Lateral Violence in Nursing

Abstract

This paper supports that idea that lateral violence, horizontal violence, and bullying is a highly controversial subject, yet an extremely real part of the nursing work field. It looks to find supporting evidence that the reality of lateral violence and bullying can be found in documentation as well verbal communication, proving that it is a subject that needs addressing. Formally it discusses the realities of the damage that is caused by it and the repercussions that are felt by both employee and employer. The paper highlights ideas that could diminish LV and bullying in the work force and what approaches should be taken to ensure that both the employees and employers fully understand the damage that these torments cause. Specifically, this paper focuses on psychological aspects, avoidance and hazing, education and leadership, prevention through education and awareness, as well as suggesting authoritative action. The entirety of the paper focuses on credible and reliable sources that support the thesis of the paper by giving excellent examples and contributing to the demolishment of lateral violence and bullying altogether. Although no result or solution is confirmed, it suggests many solutions to the problem being discussed. The paper contains no personal opinion, only personal suggestions in finding solutions that are also backed by credible sources and statistics. The paper is conclusive in the fact that lateral violence should be completely demolished at some point and suggests that if the problem is not taken care of, health companies will certainly begin to fail, and the employees will as well.

Introduction

Lateral violence in the nursing world is not only morally wrong but it is dangerous, unprofessional, and disruptive as well. Lateral violence as well as bullying play a significant role in almost all work environments, making for uncomfortable daily interactions with co-workers and affecting the mental health of not only the employees but employers as well.

Unfortunately, lateral violence is prevalent in the nursing world, consuming many employees on a day to day basis. The undermining of nurses is a horrendous occurrence that is displayed in many forms and by many different members of the work force. Not only is nurse on nurse bullying a common occurrence, but co-workers that are higher on the totem pole undermine fellow employees as well. The most disruptive area of this ongoing problem, however, is the fact that it also affects patients. When a patient is affected by disruptive behavior from whichever professional is attending to them at the moment, it not only causes a problem for the specific department of the employee, but it is detrimental to the business of the corporation as well.

These occurrences must be taken into consideration as they contribute to a hostile work setting and an uncomfortable situation for each party involved. In a health-conscious work field, one would assume that the work environment would be both mentally and physically satisfying for the employees who chose to pursue a career in it. Although work conflicts are inevitable, the degree at which these conflicts develop eventually turn out to be seriously harmful to all parties involved. Solutions to this type of violence should be easy, however it seems that lateral violence runs rampant and the ability to control its growth becomes increasingly more difficult. Naturally this problem is a serious concern and is proving to be a difficult one to solve. Fortunately, there are many people navigating through the system of it to break it down into a formula that can be resolved.

Critical Review

Throughout the literature being researched there are several instances that prove that lateral violence is a dominant problem in the nursing workforce. The articles portrayed numerous examples and firsthand accounts of verbal abuse while at work. Most of the accounts of abuse seem to be referred to as hazing, and nurse on nurse arguments taking place in the work environment seems to be the most dominant type of scenario. So many occurrences happen to fall in this category, and unfortunately many of them go unpunished. In the healthcare field, turning a blind eye to lateral violence is a common occurrence, making that particular work environment a breeding ground for bullying. A constant avoidance of a problem on an employer’s part causes rifts between employees. It seems that the employees begin to feel that their behavior is acceptable and unfortunately the cycle continues.

Psychological Aspects

The propositions from other nurses to support that lateral violence occurs specifically in nursing units is overwhelming; unfortunately, it is hard to pin down specific events with only hearsay accusations. Although it is fact that this type of bullying occurs, it’s more than necessary to not only log complaints but to try and gather an acceptable amount of evidence against the bully. This type of bullying is not based solely on an employee or co-worker’s capability in the field but directs to other more personal subjects as well. As Clark (2013) attests to the matter by reporting on a study she completed about faculty incivility “Approximately 13% of the respondents reported experiencing racial, ethnic, sexual, gender, or religious slurs within the past 12 months.” (p.1) Not only does this affect the person involved in the work area, but the bullying stays with them away from the environment they work in as well.

