Lateral Violence and Bullying in

the Workplace
Nurs 4803 The Nursing Leadership
and Management Experience

Gloria L. Byrd
Rev.01.05.16

Code of Ethics for Nurses

The Code of Ethics for Nurses with Interpretive
Statements serves the following purposes:
It is a succinct statement of ethical values,
obligations, duties, and professional ideals of
nurses individually and collectively.
It is the professions non-negotiable ethical
standard
It is an expression of nursings own understanding
of its commitment to society (American Nurses
Association, 2015, p. vii).
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Co
deofEthicsforNurses/Code-of-Ethics-For-Nurses.html
2

Code of Ethics for Nurses

Provision relevant to disruptive behaviors.
1.5 Relationships with Colleagues and Others
Respect for persons extends to all individuals with whom
the nurse interacts. Nurses maintain professional,
respectful, and caring relationships with colleagues and are
committed to fair treatment, transparency, and integrity
preserving compromise, and the best resolution of conflicts
(American Nurses Association, 2015, p. 4).
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Co
deofEthicsforNurses/Code-of-Ethics-For-Nurses.html

`
3

Code of Ethics for Nurses

1.5 Relationships with Colleagues and Others cont.
nurse creates an ethical environment and culture of
civility and kindness, treating colleagues, coworkers,
employees, students, and others with dignity and respect
Disregard for the effects of ones action on others, bullying,
harassment, intimidation, manipulation, threats or violence
are always morally unacceptable behaviors (American
Nurses Association, 2015, p. 4).
http://
www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEth
icsforNurses/Code-of-Ethics-For-Nurses.html

ANA Panel Aims to Prevent Violence,

Bullying in Health Care Facilities (4/6/15)
In an ongoing ANA survey

21 percent reported they were at a significant level of

risk for violence at work,
25 percent to 50 percent reported experiencing
various instances of bullying in their workplace,
50 percent said they had experienced verbal or nonverbal aggression from a peer
42 percent from a person in a higher level of authority
43 percent had been verbally and/or physically
threatened by a patient or a patients family member.

http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/HealthyNurse/bullyingworkplaceviolence/ANA-Panel-Aims-to-Prevent-Violence-Bullyingin-Health-Care-Facilities.html
5

Terms Used in the Concept

horizontal abuse
horizontal hostility
horizontal or lateral violence typically two
nurses of similar standing (Blair, 2013)
workplace incivility
bullying typically supervisor to staff nurse
Stanley, 2008. p. 1248
Embree, J.L. & White, A.H., 2010

Perspective on bullying
The Center for American Nurses views bullying as
associated with individuals at different levels in an
organization (different levels of power and
authority).
Examples of bullying include:
being assigned undesirable work assignments,
resources or information withheld, excluded
from activities or conversations, being
humiliated in front of others, nonverbal
intimidation.
http://www.centerforamericannurses.org/
7

Lateral Violence
or horizontal violence and horizontal
hostility are terms used to describe the
physical, verbal, or emotional abuse of an
employee.
endemic in the workplace
unacceptable
destructive
Center for American Nurses, 2008, p. 2

Why Lateral Violence?

arises from oppressed group behavior

learned behavior in a work environment
gender issues, self esteem
anger

Interesting to note that nurses in the least

organizational powerful positions typically manifest
lateral violence on a unit and directs it to those with
the least power.new RNs.
Embree, J.L. & White, A. H., 2010. p. 170

Characteristics of Perpetuators
of Violence
This is not an unintentional event, but is deliberate,
ongoing and continues over time.
skilled at manipulation
denies doing anything wrong
pits people against people
derives immense satisfaction
demonstrates arrogance in verbal and nonverbal
communication (undue criticism, sarcasm, raised
voice, aggressive stance)
Broome, 2008, p. 28
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Stanley/Martin Applied Model of Oppressed

Group Behavior to Explain Lateral Violence
in Nursing

historical patriarchal system

oppressed groups tend to become like their
oppressors because the way they think become
distortedthey unconsciously identify with the
oppressors and in the process become oppressive
themselves.
Weinand, M.R.,2010, p. 23

young girls are socialized to internalize aggressive

feelings internalize anger and become nurturers
unexpressed feelings may become passive aggressive
behaviors
Stanley et al., 2008, p.1249
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Stanley/Martin Applied Model of Oppressed

