Lateral Violence – Ethical Responsibility
Greg Riehl RN, BScN, MA
Lateral Violence
•Exists on a spectrum, from seemingly ordinary
behaviour such as gossiping or criticism, to
intimidation, racism and outright physical
intimidation or harm.
•Many have firm views on the necessity for
younger nurses to endure what they themselves
had to endure in their "training" for the
profession.
•Some new nurses personalize their
experiences and assume they are unique to
themselves
•Tackling the nursing shortage requires action
on both attracting recruits and making it easier
for them to stay.
•For nurses, Lateral violence takes on at least
two different forms:
1. Lateral psychological violence or bullying
(also known as “horizontal hostility”) within
the nursing profession; and
2. Psychological violence of nurses by others.
Signs of Workplace Violence
Workplace violence and harassment experts
identify the following behaviours related to
workplace lateral violence:
• aggressive or mocking body language
such as raising eyebrows or making
faces
• verbal retorts, abrupt responses, vulgar
language
• undermining behaviour such as ignoring
questions, constantly criticizing or
excluding individuals from discussion
• withholding needed information or
advice
• sabotage such as setting up a new hire
for failure
• infighting and bickering
• scapegoating
• blaming and gossiping behind a
colleague’s back
• failure to respect privacy, and broken
confidences
• shouting, yelling or other intimidating
behaviour
• judging others on age, gender, sexual
orientation, ethnicity or size
• physical violence
Reasons for Bullying Behavior
•Some studies suggest that nursing has always
condoned intimidating behavior.
Oppressed Groups
•Nurses generally don't have sufficient control
over their work environment and have a high
degree of accountability coupled with a low
degree of autonomy.
•Lateral violence in nursing is connected to
behaviours of other oppressed groups, where
inter-group conflict is seen in the context of
being excluded from the power structure.
We do not accept bullying in our schools or
other workplaces so why is it ok in Nursing?
Is this the culture that was learnt by nurses
in the past, and if so, what is being taught to
new nurses?
•The profession established itself at a time
when public health was a reform movement,
requiring its practitioners to educate the "lower
orders" in health-related behavior for their own
good. A bossy and controlling manner was seen
as part of the nurse’s role.
•The first published academic analysis of the
behavior as a negative characteristic, however,
may have only appeared in 1984; this was in the
form of advice to nurses on how to manage the
stress associated with this kind of behavior.
"When nurses don't have control but must
be accountable, you can see where they
might not be happy with one another."
"Our program empowered nurses to
advocate for themselves. As it liberated
them, retention rates improved. We attribute
this to recognition of lateral violence. Newer
nurses can learn from those who've gone
before.“
Bystanders and Managers
•Sometimes staff witness lateral violence events
but are not prepared to support their colleague
for fear that they might be the next victim.
•Ignoring the victim’s behavior and distress
seemed to be the way both staff and the
organization responded to the issue.
•There may be a style of management within
nursing at various levels and institutions that is
based on fear rather than respect.
•Anti-harassment and diversity initiatives can
make a difference: Backbones not wishbones.
Confront Behaviour
•If one speaks critically or takes a questioning
stance then one may be positioned as disloyal,
ungrateful or a bad nurse.
•Confront behavior and acknowledge if it has
been there for a long time but was never
discussed.
•The way forward is to focus on implementing
strategies to reduce the opportunities for
bullying behavior to occur.
•Take personal responsibility for the situation.
•Try to reach consensus to actively bring about
change by developing, publishing, and
implementing strategies.
•Some people are shocked to discover that they
actually contribute, either inadvertently or
otherwise, to a bullying culture by their actions
or inactions.
•In practice, this means Nurses can’t stay silent
when another nurse’s actions “makes them
cringe”.
Culture of Silence
“Because we set ourselves up to be healers,
this kind of behaviour is in the shadows. We
don’t know what to do about it, so we try to
disown it.”
Conclusions
•Having the conversation is what matters . . . it
shows that both professionals share
responsibility for behaviour affecting staff and
patients.
•Dialogue is ultimately far more effective than
pointing fingers.
•Health care professionals across the spectrum
working together more effectively, and patients
receiving better care.
Teamwork and Communication
•Developing more open communication and
increased access to nursing senior
management.
•Ensuring that nursing supervisors receive
adequate nonclinical training for their roles.
•Ensuring that competency standards refer
specifically to managing bullying and that these
standards are maintained through an effective
performance management system.
•Providing accessible professional development
opportunities for all staff.
•Developing policy on bullying/lateral violence in
the work-place & conflict resolution mechanisms
"Lateral violence cannot thrive when
employers become ethically and legally
responsible."
Acknowledgments
I thank the SRNA, my past co-workers, and all
Registered Nurses who have contributed to
raising awareness of Lateral Violence.
For further Information, References or Requests:
Greg Riehl
306.352.1045
gregriehl@sasktel.net
“Ultimately we know deeply that the other side of every
fear is a freedom.”
Marilyn Ferguson (b.1938)