Lateral Violence in Nursing Can Take Many Forms

Joni Watson, MBA, MSN, RN, OCN

Joni Watson, MBA, MSN, RN, OCN

The American Nurses Association defines “lateral violence" as behaviors between colleagues involving covert or overt acts of verbal or nonverbal aggression. Though this might seem unlikely in a workplace full of helping professionals like healthcare, oncology nurse Joni Watson, MBA, MSN, RN, OCN, has seen these scenes play out in many different forms.

In her role as director of Oncology Services at Baylor Scott & White Medical Center-Hillcrest, in Waco, Texas, Watson said that she has made creating a healthy workplace environment among her staff a top priority. This means setting high expectations for acceptable behavior right out of the gate and following up decisively when those standards are breached.

“I have to counsel team members, and I’ve actually terminated individuals as a result of lateral violence or bullying,” Watson said. Although she has not been a victim of such behavior herself, she finds it can be insidious and manifest itself in many different ways, making it hard sometimes for team leaders to pin it down. Examples she has seen over the years include excluding or manipulating another team member, practicing “triangulation,” whereby a nurse pits one colleague against another, and blatant gossip—sometimes even slander. The situation is further complicated by the fact that nurses and other healthcare professionals typically have not been adequately trained in how to discourage such behaviors in their workplace.

Whatever form lateral violence may take, she stressed, “A healthy work environment is primarily the responsibility of the leader. The leader sets the expectations, the tone, and, especially, the level of tolerance for the amount of bullying or unhealthy behaviors in the workplace.”

The research literature points to several components that characterize a healthy work environment, Watson explained, including a sense that people are treated fairly, a strong ethos of teamwork, open communication with each other and their leader, a sense of physical safety, and, most important, feeling a sense of family.

“It doesn't matter how great a nurse you are...you're in the people business.”

WHAT’S YOUR EQ?

The decision to terminate an employee is never taken lightly, Watson stressed, and only comes after mentoring, counseling, and a warning that if the unprofessional behavior continues, the nurse will be fired. The counseling often includes recommending a course in emotional intelligence, and she directs staff to online training and free webinars.

“I have had some team members who don’t realize what other people are feeling; they just haven’t built that social capacity as well as other team members have, so they do and say unprofessional things.” “EQ,” or “emotional quotient,” is important, and directing employees to emotional intelligence training, followed by actionable steps to improve, really helps.

“It doesn’t matter how great a nurse you are, if you can’t greet a room and get a sense of what your colleague is feeling so that you talk professionally, that’s a problem. You’re in the people business.” And, it will come as no surprise to nurses that colleagues on the physician side may also need to be reminded that their behavior or language is inappropriate. Nurses shouldn’t be afraid to speak up, because a toxic workplace culture affects everyone.

“Team members have come to me in the past and said, ‘Dr So-and-So, he has some passive—aggressive behaviors, and we need to address that.’ Or, ‘he blatantly dropped the f-bomb today in clinic and chewed me out when I asked him to clarify his orders.’” Many physicians have some of the same issues with low emotional intelligence as well, Watson added, and they don’t realize the power that their words have on other people.

EVERYONE ON BOARD

Ultimately, managers shouldn’t be afraid to take the final step, nor should they use staff shortages as a reason not to. “Lateral violence and bullying can destroy a culture faster than anything else—not just in healthcare, in any workplace,” Watson said.

Supervisors can be reassured that when an employee’s toxic behavior leads to termination, Watson has found the improvement in the work environment is swift and palpable, and other team members are generally happy to step up and take on additional responsibilities until a replace- ment is hired. “We won’t be short-staffed if we cultivate a healthy work environment—a place where people feel like they’re part of a family and feel trusted and respected.”

Most important, Watson said, is that leaders set their expectations and accountability mechanisms for staff clearly and up front. When she starts on a new unit, she tells her team: “These are the expectations that I have, and I’m going to hold myself accountable, but you have a role in this, too.

“We’re 200% accountable for our work environment—100% from me and 100% from you. We’re going to be accountable for one another, and when we see those unhealthy behaviors, we’re not going to perpetuate them forward. We’re going to call them out and correct them."