This part of lateral violence is extremely detrimental to any employee’s mental stability. There are numerous reasons that workforce bullying should not be allowed and one of the bigger reasons is because of the impact it can have on someone’s social life as well as their private life. A person wellbeing should be of the utmost importance and in a field that works in healthcare, a shocking amount of employee’s plague offices on a daily basis with negative attitudes toward one another. Nurse-on-Nurse bullying can cause serious backlash, as Bigony et al (2009) states,

“Psychologically, nurses have experienced anxiety; depression; substance abuse; feelings of isolation, insecurity, and low self-esteem; and in severe cases, post-traumatic stress disorder, including suicidal and homicidal thoughts. Studies have shown an increase in dysfunctional relationships for victimized nurses”

This unfortunate backlash is a huge reason why this problem needs to be solved. As nursing is considered one of the most rigorous careers to pursue, the result of working for years toward a certification in it should not be a psychological trauma; instead it should be rewarding both for the nurse and the patients involved.

Avoidance and Hazing

As studies prove that repercussions of lateral violence exist, it makes it harder to ignore, unfortunately, avoidance is one of the most common reactions to it thus far. As Sincox and Fitzpatrick both suggest in their article Lateral Violence: Calling out the elephant in the room, hazing in the nursing world is its best kept secret. By avoiding something that causes such outrageous results, things will only get worse in the working world for nurses. It seems that hazing for nurses is in actuality, a bit of a game. The mistreatment of other employees can certainly be overlooked, especially if it is considered an initiation of sorts, but when it starts to affect the persons being hazed in everyday life, it has gone too far.

It seems that hazing, and avoidance merge into one more often than not. The idea of hazing has become a part of American culture and it is becoming quite the controversial subject. Whether it is in the work force, or on a sports team, at this point it seems almost expected. There seems to be, at this point, a fifty-fifty split of what is acceptable and what is not when it comes to hazing. It seems incredible that hazing is even considered to be something that is understandable between humans but whether it’s right or wrong is an entirely different moral debate. Unfortunately, this acceptability seems to be taking place in the nursing world and each department is finding it more and more socially acceptable.

Rather than try to bring the violence to an end and find a valuable solution, many nurses are “jumping on the bandwagon” so to speak and contributing to problem. To identify with nurses who are constantly trying to hide something when asked about hazing, makes it increasingly difficult to pinpoint an exact area of a problem that needs to be resolved. As Haselhuhn (2005) attests “Bullying has been difficult to operationalize because many methodologies rely heavily on the victim’s interpretation” (p.7) This data makes it much harder to try and find solutions to an ever-growing problem.

Proposal

Any incentive to encourage good behavior certainly changes the work dynamic, and although it is unfortunate and trivial to try and persuade career seeking adults to behave properly toward one another, it is a reality that needs to be dealt with.

Education and Leadership

Fortunately, when dealing with situations such as lateral violence and bullying, it is important to understand that one is dealing with educated adults, and therefore it must be taken into consideration that there will be participants who don’t agree with certain solutions for this problem. I personally believe that taking a route that signifies to the employee a more personal approach, would be highly effective in solving some of these problems. As Chief Nursing Officer of the hospital, I certainly believe that leadership is a great quality to have. The benefits of being a leader in an atmosphere where bullying is taking place has the ability to demolish many negative scenarios. By asserting my authority in a helpful way without being too aggressive, it will signify to my employees that I am an understanding boss who can understand when there are disagreements in the office. This will be supplemented by implementing a zero-tolerance policy as well. This policy is among one of the most popular solutions, as The American Nurses Association (2011) suggests it for the top solution on their list.

By suggesting the new policy and communicating in a friendly yet authoritative tone, this may show positive results in gaining the employees trust as well as changing their minds about respecting one another in the work environment. If they have to respect me as their superior and I have to respect them as my employees. This chain of events should take a turn for the best and set off a positive work environment for everyone.

This theory seems to make sense when looked at from any humanistic angle. There is always an authoritative figure in any world and there is a common law that must be obeyed. Otherwise there would be no regulations anywhere and everyone would be their own boss. To support this theory, Stanley, et al (2007) explains “Education and effective leadership were found to mediate oppressive and negative behaviors, whereas ineffective leadership was found to exacerbate lateral violence” (p.1) This seems like an affective idea because based on work environments, it seems that people do well under scheduling and restrictions rather than having the capability to do or work wherever and whenever they want. Not only would leadership positively affect these problems, but education may seem like the best weapon in this type of situation.

