Lateral What

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Lateral What?
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Lateral Violence in Nursing

• Karen Stanley, APRN, BC

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Whats in a Name?

• Lateral Violence
• Horizontal Violence
• Horizontal Hostility
• Bullying
• Workplace Incivility

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Questions Addressed Today

• What is lateral violence?
• How is it measured?
• What innovative strategies can be used to combat
  it?

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Definition

• Nurse-on-nurse aggression
• Inter-group conflict
• The term violence is used because there is a
  victim

DeMarco Roberts 2003 Ferrell 1997 Griffin
2004 McKenna, Smith, Poole Coverdale 2003
Roberts 1983.
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Lateral Violence Nurse Turnover

• Researchers report that verbal abuse contributes
  to 16-24 of staff turnover and 25-42 of nurse
  administrator turnover (Braun et al. 1991 Cox
  1991 Hilton et al 1994)
• In the U.S. the turnover rate is 33-37 for
  clinical practicing nurses and 55-61 for newly
  registered nurses (Griffin 2004).
• Approximately 60 of newly registered nurses
  leave their first position within six months
  because of some form of lateral violence
  (Griffin 2004).

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Forms of Lateral Violence

• Nonverbal innuendo
• Verbal affront
• Undermining activities
• Withholding information
• Sabotage

Griffin 2004
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Forms of Lateral Violence

• Infighting
• Scapegoating
• Backstabbing
• Failure to respect privacy
• Broken confidences

Griffin 2004
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Lateral Violence Concepts

• Nurses are an oppressed population
• Dominated by the medical profession
• Excluded from the power structure
• Taught to silence our voices
• Nurses use the adaptive strategies of oppressed
  populations and direct dissatisfaction toward
  each other

Buresh Gordon 2000 Ferrell 1997 Friere 1999
Freshwater 2000 Griffin 2004 Roberts 2000
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Cycle of Oppressed Group Behaviors
Low morale
Inability to assert self
Conflict-charged environment
DeMarco Roberts 2003
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Contributing Factors

• Gender
• Alternative aggression (Simmons 2002)
• Collusion and acquiescence
• Organization of workload
• Benefits of the system to those in power
• Societys inaccurate understanding of the role of
  the nurse

DeMarco Roberts 2003, p. 113 Summers 2005
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Vulnerability

• Lateral violence occurs in all areas of nursing
• Administration
• Academia
• Clinical Practice
• Those with the least real or perceived power in
  the hierarchy are most vulnerable
• Newly licensed nurses
• Newly hired nurses
• Hospital pool, float, and traveling nurses

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Interventions

• Communication techniques
• Conflict management
• Stress management
• Team building
• Event rehearsal
• Event review

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Interventions

• Raise the level of professionalism
• Adopt professional behavior standards
• Focus on the patients we serve
• Choose your colleagues for their professional
  philosophy
• Develop mentoring skills that promote
  professional behavior

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Lateral Violence in Nursing Pilot Study

• Lateral Violence in Nursing Survey
• Online
• Voluntary and anonymous
• N 663
• RN participants 601
• 37 response rate
• Ancillary staff participants 52

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Conceptual Framework

• Oppressed group behavior
• Dissatisfaction is directed toward one another in
  behavioral ways
• Constructs measured
• Perceived seriousness
• Perceived susceptibility
• Mediating factors
• Oppressive factors

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Pilot Survey Instrument

• 22 items
• Quantitative
• Qualitative 3 items
• One extra item related to the interdisciplinary
  team
• Demographic information

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Future Plans

• Preliminary analysis of the quantitative and
  qualitative pilot data are being used to
• Refine or eliminate various survey items
• Increase internal reliability and validity
• Develop appropriate interventions

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Mentors

• Mary Martin, DNS, ARNP, NAP
• Yovnne Michel, PhD
• Lynne Nemeth, PhD, RN

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Group Discussion

• Questions
• Comments
• Suggestions