The Problem of Lateral Violence: How Nurse Bullies Affect Patient Care
Have you ever had to work with one of those intimidating nurses who makes you feel about three inches tall? You know the kind. The nurse who sends you not-so-subtle messages that you are incompetent and your questions are a waste of their time? We have all had that experience at some point. And that needs to change.
What is Lateral Violence?
Put simply, lateral violence is bullying. It includes intimidating behavior, making faces behind someone’s back, name-calling, or threatening, but often, it is more covert. When a nurse speaks with exaggerated impatience, refuses to answer valid questions, uses condescending language, or questions a nurse’s judgment constantly (especially in front of others), that is bullying.
How Does Someone Become “That Nurse?”
Every student nurse I have ever known has said the same thing: “I will never be one of those nurses!” And yet, every one of “those nurses” was once a student or a new grad who probably dealt with a bully. When does that transformation happen? At what point does a nurse slip into bullying behaviors herself, and why?
One of the theories about lateral violence is that it happens when nurses feel disempowered. Nurses have a lot of responsibility, but much less power or authority than physicians or hospital administrators. Due to fear of retribution, instead of directing their frustrations at those in authority, nurses tend to act out against someone safer — a peer.
Bullying isn’t usually a conscious redirection of anger (though sometimes a victim is singled out), but that frustration has to go somewhere. This redirected anger is often aimed at the person least likely to strike back: the new graduate or the student nurse. When this behavior goes unchecked, it becomes part of the culture, just “the way it is.”
How Bullying Affects Our Patients
Bullying isn’t only a problem for other nurses. I’m sure you can recall a time you have hesitated to approach “that nurse” about a patient concern or delayed asking for information or help because you knew the request would be met with an exaggerated sigh or a comment meant to make you look inadequate to the nearby staff.
Lateral violence in nursing jeopardizes the communication of critical information and collaborative decision-making, increasing medical errors, and leading to poorer patient outcomes (Vessey et al., 2010). The risk of medication errors increased as well: An Institute for Safe Medication Practices survey showed that 49% of respondents had altered the way they handled a medication order or clarification because of intimidation.
What Can We Do About Bullying?
The most important thing you can do to change the culture of bullying is to refuse to engage in it or accept it. Don’t take part or encourage other nurses when they criticize or give a colleague a hard time. You should always try to set an example by being helpful and kind to other nurses and support staff.
Don’t allow another nurse’s behavior to affect your patient care. If your questions or requests are being ignored or met with sarcasm, let them know you won’t be bullied: “I need to do my job. Will you answer my question (or help me)?” If they refuse, let the nurse manager know. Management has a responsibility to address hostile workplace behavior and the Joint Commision requires this.
Bullying will not be an accepted part of the culture if it is not accepted by nurses. Be a part of the changing culture by leading the way as a role model nurse for our “caring profession.”
Are you being bullied or intimidated on the job or at clinicals? Check out Dr. Renee Thompson’s site for more information and specific suggestions on handling it:
One Stop Nurse-to-Nurse Anti-Bullying Shop!
What if Your Nursing School Instructor is Bullying You?
- Carolyn Mallon, RN
Carolyn is our guest blogger, a Registered Nurse. If you’d like to learn more about her, check out her personal blog: The Distracted Mom
Originally published at blog.nclexmastery.com on July 9, 2015.
