Lateral Violence

There isn't a universally common definition for lateral violence. In fact, the same vice is also variously referred to as horizontal violence, bullying, work place violence and nursing incivility. According to the American Nursing Association (2011), lateral violence refers to verbal, emotional or physical abuse. Indeed, lateral violence is a common phenomenon in nursing practice. It is both a costly practice to the healthcare organization and the individual nurse's mental and physical health. The incident of lateral violence compromises the healthcare quality within a facility where it occurs. Consequently, poor patient health outcomes are observed (Hill, 2014). This study aims at exploring the effects of lateral violence on healthcare, and establishing its relevance to nursing practice.

In precise terms, lateral violence is disruptive. It is a phenomenon that destroys the people and objectives of healthcare provision. Lateral violence is inappropriate and disruptive conduct by an employee within a healthcare environment. Such behavior may be directed towards an employee at the same level or a junior member of staff. Although, sometimes, such behavior is openly shown by certain employees, often, it is subtle, quietly meted and repeated. It gets worse over time. If observed in isolation, such behavior may seem harmless at first glance. However, cumulatively, the aggressive behavior and insults amount to seriously harmful practices to the nurses they are directed at (Christie & Jones, 2014).

LV shows a consistent pattern of behavior that is deliberately designed to demean and undermine peer members' self-esteem. It may also be directed at a group. Verbal abuse is a more common phenomenon. It includes all forms of professional and personal mistreatment and violence. Lateral violence refers to both the overt and covert behavior aimed at demeaning other healthcare workers. Covert LV is the most destructive. Covert behavior with lateral violence effects include sarcastic comments, assignments that are given unfairly, ignoring colleagues, eye-rolling, making faces behind one's back, whining, sighing, declining to assist colleagues; even when time and space allows; exclusion, sabotage, fabrication and isolation (Embree & White, 2010). Other behaviors with similar effect include withholding information, scapegoating, infighting within groups, gossiping, and intrusive behavior that fails to respect the privacy of others (Roberts, 2015).

It has been noted that Nursing is the primary job type at the most risk of lateral violence. Research shows that between 44% and 85% of healthcare staffs are exposed to lateral violence. Indeed, 93% of nurses have testified that they have observed lateral violence at the work place. The occurrence of lateral violence is usually perpetrated by experienced nurses, while the novice nurses are, often, the victims. Nursing students and the nurses that have been newly licensed are the most affected in these situations. Owing to the prevalence of this practice, it has become almost acceptable within nursing environs. Therefore, it usually goes unreported (Christie & Jones, 2014).

Accurate data showing the incidence of lateral violence in nursing circles is, widely, unavailable. Nevertheless, more recent reports show that the vice is widespread, and ranges from 65% to 80%; judging from the nurses that were surveyed. A research conducted among students in junior nursing illustrates that lateral violence incidents happens as soon as the first interaction between the student nurse and the experienced nurse they are meant to work under or with. Graduate nurses encounter LV, and reported a high absenteeism rate. Some of them even contemplated quitting the profession (Becher & Visovsky, 2012). It is also noted that LV extends to other staff within the healthcare settings. It may also involve doctors and staffing supervisors who were found to represent 49.1% and 26.9% respectively. Yet, it has also been found that lateral violence is not a preserve of lateral positioning. The vice has been noted to extend from nursing fraternity leadership to other staff under supervision (Becher & Visovsky, 2012).

There are many negative effects of lateral violence. There is a generally, reduced sense of good health and wellbeing. There are persistent complaints related to health, and symptoms of depression. The negative perception of nurses makes them, and the general world around them, heightened. They are observed to adopt strategies that are largely ineffective to manage their state of mind and problems that come with it. More signs of disturbance include disturbance of sleep, and suicidal tendencies or anxiety. Indeed, some may manifest all these characteristics and even show symptoms of post-traumatic stress complications. The nurses that have undergone LV experiences do not trust their organization. They also show a lower level of job satisfaction. The chances of such nurses leaving their profession are significantly high. Poor communication and decreased productivity are the inevitable effects (Christie & Jones, 2014).

Nurses have been widely seen as a group that is oppressed because they lack control and power at their places of work. The situation might have been caused by the fact that there has been dominance of the medical profession since the transition of nursing care from home to healthcare facilities. Nurses inherited this unfortunate setup because they work in an environment of poorly balanced power arrangements, i.e. low self-esteem, anger suppression and passive communication that is aggressive in nature and suppresses their voices and needs too (Roberts, 2015).

