Creating a Positive Work Culture: 5 Strategies for Preventing Lateral Violence in Nursing

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Lateral violence takes place when an employee engages in disruptive and inappropriate behavior toward another employee of equal or lesser position. The Online Journal of Issues in Nursing recognizes lateral violence as a problem in nursing, affecting 44 to 85 percent of nurses. Up to 93 percent of nurses have witnessed lateral violence in the workplace.

High rates of threats and verbal abuse among nurses have a negative impact on the profession. Victims report depressive symptoms, physical health complaints and an overall decreased sense of self-esteem. Quality of patient care suffers when nurses have significantly lower job satisfaction and are more likely to leave their jobs. The Journal for Nurses in Staff Development estimates that the financial cost of replacing and training a medical-surgical nurse is $92,000, while the amount can be closer to $145,000 for specialty nurses such as critical care or emergency department nurses.

Often overlooked and unreported, lateral violence in nursing demands that intentional steps be taken to combat the problem. The following five strategies can help.

1. Establish a Code of Conduct

A code of conduct defines what types of behaviors are considered disruptive. It must apply to all members of the organization, including nurses and physicians.

The policy must clearly communicate that a culture of bullying and incivility cannot exist. Across the nursing profession, zero tolerance policies have become standard. “In order for a code of conduct to be effective, it must be applied in all circumstances where there is a possible breach,” according to The Online Journal of Issues in Nursing. “Without this enforcement, the code is meaningless.”

The American Medical Association and HCPro offer resources for developing a code of conduct.

2. Develop a Process to Manage Disruptive Behaviors

Organizations must have a clear channel and process for handling breaches in the code of conduct. Employees need to be aware of how they can report any disruptive behaviors that occur.

When disruptive behaviors are reported, a review process can verify the facts of the incident. Management or an independent review team should meet with the alleged perpetrator and the person who reported the breach to listen to each side. Then, the review process can determine whether a violation has occurred and if further actions are needed.

If the accused person has violated the code, corrective action should be taken. Focus should be on the behavior and not the person. Privacy and confidentiality are paramount. Also, management should help the person understand the situation. “Sometimes people are not aware of how their behaviors are affecting others or how they appear to others, so a designated person in management needs to discuss their behaviors with them,” The Online Journal of Issues in Nursing says. “In this conversation an important link must be made between the disruptive behavior(s) and the potential breach in patient safety.”

3. Provide Coaching and Mentoring

In some cases, coaching and mentoring can serve as an effective intervention method, providing flexibility and the proper response to certain disruptive behaviors.

“In keeping with principles of a culture of safety as well as just culture, the hospital must ensure that it treats both employees and medical staff fairly while maintaining individual accountability for performance,” Patient Safety & Quality Healthcare says. “This requires not only swift disciplinary action when warranted, but the withholding of discipline when it is not.”

Proper coaching will explain how future behavior will be monitored. Also, the consequences for additional breaches will be clear. Through mentorship, the employee can receive encouragement and feedback for developing skills and achieving growth.

4. Educate Nurses and Nurse Leaders

More education is needed to bring attention to the issue of lateral violence in nursing. The experienced nurse is most often the perpetrator and the novice nurse is typically the victim, according to research in The Online Journal of Issues in Nursing. Also, nursing students and newly licensed nurses regularly witness lateral violence and personally experience bullying in clinical settings. Due to the prevalence, this type of behavior can be considered normal and accepted in nursing culture. Therefore, it is often overlooked and unreported.

Although most research concentrates on the incident and the consequences of disruptive behaviors, early studies in The American Journal of Nursing, the Journal of Continuing Education in Nursing and Issues in Mental Health Nursing all point to education as a crucial method to help remedy the situation. Evidence-based interventions in education along with practice have helped nurses address bullying.

5. Learn Effective Communication Strategies

Research in The Online Journal of Issues in Nursing links skilled communication to a healthy workplace, collaboration and positive outcomes. Nurses should continually evaluate their own communication skills to ensure they are communicating with others properly. Otherwise, it is easy to lose sight of the importance of communication skills in a challenging or confrontational situation.

Of course, nurses must have the desire to communicate when difficult situations arise. A study of more than 1,700 healthcare workers found that 77 percent are concerned about disrespect and abuse they experience, but only 7 percent have spoken with the person to share their concerns. This behavior was the primary reason that these respondents were more likely to quit their jobs; the longer the behavior lasted, the greater the intent to quit. The study found that nurses and other clinical care providers who are confident in their ability to confront others about disrespect or abuse are more satisfied with their workplace, exhibit more effort at work and intend to keep their job.

Proactive communication strategies are also helpful. American Nurse Today recommends that nurses serve as a role model for professional behaviors, make an effort to welcome new nurses and to raise issues at staff meetings. Nurse leaders can encourage staff to report incidents and to take action when disruptive events occur.

Awareness and Education

Lateral violence in nursing is a threat to the well-being of both employees and patients. But through the right procedures, awareness, education and skill development, nurses and nursing leaders can join together to help prevent inappropriate behavior.

The online RN to BSN program from Aurora University can help nurses take a leadership role in their field. Nurses are able to learn how to be an asset in their current role and to pursue advanced career opportunities. The program takes place in an online learning environment, allowing students the flexibility and convenience to complete their degree while maintaining their work and personal schedule.