Lateral violence in nursing refers to hostile, aggressive, or harmful behavior by one nurse toward another within the same level of authority. It can be verbal, nonverbal, covert, or overt, and often manifests as bullying, sabotage, exclusion, or persistent criticism.
Maybe you heard of lateral violence but wonder, “What is lateral violence in nursing?” In this article, I will share information about lateral violence in nursing with you, including giving you examples of it and insight on how to deal with it. Additionally, you will learn about consequences that may occur because of lateral violence among nurses. While not every nurse commits acts of lateral violence, we all can work together to help reduce or prevent its occurrence and create safer work environments that promote better patient, employee, and organizational outcomes.
Also known as horizontal violence, workplace bullying, or nurse-to-nurse aggression, lateral violence refers to behaviors that harm or intimidate colleagues, creating a hostile work environment.
Types:
- Verbal abuse (e.g., yelling, belittling)
- Nonverbal behaviors (e.g., eye-rolling, exclusion)
- Physical intimidation (e.g., standing too close)
- Psychological manipulation (e.g., gossip, sabotage)
- Cyberbullying (e.g., online harassment)
Lateral Violence vs Bullying: What’s the Difference?
According to the National Center Against Bullying, bullying is defined as “an ongoing and deliberate misuse of power in relationships through repeated verbal, physical, or social behavior that intends to cause physical, social, or psychological harm.” The difference between bullying and lateral violence is that bullying is often repeated behavior or has the potential to be repeated. Lateral violence, on the other hand, may be an isolated event or sporadic behavior.
How Prevalent is Lateral Violence in the Field of Nursing?
Lateral violence in nursing is a serious and prevalent problem. An article published by the National Library of Medicine suggests that, according to some studies, 66.9% of nurses report having experienced some type of lateral violence in their careers. Identifying behaviors that constitute lateral violence is only one step in reducing and preventing its occurrence. It is up to each of us to be proactive about the way we treat one another and work to create awareness of inappropriate behaviours so we can promote better teams and outcomes for the clients we serve, our peers, ourselves, and our profession.
Theories Applied to Bring out the Goodness of Nurses
1.Nurse as Wounded Healer
In one study, researchers applied the Theory of the Nurse as Wounded Healer to lateral violence in nursing. The theory, developed by Marion Conti O’Hare, states that individuals are drawn to specific professions, such as nursing, by a desire to relieve individual suffering after experiencing or witnessing traumatic events in their own lives. When the individual’s coping with trauma is effective, the pain is transformed into healing.
2.High Stress Work
A survey sent to participants in Britain’s health care system revealed nurses scored 1.5 times higher in stress levels than the average for soldiers after war zone trauma and twice as high as individuals working in emergency services. It was thought that nurses had higher stress scores because their line of work did not have the same degree of stress recognition as other stressful occupations, therefore the support for nurses to process their emotional reactions to their work was considered an abnormal response. What this translated to among participants in the study was low morale and high burnout rates in the workplace
3.An Oppressed Group
A study suggested nurses working in hospital settings are an oppressed group, influenced by medical hierarchies in which nurses lack power and control. This can lead to a high level of vulnerability among nurses to workplace aggression as well as a pervasive individual level of negative self-concept. Oppressed group behaviors may occur when the powerless are fearful and silent when encountering authority, resulting in anger and aggression toward members of one’s own group. Low levels of social support can exacerbate this internal emotional abuse, leading to further low self-esteem and social isolation.
4.What You Can Do
Calling out workplace violence when it occurs is important in order to help resolve inappropriate and potentially harmful behaviors. Having an honest discussion with a colleague about aggressive behavior can help bring awareness to the issue while also communicating that this type of behavior will not be tolerated at work.
What are the implications of lateral violence in nursing?
Lateral violence in nursing has serious implications, both for victims and the organizations for which they work. These implications can be physical, psychological, or structural, and include the following:
1.Compromised physical health
According to a recent study, individuals who experienced bullying in the workplace were 59% more likely to suffer adverse health effects as a result. Cardiovascular disease, weight gain or loss, cardiac arrhythmias, musculoskeletal problems, insomnia, gastrointestinal disorders, and headaches can lead to employee absences that leave healthcare organizations short-staffed.
2.Mental health challenges
Research has also shown that lateral violence can also lead to poor mental health among victims. Symptoms of lateral violence include a decreased sense of well-being, negative self-image, and depression. Victims also report symptoms and effects consistent with post-traumatic stress disorder, including anxiety, insomnia, suicidal behaviors, and substance use disorders.
3.High turnover
Bullying significantly reduces job satisfaction and one’s sense of commitment to their employer. It also leads to a high rate of turnover within an organization. According to one recent study, over 30% of nurses strongly considered leaving their jobs due to lateral violence.
