Lateral Violence

The Negative Effects of “Nurses Eating their Young” and how to stop them Kenton David Peacock, RN Chipola College BSN Program Jonna Bradley, ARNP, Instructor The Nursing profession is not one that one would expect to be riddled with acts of violence among colleagues. A common saying among new nurses relating to more seasoned nurses is that “Nurses eat their young”. Two of the reasons that were cited as factors in lateral violence, according to a journal article in Virginia Nurses Today, are low self-esteem and lack of respect for others (Brothers, Condon, Cross, Ganske, & Lewis, 2011).

These traits are not traits that one would expect to be a major player in the personality of such a caring profession. The presence of lateral violence (LV) in the workplace has a negative effect on healthcare delivery. Oddly, the introduction that a potential nurse will have to LV in the workplace can actually begin within the Nursing school setting. There are those that question whether that the origin of LV is within the educational institutions that train nurses and their faculty (Beasley, 2010).

Faculty incivility, in which incivility is a term that was coined for lateral violence, creates a destructive culture that denies students the opportunity to learn, grow, and develop in a profession that is known for its compassion (Beasley, 2010). Lateral violence can be significantly reduced or eliminated when the behavior is recognized, acknowledged, and appropriately and consistently addressed at both the individual and organizational level (Harley, n. d. ).

The implementation of training regarding the incidence of LV and its’ consequences is a means to improve the nursing work environment, patient care outcomes, and nurse retention – elements negatively affected by LV in the workplace (Embree & White, 2010).

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There are many negative results from LV related to the nursing work environment. The direct result is the level of stress that those that are involved, especially on the receiving end of LV, are plagued with within the workplace. This directly results in an increased use of sick leave once the physical symptoms of the increased stress have their toll on the nurse’s body. Harter & Moody, 2010) Nursing retention is also a big problem, considering it is estimated that 60 percent of nurses leave their first position as a nurse due to some form of lateral violence (Harter & Moody, 2010). The average turnover rate is 8. 4 percent but increases to 27. 1 percent when it comes to first-year nurses. When nurses leave, then the nurses that remain have a harder work-load and the end measure is a decrease in the care of the patient. The point of a nursing environment is the care of the patient and LV directly can affect this aspect of nursing.

In a study to develop preventive intervention strategies, it was found that many new graduates experienced LV across all clinical settings. The results of the study of, with a response rate of 47 percent and 551 completed questionnaires, showed a increased rate of absenteeism, a high number of nurses considering leaving the field, and scores on the Impact of Event Scale (a psychological tool to evaluate impact of events in ones’ life or level of distress) indicated a serious impact of interpersonal conflict.

As a result of the experience LV, several nurses mentioned that the events were detrimental to their confidence level and the self esteem (Mckenna, Smith, Poole, & Coverdale, 2003). It is of best practice to refrain from ignoring the behaviors that accompany those that respond to the work environment by acts of LV. Many nursing environments do not have on job educational opportunity regarding LV in the workplace and it often goes ignored by the upper-echelon of administration within an institution.

Employers and Nurse Leaders should ensure that supportive services are available. Primary prevention begins with education and training of staff. According to the findings from this study, the importance of developing programs which effectively reduce horizontal or LV and lessen the psychological sequelae of these events was recognized (Mckenna, Smith, Poole, & Coverdale, 2003). Encouraging positive working relations among healthcare providers requires effective conflict management as part of a healthy working environment (Yoder-Wise, 2011).

The role of the nurse leader is to create an environment that fosters open communication and collaborative practices for achieving mutual goals that enable nurses to practice constructive approaches to conflict management (Yoder-Wise, 2011). Through the use of LV, there are no conflict resolution measures enacted and individuals are ignoring the possibility of attempting resolution through the methods that are involved with lateral violence. Examples of lateral violence include: non-verbal innuendo, verbal confrontation, undermining ctivities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy, and breaches of confidentiality (Yoder-Wise, 2011). Bullying is closely related to LV but a real or perceived power imbalance has to exist. New nurses may question the caring environment and aspect of the job when they are first introduced to LV in the workplace. In a study by Spartanburg Regional Healthcare system (SRHS), the addition of education regarding LV saw a great response from nursing leaders and educational sessions became a regular occurrence (Stroud, 2010).

