The given assessment will primarily focus on the issue of lateral violence in nursing, which is a form of non-physical violent behavior and bullying taking place between healthcare workers, such as nurses. When new nurses enter the profession, they often hear the expression that “nurses eat their young” (Christie & Jones, 2013; Tedone, 2020) but what does “eating their young” really mean, what does it look like, and what is the reason behind it? In other words, the implications of the problem are at their highest among entry-level nursing professionals, which is why systematic strategic measures, such as the wounded healer theory-based approach, need to be undertaken in order to prevent such behaviors from occurring and increase job satisfaction.
Explanation of the Issue
Lateral violence in nursing is a hostile non-physical interaction between nursing professionals operating in an organization, which primarily affects younger nurses or entry-level nurses and is mostly inflicted by older nurses with a higher degree of experience. It can manifest itself in bullying, harassment, and other forms of hostile behaviors. In recent years, this problem has come to be recognized not only as “the ways things have always been done” or a right-of-passage for new nurses, but as a significant problem for the profession resulting in frequent job turnover, new nurses leaving the profession before ever becoming firmly established in it, a risk to patient care, and an exorbitantly expensive problem for nursing employers. (Christie & Jones, 2013; Tedone, 2020) This problem is now recognized by several different names, including lateral violence, horizontal violence, and nurse bullying. Lateral violence includes everything from overt acts of physical violence between nurses to less obvious offenses such as gossiping, sabotaging, and humiliating peers. (Stefano et al., 2017) Studies on lateral violence show it to be a prevalent issue which most nurses experience at some point in their career, yet one which is overwhelmingly rejected by members of the profession. (Anthony & Brett, 2020; Stefano et al., 2018; Tedone, 2020). Therefore, the issue is both widespread and severe in all healthcare organizations.
The top three causes or reasons for lateral violence are high-stress settings, work environment, and a severe inequality of vertical power dynamics. One proposed explanation is that preceptors are expected to assume the additional responsibility of teaching new nurses without any reduction in their preexisting workload, creating additional stress for the preceptors. As Edmondson (2019) states, “Bullying is more likely to occur in high-stress settings with high-stakes outcomes, heavy workloads, and low job autonomy – all part and parcel of the nursing profession” (p. 274). If preceptors feel powerless in reducing their stress, they may take their stress out on the new nurses they are training. (Tedone, 2020).
Another proposed theory for the prevalence of lateral violence among nurses is that of the “walking wounded,” meaning that many nurses enter into the profession because they have experienced some trauma in their lives which they hope to alleviate in others through their nursing care. However, when these traumatic issues remain unresolved, nurses use hurting other nurses as a way of misdirecting the hurt caused by their trauma (Christie & Jones, 2013). The alternative theory is that nurses are frustrated by the balance of power in healthcare settings, and their voices are not heard. When nurses are the victims of vertical violence – violence between positions of higher and lower authority, such as between physicians and nurses – they may, in turn, take out their frustrations on their peers or try to establish power over other nurses to satisfy their need for validation (Zelonka & Zelonka, 2019).
The top three negative outcomes are deterioration of mental health among nurses, high turnover rates, and job dissatisfaction among existing nurses. The negative impact of lateral violence on nursing is well-documented, with studies showing that up to 34% of nurses decide to leave or think about leaving the profession because of bullying (Zelonka & Zelonka, 2019). In a profession that already struggles with staffing shortages, it is imperative to the robustness of the profession that it retain its members. Moreover, because understaffing is a stressor that contributes to lateral violence, having nurses leave the profession because of lateral violence only increases the likelihood of new nurses being the victims of lateral violence. Other nurses cite the side effects of lateral violence as depression, anxiety, low morale, decreased on-the-job productivity, and increased absenteeism. (Tedone, 2020.) According to Edmonson & Zelonka (2019), a 2008 study of 511 randomly selected registered nurses in Massachusetts found that job satisfaction was more closely tied to a positive work environment than even salary.
The proposed strategy is the wounded healer theory, which emphasizes the notion that an experienced nurse, who suffered from lateral violence, will be more compelled to help younger or entry-level nurses due to their past experiences (Christie & Jones, 2013). It will directly address job dissatisfaction among nursing professionals by providing knowledge and skills to combat lateral violence. The nursing profession recommends increased training in a top-down format to eliminate lateral violence from the nursing culture to increase nurses’ job satisfaction. The rationale for why the proposed strategy and subsequent outcome should be addressed first is because it has a wide range of severe implications, where high retention increases the workload on existing nurses, which worsens an already hostile environment, and thus, the cycle needs to be disrupted with the proposed measures.
- Acknowledge that lateral violence is a real problem in the nursing profession;
- Eliminate workplace factors that increase stress, such as inadequate staffing and required overtime, and which may contribute to bullying;
- Implement a top-down approach that ensures nurse leaders are modeling appropriate professional behavior;
- Create a zero-tolerance policy that clearly outlines bullying behavior and that explains how bullying should be reported and addressed;
- Create an environment where nurses feel safe and supported in reporting acts of lateral violence;
- Address incidents of lateral violence quickly and involve other organizational leaders, such as Human Resources, if necessary;
- Include the prohibition of lateral violence in social media policies;
- Encourage nurses to call out lateral violence among their peers and empower them in doing so.
Evidence to Support Strategy
The cause of job dissatisfaction among nurses can be effectively targeted by the wounded healer strategy. Evidence supporting the proposed measures states that job satisfaction requires a multilateral measure, which is why no single change will have the desired effect. (Bambi & Guazzine 2017). Bambi & Chiara (2018) have likewise reported scientific evidence does not yet support a single solution to lateral violence among nurses. Rather, they suggest that a shift in the collective conscientiousness of the nursing community must take place to eradicate the problem, which is why a top-down format training alongside the eight proposed changes will be effective since they are systematic. Edmonson et al. (2019) have identified key elements which collectively could produce the culture change necessary to reduce lateral violence among nurses, and thus the strategy is eight-step organizational modifications and changes proposed above.
In conclusion, lateral violence in nursing is a major problem, which requires more acknowledgment and recognition. It is responsible for high turnover rates, staffing shortages, high workloads, and mental health deterioration among nursing professionals. The proposed strategy is to introduce key organizational changes, which are centered around the wounded health theory. Nurses, who experienced lateral violence, will be given time and resources to train newly coming nurses on how to report, respond, and prevent lateral violence affecting their performance and well-being.
Anthony, M. R. & Liners, A. B. (2020) Nurse Leaders as problem-solvers: Addressing lateral and horizontal violence. Nursing Manage., 51(8), 12-19. Web.
Christie, W. & Jones, S. (2013) Lateral violence in nursing and the theory of the wounded healer. OJIN: The Online Journal of Issues in Nursing, 19(1), 1-9. Web.
Edmonson, C. & Zelonka, C. (2019) Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly, 43(3), 274-279. Web.
Stefano, B. & Guazzini, A. (2017) Preventing workplace incivility, lateral violence and bullying between nurses. A narrative literature review. Acta Biomedica, 88(Suppl 5), 39-47. Web.
Stefano, B., Chiara, F. et al. (2018) Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors. Acta Biomedica, 89(Suppl 6), 51-79. Web.
Tedone, D. A. (2020) Eliminating horizontal violence from the workplace. Nursing, 50(8), 57-60. Web.