Lateral violence is a reality for many people working in the health care field. This presentation looks at causes and looks at ways to addresses bullying behavior.

1. Mamawetan Churchill River Health Region
November 8, 2013
Managing Lateral Violence
and its Impact on the Team:
Eli Ahlquist RN MPA
Greg Riehl RN BScN MA

2. Outline
 What is lateral violence?
 What causes lateral violence?
 Who is doing it?
 Types.
 Effects.
 What can be done?
 Discussion.

3. Objectives
1.
Identify terms used to describe negative coworker
behavior
2.
Describe an experience with negative coworker
behavior
3.
Discuss strategies to manage negative coworker
behavior

5. Honesty
Change
Hope
 Prisoners, vacationers, keeners,
 Communication will be key for today’s work on
Lateral Violence
 We have 2 ears and one mouth, listening
should always be 2:1
 I do not have the power to fix Lateral
Violence, but you do.

6. Lateral Violence
 “Exists on a spectrum, from seemingly
ordinary behaviour such as gossiping or
criticism, to intimidation, racism and outright
physical intimidation or harm.”

Linda Rabyj, 2005

7. Definition
 Lateral Violence (LV), also called Horizontal
violence, Nurse-to-Nurse
violence, incivility, and disruptive
behaviours, creates an unpleasant work
environment and has harmful effects on
individual nurses, patient safety, and health
care organizations.

Johnson, 2009 & Dimarino, 2011

8. Building a culture of respect
combats lateral violence
 A study in the Journal of Advanced Nursing
found that half of newly qualified nurses
report first-hand experience with lateral
violence.

Linda Rabyj, 2005

9. Who gets targeted?
 Anyone who is different from the group
norm on any major characteristic
 Experience
 Education
 Race/ethnicity
 Gender
 Targeted person’s gender
 79% Female
 21% Male

10. Who is Doing the Bullying?
 2009 survey by Workplace Bullying
Institute:
 Main perpetrator’s gender
 65% Female
 35% Male
 2009 WBI survey sited in New York Times:
 Men target men and women equally
 Women target women 70% of the time

11. Why does this happen in the
Workplace?
•
Isolated from the public and other staff
•
High-stress environment
•
Limited autonomy in practice
•
High-paced environment
•
Lack of experienced staff
•
Cliques or closely bonded groups
•
Hierarchical climate
•
Gender imbalance
•
Attitudes to training
•
Non acceptance of difference

12. Why?
 Nurses practice in a historically patriarchal environment.
 Oppression leads to low-self esteem.
 Nurse exert power over one another through lateral
violence.
 Lateral violence is perpetuated through the culture of
nursing (new nurses, curriculum, etc).
 “Nurses eat their own”
 “See one do one teach one”
 We now work with four different generations in the
workforce, adding to the complexities of effective
communication.

13. Why?
 Some professionals can receive preferential
treatment from administration.
 Crowded working conditions
 Overworking conditions
 Too many demands
 Mistrust between experienced staff and the new
staff
 Mistrust between subordinate and supervisor
 Ineffective classroom and or practice management
skills
Luparell 2008

14. Warning Signs
 Drugs and alcohol abuse
 Gambling
 Addiction
 Sudden shifts in behaviour
 Job performance goes down
 Threats of violence
 Preoccupation with violence
 Co-workers complaining

15. Who is doing it?
 Coworker-on-coworker aggression
 Directed toward individuals at same power level
 Intended to cause psychological pain
 Does not include physical aggression
 Intergroup conflict
 Shift to shift/class to class/group to group…
 Cliques within a workgroup
 Department to department

16. Bystanders, Managers, Leaders
 Sometimes staff witness lateral
violence events but are not prepared to
support their colleague for fear that
they might be the next victim.
 Ignoring the victim’s behavior &
distress often seem to be the way staff
and organizations respond to the issue.
 There may be a style of management
at various levels and within institutions
that is based on fear rather than
respect.

17. Conflict It’s not all Bad
 Functional Conflict is considered
positive, as it can increase
performance, support change, and identify
weaknesses or areas that need to be
supported.
 Dysfunctional Conflict is harmful to people
and the organization. This type of
confrontation does nothing to support
goals or objectives.

18. Workplace Violence & Harassment
Experts identify two primary
categories of lateral violence.
1. Overt(direct)
2. Covert (passive)

19. Lateral Violence Covert - Passive
 Judging others on age, gender, sexual
orientation, ethnicity or size
 Failure to respect privacy, and broken
confidences
 Blaming and gossiping behind someone’s back
 Scapegoating and humiliation,
 Infighting and bickering
 Sabotage such as setting up a new hire for
failure
 Withholding needed information or advice, or
taking credit
 Obnoxious behaviour making people feel
inadequate

21. 10 Most Common Forms of Lateral
Violence in Nursing
1. Non-verbal innuendo,
2. Verbal affront,
3. Undermining activities,
4. Withholding information,
5. Sabotage,
Griffin. 2004

22. 10 Most Common Forms of Lateral
Violence in Nursing
6. Infighting,
7. Scapegoating,
8. Backstabbing,
9. Failure to respect privacy, and
10.Broken confidences.

