âNurses eat their youngâ, itâs a phrase that all nurses have heard before.  But what does it really mean? âNurses eating their youngâ is a common phrase referring to the sometimes high levels of hazing or initiation new nurses experience at the hands of their more experienced coworkers (Katz, 2014)â. This can be referred to as bullying or lateral violence in the workplace. Lateral violence (LV) usually takes form as verbal and emotional abuse and less commonly occurs as physical abuse. LV is an important issue in the nursing profession and may be correlated with other issues in nursing such as understaffing and poor patient outcomes. Ethics comes into play when nurses purposely inflict injury onto each other â emotionally and physically.
Lateral workplace violence is described as an act of hostility and includes actions such as ânon-verbal innuendo, verbal affront, under mining activities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy, and broken confidences (Griffin, 2004)â. Younger nurses and new grad nurses who have less than 1 year of work experience are more susceptible to LV than older âseasonedâ nurses. According to Sheridan-Leos (2008), a registered nurse with the Clinical Journal of Oncology Nursing in Pittsburgh, nurses project LV because of low self-esteem and lack of respect from co-workers. Nurses who fall victim to LV often have their confidence lowered, and have low self-esteem. This can lead to a vicious cycle of LV, with those who used to be victims of LV now be the aggressors.
In 2000, a study was conducted in the UK, led by Brianna McKenna of the School of Nursing at the University of Auckland, on registered nurses in their first year of practice and horizontal violence (HV, another term for LV). In this study, all nurses who had been practicing for under a year were mailed a questionnaire survey. They were asked if they were subjected to overt and/or covert interpersonal conflict in their workplace. This included being humiliated, undervalued, given too much responsibility and not enough support, sexually harassed, stalked, and having racist comments made against them. If they answered yes to being a victim of HV, they were then asked how many times it occurred and then asked how much distress it caused them on a scale of ânone, minimal, moderate, severe (McKenna et al., 2003)â. The participants were then also asked if these incidences caused absenteeism or made them want to leave their jobs and if counseling or debriefing were provided for them.
The study was able to get responses from 551 people or 47% of the people invited to participate in their study. Of these 551 people, more than half said they were victims of being undervalued, referred to as being treated as a student nurse. About one third said they ignored and were given too much responsibility without support. 34% of the sample size reported having experienced verbal humiliation or unfair criticism at least once (McKenna et al., 2003).
A majority of the sample, 83%, reported that the person subjecting them to LV was a female and 54% reported that the transgressor was someone who was in a higher position or had been employed at the workplace for a longer period of time. Only 12 percent had received counseling or a debriefing following the incidence of LV.
LV can cause stress, high turnover rates, absenteeism, short-staffing, low nurse to patient ratios, and overall unhappiness at a job. It can also lead to toxic workplace environments, lack of communication between nurses, and poor patient outcomes and satisfaction. The effects of LV trickle down into other issues in nursing and can be seen as a risk factor for all nursing issues mentioned above. LV will continue to be an important topic in nursing until nurses find a way to support each other and promote a positive work environment.
Nurses who are victims of LV may dread going to work, and may call in sick to work frequently. When nurses call in sick, the rest of the staff must pick up for them, including taking on larger patient workloads. When those nurses return to work the following day, they may be insulted and picked on for calling out of work and causing the other nursing staff to take on extra patients. A third of the sample size conducted in the UK reported that they took time off of work due to LV.
If the LV is severe, victims may feel the need to leave their jobs, leading to high turnover rates. LV in the workplace causes toxic environments. In a toxic work environment, all work efforts are decreased, stress levels go through the roof, and tension leaves everyone on edge. LV has been reported by victims as psychologically taxing, and some nurses have even thought of leaving the profession of nursing as a result of LV. Poor communication can result from LV, as nurses either try to put each other down or avoid each other in fear of facing LV again. Nurses who have poor communication may be subjected to poorer patient outcomes and safety. When nurses are working under stress or are unwilling to help other nurses, mistakes and accidents can happen. Not only does LV cause a toxic environment for the employees, but it affects the patients as well.
