By Nadine Salmon, BSN, IBCLC, Clinical Content Specialist AMN Healthcare
We began May by celebrating National Nurses Week, which is an opportunity to honor nursing colleagues and the profession of nursing. Yet, lateral violence in nursing is becoming an ever-increasing epidemic that needs to be eradicated from the nursing profession.
What is the difference between lateral violence and bullying? According to the American Nurses Association (ANA) factsheet on Lateral Violence and Bullying in Nursing (2012), lateral violence refers to acts that occur between nursing colleagues, where bullying is described as acts perpetrated by someone who is in a higher level of authority than another, and displays hostile behavior over a period of time. The acts of bullying can be verbal or non-verbal aggression, and behaviors may include gossiping, withholding information and ostracism (Dellasega, 2009). Furthermore, bullying isn’t limited to the workplace, but also appears to also occur outside of the workplace, in person or online.
Cheryl Dellasega, GNP, PhD, and Professor of Humanities at Penn State University College of Medicine, has written extensively about lateral violence among nurses. In her work, Dellasega has explored whether this destructive pattern is an inevitable consequence of people (primarily women) working together, or if bullying is a persistent, destructive presence inherent in nursing itself. To the second point, Dellasega identifies the nursing education system, in which nurses are generally trained to be subservient and accept orders, thereby predisposing them to bullying from others. In addition, the nature of nursing tends to create a restrictive workplace, in that there is little opportunity to walk away from an escalating emotional situation, even temporarily; the nurse is responsible for his or her patients at all times during a shift.
According to the ANA (2012), the statistics on lateral violence in the workplace are disconcerting: In 2007, a study of student nurses reported that 53% had been put down by a staff nurse at some point in their career (Longo in ANA, 2012), and 48% nurses, pharmacists and other healthcare professionals reported experiencing strong verbal abuse in the workplace (Institute for Safe Medication Practices, 2004, in ANA, 2012).
Perhaps most troubling is the fact that lateral violence can have serious health consequences for the person being abused. Unmanaged anger can contribute to hypertension, coronary artery disease, depression and psychological disorders such as post traumatic stress disorder (Meyers, 2006 in ANA, 2012). A hostile work environment can also lead to lowered staff morale, increased absenteeism and affect the overall quality of nursing care delivered. Thus, bullying can be a risk to patient safety, as it interferes with teamwork, collaboration and communication - the underpinnings of patient safety (Stokowski, 2012).
Bullies often target the most vulnerable, such as recent graduates or new hires. Other situations that may make nurses susceptible to bullying include: Receiving a promotion or award that a bully may feel is unjustified receiving attention from physicians, or working under stressful conditions (i.e. staff shortages and/or high patient acuity levels) (Dellasega, 2009).
Fear of retaliation may prevent the victim or observers of the situation to report the abuse. Sadly, some nurse managers may choose to avoid confronting the bully themselves, even when the situation is brought to their attention. Most organizations have a code of conduct that outlines acceptable and unacceptable behavior and offers a process for managing disruptive behavior. Yet some nurse leaders may continue to shy away from taking a firm stand against bullying in the workplace.
However, observers of workplace bullying can sometimes diffuse a hostile situation. If you observe a colleague victimizing another nurse, try speaking up for the victim or request that he/she assist you with a patient. Sometimes, simply standing next to the victim displays solidarity and may be enough to prevent a situation from deteriorating (Dellasega, 2009).
Nurses need to pull together and support each other; the profession of caring for others should be extended to caring for our colleagues. Nursing is stressful enough without bullying. Now is the time to take a stand against bullying and eradicate it from the workplace.
The American Nurses Association (ANA) has released a new e-book entitled, Bullying in the Workplace: Reversing a Culture. It can be accessed online here. Let’s work together to create a healthy nursing culture -- a collaborative, caring work environment that does not tolerate bullying.
ANA (2012). Lateral Violence and Bullying in Nursing Factsheet. Retrieved from http://navigatenursing.org/PDFs/Fact%20Sheet%20Lateral%20Violence%20and%20Bullying%20in%20Nursing.pdf
Dellasega, C. (2009). Bullying among nurses. American Journal of Nursing, 109 (1), 52-58.
Stokowski, L. (2012). Medscape. A Matter of Respect and Dignity: Bullying in the Nursing Profession. Retrieved from http://www.medscape.com/viewarticle/729474_2
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