Griffin. 2004

23. Mobbing
A group of coworkers gang up on another
– often with the intent to force them to
leave the work group
Five phases of Mobbing
1.
2.
3.
4.
5.
Conflict
Aggressive acts
Management/Faculty Involvement
Branding as Difficult or Mentally ill
Expulsion

24. Who else is involved?
•
Patients
• Quality care
•
Staff
• Co-workers as bystanders
• Management
•
Systems
• Employers
• Faculty
• The ‘System’

25. Do Nurses eat their young – and
each other…
 This old adage should not be the price the
next generation has to pay to join the
nursing profession.
 What stories do you want your students to
talk about with their peers, co-workers, or
at their 5 or 10 year reunion?

26. Clinical Settings - Impacts on
Patients
 Disruptive behavior linked to:
 71%: medical errors
 27%: patient mortality
 18%: witnessed at least one mistake as a result
of disruptive behavior Rosenstein & O’Daniel, 2008
 Ruminating about an event takes your
attention off task and leads to increased
errors and injuries
Porath & Erez, 2007

28. Health Impacts on Staff/Victims
 Physical/Body
 Emotional
 Mental/Mind
 Spiritual

29. Impact on Nurses/Students

30. Impacts on Health Systems
 Dwindling workforce
 1 in 3 nurses will leave the profession
(2003)
 Reduced professional status
 Corrosion of recruitment and retention

31. Impacts on Health Systems
 Negative Impact on the work environment:
 Communication and decision making
 Collaboration and teamwork
 Leading to:
⇑
⇓
⇑
⇑
employee disengagement
job satisfaction and performance
risk for physical and psychological health problems
absenteeism and turnover

32. Impacts on Health Systems
cont.
Cost of Lateral Violence:
 “Turnover costs up to two times a nurses
salary, and the cost of replacing one RN
ranges from $22,000 to $145,000
depending on geographic location and
specialty area.”
Jones, C & Gates, M. (2007).
 The lag in time for a new nurse to become
proficient is a significant consideration.

33. Impacts on Students and New
Hires
 Students and new hires are extremely
susceptible to Lateral Violence and experience
more negative impacts than experienced
workers.
 Prevention Strategies are needed
•
•
•
•
•
Top down and bottom up approaches
Mentoring and investigation systems
Role Models
Education
Empowerment

34. We All need to ask ourselves:
 “Did I participate in bullying?”
 “Did I support this kind of behavior in others?”
 “Did I intervene if and when I observed it?”
“We must work to uncover and reverse
atrocities, one person, one company, and
one law at a time”
Bullyproof Yourself at Work, G & R Namie

35. What to do?
•
Awareness
•
Education
•
Dialogue
•
Zero tolerance policy
•
Be confident
•
Develop effective coping mechanisms
•
Confront the situation
•
Rehearsal
•
Enact policy and procedure
•
Code of conduct
•
Don’t accept it!

36. Zero Tolerance Policies
 The Joint Commission and the American Association of
Critical Care Nurses (AACN).
 2008: mandate the development and implementation of
processes to offset LV that enforce a code of
conduct, teach employees communication skills, and
supporting staff.
 2009: advocates that communication skills should be as
proficient as clinical skills.

37. What do we do with bullies?
 Kick them out? Discipline? Isolate them?
Dissocialize them?
 Similar to a criminal, who has broken the
law, punishment rarely has positive consequences
 Dignity + Respect = no bullying

38. Dignity + Respect = no bullying
 The solution or approach to address bullying is to
promote its real enemy - dignity and respect;
 because with these principles, bullying can not prevail.
 Bullying is ultimately about isolation - isolating
workers and making them feel inadequate. If this
is so, then the antidote to bullying lies in working
together.

39. Culture of Silence
 “Because we set ourselves up to be
healers, this kind of behaviour is in the
shadows. We don’t know what to do about
it, so we try to disown it.”
 In practice, this means nurses can’t stay silent
when another nurse’s actions “makes them
cringe”.
 Having the conversation is what matters . . . it
shows that both professionals share
responsibility for behaviour affecting staff and
patients.
Monica Branigan, 2009

40. Our Culture needs to change
 “We personalize their experiences and
assume they are unique to themselves”
 "Our program empowered nurses to
advocate for themselves. As it liberated
them, retention rates improved. We
attribute this to recognition of lateral
violence. Newer nurses can learn from
those who've gone before.”
Dr. Martha Griffin, 2005

41. Why Don’t We Stop Lateral Violence?
 “It’s not a problem in our work area”
 “Everybody does it – just get used to it”
 “If I say anything, I’ll be the next target”
 “We have policies but they aren’t enforced”
 “She sets herself up for getting picked on”

42. What can you do?
 Dialogue is ultimately far more effective than
pointing fingers
 Cognitive Rehearsal Techniques
 Health care professionals across the spectrum
working together more effectively, and
patients receiving better care.