A nurse purposely hurting other nurses is very ironic. For the 17th year in a row, nurses have been voted by Americans as the most trusted profession. How is it that nurse can provide such care and compassion at the bedside for patients, but cannot provide that same compassion and care for their co-workers that they see daily? The nursing Code of Ethics set forth by the American Nurses Association states that collaboration, professional boundaries, acting on professional practice, and moral self-respect plays a large part in how we provide care to patients (Slate, 2015). Allowing LV to interfere in the workplace violates the Code of Ethics. As nurses, we need to advocate for those who are of victims of LV and provide training to prevent LV and counseling after incidences of LV.
In 2004, Dr. Martha Griffin, conducted a 2-year study at the Brigham and Womenâs Hospital in Boston Massachusetts on ways to prevent and take LV head on. 26 newly registered nurses were provided education on LV and how to deal with and respond to acts of LV. Nurses were provided with education on common LV practices during their orientation phases of working at the Brigham and Womenâs Hospital. They were also told that stopping the perpetrator of LV was possible and within their capabilities (Griffin, 2004)â. The intended outcome of this teaching was to provide the newly registered nursing with liberation which is âwhat allows learning to continue (Griffin, 2004)â.
Overall, the study proved to be successful and helped to lower the retention rate among nurses at the Brigham and Womenâs Hospital. Nurses were better able to identify LV in the workplace and were able to desensitize themselves to the situation and respond to LV with neutral or non-partisan feelings. Education on LV can help newly registered nurses how to respond to LV, maintain their confidence as new nurses, and promote healthy work environments.
Incorporating these teachings to nurses in undergraduate courses and during work orientations may help to prepare nurses for the real world of nursing. In their undergraduate studies, RN students are not aware of LV, and if they are, they are provided with little information. Nursing care has shifted to a more preventative approach in recent years for illness and disease, early educationabout LV can help to prevent new nurses from facing the negative effects of LV. This can be especially helpful for preventing stress as new nurses are already facing stress from adapting to new work roles and environments.
New nurses should also be provided with a platform of support for reporting LV in the workplace without fear of retaliation from the perpetrators of LV. Proving a safe place to talk about LV can provide stress relief, and promote a positive work environment. There is a stigma that things like LV or bullying should not be reported because you may be viewed as weak or as a tattle-tale. Open platforms can help to uncover the underlying causes of LV in the workplace and provide a stop to it.
As a new nurse an victim of LV myself, I believe that if I was provided information on LV during my A.A.S. RN course, I would have been able to deter myself from feeling helpless and powerless when LV was inflicted upon me. I have experienced many incidences of LV, including racist comments, humiliation, being undervalued or undermined horizontally and up and down the ladder of authority and seniority. Most times, I felt attacked and it took a toll on me mentally and emotionally. At work I would be flooded with emotions from rage to extreme sadness. It had caused such severe distress that I had even considered a change in my career path. It wasnât until I had spoken with my RN supervisor that she had provided me with teaching and coaching on how to deal with LV that I finally took a stand for myself. As Griffin mentions, it really is so liberating to know that you do not have to be a victim of workplace violence to know that there is a supportive group of people to talk to about LV.
LV is a preventable and appalling behavior that seems to be woven into the culture of nursing. It is something that nobody wants to talk about, but is something that most new nurses experience at least once during their first year of practice. Providing new nurses with education on LV and how to approach it can prevent negative outcomes such as high retention rates, poor staffing, stress, and low self-esteem and confidence. As mentioned earlier, this topic will continue to be pertinent to the nursing profession until nurses can find a way to promote and maintain confidence and positive work environments by intervening LV when occurs.
References
Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal of Continuing Education in Nursing 35 (6), 257-63.
Katz, K. (2014). Bullying in nursing: Why nurses âeat their youngâ and what to do about it. Rasmussen College. Retrieved from http://www.rasmussen.edu/degrees/nursing/blog/bullying-in-nursing-nurses-eat-their-young/
McKenna, B. G., Smith, N. A., Poole, S. J., & Coverdale, J . H. (2003). Horizontal violence: experiences of registered nurses in their first year of practice. Journal of Advanced nursing 42(1), 90-96.
Sheridan-Leos, N. (2008). Understanding lateral violence in nursing. Clinical Journal of Oncology Nursing; Pittsburgh 12 (3), 399-403. Doi: 10.1188/08.CJON.399-403
Slate, M.K. (2015). Nurse Code of Ethics. RN.org. Retrieved from http://www.rn.org/courses/coursematerial-177.pdf
