Lateral Violence in Nursing: Causes, Evidence, and Change

Introduction

Lateral violence encompasses all acts of intimidation, humiliation, bullying, unwarranted criticism, and angry outbursts, among other harmful behaviors, directed from one worker toward another (Clarke, 2014). In current nursing practice, more experienced nurses often feel superior to their less experienced junior colleagues and may treat them with contempt, assuming they are more knowledgeable. For instance, a nurse may respond with an outburst when a colleague asks a question that has already been answered or is considered too obvious. In some instances, a nurse may be disrespectful and refuse to share pertinent patient information with a colleague. If no one is willing to address lateral violence, it will become an entrenched cultural norm in nursing that hinders teamwork and information sharing, ultimately undermining overall service quality.

Reasons Why Lateral Violence Must Change

There are several compelling reasons why lateral violence must change, particularly in nursing practice. First, all healthcare systems aim to create an environment that enables safe healthcare delivery. That safety relies heavily on cooperation and communication among caregivers. Lateral violence impedes this communication and therefore acts as a barrier to safe healthcare provision (Clarke, 2014). Eliminating lateral violence is thus essential to creating an environment that supports patient safety.

Second, lateral violence undermines the productivity of individual nurses and their ability to fulfill their professional responsibilities. An atmosphere of intimidation erodes nurses' confidence and motivation. A nurse who is constantly harassed will not be able to provide care freely and effectively. Eliminating lateral violence gives all nurses the support they need to perform with confidence and deliver quality healthcare.

Third, lateral violence obstructs information sharing in nursing practice. A nurse may be reluctant to share important patient information with a colleague out of fear of prejudice or hostility. As a result, that colleague may be unable to provide adequate care because critical information is withheld. Changing the culture of lateral violence is therefore necessary to promote the efficient flow of information between caregivers.

Together, these reasons illustrate how deeply lateral violence affects the provision of safe, quality healthcare. It is reasonable to conclude that its elimination is necessary to guarantee an environment truly supportive of patient welfare.

Stakeholders in the Nursing Practice

Several stakeholders in the nursing practice are affected by lateral violence in healthcare settings. These include healthcare facility management, patients, government, physicians, and nurses themselves. Each must play an active role in eliminating lateral violence.

The management of any healthcare facility holds primary responsibility for shaping organizational culture through policies, procedures, and institutional expectations. To address lateral violence, management should take three key steps. First, leadership should institute a formal policy against lateral violence that fosters mutual respect and tolerance. Second, strict disciplinary consequences should be established for acts of lateral violence. Third, management must carry out extensive awareness campaigns among staff — particularly nurses — regarding the effects of lateral violence on healthcare quality.

Patients must also be involved in stopping lateral violence. They should not tolerate witnessing one caregiver intimidate another in their presence. Patients can speak out when they observe such behavior, condemn it, and inform healthcare workers of how such conduct affects the overall quality of care they receive.

The government, as a regulator of healthcare services, has an equal stake in changing the culture of lateral violence. It can institute policies and laws that monitor workplace behavior and impose consequences for lateral violence in healthcare facilities. Such regulation and enforcement would substantially advance cultural change.

Finally, nurses themselves must play a critical role. Peer sensitization — nurses educating fellow nurses about the impact of lateral violence on the entire healthcare system — can create widespread awareness and foster mutual accountability. This peer approach helps keep each other in check and cultivates an atmosphere of tolerance.

Pontus, C., & Ortner, P. (2013). The Relationship between Lateral and Horizontal Violence and Bullying. Epidemic of Medical Errors and Hospital-Acquired Infections, 2(2), 209–224.
Evidence strength: 2 (case study)
This article presents a case study demonstrating how bullying, horizontal violence, and lateral violence interact. The authors show how different stakeholders can both foster and help eliminate lateral violence, making it relevant to understanding the systemic nature of the problem.

Sanner-Stiehr, E. (2017). Using Simulation to Teach Responses to Lateral Violence. Nurse Educator, 42(3), 133–137.
Evidence strength: 6
This article illustrates how simulation can be an effective educational tool for teaching nurses about the impact of lateral violence. It is particularly useful for explaining how healthcare administrators can use training as a means of sensitizing staff to the effects of lateral violence on the healthcare system.

Sanner-Stiehr, E., & Ward-Smith, P. (2014). Lateral violence and the exit strategy. Nursing Management (Springhouse), 45(3), 11–15.
Evidence strength: 5
This article defines lateral violence, outlines its effects on the healthcare system, and discusses how various stakeholders contribute to — and can help eliminate — it. It is particularly relevant for its discussion of strategies for exiting a culture of lateral violence and creating an atmosphere of tolerance.

