Lateral Violence in Nursing: How to Deal with Bullying in the Workplace

Lateral Violence in Nursing By Victoria Bey

Lateral violence in nursing, which may involve incivility, bullying or physical aggression, is an unfortunate reality amongst colleagues. 

But it’s a reality that shouldn’t exist, and nurses across the country are making a concerted effort to mitigate colleagues’ negative behaviors. 

Whether you’re new to nursing or have decades of experience, review the latest information about lateral violence in nursing and effective techniques to address it in the workplace.

How Common is Lateral Violence in Nursing?

Workplace violence in nursing is distinctly different from dealing with coworkers who have negative attitudes, although negativity is a trait associated with perpetrators of lateral violence. 

As Johns Hopkins Nursing Magazine reports, a literature review spanning three decades of research found that anywhere from 46 to 100 percent of nurses have experienced lateral violence at some point in their careers.

A different study surveyed published in the Journal of Nursing Administration found that more than 27 percent of nurse respondents had experienced workplace bullying in the previous six months. 

The study confirmed a link between workplace violence in nursing and attrition. Additionally, the authors noted that most respondents who experienced bullying were the targets of lateral violence from their superiors or charge nurses.

The bottom line is that lateral violence in nursing is far more common than it should be and vastly underreported.

Examples of Lateral Violence in Nursing

The first step any nurse should take in preventing harm against coworkers is to learn to recognize behaviors that meet criteria for lateral violence. 

Blatant physical violence is easy to identify and more reported than more subtle verbal or emotional forms of violence. 

The Academy of Medical-Surgical Nurses’ (AMSN) "Healthy Practice Environment Advocacy Guide" reviewed the incidence of workplace violence in nursing and offers a summary of behaviors to look for, including:

  • Use of power to control or manipulate others
  • Intentionally withholding information in an effort to get a coworker in trouble
  • Shaming coworkers by publicly displaying errors, such as documentation errors
  • Using verbal threats of violence or disciplinary action to intimidate coworkers
  • Refusal to offer guidance or help when needed
  • Yelling at or harshly demanding a coworker perform tasks
  • Writing overly critical or threatening notes
  • Nonverbal incivility, like eye-rolling or refusal to look in a coworker’s direction when talking to them
  • Targeting coworkers with angry outbursts
  • Blaming others for mistakes
  • Gossiping about coworkers
  • Humiliation or mockery of coworkers

Though not an exhaustive list of violent behaviors, the above offenses are aligned with the definition of lateral violence, which is “disruptive and inappropriate behavior demonstrated in the workplace by one employee to another who is in either an equal or lesser position.”

Research indicates that, more often than not, the victim is a novice nurse, while the perpetrator is an experienced nurse.

Implications of Workplace Violence in Nursing

Lateral violence in nursing has implications for both individual workers and the organization as a whole. 

The toxic work environment created by workplace violence contributes to lost productivity, higher risk of medical errors, and increased staffing and training costs. 

Individually, nurses who have experienced workplace violence have a higher turnover rate, experience negative health effects and may engage in negative coping strategies.

1. High Turnover

A study published in Advances in Nursing Science examined bullying behavior among nurses and how it relates to a nurse’s intention to leave the organization. 

Results showed that 31 percent of respondents experienced bullying in the workplace, and bullying was determined to be a significant predictor of turnover intention.

2. Negative Health Effects

The 2017 U.S. Workplace Bullying Survey found that 40 percent of respondents who were victims of workplace bullying experienced adverse health effects as a result. 

A study of employees who experienced repeated bullying had higher rates of absenteeism and poor well-being than those who did not. Common physical health issues that arise from violence-related stress include GI disorders, insomnia, headaches and hypertension.

3. Mental Health and Substance Abuse

The AMSN  warns that mental health and substance abuse disorders can develop in individuals who are victims of repeated lateral violence. 

Substances like alcohol, nicotine and drugs may be used to cope with work-related stress or self-medicate mental health symptoms, such as depression, anger, panic attacks and low self-esteem.

What to Do if You are the Target of or Witness Lateral Violence

Physical violence is a crime whether or not it is work-related. Do not allow yourself or anyone else to be physically abused; call 911 for help. 

Other steps you can take to deal with lateral violence include:

  • Call for help while the bullying behavior is occurring
  • Consider taking time off to care for yourself physically and mentally
  • Document all incidents of workplace violence, including verbal abuse and harassment
  • Offer aid and support to your colleague immediately after the event if you witnessed it
  • Review your organization’s policies and procedures about workplace violence
  • Speak with leadership to determine if there is a specific code that can be called to signal that lateral violence is underway, such as Code Pink
  • Following the chain of command, file a complaint with a nursing association, the DoJ or OSHA
  • Seek legal counsel to help address the issue

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