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Bullying in nursing

section identifier imagethe front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

Building a culture of respect combats lateral violence

By Abigail Pugh

Winter 2005-06, Vol 9 No 2“

When Mary retired, we realized she’d been hoarding equipment in her locker. We’d all wanted to be as organized as her but we hadn’t realized all those years that she was preventing us from doing our jobs.”


“On my very first shift out of nursing school, I tried my very best and got great feedback from patients. All my supervisor could say at the end of the night was ‘Pick up the pace tomorrow.’ I was crushed!”


“Physical violence, racism, swearing, making faces, gossiping, sabotaging work … oh yes, I’ve seen it all in my 35 years on the job. Every bullying behaviour you can think of.”

The behaviours described above by three nurses in Canada and the United States illustrate what is known as lateral violence or horizontal hostility, a form of bullying that has been described in the nursing literature for more than 20 years.

According to Linda Rabyj, a registered psychiatric nurse and consultant with McKenzie Carver and Associates in Saskatoon, Saskatchewan, who provides lateral violence workshops to health care professionals, lateral violence exists on a spectrum, from seemingly ordinary behaviour such as gossiping or criticism, to intimidation, racism and outright physical intimidation or harm.

Although no comparative studies exist, research suggests that lateral violence may be particularly common in the nursing profession (although Rabyj points out that it occurs in all professions and is by no means limited to nursing). A 2003 study in the Journal of Advanced Nursing found that half of newly qualified nurses report first-hand experience with lateral violence. “Many senior nurses expect graduates to hit the ground running,” says Judith Tompkins, chief of Nursing Practice and Professional Services and executive vice-president of Programs at the Centre for Addiction and Mental Health (camh) in Toronto. “When there is a lack of collegiality and mentoring from peers, young nurses are thrown into the workforce and are left feeling unsupported.”

But why are nurses especially vulnerable to lateral violence? According to Dr. Barry Stein, a psychologist in Duncan, British Columbia, who specializes in workplace harassment and violence, “One of the real challenges is that most nurses are being worked off their feet. Lateral violence may be due to nurses displacing stress and aggression on one another.”

A 2002 Canadian Health Services Research Foundation report on the health of nurses states that “Workloads are reported to be at unsustainable levels, particularly in light of the fact that the average age of nurses is increasing at the same time that the industry is anticipating a significant staffing shortage.” Stein believes that despite attempts over the past few decades to raise the profile of nursing and attract more men, “nursing is still a pink ghetto, and often doesn’t have enough support from human resources in the organization.”

Dr. Martha Griffin, an activist and nurse educator in Boston, Massachusetts, reiterates the connection of lateral violence in nursing to the behaviours of oppressed groups, where inter-group conflict is seen in the context of being excluded from the power structure. “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,” says Griffin. “When nurses don’t have control but must be accountable, you can see where they might not be happy with one another.”

In such an entrenched culture, nurses who experience lateral violence may have few options. “Many decide to tough it out, go on stress leave or leave the profession,” says Stein. Before preventive measures were taken at Brigham and Women’s Hospital, where Griffin works, 60 per cent of nurses left within six months due to lateral violence. Other unhealthy coping strategies include taking up smoking, using alcohol excessively and abusing prescription medication. To the list, Rabyj adds decreased productivity and creativity, as well as increased orientation time and more sick leaves and use of benefits and short-term workers.

But Tompkins stresses that anti-harassment and diversity initiatives can make a big difference. “I’m encouraged by changes over the past 10 years,” she says. “Our anti-harassment policy says that lateral violence is no longer going to be tolerated.” Rabyj agrees on the importance of policies that promote healthy workplace cultures. “Zero tolerance is an important piece,” she says. “Lateral violence cannot thrive when employers become ethically and legally responsible.”

Retention rates at Brigham and Women’s Hospital rose to 94 per cent from 60 per cent after Griffin started a cognitive-behavioural-based awareness program. Griffin is hopeful that naming the problem and suggesting simple ways to combat it will create a powerful effect: “New nurses personalize their experiences and assume they are unique to themselves,” she says. “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.”


Signs of workplace violence

Workplace violence and harassment experts identify the following behaviours that constitute lateral violence in the workplace:


  • 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