Even if you don’t lose nurses, lateral violence can still take a financial toll. According to one study, workplace turnover paired with reduced productivity and lost time as a result of lateral violence among nurses costs the healthcare industry more than $4 billion each year.
Reduced quality of care
Nurses are more likely to detach from their jobs when they experience lateral violence and other workplace stressors. This detachment directly impacts their ability to address patients’ diverse needs and fully perform their jobs.
Lateral violence also hinders productive working relationships by disrupting teamwork and communication between nurses. Without a strong sense of collaboration, organizations may experience an increase in medical errors and administrative mistakes that can compromise patients’ health and well-being.
How should nurses handle lateral violence?
To appropriately address lateral violence, a nurse must learn how to identify it and then know what do.
1 – Identify the behaviour’s
While the exact nature of lateral violence can vary between individuals and organizations, common behaviors include:
- Using power to manipulate or control others
- Intentionally withholding information to get a coworker in trouble
- Humiliating, mocking, or publicly shaming coworkers
- Intimidating coworkers through verbal threats of disciplinary action or violence
- Refusing to offer help or guidance when needed
- Yelling at a coworker or harshly demanding that they perform tasks
- Eye-rolling or refusing to look at a coworker when speaking to them
- Gossiping about coworkers
- Excluding coworkers and making sarcastic or belittling comments
2 – Use available resources
Dealing with lateral violence is challenging, especially in environments where such behavior is an accepted part of the culture. It’s up to organizations to address lateral violence and create a culture in which nurses feel comfortable reporting instances of bullying. If a nurse identifies even one of the above behaviors directed at themselves or others, administrators should encourage them to:
- Immediately call for help.
- Tell the perpetrator that their behavior is unacceptable — silence implies acceptance.
- Clearly communicate how you would like to be treated.
- Carefully document every detail of each instance of bullying.
- Follow the chain of command to register a complaint internally and then with a third-party organization, such as the Occupational Safety and Health Administration.
- Offer support and assistance to any colleagues who are experiencing lateral violence.
How can healthcare organizations create a safe workplace?
Supporting nurses when they report abuse is important. But leaders must take their efforts one step further to create a positive, healthy workplace culture that prevents lateral violence from occurring in the first place. To do this, organizations should:
1.Develop a zero-tolerance policy
Zero-tolerance policies for workplace hostility outline clear expectations for employee behavior. They also clearly outline the consequences for those who fail to meet these expectations. Having strong zero-tolerance policies in place also empowers employees to speak up without fear of retribution.
2.Lead by example
Managers and other leaders must commit to enforcing zero-tolerance policies and modeling positive workplace behavior. When leaders model positive behaviors, they signal to everyone that the organization does not tolerate lateral violence.
3.Assess the root cause
Organizations can use behavioral and situational assessments to help determine the root cause of violence in the workplace. This data can helps leaders create a more comprehensive framework for addressing lateral violence where it starts — such as within specific teams, departments, or roles.
4.Provide education
Effectively confronting lateral violence takes courage and tact. By providing conflict resolution training, healthcare leaders empower their nurses with the characteristics and skills they need to address and manage workplace violence.
5.Raise awareness
It’s important for all nurses (and especially new ones) to have a firm grasp of the signs of lateral violence. Training materials can help nurses better idenitfy unacceptable behavior and encourage them to report cases of abuse.
6.Promote team building
Nurses who feel that they are part of a strong team are less likely to engage in lateral violence. Develop strong nurse leaders, emphasize the importance of support networks and create time and space for team building. By doing so, organizations can help foster positive interpersonal relations among their staff.
REFERENCES
- Spector PE, Zhou ZE, Che XX. Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. Int J Nurs Stud. 2014;51(1):72–84. [PubMed]
- Christie, W., Jones, S., (December 9, 2013) “Lateral Violence in Nursing and the Theory of the Nurse as Wounded Healer” OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 1.
- Roberts, S. (2015). Lateral Violence in Nursing: A Review of the Past Three Decades. Nursing Science Quarterly, 28(1), 36–41. https://doi.org/10.1177/0894318414558614
- Lateral Violence in NursingBlair, Patricia L.Journal of Emergency Nursing, Volume 39, Issue 5, e75 – e78
- Vidal-Alves MJ, Pina D, Puente-López E, Luna-Maldonado A, Luna Ruiz-Cabello A, Magalhães T, Pina-López Y, Ruiz-Hernández JA, Jarreta BM. Tough Love Lessons: Lateral Violence among Hospital Nurses. Int J Environ Res Public Health. 2021 Aug 31;18(17):9183. https://pmc.ncbi.nlm.nih.gov/articles/PMC8431196/
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