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A black-headed python awakes at twilight to find its next meal. Ravenous, it devours one of its own offspring.
It’s not just the animal kingdom that practices filial cannibalism; nurses are infamous for “eating their young.” Before your mind leaps to pictures of your manager devouring a colleague, we are, of course, speaking metaphorically.
Lateral violence in nursing may not leave behind the blood and scars, but it can leave profound psychological and emotional wounds on its victims.
No one should have to endure bullying, and this article is here to let you know you’re not alone. We’ll explore the causes of lateral violence, its potential effects, and practical strategies to address this challenging issue.
What is lateral violence in nursing?
Lateral violence or horizontal violence is when nurses behave in toxic, hostile, or harmful ways towards colleagues. It can start as small actions or subtle behaviors, but gradually increase over time to outright bullying.
These behaviors can be overt, such as eye rolling, verbal abuse, or publicly shaming colleagues. Lateral violence can also manifest as covert criticism, such as ignoring, withholding important information from, or gossiping about colleagues.
Who are the victims of horizontal violence?
Unfortunately, the victims of lateral violence are often newly graduated nurses or new recruits. In many cases, the perpetrators can be nurse managers, directors, or more seasoned nurses. This can make it difficult for victims to report the bullying, as they fear the repercussions.
The article, “Lateral Violence in Nursing and the Theory of the Nurse as Wounded Healer,” estimates that 44% to 85% of nurses suffer this kind of behavior. The same article reported that 93% of nurses reported witnessing bullying in the workplace.
These are not one-off events; lateral violence is a systemic issue within nursing, and it can have far-reaching consequences.
Causes of nurse-on-nurse bullying
One reason that lateral violence has become so widespread is that it has become an accepted part of the nursing culture. It is often seen as a rite of passage and a way to build resilience in new recruits.
The prevalence and acceptance of bullying in nursing make it difficult to change, especially when many of the perpetrators are in positions of authority.
High stress levels and pressurized work environments
Another contributing factor may be nurses’ high stress levels and the pressure of the work environment. Several studies have found that nursing may have higher burnout and turnover rates than the armed forces. In the article, “What is Lateral Violence in Nursing?” 80% of nurses surveyed reported having no time to rest.
Nurses who engage in lateral violence may be doing so to relieve their high stress levels by taking their frustrations out on more vulnerable nurses.
Filial cannibalism
Diving into the creepy corners of the animal kingdom, filial cannibalism is the practice of animals eating their own. The concept of “nurses eating their young” may share some of the same motivations—namely, weeding out the weak, removing the competition, and strengthening the survivors. Using these lenses, it could be seen as the nursing version of survival of the fittest.
Nurses as the wounded healers
There are many reasons why people are drawn to the nursing profession. One reason is that many have experienced trauma in their own lives and therefore want to help and care for others.
If nurses’ personal traumas are not fully resolved, they can become “walking wounded.” This can increase the likelihood that they will be re-victimized by lateral violence—back to survival of the fittest. Victims of bullying may also repeat the cycle and go on to bully others.
How does lateral bullying affect nurses?
Lateral violence can have far-reaching consequences, such as physical or mental health problems.
Mental health issues
Lateral violence can cause the following mental health problems:
- Depression
- Anxiety
- Insomnia
- Suicidal thoughts
- Post-traumatic stress disorder
Physical health effects
Bullying in the workplace can also cause adverse physical effects. A survey cited in “What is Lateral Violence in Nursing?” found that 59% of nurses were more likely to suffer adverse health problems, such as cardiovascular disease.
Quality of patient care
How are patients affected by lateral violence?
Obviously, a lack of communication, added stress, and poor teamwork will impact the quality of patient care. It’s difficult to provide high-quality care if you are personally under increased emotional and physiological pressure.
Mary’s story
“Lateral Violence in Nursing and the Theory of the Nurse as Wounded Healer” recounts the story of Mary, a nurse with more than 30 years of experience, who suffered lateral violence when she joined an emergency department (ED). This is what Mary said:
"I was a new face in the ED and was subject to criticism and disdain as if it were my very first day as a nurse. I would say hello to staff members, and they wouldn’t answer. One other ED nurse, Leah, seemed to have it in for me. One day in particular, Leah was talking and laughing with another nurse. I walked up to them, and they suddenly became silent. When I asked them what they were laughing about, Leah rolled her eyes and muttered something to the other nurse as they turned their backs to me and walked away."
Mary also reported that her co-worker, Leah, had sabotaged the quality of her patient care on one occasion. When Mary discussed the issues with her manager, she wasn’t taken seriously and was told that she needed to be less sensitive.
As a result of the bullying, Mary started to feel depressed and isolated. It also made her think about leaving her job in the near future. Mary is not alone; the survey cited in “What is Lateral Violence in Nursing?” found that 30% of nurses were strongly considering resigning due to lateral violence.
Coping, communicating, and building resilience
Resolving institutional problems, such as lateral violence, is the responsibility of the healthcare organization. Unfortunately, as bullying is seen as an acceptable part of the culture, that is not always the case, as Mary’s experience demonstrates.
If you are experiencing lateral violence, here are practical steps you can take to protect yourself.
Master communication techniques
You must develop strong communication skills, such as setting boundaries. In the event of bullying, adopt a calm, professional manner. Be assertive, not defensive, but make it clear that your colleague’s behavior is unacceptable.
Speaking up isn’t always easy, and you may choose to let some things go, but silence may be taken as permission to continue—so decide when you want to speak out.
Report the incident
If the perpetrator of the bullying is the manager or director (as is often the case), reporting it can be especially difficult. However, if you can, it is important to speak to a supervisor and to follow the internal process for lodging a formal complaint.
You can also file a complaint with an external body, such as the Occupational Safety and Health Administration (OSHA). With OSHA, you can register your complaint online, and a signed complaint is likely to trigger an on-site inspection.
As soon as nurse managers become aware of lateral violence, they should refer the matter to HR or an Employee Assistance Program (EAP) so that the staff member can receive appropriate support. After taking action, managers should provide ongoing support to the victim.
Remember, too, that you may be able to get support, guidance, and mentorship from your peers. Consider joining online support groups, such as Don’t Clock Out.
Prioritize self-care and wellness
If you are a victim of lateral violence, and especially if it is difficult to report because the perpetrator is in a position of authority, it is vital to take care of yourself.
You may benefit from psychological support and engaging in wellness activities, such as mindfulness or exercise. While it may not feel right to move on immediately, taking care of yourself may mean leaving a toxic environment at some point.
Moving forward on a supportive nursing path
In the face of an institutional problem like lateral violence, it may seem that we have little power. However, we can focus on small individual actions to bring about change.
Remember, if you are experiencing bullying, communication is key. If direct communication isn’t your strong suit, take the opportunity to develop assertiveness, which is essential for professional advocacy. Learn how to set strong boundaries and make it clear how you want to be treated.
It is vital to speak to your supervisor and to report the incident if you can. In the meantime, practice self-care strategies and, when you are able, consider a change to your workplace.
Let’s transform the toxic narrative of nurses eating their young into one of support, growth, and mutual respect.
Find more practical strategies for handling nurse bullying here.
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