It was discovered that by raising employees’ awareness of the issues and behaviors of LV, SRHS has seen a significant culture change within the organization. The culture change has not only decreased the negative effects of LV on retention, but it has empowered nurses as well as allied personnel to bring about significant change in their working relationships and their overall working environment (Stroud, 2010). Negative patient care outcomes have been shown to be linked to the incidence of lateral violence in the workplace setting.

The effects of this type of violence within the healthcare setting not only affects the individual staff or team that is involved but also the effects are seen in the outcomes of the whole health care team due to the widening rift between employees, but ultimately the patient faces the repercussions (Becher & Visovsky, 2012). The Joint Commission indicated that the lack of communication that is associated with LV is a main factor in sentinel events affecting health care teams and compromising patient safety (Becher & Visovsky, 2012).

Often, essential information can be omitted as a result of LV and the victimized nurse is found in a poor position to provide care for the patient and patient safety is compromised (Becher & Visovsky, 2012). Patient care can also be decreased by another form of hostility in the workplace known as vertical violence which is when a person in a position of authority over another uses negative behaviors towards staff. Those that find themselves in intimidating situations may sometimes choose to forego their role as patient advocate to avoid these intimidating situations (Center for American Nurses, 2008). It stands to reason that nurses that are perpetuating, participating in, or dealing with the effects of negativity” are less likely to respond fully and attentively to the needs of their patients (Weinand, 2007). Another researcher states that “some studies have even suggested that disruption among hospital coworkers can adversely affect clinical outcomes” (Weinand, 2007). The Joint Commission reports that up to 60 percent of actual or potential harm to patients can be linked to insufficient communication in healthcare organizations (Purpora & Blegen, 2012).

It is hypothesized that with a breakdown in communication between nurses there is also a breakdown of quality and safety of patient care (Purpora & Blegen, 2012). One of the greatest aspects of the continuing incidence of lateral violence is the retention rate of nurses, as well as the financial consequences and future of the nursing field related to nurses leaving the field due to LV. Nursing is already a highly stressful field in ensuring that everything is done that can be done during a shift to take care of a patient.

Patient loads are heavy and the degree of illnesses that nurses are tasked to deal with on a daily basis are enough to cause “burn out”. With the added weight of Nurses not getting along with each other many will eventually decide that the field is not right for them or the current place that they are employed is not right and will leave to search for greener pastures. LV has been linked to leaving employment (Ward-Smith, 2011). The use of LV in the work setting has some major consequences which include low employee morale and high employee turnover rates, according to Weinand (Weinand, 2007).

One out of every three employees will leave the workplace due to LV (Weinand, 2007). There are many consequences of LV in the workplace, to include: sleeplessness, lowered confidence, anger, and they can lead to suicidal behaviors as well (Weinand, 2007). In one study related to the effects of LV and nurses leaving the workforce or their place of employments states that 41 percent of the respondents thought that the problem with conflict was “too invasive” in the organization with Nurses leaving the profession which resulted in a nursing shortage due to voluntary attrition rather than the lack of personnel (Weinand, 2007).

The result of losing a nurse due to LV can be very detrimental to the finances of an institution due to the fact that it is estimated that training a nurse to replace a nurse that is leaving can approach or exceed 145,000 dollars for specialty areas. It is also estimated that LV can result in 30,000 – 100,000 dollars per year for each individual as a result of work absenteeism, treatment for depression and anxiety, decreased work performance, and increased turnover (Becher & Visovsky, 2012).

