Lateral violence in nursing: causes, effects, and the oppressed group model

¶ … Violence

MORE THAN A BRAWL

A long-standing epidemic, which is recognized and addressed after 25 years, may be as serious as the diseases, which the healthcare industry has been zealously combating. It is called lateral violence or LV. It is hostility in both verbal and physical forms dealt by nurses upon fellow nurses under them, on the same level and among themselves. Six authors discuss its causes, forms, frequency, the victims, and approaches to this malady that distorts the very caring and compassionate image of the nursing profession.

The phenomenon sounds as new as it is repulsive and horrible, but it has been reported for more than 25 years (Farrell, 1997; Roberts, 1983 as qtd in Sheridan-Leos, 2008) but catching real attention only now. It is known as horizontal violence or hostility, bullying, aggression, verbal abuse and as ":nurses eating their young (Griffin, 2004 as qtd in Sheridan-Leos)." There is as yet no exact or universal terminology adapted to concisely describe all the actions performed within lateral violence or LV as it represents a full range of expressions of antipathy among nurses, open or secret, whether under them or to themselves (Bartholomew, 2006; Alspach, 2007 as qtd in Sheridan-Leos) while performing their dignified role as healer and givers of care. The message is simple, clear and strong: lateral violence among nurses is ironic but real and serious.

The Rationale

LV is animosity felt and addressed to one nurse by another (Sheridan-Leos, 2008). Griffin (2004 as qtd in Sheridan-Leos) described it as the content of nonverbal gestures, verbal affront, undermining behavior, keeping information away, sabotaging, infighting, scapegoating, disrespect for privacy, backbiting, and breaking confidences. It can also border on physical hostility (Longs & Sherman, 2007 as qtd in Sheridan-Leos). It has been a long-standing issue in the nursing community and profession. There are a number of theories on its origin, but the most widely accepted version is the oppressed group model (Robertts, 1983 as qtd in Sheridan-Leos). This model states that nurses are an oppressed group by domineering others (DeMarco & Roberts, 2003). It explains that oppression often occurs when a more powerful and dominant group of persons take advantage of those less powerful than them. Nurses have been construed as an oppressed group because they are mostly women who are subordinated to male physicians and administrators (Farrell, 1997 as qtd in Sheridan-Leos). Those who inflict LV consider the traditionally amiable and admirable traits of caring and compassionate nurses as less important or even meaningless when compared with medical practitioners who are the prominent figures in health care (Woelfle & McCaffrey, 2007 as qtd in Sheridan-Leos). Nurses indeed lack autonomy and control over their own work. They thus lack self-esteem and must yield to aggression to get things done in the hope of a change. This submissive-aggressive syndrome occurs when a nurse feels losing power and must regain it by overpowering others through hostility (Bartholomew, 2006). Roberts (1983 & 2000 as qtd in Sheridan-Leos) applies Freire's theory in suggesting that oppressed nurses thus exhibit similar behaviors, such as low self-esteem and self-rejection. LV develops from that lack of self-esteem and respect from others in their workplace (Longo & Sherman, 2007 as qtd in Sheridan-Leos). The oppression theory describes such nurses not only as powerless but also oppressed in their work environment. They feel alienated with little work control. Instead of addressing the problem and risking the ire of her superior, these nurses project their hostility towards other nurses in their own level Non-verbal abuse creates stronger impact than verbal abuse (Sheridan-Leos).

Concept Analysis

This above rationale is consistent with the concept analysis conducted on the origins of LV. These are role issues, oppression, strict hierarchy rule, disenfranchising work practices, low self-esteem, self-perception of powerlessness, anger and positions of power (Embree & White, 2010). This concept analysis guides organizations in its elimination and in arming nurses with skills to crush it. Target outcomes are an improved nursing work environment, better patient care, and retention of nurses (Embree & White).

Very Real, Very Serious

Researchers led by Stanley (2008) responded to the disturbing phenomenon and conducted a survey on the incidence and severity of LV among 663 nurses at a Southeastern tertiary care medical center recently. Results showed that 46% of the participants witnessed LV and described the incidents as "very serious" or "somewhat serious" while 65% of them reported observing frequent LV among their fellow workers. The survey also recommended education and effective leadership as approaches in reducing or preventing LV that should be implemented promptly (Stanley et al.).

Verbal Abuse Most Prevalent

A study conducted by Rowe & Sherlock (2005) found that occupational burnout inclines nurses to commit verbal abuse. Nurses themselves were the most frequent source at 27%, patients' families at 25%, doctors at 22%, patients at 17%, residents at 4%, and interns at 2%. Among nurses, the most frequent sources were staff nurses at 80% and nurse managers at 20%. The study concluded that verbal abuse is a very costly issue to all involved, especially the nurses. They become more stressed and dissatisfied with their jobs, unable to finish their tasks, or regret giving quality care to patients (Rowe & Sherlock).

The Solution: Patient Advocacy

Open awareness of this horrible practice began when Meissner aired the accusation 25 years ago (Sauer, 2012). Fortunately, the means to breaking this hideous cycle are available to the victims. They can apply the principle of patient advocacy to protect themselves and fellow workers in the profession against all negative behaviors against them. They have to decide that they will not tolerate these indignities any more. They should act in concert rather than keep silent. Those not affected should extend support to the victims and confront their aggressors. They should record the incidents and the witnesses and then report these to their superiors. It is utterly important for the victims to take courage and confront their aggressors to express their grievance and in the presence of another nurse or the superior. On the hospital management's part, employee policy on workplace violence, which is supposed to protect employees, should be strictly implemented. If there is no such policy, one should be promptly adopted. The Management and organizations should not tolerate this very destructive practice at a zero-tolerance level. But under all circumstances, nurses should stand united in this fight and regain their time-honored reputation of care-giving and compassion, possible only in an atmosphere of harmony (Sauer).

Conclusion

Lateral violence is a shocking phenomenon that has only recently gained wide attention and alarm because of its costly consequences to healthcare in general. Studies say that about 50% of nurses, especially newcomers, are victims of physical hostility by fellow nurses and of verbal abuse at 62%. Burnout is the identified as the major cause of it. Approaches have been recommended with zero tolerance as an overall target. But until they become effective, it must be conceded that LV is real, chronic and serious.