Lateral Violence: A Real Threat To the Nursing Profession

Lateral violence in the nursing profession also referred as Lateral/Horizontal (L/H) violence in the (2012) study “A comprehensive systematic review on lateral/horizontal violence in the profession of nursing” published by the JBI Library of Systematic Reviews identifies the problem and aggressively notes the prevalence of LH violence in the nursing profession. The study provides substantial evidence that this is a widespread epidemic and has been an issue in the nursing profession for over two decades.

Lateral violence is found to be disruptive because of its peer-related nature. The damage of this type of violence is far-reaching in that it undermines the profession of nursing. Nursing is seen as a profession that is nurturing and caring for most. Therefore, to reveal that in-fighting and overall disrespect for one another has been ingrained in the professional as normal and acceptable is disconcerting. This devaluing of one another sets the stage to thwart concise and clear communication and is of significant concern since it is bound to affect the care of the patients served.

Rittenmeyer studies note that LH violence and the implications it yields have been reported in nursing literature for nearly 20 years (Rittenmeyer et al., 2012). To support the claims of the seriousness of this problem in nursing, several articles have been written in various publications. Some of the articles refer to LH violence as “nurse-to-nurse” bullying (Bartholomew, 2013). Bullying tactics are both overt, such as “name-calling, bickering, fault-finding, criticism, intimidation, gossip, shouting, blaming, put-downs, raised eyebrows;” and covert such as. “unfair assignments, refusing to help someone, ignoring, making faces behind someone’s back, refusing to only work with certain people – or not work with others, whining, sabotage, exclusion, fabrication” (Bartholomew, 2013).

A study in the Journal of Nursing Administration on workplace bullying defines this as a critical concern since the writers believe that this is directly related to nurse retention (Johnson, 2009). Johnson in this study (2009) further notes that “Workplace bullying, which was first identified by Swedish psychologist Leymann in the 1980s, is defined as an ongoing conflict in which the victim is subjected to 2 or more negative incidents on at least a weekly basis over at least a 6-month period” (p.84). This negative aggressive behavior is seen in other professions as well and is a complex sociological issue. However, in the field of nursing, it is especially hazardous since it impacts the mental and physiological atmosphere of those in a field where mistakes made can mean life or death when it comes to patient care. The importance of remedying this phenomenon which has been going on for decades cannot be overstressed.

Validity of Resources

The evidence to support LH violence and the remedies in Rittenmeyer’s study are well documented. The path taken is logical and the data collected are from reliable sources. The study objectives are as follows: to qualify the experience of LH violence from the perspective of licensed and student nurses; determine how this influenced job retention and promotion; and discover strategies for resolving or lessening the problem (Rittenmeyer, 2012).

The study identifies specific standards for determining several levels of review. A substantiated peer review from professional medical and nurse’s organizations provide the best subjects to participate, they are licensed and student nurses. Licensed nurses are those “license to practice nursing at any level” to include, but not limited to registered, practical and vocational nurses (Rittenmeyer, 2012). The review outlines in detail the qualitative aspect that specifically interviewed abused nurses to determine the validity that LH violence and bullying exist in the workplace and that its participants are concerned about resolution. The quantitative aspect identified and examined reasonable practices designed to eliminate or at least diminish LH violence in the workplace. Qualitative and quantitative objectives were also defined in the context, specific outcomes, and documented studies. The reviews outlined the search strategy, detailed how the data were extracted and synthesized.

Review Criteria

Several references to accredited journals and publications are cited in the systematic review of LH violence. The findings as listed are supported with documentation. The Appendix detailing “JBI CRITICAL APPRAISAL INSTRUMENTS” provided the context of the research and identified the methodology and processes. Rittenmeyer and associates provide a credible background for the information on LH violence. The culture of nurse-to-nurse inappropriate behavior is clearly identified. Nurse bullying, as noted in the study, is easily recognized as a legitimate problem. Several studies are noted which detail the intensity and widespread issues.

Moreover, new graduates are easy targets. “Over half of the participants reported feeling undervalued, over a third reported that they had learning opportunities blocked and were given too much responsibility without support.” Studies also indicated verbal abuse, feelings of degradation, harsh, and unjust treatment. In addition, the evidence presented supported that managers and charge nurses were responsible for the highest incident of violence against their subordinates. A disturbing trend was also uncovered, nurses extending their bullying tactics to their patients, and expecting new recruits to do the same (Rittenmeyer, 2012).

However, the remedies noted such as “cognitive rehearsal strategies” and “restorative justice” beg for further clarification (Rittenmeyer, 2012). They are neither elaborated on nor explained. The success rate of these programs is omitted. So, while LH violence has been more than substantiated, there remain unanswered questions regarding the success of tools implemented to dissuade nurse-to-nurse aggression and bullying.