The cost of a medical surgical nurse can approach 92,000 dollars to recruit, hire, and orient (Harter & Moody, 2010). The United States will soon face a nursing shortage that far outweighs the shortages of the past. With the increased amount of baby-boomers that will be entering the age that more hospitalizations and healthcare will be prevalent, there will be an increase in the need for the more experienced nurses to stay in the workforce and for the revolving door of the new graduates to slow down.

The costs that further increase the effects of LV in the workplace are the increase in medication errors and the lawsuits that result from them (Harter & Moody, 2010). Nurses should embrace their peers and “show them the ropes”, helping each other to learn to be better nurses rather than belittling them for what they don’t know. In order to do away with the cannibalistic phrase related to seasoned nurses consuming the new nurses, a system will need to be embraced universally throughout the healthcare system.

The Joint Commission has already created an adoptable outline to ensure that there are educational intentions regarding LV and maneuvers to evade continuing LV related practice. There are studies and literature that explain that the best way to rid the work setting of LV is to educate the staff and to create or adapt a “no tolerance” policy regarding LV. It is a necessary component of Nursing, as defined by the American Nurses Association Code of Ethics, to refrain from treating people in a way that denies them dignity.

According to the Code of Ethics, “Individuals who become nurses are expected not only to adhere to the ideals and moral norms of the profession but also to embrace them as part of what it means to be a Nurse”. “The Code of Ethics for Nurses … is the profession’s nonnegotiable ethical standard” (Dulaney, 2010). First and foremost a policy should be created or adopted which outlaws all forms of LV. People should be made aware of the policy and become familiar with it and it should be encouraged for Nurses to report incidents of LV.

All staff members should be trained on how to deal with a situation that consists of inappropriate behaviors including recognizing them and how to report them. There should be an interdisciplinary group defined to deal with these situations and define violations as well as to deal with them appropriately. Dealing with LV in the workplace can increase nursing retention and serves to protect the reason why nurses exist – which is to care for the patient and to do so safely.

Reference Beasley, S. (2010). Nurse Educators:. The South Carolina Nurse, 4. Becher, J. & Visovsky, C. (2012). Horizontal Violence in Nursing. MEDSURG Nursing, 210-213, 232. Brothers, D. , Condon, E. , Cross, B. A. , Ganske, K. M. , & Lewis, E. (2011). Taming the Beast of Lateral Violence Among Nurses. Virginia Nurses Today, 7. Center for American Nurses. (2008, February). Lateral Violence and Bullying in the workplace. Center for American Nurse: Lateral Violence and Bullying in the workplace: Position Statement. Dulaney, P. (2010). Ethical and Legal Resources that relate to Lateral Violence. South Carolina Nurse, 5. Embree, J. L. , & White, A. H. (2010). Concept Analysis: Nurse-to-Nurse. Nursing Forum: An independent voice for nursing, 166-173. Harley. (n. d. ). Lateral Violence Background. Retrieved from Upstate AHEC: http://upstateahec. org/lateral-violence-programs/lateral-violence/ Harter, N. , & Moody, C. (2010). The Cost of Lateral. The South Carolina Nurse, 4. Mckenna, B. G. , Smith, N. A. , Poole, S. J. , & Coverdale, J. H. (2003). Horizontal violence: experiences of Registered Nurses in their first year of practice. Journal of Advanced Nursing, 90-96. Purpora, C. , & Blegen, M. A. (2012). Horizontal Violence and the Quality and Safety of Patient Care: A Conceptual Model. Nursing Research and Practice, 5. Stroud, S. H. (2010). Lateral Violence: Creating an Organizational Culture Change to Improve Retention. The South Carolina Nurse, 10. Ward-Smith, P. (2011). Let’s Leave Bullying on the Playground! Urological Nursing, 257, 263. Weinand, M. R. (2007). Horizontal Violence in Nursing: History, Impact, and Solution. The Journal of Chi Eta Phi Sorority, 23-26. Yoder-Wise, P. S. (2011). Leading and Managing in Nursing. St. Louis: Elsevier.