Lateral violence in the workplace
Lona A Smeltzer
Southern New Hampshire University

Lateral violence in the workplace Abstract
This paper explores five published articles as they relate to the concept of Lateral violence (LV) within the nursing profession and how it directly affects the work environment. The concept of LV is also known as abusive behavior, horizontal violence, bullying, aggression, horizontal hostility, verbal abuse or “nurses eating their young”. There are four main themes that appear throughout the five articles. The negative effects that LV has on nurses’ health, moral and sense of worth. The negative impact that LV has on patient care and outcome. The negative impact that LV has on the recruitment and retention of nurses by health care organizations. And who should be responsible for eliminating the phenomenon.
Within the articles there is a shared belief that strong leadership is needed to create codes of conduct and enforce zero-tolerance policies. Employees should be provided education and training on effective communication skills as well as conflict resolution. Furthermore nurses should hold themselves accountable through adopting and modeling professional ethical behaviors so that LV can be eradicated from the professional workplace.
Keywords: abusive behavior, lateral violence, horizontal violence, bullying, aggression, horizontal hostility, verbal abuse, nurse eating their young.

Thesis
Even though nursing is known as a caring profession, it is not uncommon to find Lateral violence (LV) within the field of nursing. Lateral violence is a negative phenomenon within the nursing profession therefor it is the responsibility of the organization, management, as well as the nursing professional to eradicate the behavior from within the workplace. Lateral violence behaviors are toxic to the nursing profession causing a negative impact on nurses' health, morale and self-esteem. Lateral violence has a negative impact on patient care and outcome. And LV has a negative impact on recruitment and retention (Rowe M. M. & Sherlock H, 2005, p. 243).

Introduction
Lateral violence has become an all too common negative phenomenon within the nursing profession and goes by many different names. According to Griffin (2004) lateral violence is also known as horizontal violence, bulling, or aggression. Griffin describes the manifestations of LV as non-verbal innuendo, verbal affront, under-mining activities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy, and. Most commonly LV is made up of emotional or verbal abuse, However Longo & Sherman (2007) reports LV can become physical (as cited in Sheridan-Leos, 2008, p. 399). According to Lipley (2006) more than 50% of nurses reported being a victim of abuse at work, and more than 90% stated that they had witnessed abusive behavior in the workplace. And that workplace bullying among nurses is also reported to be on the rise (as cited in Olender-Russo, p. 75). According to Rowe & Sherlock (2005) the effects and consequences of verbal abuse can be devastating and long-lasting. They indicate research has focused on the consequences of verbal abuse and has determined that it is both physiologically and psychologically damaging. Furthermore Rowe & Sherlock state “Nurses who regularly experience [abuse] may be more stressed, may feel less satisfied with their jobs, may miss more work and may provide a substandard quality of care to patients”(Rowe & Sherlock, 2005). In fact healthcare literature according to Sauer (2012) suggests that significant numbers of nurses who are victimized by bullying will leave their jobs and may even leave the nursing profession within the first year of employment (Sauer, 2011). In fact LV according to Embree (2010) is the cause of approximately 60% of new nurses leaving their place of employment within the first 6 months (Embree & White, 2010).

There are many theories as to the origin of LV within the nursing profession. According to Roberts (1983) the most cited is the oppressed-group model. One theory behind the oppressed-group model according to DeMarco & Roberts (2003) is nurses perceive themselves as powerless, oppressed and dominated by others. From this perception arises the feelings of alienation and loss of control over ones practice. This in turn leads to a cycle of low self-esteem and feelings of powerlessness (as cited in Sheridan-Leos, 2008, p. 399). Sheridan-Leos (2008) further states that the oppressed nurse fears retaliation from those in leadership if the feelings of oppression are verbalized, causing further frustration. This frustration is then projected onto ones’ peers (Sheridan-Leos, 2008). An equally important theory discussed by Sauer (2012) supports the idea that an organization’s culture contributes to the prevalence of bullying. Sauer indicates some organizational factors that can increase or promote bullying are hierarchal management, restructuring or downsizing of the organization and employees who do not feel empowered (Sauer, 2012). This same belief is shared by Hutchinson, Vickers, Jackson & Wilkes (2006) they theorize organizations can be fully aware of bullying yet chose to focus on other priorities. They believe when leaders within an organization disregard the behavior they are aiding and abetting the very act itself (as cited in Olender-Russo, 2009, p. 76). Consequently Olender-Russo (2009) believes the targeted individual becomes a victim not just of the bully, but of the organization at large (Olender-Russo, 2009).
There is a cost factor to LV that must be recognized. For an organization it can be the loss of revenue related to complaints from patients and family members. Equally important the cost to nurses’ can be the loss of enthusiasm for the profession related to the extended exposure to LV. To illustrate this point Bland-Jones & Gates (2007) report recent studies estimate the economic cost of nurse turnover due to LV to be between $22,000 and $64,000 per nurse. Whereas Bartholomew (2006) describes the cost of LV on nurses can be low self-esteem, poor moral, the feeling of disconnect from other staff members, depression and excessive sick leave (Sheridan-Leos, 2008).
How do we eradicate this phenomenon called LV within the workplace? I believe organizations must first implement zero tolerance policies that address and enforce LV in the workplace. I believe management must make it a practice to investigate all cases of reported LV and discipline offenders according to policy. Furthermore I believe nurses must reflect on their own behavior and address LV behavior of others immediately. I believe Sauer (2012) makes an excellent point when she reminds us that a core principle of nursing is patient advocacy. She further states if nurses were to use these same principles to support colleagues and the profession against bullying, the negative behavior would stop (Sauer, 2011).
Who you ask should be responsible for eliminating LV in the workplace? The answer to this question as I have documented is multi-layered. I believe because LV is often inconspicuous throughout organizations, management and nursing all should adopt and model professional and ethical standards to facilitate the eradication of LV within the nursing profession.

References
Embree, J. L., & White, A. H. (2010). Concept Analysis: Nurse-to-Nurse Lateral Violence. Nursing Forum; Jul-Sep 2010; 45(3), 166-173.
Olender-Russo, L. (2009, November, 2). Creating a Culture of Regard: An Antidote for Workplace Bullying. Creative Nursing, 15(2), 75-81.
Rowe M. M. & Sherlock H. (2005). Stress and verbal abuse in nursing: do burned out nurses eat their young? Journal of Nursing Management, 13(13), 242-248.
Sauer, P. (2011, 12, November 2011). Do Nurses Eat Their Young? Truth and Consequences. Journal of Emergency Nursing, 38(1), 43-46.
Sheridan-Leos, N. (2008). Understanding Lateral Violence in Nursing. Clinical Journal of Oncology Nursing, 12(3), 399-403.