to an end and us, as individuals can make a difference.
The Joint Commission mandated all healthcare organizations to have a policy against violence in the work environment. It is imperative that these organizations now to enforce their policies and act accordingly when a case of bullying is presented. Other strategies that healthcare organizations can use are: couching and mentoring; communication strategies; and support programs to help new nurses transition into their role. No nurse should carry stress and feel helpless in the profession of nursing.
This article was very informative about one of the issues in the healthcare system that still prevails. Many of us are familiar with nurses being abused by patients; however, it is unfortunate that abuse varies in directions. My reflection from the article is that we must work together to come up with a plan to finally put an end to workplace violence. Nurses devote their lives to saving patients and honoring their dignity and it is completely heartbreaking that they get verbally or physically abused by other peers or coworkers at the workplace. It certainly takes a lot of effort to become a nurse and it is discouraging to think that a person made it that far just to be psychologically or physically abused. We must be aware that violence can take many forms and is it important that we approach the issue immediately and treat it as if it was an epidemic.
To conclude, if the right measurements are not taken, lateral violence will continue to exist in the culture of nursing; sometimes causing irreversible damage such as suicide. If healthcare systems approach the problem with the right mindset, collaboration, communication, and coordination would improve, thus promoting better patient quality outcome. Nursing is a profession of critical thinking, caring, commitment, and compassion; at no given point should bullying or uncivil behavior be encouraged.