43. Rehearsal
 Research has demonstrated the benefit of rehearsal for
new employees experiencing lateral violence.
 i.e.
 When a staff member makes a facial gesture (such as
raising an eyebrow), the participant was instructed to
say, “I see from your facial expression that there may be
something you wanted to say to me. It’s OK to speak
directly to me”.
Griffin, M. (2004) Teaching Cognitive rehearsal as a shield for lateral violence: An intervention
for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257-263.

44. DESC COMMUNICATION MODEL
 Describe – the behavior
 Explain – the effect the behavior has on
you, coworkers, patient care
 State – the desired outcome
 Consequences – what will happen if the
behavior continues?

45. Lateral Violence personal level
 The truth is that most of the violence in the world is
committed not by bullies but by victims!
 A person may see himself as a victim. They used to be
the victim of the kids who enraged him by calling him
names. Now, in addition, he feels himself to be the
victim of the crooked adult society.
 Society takes his tormentors' side against him and
punishes him for trying to stop his bullies. He is now
angrier and therefore more dangerous than before the
wise adults disciplined him for being a bully!
 Victims Bullies Hero’s

46. Review Workplace Bullies
 Sydney-based clinical psychologist and workplace
bullying specialist Keryl Egan has formulated three
workplace bully profiles: 1) accidental bully, 2)
narcissistic bully, and 3)serial bully. Egan describes the
accidental bully as emotionally blunt, aggressive and
demanding. "This person is task orientated and just
wants to get things done, tends to panic when things are
not getting done, and goes into a rage about it. This
person is basically decent, they don't really think about
the impact of what's happened or what they have done.
They are responding to stress a lot of the time."
Importantly, Egan believes this type of bully can be
trained or coached out of the bullying behaviour.

47. Three Workplace Bullies
 The second profile formulated by Egan is the narcissistic
bully, who is grandiose and has fantasies of breathtaking achievement. "This type of bully feels they
deserve power and position. They can fly into rages
whenever reality confronts them. This person is very
destructive and manipulative, they don't set out in a
callous way to annihilate any other person - it's purely
an expression of their superiority."

48. Three Workplace Bullies
 Finally, Egan's third profile is that of the serial bully "who
has a more sociopathic or psychopathic personality. This
type of bully is intentional, systematic, and organized and
the bullying is often relentless. They usually get things done
in terms of self interest, not in the interest of the company."
Egan's serial bully employs subtle techniques that are
difficult to detect or prove and training or coaching is
always unsuccessful; simply, the serial bully is often:
 grandiose yet charming,
 authoritative, aggressive and dominating,
 fearless and shameless,
 devoid of empathy or remorse,
 manipulative and deceptive;
 impulsive, chaotic or stimulus seeking; and
 a master of imitation and mimicry.

49. Teamwork and Communication
 Involve everyone in solving problems related to
these issues.
 Develop a set of “RIGHTS” for everyone.
 Effective anti-bullying practices must include a
statement of exactly what constitutes bullying.
 Communication needs to be a part of culture.

50. Teamwork and Communication
 Teamwork in this area involves many staff in
solving problems related to these issues.
 Policy documents on bullying and intimidation
need to be developed.
 Specify the sorts of behavior that will not be
tolerated, and include, within the policy, the
"rights" of individuals to be treated fairly and with
respect.
 Effective anti-bullying practices must include a
statement of exactly what constitutes bullying.
 We need to work with
everyone, bullies, targets, and bystanders.

51. Tackling a Culture of
Intimidation
 Developing more open communication and increased
access to senior management.
 Ensuring that supervisors receive adequate training
and support for their role.
 Ensuring that policies refer specifically to managing
bullying & that these standards are maintained
through an effective performance management
system.
 Providing accessible professional development
opportunities for all staff.
 Developing policy on bullying/lateral violence in the
work-place and conflict resolution mechanisms.
 Self-reflection and active feedback from our peers to
develop insight into our own behavior

52. Safe Place
 Where is the safe place where you work?
 What makes it “safe”?
 Will you be able to respond to lateral
violence when it happens?”

53. Discussion, questions,
comments!!!
Thank you for your participation

54. Contact information
Eli Ahlquist RN, MPA
Greg Riehl RN BScN MA
Program Head
Aboriginal Nursing Student
Advisor
Perioperative Nursing
Aboriginal Nursing Student
Achievement Program
SIAST, Wascana Campus
SIAST, Wascana Campus
Email: ahlquist@siast.sk.ca
Email: greg.riehl@siast.sk.ca
Phone: 306.775.7568
Phone: 306.775.7383

55. References available on Request
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