Running head: POLICY ANALYSIS: LATERAL VIOLENCE 1

Policy Analysis: Lateral Violence

Anne Gonzalez

University of Arizona

August 1, 2015

Policy Analysis: Lateral Violence

Introduction

Nurses that are working in an environment that is bountiful in negative and toxic energy

that can and will lead to poor patient outcomes. Organizations that fail to have a policy to

address lateral violence will corrupt the safety culture of every healthcare organization (Johnson,

2015). Many nurses are leaving the profession related to lateral violence and ramifications of the

high turnover rate of nurses can cripple the healthcare system. This will create a nursing shortage

that is unable to care for the baby boomer population that is becoming of age. Patient safety is

our number one concern, having an environment that is intended to be a therapeutic setting and is

then exposed to lateral violence will disrupt patients safety and alter patients outcomes.
 Practice Issue

Lateral violence is also known as incivility, bullying, workplace hostility, inappropriate

work behavior or disruptive behaviors that a nurse reflects onto another nurse or another

healthcare provider in an aggressive manner (Rainford, Wood, McMullen, & Philipsen, 2015). In

an article by Becher and Visovsky (2012), reports that this disruptive behavior trend causes poor

patient outcomes because of the lack of teamwork resulting in decrease patient satisfaction and

decreased quality of care. Lateral violence pushes many nurses to leave the nursing profession

altogether creating a lowered rate of nurse retention and causing increased cost for healthcare

organizations (Hubbard, 2014). Nurses that leave the nursing profession have been identified as

new graduate, novice and student nurse (Coursey, Rodriguez, Dieckmann, & Austin, 2013). All

of these nurses become involved with healthcare with the goal to help care for patients and is

unable to fulfill this role. This behavior can lead to mental and physical distress to the nurses that

are victims to lateral violence (Lachman, 2014). By addressing this issue of lateral violence

fewer adverse events will occur from lack of errors made related to poor teamwork (Coursey et

al., 2013).

Evidence of the Issue

Data has been collected from research surveys showing that an estimated 97 percent of

nurses have experienced or know of lateral violence or horizontal violence in the workplace

(Rainford et al., 2015). In the article by Roberts (2015), presents that 90 percent of nurses that

have experienced lateral violence will not confront the assaulting nurse and that 40 percent

nurses consider leaving the nursing profession because of lateral violence. Currently there is not

a federal standard that requires the workplace to instill violence protection program. Many states

such as Arizona, has set up penalties for assaults against nurse to nurse. However, The Joint
POLICY ANALYSIS: LATERAL VIOLENCE 3

Commission Standard LD.03.01.01 stipulates that healthcare leaders are to implement and

manage a culture of safety in the work place to decrease errors that could potentially lead to poor

quality of care and outcomes ("Joint Commission," 2012). The article further reports, that poor

patient care and preventable adverse event such as, medication errors and death could have been

prevented with new policies on lateral workplace violence ("Joint Commission," 2012). The lack

of communication, withholding information and assigning a nurse a unrealistic work assignments

are all example for lateral violence that act as a catalyst to adverse events (Johnson, 2015).

Patient satisfaction and outcome is now a major contributor to organizational reimbursement

from Centers for Medicare and Medicaid Services (CMS) and will affect the organizational

longevity if there is a failure to receive payment (Lachman, 2014). It is estimated that, 30 percent

to 50 percent of all novice and new graduate nurse are the highest risk for leaving nursing

(Frederick, 2014). Thus, causing the nursing field to cope with a nursing shortage that is to

exceed by 500,000 nurses by the year 2025 (Frederick, 2014). Furthermore, organizations that

have a high nurse turn over rate will have an estimated coat of $75,000 for each new employee

that is needed (Frederick, 2014).

Suggested Alternatives

Creating a code of conduct and standards that has an emphasis in treating and respecting

each team member with dignity will help resolve lateral violence (Johnson, 2015). This plan will

also meet the standards from Joint Commission Standard LD.03.01.01 of implementing and

managing a workplace environment that is focused on a culture of safety (Lachman, 2014). The

code of conduct will have a built in training program on professional interaction development

skills and education. The training program will require all employees to complete a survey about

lateral violence (Roberts, 2015). This survey will serve as a measurement tool to assess all
POLICY ANALYSIS: LATERAL VIOLENCE 4

employees knowledge of lateral violence, gage how frequently it is occurring, and demographics

of occurrence. A class will be organized to teach how to defuse and manage lateral conflict

between coworkers (Dahlby & Herrick, 2014). Skits will be preformed with cue cards on how to

coworkers should response in a professional manner. Presenting and making all employees aware

that lateral violence is present and will cause harm if not reported. Emphasis should be placed

that all nurses are responsible for preventing and reporting all lateral violence to promote a

culture of safety.

