Lateral Violence (Bullying) Among Nurses

Every new nurse has either heard about it or experienced it first-hand. “Nurses eat their young.” Many nurses can relate a story that happened to them or someone with whom they work. Brittney Wilson, RN, author of the nurse blog “Nerdy Nurse,” describes her story of bullying as a new nurse, “Everyone would go to lunch at the same time and leave just me at the desk to answer the phone and lights. Often when they did this I wasn’t even aware until they had all left the floor.”

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Common bullying behavior includes giving a nurse the silent treatment, spreading gossip, humiliating or putting down another nurse, excluding a peer from socializing on or off duty with co-workers, making fun of another nurse, refusing to share or providing limited vital patient information, intimidating another nurse, saying something unkind and then pretending it was a joke, name calling or telling a nurse in front of others that she/he lacks skills or knowledge or attempting to get others to turn against a nurse.

Nurse researchers Cheryl Woelfle and Ruth McCaffrey speculate on the reasons behind why nurses attack their own peers in the article “Nurse on Nurse.” “Nurses often lack autonomy, accountability and control over their profession,” they write. “This can often result in displaced and self-destructive aggression within the oppressed group.”

The effects on nurses

According to Karen Bartholomew, author of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other, verbal abuse contributes to up to 24% of staff turnover and 42% of nurse administrator turnover. In addition, studies indicate that approximately 60% of newly registered nurses leave their first position within six months because of some form of horizontal hostility.

The effects on patients

Breakdown in communication and collaboration between nurses hurt patients as well.  According to a study of 4,539 nurses, 67% felt there was a link between disruptive behaviors and adverse patient events, 71% felt there was a link to medication errors, and one in four nurses felt there was a link to patient mortality.

Reverse bullying?

Increasingly, reverse bullying is being discussed as older nurses complain about bullying from new nurses. New nurses may have more advanced degrees than older nurses, and they are more likely to be much more comfortable with electronic medical records. Younger nurses may become impatient with seasoned nurses and just take over, saying, “I’ll just do it myself.”

What nurses can do

Often nurses are reluctant to report bullying behaviors for a number of reasons. They may be concerned for their job, fear of increased bullying, no confidentiality around the report, no managerial follow-through on complaints, and no real information regarding where to get help.

But nurses aren’t powerless. They can learn new strategies for dealing with bullies. Renee Thompson, RN offers several suggested scripted dialogues in her book, Do No Harm.  While it may be uncomfortable, nurses must learn to develop an assertive communication style without backing down or getting defensive if we feel we are under attack. Possible responses to antagonistic behavior include “I do not need your criticism, but I do need your support,” or a nurse can directly state, “I need your help with this. Can you please help me?”  In addition, sometimes body language can be incredibly effective. Look people in the eye and walk tall. Let the people around you see that you are effective and capable and keep the focus on your patient by asking “How can we work together?”

Resources:

“Nurse to Nurse” http://www.ncbi.nlm.nih.gov/pubmed/17661804?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=15

Rosenstein, A.H. (2002). Nurse-physician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing, 102(6), 26-34.

Rosenstein, A.H., & O’Daniel, M. (2008). A survey of the impact of disruptive behaviors and communication defects on patient safety. The Joint Commission Journal on Quality and Patient Safety, 34(8), 464-471.