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Lateral Violence in Nursing

'The old adage seemed true - nurses do eat their young!'

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In January 2009, Nursing Administration at Spartanburg Regional Healthcare System (SRHS) joined forces with the Nursing Education and Human Resources departments to take an in-depth look at the causes of nursing turnover within our organization and to develop strategies to improve our overall nursing retention rates.

After an intense analysis of the nursing turnover data and an extensive review of the nursing literature, several opportunities to improve nursing retention within our organization were identified by this taskforce.

One of the most surprising (and challenging) issues discovered by the taskforce was the fact that some nurses were choosing to leave our organization due to unbearable conflict with their colleagues and/or direct supervisor.

This discovery seemed paradoxical!

The central focus of the nursing profession is caring; yet interpersonal conflict among nurses in the workplace was significantly impacting SRHS's nursing turnover rates.

The old adage seemed true-- nurses do eat their young!

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Uncovering the Issues

After continued literature review, our retention taskforce soon discovered that the issue of interpersonal conflict among nurses in the workplace, or lateral violence, was not unique to SRHS.

The effect of lateral violence on the nursing profession has been reported in the nursing literature for more than 20 years.

Impaired personal relationships among nurses in the workplace can undermine the organization's culture of safety by leading to errors, accidents, and poor work performance.

Lateral violence also drains nurses of their energy and challenges an organization's attempt to create a satisfied nursing workforce.

Raising Awareness Among Staff

Our taskforce soon learned that Upstate AHEC had recently been awarded a grant from the Nursing, Education, Practice and Retention Program (NEPR), part of the Department of Health Resources and Service Administration (HRSA), to address the issue of lateral violence among nurses in South Carolina.

The purpose of this grant was to provide a training program for registered nurses directed toward raising awareness of lateral violence.

By raising nurses' awareness of the issues and behaviors of lateral violence, it is hoped that the destructive cycle of this behavior can be broken.

This heightened awareness will in turn allow nurses to feel empowered to bring about significant change in their working relationships and their overall work environment.

Our taskforce immediately contacted Upstate AHEC and began a collaborative education initiative on lateral violence within our organization.

Initial lateral violence educational sessions began in April 2009 and were targeted toward our nursing leaders, such as nursing directors, nurse managers, clinical unit educators and charge nurses.

Response to the first lateral violence educational sessions was phenomenal!

Our nursing leaders were relieved to learn that they were not alone in their struggles to deal with destructive behaviors among their staff.

Through the lateral violence classes that were provided by Upstate AHEC, our nursing leaders not only learned how to recognize lateral violence behaviors in the workplace, they also were taught effective ways in which to deal with these aggressive behaviors.

Transforming Our Culture

By August 2009, Upstate AHEC, as outlined in their HRSA grant, had provided several train-the-trainer sessions for key SRHS employees, which positioned us to assume internal responsibility for continuing lateral violence education within our organization.

Although the original target audience for the lateral violence education at SRHS was intended to be nursing personnel, the news of the success of the classes quickly spread throughout other departments within the organization.

As a result of popular demand, lateral violence educational classes were developed for allied personnel.

We soon found ourselves teaching 6-9 lateral violence classes per month for a wide variety of hospital employees, often with an overflowing audience.

Lateral violence classes continue to be offered several times each month for all SRHS employees. Class attendance remains high and as of our last count, we have provided lateral violence education to more than 3,000 nursing and allied personnel.

Also, as part of the SRHS taskforce's goal to change the organizational climate that supports this behavior, lateral violence class content has also been threaded through various other educational programs within the organization, such as general hospital orientation and nursing preceptor workshops.

Measuring Success

In February 2010, as a result of the heightened awareness of lateral violence behaviors in the workplace at SRHS, a key component was added to the bi-annual employee survey.