Suggesting Psychology

Psychologically it is impossible not to be affected by the results of lateral violence and because of this the necessary requirements to reverse the damage should be taken immediately. By suggesting that employees who feel they have been negatively affected by the aftermath of lateral violence and bullying, psychologists and psychiatrists alike should be a suggested part of treatment. Obviously, this should be paid for by the company that the employee works for. The amount of money that is put out to ensure that the quality of the care is sufficient for the patient should not be argued. The best quality care should be provided in ensuring that the employee is mentally stable and feels that they can carry on in the work environment they are in. This will decrease absenteeism and most certainly play a role in the employee continuing to work for the company.

Financially it can certainly become a burden for the company, but with healthcare industries pulling in billions of dollars per year it seems inconsequential and a necessary idea to activate. The repercussions of not taking action in trying to help employees psychologically could absolutely result in any kind of legal accusation, as well as taking more money from the company when the employee either sues or needs to collect unemployment if they are no longer fit to work. The benefits of providing psychological support widely outweigh the consequences of not providing it. This can be seen when Sanner-Stiehr, and Ward-Smith (2013) suggest, “When targets of Lateral Violence perceive having the personal and/or professional resources for managing the situation, the shift from baseline comfort and changes in emotional status are temporary. When targets of Lateral Violence lack effective coping resources, comfort and emotional status changes are sustained, resulting in harm.” (p.85) A solution for most companies would be something that doesn’t involve a paying out situation, however in this case there are too many incidents that could backfire in the companies face, causing unnecessary trouble for both the employee and employer.

Prevention through Education and Awareness

Although education has already been discussed, the success that could be seen in decreasing bullying and lateral violence by prevention through education and awareness could be extremely beneficial with a much lower cost than psychologically helping the affected employee. By providing classes that incorporate both the boss’s and the employees, this could establish a solid relationship between the two, making them both feel on the same level. The class should be taught by an outside source, rather than upper management, making it impossible for either party to feel inferior to the other. Both parties should be expected to complete a certain amount of work but on the same exact level. During the meeting or classes, depending on which type decides to be set up, group activities should be taken place where the outside source will randomly choose the groups. This randomness will allow employees and employers to get to know each other on fair playing grounds, as well as an intimate setting that will supply both with a better understanding of the other, not only in the work world, but personally as well. This will hopefully help to guarantee a closer partnership between all employees, flushing out lateral violence and bullying from the environment.

Giving Employees Authority

Another reasonable idea, yet a possible last resort to control lateral violence would be whether or not employees would be interested in making their own scheduling. This idea could turn out to be a bit contradictory, as there would obviously be requests to either avoid another employee or work with them, contributing to the idea of bullying. However, it could certainly be beneficial in the grand scheme of all the solutions. This is because if employees can be satisfied and feel they did it themselves, perhaps it would supply them with the authority that they are trying to depict when actually hazing another employee.

Conclusion

Ultimately lateral violence is an unusual and yet highly likely possibility when it comes to the nursing field. It is an issue that must be taken seriously with no exceptions. The idea of hazing and bullying in the adult world is almost ridiculous and should be held at a standard of zero tolerance, allowing each employee to work in a comfortable atmosphere that they look forward to coming to everyday. If no action is taken, unemployment rates will skyrocket for nurses everywhere, as the ability to stay on a task force that is detrimental to one’s health simply does not make sense. This should be a sufficient suggestion when it comes to solving the problem of lateral violence because if it isn’t solved, nursing will take a turn for the worst, affecting both employees and patients and putting the healthcare system dangerously on its back.

References

Lateral Violence: Calling out the elephant in the room. (2011). American Nurses Association, n/a, 1.

Bigony, L., Lipke, T. G., Lundberg, A., McGraw, C. A., Pagac, G. L., & Rogers, A. (2009). Lateral violence in the perioperative setting. AORN Journal, 89(4), 688-696.

Clark, C. M. (2013). Healing from the bitter pill of incivility. Minority Nurse, n/a, 1.

Haselhuhn, M. R. (2005). Strategies to Address a Significant Occupational Stressor. Adult Bullying Within Nursing Workplaces, n/a, 1-39.

"Lateral Violence and Bullying in Nursing." (2011). American Nurses Association N/A: 1.

Sanner-Stiehr, Ericka, Peggy Ward-Smith. "Psychological distress among targets for lateral." Journal of Nursing Education and Practice 3.6 (2013): 84-90.

Stanley, K M, M Martin, Y Michel, J M Welton, L S Nemeth. . "Examining Lateral Violence in the Nursing Workforce." Issues in Mental Health Nursing 28.11: 1247-1265.