Lateral Violence

1. 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. • 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." • 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? 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)