Dahlby, M. A., & Herrick, L. M. (2014). Evaluating an Educational Intervention on Lateral Violence. The Journal of Continuing Education in Nursing, 45(8), 351–352.
Evidence rating: 1 (experimental)
This article evaluates the effectiveness of educational interventions in reducing lateral violence. The study used a pre- and post-education evaluation design with 29 nurses. Findings indicate that educational interventions significantly reduce lateral violence incidents, providing practical experimental evidence for this intervention strategy.

Ceravolo, D. J., Schwartz, D. G., Foltz-Ramos, K. M., & Castner, J. (2013). Strengthening communication to overcome lateral violence. Journal of Nursing Management, 20(5), 599–606.
Evidence rating: 1 (experimental)
This article describes how strengthening communication among nurses can effectively reduce lateral violence. The study used a pre- and post-intervention survey design following a communication-strengthening educational program. Findings showed a significant reduction in reported cases of lateral violence, supporting communication training as a key intervention strategy.

Evidence Summary

The evidence presented above collectively demonstrates that lateral violence is a significant impediment to quality healthcare and to the creation of a healthy professional environment for nurses. Pontus and Ortner (2013) illustrate that top management shapes organizational culture. In facilities where leadership tolerates or models horizontal violence, lateral violence is likely to flourish. The article advises leaders to reject horizontal violence as a prerequisite for addressing lateral violence among peers.

Sanner-Stiehr and Ward-Smith (2014) similarly emphasize leadership as the foundation on which organizational culture is built. Leadership that openly condemns lateral violence fosters an environment of intolerance for such behavior. The article also identifies the healthcare administration, physicians, nurses, patients, and the broader community as critical stakeholders whose coordinated action is necessary to shift the culture.

The evidence further highlights specific interventions capable of producing meaningful change. Enhanced communication among healthcare providers emerges as a critical strategy. The experimental research of Dahlby and Herrick (2014) demonstrates that programs designed to enhance communication significantly reduce lateral violence incidents. Sanner-Stiehr (2017) further outlines effective methods for teaching interpersonal communication skills to caregivers, while Ceravolo et al. (2013) provide empirical support for the effectiveness of communication-focused interventions in reducing lateral violence.

In summary, all reviewed articles agree that lateral violence undermines the effectiveness of healthcare delivery. They also converge on the practicability of targeted interventions — particularly communication training — and collectively underscore the importance of each stakeholder group in addressing the problem.

Conclusion

Lateral violence in healthcare settings undermines the ability of healthcare systems to deliver safe, quality care. It reduces nurse productivity, erodes professional confidence, and obstructs the information sharing that effective patient care requires. Given these adverse effects, it is imperative that all stakeholders — management, government, patients, and nurses themselves — take active roles in changing this culture.

The reviewed evidence consistently confirms that lateral violence has serious negative consequences, and that targeted interventions, particularly those focused on communication, can be effective in reducing it. The Star Model for Knowledge Transformation is the most appropriate framework for implementing this change, because it centers on knowledge transfer — the mechanism most supported by the evidence — and includes a built-in process for evaluating effectiveness and ensuring continuous improvement.

Nevertheless, the implementation process is likely to face significant challenges, including the difficulty of changing entrenched individual behaviors and organizational cultures, resistance from leadership, and financial constraints. Additionally, the implementation carries genuine ethical tensions that must be thoughtfully managed, including the protection of patient confidentiality, the preservation of freedom of expression, and the safeguarding of nurses' professional duty to engage in constructive critique. Addressing these challenges and ethical dimensions with care will be essential to the sustainable success of any anti-lateral-violence initiative in nursing.

References

Ceravolo, D. J., Schwartz, D. G., Foltz-Ramos, K. M., & Castner, J. (2013). Strengthening communication to overcome lateral violence. Journal of Nursing Management, 20(5), 599–606.

Clarke, P. N. (2014). Nursing science. Nursing Science Quarterly, 28(1), 34–35.

Dahlby, M. A., & Herrick, L. M. (2014). Evaluating an educational intervention on lateral violence. The Journal of Continuing Education in Nursing, 45(8), 351–352.

Dimarino, T. J. (2011). Eliminating lateral violence in the ambulatory setting: One center's strategies. AORN Journal, 93(5), 583–588.

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Wolters Kluwer.

Pontus, C., & Ortner, P. (2013). The relationship between lateral and horizontal violence and bullying. Epidemic of Medical Errors and Hospital-Acquired Infections, 2(2), 209–224.

Sanner-Stiehr, E. (2017). Using simulation to teach responses to lateral violence. Nurse Educator, 42(3), 133–137.

Sanner-Stiehr, E., & Ward-Smith, P. (2014). Lateral violence and the exit strategy. Nursing Management (Springhouse), 45(3), 11–15.