Another intervention would be nurse mentorships (Frederick, 2014). Each new employed

nurse will be assessed for compatibility and paired with a seasoned mentor nurse. Having a

mentor will help ease the new member of the team in the culture of the organization. The mentor

will help nurture and assist the newest employee to become proficient in all nursing skills that

are required to become competent in the designated work unit. Mentorship can last for six to

twelve weeks. The time that is spent with mentee and mentor will develop a professional

relationship of trust and dependability. In the article by Hubbard (2014) it is noted that

mentorships helped with decreasing high turn over rated by 50 percent. Nurse retention will help

promote a safety culture and prevent a nursing shortage. A nursing shortage can result in an

unhealthy working environment, leading to poor patient care and satisfaction (Longo & Hain,

2014). An environment that is free of toxic behavior and works, as team will yield the best

patient outcomes.

Evaluation Context

Ethic/Values

Nurses uphold an oath to do no harm to patients. Lateral violence creates an environment

that is negative and not conducive to providing effective care. Lack of communication and
POLICY ANALYSIS: LATERAL VIOLENCE 5

withholding valuable patient information from other team members is unethical, resulting in

patient harm (Longo & Hain, 2014).

Economics

Low retention rates of nurses can cost organizations a substantial amount of money. Cost

can consist of recruiting, advertising, training and the use of travel agency nurses. High turn over

rates can cost organization up to $75,000 per nurse that is required (Frederick, 2014). The act of

lateral violence and withholding important patient information can cause costly adverse events

for patients and the organization (Longo & Hain, 2014). This can damage the image of the

organization and become a hospital that is not first choice by patients and family members

because of staff interaction.

Politically

The political ramification of not having a policy can lead to failure to receive

reimbursement from CMS (Lachman, 2014). New policies have been instilled on healthcare

reimbursement declaring that patient satisfaction will play a role in the amount of money that is

reimbursement to each organization. This could alter the longevity of many organizations if

bullying is not addressed.

Social

Nurses need to create and uphold a new culture of acceptance for all nurses to feel

welcomed and part of the team (Frederick, 2014). Lateral violence is a social attack from nurse

to nurse, creating a hostile work environment. It is necessary to provide the patient with a

therapeutic environment to promote healing and safety.

Legal
POLICY ANALYSIS: LATERAL VIOLENCE 6

Lateral violence can cause physical and psychological harm to the nurses that are

exposed to this behavior (Scanner-Stiehr & Ward-Smith, 2014). There can be legal consequences

from leadership not taking responsibility and preventing this behavior from occurring in the

workplace.

Outcomes

The implementation of a zero tolerance for lateral violence policy will promote an

environment that is rich with patient safety and positive patient outcomes. Nursing will interact

with each other in a professional manner and become a cohesive team. The organizations will be

known for providing excellent care and having a low turn over rate in nursing staff.

Determine Projected Outcomes

The projected outcome for having a code of conduct for all nurses to adhere by is already

instilled in many organizations. It is also mandated by The Joint Commission that leaders

develop, implement and manage a safety culture for the organization. Making the organization

aware of lateral violence is the first step of stopping with action from occurring. The survey will

be able to shed light to leadership on the volume of lateral violence is occurring and the area that

bullying is most prevalent. Nurses will feel empowered to communicate to leadership about

concerns of how a fellow nurse is treating them (Frederick, 2014). The negative side to this

intervention is that nurses will feel that this class is demeaning and uncalled for. Nurse could

report that classes on how to act profession are a waste of time and could be preforming patient

care. Making this class mandatory can advert from nurses from not participating in the class.

The mentor program is a positive way to bridge the gap with seasoned nurse and new

graduate nurses. A bond will develop and an open line of communication will always be present.

Mentoring will teach the new graduate nurse critical thinking skills, decision making and feel
POLICY ANALYSIS: LATERAL VIOLENCE 7

comfortable with the nursing profession (Longo & Hain, 2014). This will help retain nurses and

decrease the cost high cost of high turn over rates. The negative side to having a mentoring

program is the cost and time it takes to mentor new nurses (Frederick, 2014). Organizations

could be concern that time and effort that is applied to starting up a mentoring program and

training new nurses, could still have the same results and have high turn over rates.

