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Saturday, April 2, 2011

Lateral Violence in Nursing or Eating Their Young

Lateral violence in nursing occurs more frequently than it should, which sounds absurd because violence cannot be a part of caring
I wish I could say that I have never witnessed violent behavior in health care settings, but that would not be true. I started my nursing career on a busy telemetry unit, where I was welcomed by nurses and other staff, then I efficiently completed orientation thanks to the guidance and patience provided by the colleagues. Nurses did not eat their young on our fast-pace floor, everyone worked together through the toughest times. Most of the nurses were my age, so I first thought good work environment prevailed because there were no “young” ones to eat. Looking back, I think it was due to the fact that we respected each other, old or young, experienced or novice.
In a couple of years, I accepted a position in an intensive care unit, where the “eating”, in all forms and shapes, began with vengeance. Indirect Violence? Nice to meet you, Anna. In the majority of the situations, it came from one person, who I will refer to as Nurse K.
Nurse K. would come on to her scheduled night shift, in her perfectly ironed scrubs, with fresh make up and a fresh coffee. As well as fresh nonverbal behaviors, such as eye rolling and arm folding. Giving report on a critically ill patient was a torture: belittling seemed more important to Nurse K. than anything else. Her pet peeve was to ask minute information about the patient that was irrelevant to nursing care. If I was unable to provide that piece of information, the passive-aggressive behavior filled up the room and I could not concentrate anymore. I started getting an impression that no matter what I did, it was simply good enough. I felt like a child who was being reprimanded.
At the time, I was under impression that the attitude was personal, because I was new to the Intensive Care settings, and indeed had a lot to learn. I had no idea a term lateral violence existed, and that there was no excuse for that nurse’s behavior - she should not have been treating me so disrespectfully. I started a new job excited from anticipation of learning a wealth of information, but this feeling was overshadowed by the fear of lack of support. I am glad that this overwhelming feeling never stopped me from asking questions and connecting with other peers.
I still fail to understand why some nurses act in a similar manner to new nurses, and why they add more stress to the already stressful job. I promised myself that I would never act like that in my practice, and I have been true to my promise. I work in a specialty department, and once in a while I encounter a nurse who is unfamiliar with certain procedures or tasks. I never let myself be condescending to a co-worker; instead, I explain what is the appropriate way to perform the task and direct him or her to the appropriate resources.

What positive steps can be taken or were taken in the situation you described to respond to or stop this kind of treatment to others?

Lateral violence in nursing is well-recognized and addressed in literature; multiple resources exist for the health-care workers to stop this unacceptable behavior.
Thomas (2010) offers strategies to address violence in the workplace, suggesting that all forms of violence can and must be eliminated. She stresses the importance of education especially that of continuing education nurses who serve as role models for others. Thomas writes that organizational policies and procedures must be written and implemented to address violence, conduct organizational research and to identify specific aggressive behaviors, to educate employees, and to evaluate outcomes. Thomas proposes four key actions to address the needs of the newly registered nurses who are most vulnerable to the acts of violence.
It is important to keep in mind that victims of violence should not forget to explore their own anger triggers and management techniques, including on-line resources. Moreover, it is important for the nurses to know how to diffuse violent acts, how to act quickly, fairly, and with respect. Thomas (2005) suggests that nurses should confront the abuser immediately in a private area and to document the act of violence in compliance with the hospital policies.
Kupperschmidt (2007) puts forward a strategy of carefronting. Carefronting is a concept of caring for one another, proposing that when nurses care about each other they are less likely to engage in aggressive or violent behaviors.
Blais and Hayes (20101) propose administrative interventions to eliminate workplace violence, such as performing background and reference checks prior to employment, training on policy and procedure for reporting violent behaviors, as well as observing behaviors of co-workers.
The key point is that violence in health-care organizations is a world-wide issue and needs to be eliminated. Each individual nurse should take personal responsibility to contribute to keeping nursing a caring profession, not a bullying one.

Blais, K., & Hayes, J. (2011). Professional Nursing Practice: Concepts and Perspectives (6th ed.). Upper Saddle River, NJ: Prentice Hall.  
Kupperschmidt, B. (2007) Conflicts at Work: Try Carefronting. Journal of Christian Nursing, 25 (1), 10-17.
Thomas, T. (2010) Teaching Nursing students and newly Registered Nurses strategies to deal with violent behaviors in the professional practice environment.  The Journal of Continuing Education in Nursing 41 (7) 299-310.

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