Lateral Violence: The REAL Nurse Curse

Objective:   Lateral Violence (LV) or workplace bullying is a long-standing problem within healthcare.  So much so that the Joint Commission put out a statement highlighting the subject in 2008.  Nurses consider bullying normal, like a rite of passage; it is “just how it has always been.”   The current practice of enabling bullying among peers, allowing incivility to go unchecked, and having no accountability had to change.  Thus, a lateral violence workgroup was developed to decrease the incidences of LV and measure it's impact on nurse retention.

Design: The workgroup would isolate perceived LV behaviors and develop strategies to reduce the occurrence of or enhance the processes in being able to manage them using the Plan-Do-Check-Act Cycles.

Sample:  RNs (400+): Labor & Delivery, Postpartum, Nursery, Neonatal Intensive Care, Antepartum, Gynecologic Surgery/PACU.

Methods:   One metric used to measure our efficacy was a monthly/quarterly anonymous survey question to track the perception how often LV behaviors occurred.  This survey was used after the implementation of each educational piece.  Human Resources tracked the LV complaints and job loss/resignation due to LV. 

Implementation Strategies:   The Plan-Do-Check-Act cycles involved educating staff, supervisors, and managers.  The education ranged from PowerPoint presentations, posters, emails, tip sheets and meetings.  Administration sent a clear message to everyone showing support of this initiative; we were now a “No Bully Zone.”   Recognizing and appropriately handling LV in conjunction with accountability was a top priority especially for supervisors/managers.  Another cycle included a questionnaire to charge nurses asking how they made patient/nurse assignments.  This led to the creation of a unit specific ‘tip’ sheet, which showed how assignments were made. Staff could now see the complexities involved in making assingments.

Results: By the end of our second Plan-Do-Check-Act cycle we were already seeing a decrease in LV on the units.  The end result of this project showed an impressive decrease in LV and an increase in nurse retention.

Conclusion/Implications for nursing practice: Education and accountability are paramount when tackling LV.  The education must include supervisors and managers to equip them with tools to effectively deal with bullies, witnesses and victims of LV.  This project is being reproduced in our hospital and will spread system wide.  By decreasing LV among nurses, the benefits are far reaching; patient safety and satisfaction, job retention, effective communication, decreased stress, healthy work environments, better HCAHPS scores, the sky is the limit!

Keywords: lateral violence, incivility in nursing, workplace bullying, horizontal violence, bullying