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An 11-item Likert scale questionnaire was incorporated into the employee survey to measure the employee's perceptions of the existence of violent behaviors in the workplace:

  • infighting, bickering;
  • scapegoating, blaming others;
  • backstabbing, malicious gossiping, not respecting privacy;
  • destructive criticizing, bullying;
  • sabotage;
  • snide remarks, curt responses, lack of openness;
  • making negative faces or gestures;
  • turning away, ignoring;
  • withholding useful information, secretiveness;
  • avoiding, not being available;
  • generally rude behavior.

As of January 2011, nursing alone has seen a 21 percent reduction in lateral violence behaviors in the workplace at SRHS, as measured by the employee survey.

Organizational Impact

By raising employees' awareness of the issues and behaviors of lateral violence, SRHS has seen a significant culture change within our organization.

This culture change has not only decreased the negative effects of lateral violence on nursing retention, it has empowered nurses as well as allied personnel to bring about significant change in their working relationships and their overall work environment.

Sherri H. Stroud is Director, Cardiovascular Services, Spartanburg Regional Healthcare System, Spartanburg, SC.

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I too have been in the nursing field since the age of 17-now in my mid 40's I have witnessed the profession evolve from patient based to statstically measured outcomes. The demands on staff are great, the regulations more strigent, we are all held to a higher standard and despite staffing challenges are expected to maintain an excellent standard of care. I am proactive with ALL new hires to make them feel welcome and supported, but that is not the case with everyone....nurses are so hard on each other-we all preach "teamwork" but that is theoretical only for the most part..It is a highly stressful and demanding occupation-but I truly believe most nurses go into the profession with the right intentions, but after awhile it wears and you down...but I will forever be proud of my profession, can only account for my own actions, and will continue to be an advocate for all of my nursing peers, no matter where they are on the "food chain"!

karla  long view nursing homeJuly 27, 2012
Manchester, MD

Lateral violence, whether it be bullying or ignoring someone who needs help with his/her patients, has been going on for the 18 years that I have been in practice and I witnessed it before I graduated when I was in clinicals as well. What the people on the giving end do not see is that it is our patients who suffer from this. We should help each other to give the very best care to our patients that they deserve. If our coworker is less experienced or is just busier than we are, it does not matter how we "feel" about him/her or what we "think" about him/her. What matters is that we make sure that the care delivered to our patients is the best it can be. If that means teaching our coworker because they are less experienced, or being patient with someone who is less knowledgeable or organized than we are, then we do that. The gossip and the trash talk stays at the front door of the hospital! As an entry level manager on the front lines in the trenches with my employees, I've had to remind more than a few people of this.

Sabra July 25, 2012

Although I graduated from nursing school in 1995 as a late bloomer it didn't take me long to get in trouble when I found behaviors unacceptable and spoke up. If you defend yourself your get pushed out of the system or fired. I've seen unbelievable behaviors among managers and staff and would like to say it has changed but it hasn't. As now an independent patient advocate I have nurses who chase me down the hall to tell me how happy they are that I am there with a patient as they see things all the time that happen and if they say anythng they will be disciplined. I can't help think that physicians have some role in this. The healthcare system has always been punitive; punish punish punish; so you soon become complacent just to keep your job. There are many nurses out there that are great nurses who have left their jobs and went into other fields because there is no longer caring there is perception. Hospitals want everyone to think they care when they really just want your money. No one talks to each other and patients and families are lost. God bless those new grads that enter. When I taught I warned them all, if they thought this was a caring community they were stepping into they were wrong, so they better love caring for patients!! Because nothing else will matter and eventually that caring will get you in a boat load of trouble. I would have NEVER gone into this field if I knew how abuse I would be. Sad that we've been talking about this for more than 20 years and yet NOTHING is done and so many continue to tolerate it. If nurses walked out how would the hospitals function?? And we wonder why unions continue to be a threat? I'm disgusted with what I see every day. How are we ever going to change this culture. I only hope it improves before I need them. I don't want to be the participant of two nurses talking across my bed about their night before events rather than caring for me.


sharon gauthier,  CEO,  Patient Advocate for YouJuly 25, 2012
Hartford, CT

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