Here’s a little experiment for you to try out: Walk into any setting in which nurses work, and say the words lateral violence. Then watch what happens. If your experience is anything like mine has been, here are some of the responses you’ll get:
“I hate that term.”
“We don’t like to use the word ‘violence’ around here.”
“We prefer to call it ‘conflict’ rather than ‘lateral violence.”
I’ve been surprised by how much the term lateral violence offends nurses. In a way, it does seem like an oxymoron to think of nurses as violent. They’re caregivers and healers, and are collectively one of the most respected and trusted groups of professionals in the world. When you try to insert ‘violent’ to that list of esteemed qualities, it just doesn’t seem to fit.
So instead of hearing about ‘violence,’ you’ll more frequently hear talk of the interpersonal ills within nursing culture referred to as ‘conflict.’ It feels safer and softer, and certainly more acceptable to think of a workplace riddled with conflict instead of violence. We’re not afraid of conflict anymore. We know that as human beings, we’re self-oriented and are destined to butt heads with others whose views and objectives are different from our own. Conflict is inevitable, so instead of trying to avoid it, we prepare for it and try to make the best of it. We’ve read articles and books, we’ve watched videos, and we’ve attended seminars on how to manage and deal with conflict. We’ve even come to associate positive things with conflict, as we’ve learned that conflict can be healthy when properly resolved, and can help us to solve problems and grow our relationships with others.
But can we say the same of violence?
Violence occurs whenever a person’s feelings, possessions, or body sustains harm. I have a hard time sweeping lateral violence under the rug of generalized conflict, knowing that people are being harmed.
Consider the example of the new nurse who’s unknowingly walking around the workplace with a “kick me” sign on her back. Every time she passes by a group of her colleagues, they laugh at her and whisper behind her back. She’s being picked on, and she doesn’t know why. She puts on a brave face long enough to get through her shift, but wonders all the while what she could have said or done to warrant becoming the butt of everyone’s jokes. Then she goes home after work, finds the sign on her back, and is devastated. She spends the rest of the day crying and wonders how she can go back and face the same group of people who took such delight in shamelessly embarrassing her.
As hard as I try, I fail to see conflict in this situation. What I see is a nurse who has been bullied. I see a victim. I see violence, and I see harm done to an individual. Because of this harm, one of three things will happen with this new nurse.
- She’ll give up and quit her job, as 60% of all new to practice nurses do when they experience acts of lateral violence in their first nursing positions.
- She’ll take this as a lesson that she must learn: This is how nurses treat each other. She’ll internalize violence as part of nursing culture, and when the next new nurse arrives on her unit, SHE will be the one placing the “kick me” sign on that nurse’s back.
- She’ll return to work the next day and confront her colleagues with a statement such as, “Someone put a ‘kick me’ sign on my back yesterday, and I felt some of you were laughing at me and talking about me whenever I walked by. I don’t know why this was done to me, so I just want you to know that if you have a problem with me, you can talk to me directly about it.”
Number three is the best possible outcome for the new nurse, but unfortunately, it is the path least traveled. Why? It takes power to stand up for yourself and confront those who have abused you. Put yourself in that nurse’s shoes. After being singled out and humiliated in this manner, she probably feels like the least powerful person in her workplace. When she found the “kick me” sign on her back and she didn’t know who put it there, it was very hard for her to fight back. The anonymity of the act took away her power to confront her abuser. This is characteristic of so much of the passive-aggressive behavior that occurs in nursing. Violent acts are either hidden or disguised so that it becomes difficult for the victim to confront and address the abuser. That’s quite a difference from a true conflict, in which each party has enough power to express their argument and defend their own self. In conflict, there is enough respect between the two disputing parties that they openly communicate their disagreement with each other.
Lateral violence and conflict may overlap at times, but they are definitely not the same thing. There is a historical and cultural context to abusive peer behaviors in nursing that call for a specialized approach in order to heal the damage done and prevent future harm. Oddly enough, those same nurses who tell me how uncomfortable they are with the term ‘lateral violence’ also tell me that their units have been participating regularly in conflict resolution trainings for years, but things just never seem to change.
And they never will unless nurses are willing to be honest with themselves and their colleagues, acknowledging that lateral violence is a reality – and that they have the power to change it.
Please post a comment about a time that you felt victimized or powerless at work. How did you handle the situation? Do you feel that it was conflict, or violence? To protect privacy and confidentiality, do not use real names if you mention other colleagues involved.
We’ll choose 5 of the most interesting or thought-provoking posts and send those folks a gift! Be sure to include your email address in the comment form (it will remain hidden once posted) so we can contact you if your post is chosen.
We’ll announce the winners on December 17th!
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I was a per diem nurse in a local ED, and on one of my first shifts, lunch came and went and no one came to relieve me so I could go to eat- which was the norm in previous workplaces. When I confronted the Charge Nurse, she told me it wasn't her responsibility to make sure I ate. I asked her what she felt her responsibilities were to the team. She then talked openly about me to other nurses calling me a b@@tch because I had the nerve to question her abilities as a Charge Nurse. After that I made sure I got my lunch/meal without waiting for permission to go. I considered what she did was bullying.
I just hate it when you know that people are talking smack about you behind your back, but like you said Amy its hard to do something about it because you don't know who started the rumor and whos spreading it around. You just hear things secondhand or you notice that people are treating you differently because of what they heard. That is bullying when people do that to you. Jasmine Carpenter
Although I am not a nurse, I have certainly experienced and witnessed lateral violence in the workplace. I don't think the issue is unique to the healthcare field. As a mid-level manager several years ago in an educational setting, I had a collegue that liked to change the rules for newcomers.