Overall Findings

Rittenmeyer brings to the forefront the issues of LH violence and bullying among nurses. This study focuses on side-by-side aggression, while other studies argue by using the word “horizontal violence” applies to the nursing staff in general to include nurse supervisors and managers, and not only staff at the same level. Rittenmeyer study also determined that nursing aggression begins at the student level with classmates exhibiting negative behavior during training. New graduates also experience alienation and a lack of comradely when entering the workplace. “Attempts to explain this phenomenon has often been influenced by theories of oppression and feminism” (Rittenmeyer, 2012). Since the nursing profession is dominated by women, then oppression may play a role. However, it would appear that the oppression may be triggered by personal issues that are then perpetrated on innocent co-workers. The issue of this aggressive behavior is valid and the problems it causes such as low self-esteem and confidence is played out ultimately inpatient care. “From a very ethical perspective, tolerating bullying behaviors is wrong and violates our basic oath to keep patients safe” (Bartholomew, 2013).

Rittenmeyer also examines the culture of the nursing profession, stating that aggressive behavior is an accepted norm. If it is considered normal, there is no need to initiate change. The issue is to understand that demeaning and devaluing one another on a consistent basis is far from normal. However, this behavior is typical in many professions both blue-collar and white collar. One of the differences is that in other areas there are greater gender variables, such as not being female-dominated, and most other positions, unless another medical profession, do not impact the lives of people who are usually in unwanted predicaments.

Extensive evidence of nurse aggression exists, “696 participants responded to the research questions. The data indicated that 95.6 % reported experiencing at least one bullying behavior during the classroom or clinical work” (Rittenmeyer, 2012). Johnson and Bartholomew substantiate this in their articles as well with supportive statistics. Unfortunately, Rittenmeyer’s study does not adequately explain the long-term effects of nurse bullying, and the burden it places on the nursing profession. It is understood that nurse turnover is one of the results, but it does not provide enough identifiable findings.

Conclusions

The stated goals of the study, to have a consensus in agreement on the definition of LH violence; its impingement on nursing professionals; and solutions available to institute change in behavior; were only partially met. The study is successful, as others have been, in defining LH violence or bullying as it is also known. However, the study does not supply clear evidence of how LH violence impacts nurse careers and their performance in the workplace. Nor does it solidly provide evidence for solutions.

Awareness of the LH violence among nurses should be part of the curriculum for nurse training. The hierarchy systems in hospitals and clinics are similar to any other workplace. There are protocols in place to report abuse and disruptive behavior. The most common response to nurse bullying is to say nothing (Rittenmeyer, 2012). However, this is not practical going forward. Nursing is a much-valued profession, there aren’t enough of them; therefore, they have more influence and power than they know when armed with knowledge.

There are numerous credible nursing associations in the United States and worldwide, and most are aware of LH violence and bullying phenomenon in the nursing profession. A practical solution is to create a nursing commission on how best to eradicate this historical behavior. The problem is well documented; however, the solutions are not. A separate defined set of protocols for new graduates is needed because their experiences will not mirror the same an experienced nurse has. Any problems should be addressed by the nursing commission, making all involved accountable. To alleviate fear and retaliation, it is best if complaints are made anonymously. When a pattern has been established by an aggressor, actions should be taken, and the first step is to offer counsel to the victim and the aggressor. The second steps are mandatory retraining since this behavior is an acceptable pattern in the profession. Any further action is agreed upon by disciplinary measures. Nurses can be taken for granted by their own counterparts and by the people that they served. Re-education and reiteration that nurses are critical to the success of healthcare would benefit nurses and the public-at-large.

Lateral/Horizontal violence between and among licensed and student nurses is an ongoing situation, and its longevity have negatively affected the nursing community. The abuse has been defined and who the main perpetrators are have been revealed. The attempts to establish solutions and specific ideas to implement change needs further examination and clarification.

Rittenmeyer’s study of lateral and horizontal violence and bullying satisfies the goal of defining this as a medical emergency in the nursing community. It's far reaching impact on nurses and patients is detrimental to the profession. The urgency of correcting this problem is identified by the examples of low self-esteem, confidence and emotional stress in the nurse population. The historical background is daunting, and the fact that this has gone unchecked for decades is disturbing. Nurses who are too fearful to say anything undermines clear communication, which is critical in the care of others. There are solutions, however, they need to be quantified and implemented systematically.

References

Bartholomew, K. (2013, 2 7). Break the spell and end lateral violence in nursing. Retrieved February 5, 2014, from NursesTogether.com

Johnson, S. L. (2009). Workplace bullying concerns for nurse leaders. The Journal of Nursing Administration, 84-90. Retrieved February 5, 2014, from Ovid Technologies, Inc.

Rittenmeyer, L., Huffman, D., Block, M., Mathaler, M., Misner, S., Moore, E., Wegner, G., & Kleefisch, K. (2012). A comprehensive systematic review of lateral/horizontal violence in the profession of nursing. JBI Database of Systematic Reviews and Implementation Reports, 10 42. Retrieved February 1, 2014, from http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/172/159