Group Behavior to Explain Lateral Violence
in Nursing

generational differences have been identified

as a factor in lateral violence (different core
values and work ethic)
Stanley et al.,
2008, p. 1260

women who internalize anger feel helpless and

powerless
women who externalize anger may also feel
helpless and powerless as their anger does not
bring about desired change.
Stanley et al., 2008, p. 1249

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Stanley/Martin Applied Model of Oppressed

Group Behavior to Explain Lateral Violence
in Nursing

Nurses often feel powerless in participating in

decision making that affects their work..
Weinand, M.R., 2010, p. 23

Stanley et al. (2008, p. 1249) documents that

powerlessness triggers a cycle of oppressed
behavior leading to frustration, non-assertive
behavior, non-support of coworkers, and conflict
in the environment.

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Stanley/Martin Applied Model of Oppressed

Group Behavior to Explain Lateral Violence
in Nursing
decision to leave
work group

Unable to
effect
meaningful
change

Low self
esteem low
group
morale

Unable to
trust
coworkers

Tension in
work
relationships
; conflict
charged
environment

Powerlessnes
s and frustration

Unable to
support one
another;
dissatisfaction
directed
towards peers

Unable to
assert
self

Martin, M., Stanley, K., Dulaney, P., & Pehrson, K.

(2008).

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Common Forms of
Lateral Violence/Hostility

nonverbal innuendo: raising eyebrows, making

faces in response to comments from a colleague
verbal affront/abuse: snide, abrupt verbal
responses to questions, demeaning comments,
lack of openness
undermining activities: refusing or not being
available to help a colleague
withholding information: about nursing practice or
a patient which undermines a colleagues ability
to perform professionally
Enbree & White, 2010, p. 167
Griffin, M., 2004, p. 259
Center for American Nurses, 2008, p. 2
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Common Forms of
Lateral Violence/Hostility

sabotage: setting up a colleague for a negative

situation
Infighting: bickering with peers
scapegoating: blaming a colleague
backstabbing: complaining to others rather than
trying to resolve the conflict with the colleague
involved
failure to respect privacy: gossiping, sharing
information that is meant to be private
Enbree & White, 2010,, p. 167
Center for American Nurses, 2008, p. 2
Griffin, M., 2004, p. 259
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Outcomes of Lateral Violence

Nurse

Aggression
Physical
Verbal
Emotional

Nurse

Job Dissatisfaction
Increased stress
Physical and
psychological illness

Effects on:
retention
low morale
recruitment
quality of patient care
Embree, J.L., 2010
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Outcomes of Lateral Violence

Nurses (victims) can experience

low self esteem

poor morale
feel disconnected from other staff members
exhibit depression, stress, frustration
use excessive sick leave
have high rates of burnout
loss of trust
impairs collegiality, communication and collaboration
negative patient outcomes: errors on patient care,
sentinel events
Blair, P.L., 2013

Embree, J.L., 2010

Longo, J. 2010
Weinand, M.R., 2010
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Research on Lateral Violence

Alspach, G. (2008) Lateral hostility between critical
care nurses: A survey report. Critical Care Nurse,
28(2), 13-19.

67% of respondents identified complaints shared

with others without first discussion with you as
the most common form of lateral hostility.

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Research on Lateral Violence

Cho, S.E., Lee, J.Y., Mark, B.A., & Yun, S.C. (2012)
Turnover of new graduate nurses in their first job
using survival analysis. Journal of Nursing
Scholarship. 44(1), 63-70.

Turnover rates for new graduates are 17.7%

during the first year of employment.
33.4 during the second year
46.3% during the third year

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Research on Lateral Violence

Stanley, K., Martin, M., Nemeth, L., & Michael, Y.
(2007). Examining lateral violence in the nursing
workforce. Issues in Mental Health Nursing , 28,
1247-1265.

46% of the respondents reported that lateral

violence was very to somewhat serious.
65% reported more frequent use of lateral
violence by their coworkers and 18%
acknowledged using lateral violence themselves
(n=663).