Tradeoff

The trade-off for implementing a code of conduct with anti lateral violence policy will

improve the organizational morale if all of the employees follow along with doing what is right

and take accountability for actions (Longo & Hain, 2014). Educating the staff many not cause

not negative behaviors to stop completely. Staff could feel that leadership will not address lateral

violence when reported and could result in retaliation from the perpetrator. Mentorship could

help promote a safe environment and help develop strong nurses.

Decision-Making

Recent research has presented, that providing educational classes and teaching nurses

professional interaction development skills would be best suited to help develop a safety culture

for the organization (Longo & Hain, 2014). This would teach nurses how to defuse and empower

themselves to report lateral violence in the work place. Creating this new culture will support

patient safety and satisfaction (Coursey et al., 2013). Having a mentoring program does not

address the lateral violence completely with education and tool to deflect the situation. It would

be something to look into at a further date to help new graduate nurse retention.
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Dissemination

Lateral violence is not something that is openly talked about in healthcare organizations.

It is known that there is lateral violence but it is dismissed as someone attitude that is how she

is is how lateral violence is brushed off. It takes time to change the culture of the organizations.

There will need to be mandatory in-service meeting that nurse will sign up for. Using the intranet

is a good way to spread the word of changes to come. Leadership will also partake in the

dissemination, telling staff about what is expect of them going to the mandatory classes and the

post teaching expectations (Coursey et al., 2013). There will need to be annual competences and

a survey will be completed every three months to assess the effectiveness of the teaching.

Conclusion

The call of action is needed to stop lateral violence in the workplace, to prevent

harm from occurring to our patients. Providing nurses with the proper tools of education and

empowerment will help prevent a nursing shortage. Nurses must evolve with healthcare and

develop a professional attitude in order to keep the healthcare system healthy.

POLICY ANALYSIS: LATERAL VIOLENCE 9

References

Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. MEDSURG Nursing, 21(4),

210-232.

Coursey, J. H., Rodriguez, R. E., Dieckmann, L. S., & Austin, P. N. (2013). Successful

implementation of policies addressing lateral violence. Association of periOperative

Registered Nurses Journal, 97(1), 101-109. http://dx.doi.org/10.1016/j.aorn.2012.09.010

Dahlby, M. A., & Herrick, L. M. (2014). Evaluating an educational intervention on lateral

violence. The Journal of Continuing Education in Nursing , 45(8), 344-350.

http://dx.doi.org/10.3928/00220124-20140724-15

Frederick, D. (2014). Bullying, mentoring, and patient care. Association of periOperative

Registered Nurses Journal, 99(5), 587-593. http://dx.doi.org/10.1016/j.aorn.2013.10.023

Hubbard, P. (2014). What can be done about horizontal violence? Alberta RN, 69(4), 16-18.

Retrieved from:

http://eds.a.ebscohost.com.ezproxy1.library.arizona.edu/ehost/pdfviewer/pdfviewer?

sid=6be047d0-62c5-4e99-967d-88bce2723544%40sessionmgr4001&vid=1&hid=4103

Johnson, S. L. (2015). Creating effective anti-bulling policies. Nursing Management, 46(5), 40-

45. http://dx.doi.org/ 10.1097/01.NUMA.0000463885.99823.d9

Lachman, V. D. (2014). Ethical issues in the disruptive behaviors of incivility, bullying, and

horizontal/lateral violence. MEDSURG Nursing, 23(1), 56-58. Retrieved from

http://eds.b.ebscohost.com.ezproxy2.library.arizona.edu/ehost/pdfviewer/pdfviewer?

sid=dbc36205-df8c-4f1e-8a85-e609642a9c42%40sessionmgr113&vid=1&hid=103
POLICY ANALYSIS: LATERAL VIOLENCE 10

Leadership standard clarified to address behaviors that undermine a safety culture. (2012).

Retrieved from

http://www.jointcommission.org/assets/1/6/Leadership_standard_behaviors.pdf

Longo, J., & Hain, D. (2014). Bullying: A hidden threat to patient safety. Nephrology Nursing

Journal, 41(2), 193-199.

Rainford, W. C., Wood, S., McMullen, P. C., & Philipsen, N. D. (2015). The disruptive force of

lateral violence in the health care setting. The Journal of Nurse Practitioners, 11(2), 157-

164. http://dx.doi.org/10.1016/j.nurpra.2014.10.010

Roberts, S. (2015). Lateral violence in nursing: a review of the past three decades. Nursing

Science Quarterly, 28(1), 36-41. http://dx.doi.org/10.1177/0894318414558614

Scanner-Stiehr, E., & Ward-Smith, P. (2014). Lateral violence and the exit strategy. Nursing

Management, 45(3), 11-15. http://dx.doi.org/ 10.1097/01.NUMA.0000443947.29423.27