She victimized her collegues by her desire to look tough to her group of male administrators. Once our office sent out an internal memo to principals, but it was spelled principle. This lady insisted that the secretary call all 77 principals and apologize for the error.
A CNA came to the DON with a problem and the DON literally threw her hand in the CNA's face, shouted "I don't have time for this!" and walked away. After the CNA left, the DON mocked her to her co-workers, belittled and gossiped about the CNA's personal life, but never addressed the conflict brought up by the CNA. The CNA was later told by one of the co-workers what conspired after she left. She was so upset, she went to the Adminstrator, yet the issue was never addressed. This was a regular occurance with the DON, who insists she has a "open door policy," yet when I have went to her with problems, I was brushed off, laughed at, or gossiped about. It is terrible when conflict happens within coworkers, but worse when it comes from the administration. I have since resigned my position and found better employment.
We got a new Chief Nursing Officer at the hospital. She came in and did some very dramatic restructuring. A couple of key leaders lost their jobs. People in the department took sides. Some people were brave and maintained their friendships with those who lost their jobs. Some alienated those people because they feared that to remain in contact with them would put their own jobs at risk. Conflict arose between those who were loyal to the dismissed employees and those who chose to alienate them. People who had chosen to alienate their former colleagues suffered from major guilt.It took years for those tensions to be resolved….actually it took until that CNO left and an amazing person replaced her and mended all the broken relationships.
I'm seeing a common theme here! It sounds like a lot of you have dealt with violence from superiors and leaders. That adds a whole extra layer of difficulty in confronting and addressing abusive behaviors. From horizontal violence, we go to an even tougher version – vertical violence! In fact, it appears that there is an effort underway to recognize the term "vertical violence" when referring to violence between nurses with inequal power. Here's a peek at an abstract from an article that appeared in Nursing Outlook very recently (July 2009): http://www.journals.elsevierhealth.com/periodical...
I'm going to get the full text of this article and read it, and look at other resources out there on vertical violence. Anyone want to join me in studying up on V.V.? Please keep sharing your comments. I appreciate you sharing your experiences in nursing!
I have experienced lateral violence more than once. The most memorable one was when I was working as a CNA at the hospital on 3rd shift. My job was to go around and get everyone's vitals as often as the doctor ordered them (ev. hour, ev. 4 hours, etc.). One nurse in particular had the nastiest bedside manner of any nurse I had ever known. In fact, I'm not even sure why she was a nurse since she didn't seem to like anyone, patient or co-worker, period. Of course, one night I was assigned her patients and one of them was running a slight temperature. Although it wasn't a big deal it was my job to report this to her and then her responsibility to do something about it. I told her and she snapped at me. Why was I bothering her with this? (Um, it's what I'm supposed to do?) Then she stomped down the hall and (presumably) checked on her poor patient. I asked her sometime after that why she had become a nurse. She said the money. Figures.
I'm a caregiver in a group home for people with mental disabilities. I have a 20-year-old co-worker who has called other workers "losers" because they choose to spend time with the clients off-hours. Of course, she didn't attend the non-mandated, non-paid training session that nearly every other employee attended. The one who needs it most is the one not there. A problem that I haven't seen mentioned here is that the same mentality that causes lateral violence can bleed out into patient care. Our job is to help the people who live there to become as independent as possible; some will eventually even be able to get an apartment and live on their own. This worker doesn't seem to get this. The co-worker has OCD and then some. Usually she works third shift when it isn't a problem, but at least one day a week she works second shift. One time, in an effort to "control" the clients she ran into a bit of trouble. This particular client has a program where you sign his book if he's good and if he's good all day then he gets a quarter. The client had apparently taken an attitude with her (which was most likely because she had one with him). She asked to see his notebook. He refused. Instead of letting it go and just logging that he had refused, she felt the need to control the situation. So in her infinite wisdom, she went upstairs to his room (invasion of privacy) and took his cell phone. This caused him to chase her around the house swinging at her and ultimately resulted in the coordinator being called. The client barely escaped going to the mental hospital. The co-worker barely escaped being injured over something as stupid as a notebook. Pick your battles.
Ange, you've brought up a really interesting point. Violence between caregivers can indeed spill over into care of patients/clients. I know this from personal experience! Years ago when I was a newly certified EMT-I, I was in the back of the ambulance caring for a patient when my colleague yelled and cursed at me for not opening the sharps container before handing it to him. As he was doing the call-in report, the patient looked up at me and told me how sorry she was for the way he was treating me. At that moment I just felt horrible for her. We were supposed to be taking care of her and she was worried about ME! I am sure we looked completely incompetent are caregivers and terrible as a team. No doubt it diminshed her faith in our ability to care for her.
Lateral and verticle violence are not unique to the healthcare field. Most folks sweep it under the carpet and hope it doesn't happen again. The biggest problem that I see is that this passive behavior actually ENABLES your "attacker" to do it again. I am not saying that you should get caught in the drama of the moment, but all issues should be addressed directly to those responsible.
If no resolution can be made, then continue your fight up the ladder. Just because some of this abuse is dished out from a verticle leader, doesn't always mean there isn't someone more "verticle" than the abuser. I had a verticle attack from a manager. Our company has standard written work procedures to follow. With that said, this manager was having to deal with an exception. She did not inform me prior to my work, then had the nerve to get in my face about how I was getting into the middle of something that I didn't need to be involved with. Her attack was unwarranted. I defended myself in saying that I was following my procedures and she had not made me aware that there was a "special circumstance" in this case. She knew I was right and actually backed off. So I felt pretty sucessful in thwarting what could have been an explosive situation. I realize that all situations are not this easily resolved, but I am saying that standing up for yourself in a non-threatening way can often make a difference.