21

Research on Lateral Violence

Griffin, M. (2004). Teaching cognitive rehearsal as a
shield for lateral violence: An intervention for newly
licensed nurses. Journal of Continuing Education in
Nursing, 35(6), 257-263.

New RNs were taught about lateral violence and given

strategies to use when responding.
46% of new RNs identified that lateral violence was
directed to them.
examples included: setting them up to fail, sabotage,
not being available..
Lateral violence stopped when the new RN confronted the
behavior.
Retention of the new RNs was 91%
Empowers and raises awareness
note: small sample
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New Graduates and New Nurses

include lateral violence in orientation programs to

raise awareness
knowledge and appropriate responses to lateral
violence empowered new nurses
immediate confrontation influenced the actions of
the laterally violent nurse.
never let them feel isolated
Griffin, 2004

Note: This is an old but excellent article on how to respond when

confronted with lateral violence. The article is also cited earlier in
this power point under research (slide 22) .

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Recommendations
Nurses

adopt and model professional ethical behavior

use conflict management and resolution
look at your own behavior and communicate
respectfully
Center for American Nurses, 2008, p. 5 6

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Recommendations
Nurses

recognize the behavior exists and make an effort

to care about one another
professional and personal reflection needed to
change the lateral violence cycle
carefronting caring enough to confront the
individual and situation in a responsible manner
education about lateral violence allows nurses to
depersonalize it
Leos-Sheridan, 2008 , p. 402

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Recommendations
Nurses

defuse intense anger and after emotions have

eased discuss the incident
release the anger as holding onto it achieves
nothing
consult an expert when conflict continues on the
unit (a psychiatric clinical specialist,
a manager.)
demonstrate care and compassion to colleagues
Leos-Sheridan, 2008 , p. 402

26

Recommendations
Nurses

reach out to colleagues who are having difficulty

compliment rather than complain
develop a team spirit by socializing together
make new nurses feel welcome.
Leos-Sheridan, 2008. p. 402

27

Recommendations
Nurses

Focus on restorative justice (acceptance for ones

actions, collaboration, respect, shared power)
rather than retributive justice (punishment).
Martin, 2008, p. 59 60

Recognize and accept cultural and generational

differences (improving colleague relationships).
Martin, 2008, p. 59

28

Review the Handouts on:

Expected Behavior of Professionals
Ten Most Frequent Forms of Lateral
Violence and Appropriate Responses
Direct Violent and Indirect Violent
Behaviors

29

Recommendations
Healthcare Organizations

zero tolerance policy

encourage open and respectful communication
support individuals impacted by lateral violence
educate and counsel victims and the perpetrator
of violence and bullying
Center for American Nurses, 2008, p. 6

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Recommendations
Nursing Continuing Education & Academia

provide information to nurses and students that

address conflict and information on how to
change disruptive behavior
continuing education programs on lateral violence
and interventions to address the behavior
educate nursing students
Center for American Nurses, 2008, p. 6
Note: education allows nurses to gain
insight into their own behaviors.
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References
American Nurses Association. (2015). Code of Ethics
for Nurses with Interpretive Statements. MD:
Nursebooks.org.
Blair, P. L. (2013). Lateral violence in
nursing.Journal of Emergency Nursing: JEN:
Official Publication of The Emergency Department
Nurses Association,39(5), e75-e78.
doi:10.1016/j.jen.2011.12.006

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Embree, J., & White, A. (2010). Concept analysis:

Nurse-to-nurse lateral violence.Nursing
Forum,45(3), 166-173. doi:10.1111/j.17446198.2010.00185.x
Griffin, M. (2004). Teaching cognitive rehearsal as a
shield for lateral violence: An intervention for
newly licensed nurses. Journal of Continuing
Education In Nursing,35(6), 257-263.
Lachman, V. D. (2014). Ethical issues in the
disruptive behaviors of incivility, bullying, and
horizontal/lateral violence. MEDSURG
Nursing,23(1), 56-60.

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Longo, J. (2010). Combating disruptive behaviors:

Strategies to promote a healthy work
environment.Online Journal of Issues In
Nursing,15(1), 3.
Weaver, K. B. (2013). The effects of horizontal
violence and bullying on new nurse
retention.Journal for
Nurses in Professional
Development,29(3), 138- 142.
doi:10.1097/NND.0b013e318291c453

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