LV destroys the dignity of the person to whom it is directed. It is a stumbling block to the development of the profession too. This is particularly because that unfairness and abuse emanates from people expected to be providing guidance and support. The effect of lateral violence on students is a special one in a negative perspective. This group has special needs including the desire to be guided through the labyrinth in their careers, advice and sharing of information with a purpose to help them achieve their full potential. When graduate nurses are subjected to situations in which there is lateral violence, they are unlikely to achieve their all (Becher & Visovsky, 2012).

The entire healthcare team is likely to be negatively affected because of the rift that exists between members of the healthcare teams or even between groups within. The effects of LV are contagious. They spread from the victim to the others around the healthcare facility. The innocent patient is also caught in these negative attitude and power forces. LV victims often experience disorders including sleep disorders, anxiety, low self-esteem and even depression. These conditions lead to many nurses leaving the profession; and the resultant nursing shortage, nationally (Becher & Visovsky, 2012).

Absenteeism, a feeling of powerlessness and anger have been noted as a result of repeated bullying. Worse still, there have been suicidal behaviors reported too. It has been noted that one of the main factors that lead to poor outcomes on both the nurse's part and the patient outcomes is poor communication. For instance, if essential information is omitted because of lateral violence, the nurse under LV is negatively affected and cannot effectively attend to patients under their care. The patient, therefore, suffers because of the inside discordance among those who are meant to provide hope for recovery. It should be noted that the cost spans the institution, the patient and their family to the individual nurses. In addition, the likelihood of legal suits emerging is increased. Interestingly, in excess of half of all the LV incidents go unreported. Lack of policies that empower nurses to retaliate when under LV leads to a scenario in which the victims have no idea about what they should do or where to go and seek help (Becher & Visovsky, 2012).

The financial implication of LV has been estimated to stand in the margin of $30 000 to $100 000 annually per individual. These costs arise from incidents of absenteeism, treatment for the effects of the vice, poor performance and high turnover rates. Some studies have shown that the cost of replacing a specialized nurse in certain areas may exceed $145 000 (Becher & Visovsky, 2012).

Like other nurses, nurse managers are affected by the oppressed group members in their group behaviors. Nurse Managers are, often, marginalized in management matters because of this effect. Most managers, naturally align to the controlling power within an institution. Consequently, they become part of the existing lateral violence practices. Obviously, they cannot lead a fight against the vicious practice. A number of scholars have indicated that if managers can unearth the root of lateral violence, they will be in a position to uproot the vice from their institutions, or at least deal with it more effectively. Some of the suggested strategies that may be effective include, I. assessing the areas where LV occurs, II. Educating nurses, regarding the effects of lateral violence, and III. Giving nurses time to reflect and enjoy the feel of their work, IV. Condemning or punishing bad behavior tendencies of those who do not cooperate for positive change (Roberts, 2015).

Nurse leaders can help eliminate the vice by providing resources and educating others. Trustworthy leaders allow others to enjoy and feel supported. If resources for stress relief are availed, nurses will treat patients better. Nurse leaders should also provide fast feedback when required. Further, they should also avail opportunities for personal development and education of those under their charge. Formal education sessions in which LV is defined, and its effects reviewed and discussed, is critical. There is need for a direct approach. Informal education strategies such as posters and fliers will help to reinforce the message against LV (Becher & Visovsky, 2012).

Nurse leaders should take responsibility for what transpires among their teams. They have a chance to change attitudes and contribute towards elimination of LV. There is need to plan for correction whenever unprofessional conduct is detected. Nurse leaders must always remain objective when dealing with LV issues. The organizational policies concerning LV must be at their fingertips, even as they are prepared to implement such policies. All encompassing attendance of LV education for both managers and nurses to ensure that they remain on the same page (Becher & Visovsky, 2012)

Finally, it is evident that lateral violence in a harmful practice to both nurses and the profession. The need to find intervention measures that can effectively deal with the vice is evident. Nurse leaders are uniquely positioned to help in the fight against lateral violence at the work place. They can help by, among other ways, providing education and availing resources to support the nurses (Christie & Jones, 2014).

References

American Nurses Association. (2011). Lateral violence and bullying in nursing. Retrieved from http://www.nursingworld.org/Nursing-Factsheets/lateral-violenceand-bullying-in-nursing.html

Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. Medsurg nursing, 21(4), 210.

Christie, W.& Jones, S. (2014). Lateral violence in nursing and the theory of the nurse as wounded healer. Online Journal of Issues in Nursing, 18(4).

Embree, J. L., & White, A. H. (2010). Concept analysis: Nurse-to-nurse lateral violence. In Nursing forum (Vol. 45, No. 3, pp. 166-173). Blackwell Publishing Inc.

Hill, A. (2014). Lateral Violence Experienced by Nurses in the Workplace.

Roberts, S. J. (2015). Lateral violence in nursing: a review of the past three decades. Nursing science quarterly, 28(1), 36-41.