Our Dirty Little Secret: Lateral Violence

I wish I could give credit to this artist...

Two years ago, I retired from bedside nursing. My initial anxieties of "what next.?", were soon relieved by sleeping late every day, volunteerism, crafting and oil painting. Ahhhh, Nirvana. A two-year nursing honeymoon period, for sure.

Last week, in an effort to maintain licensure, I attended the American Association of Critical Care Nurses' National Teaching Institute (AACN-NTI) where over 8,000 Critical Care Nurses converged on New Orleans, La.

I chose this conference because I could knock out over 20 CE's in 4 days. 

Coming to terms with recognizing my interests no longer lay in "Advance Concepts in Ventilator Management" or "Cardiomyopathies: Understanding the Complexities of Diverse Diagnosis", I chose to attend classes on topics that are rarely discussed outside of nursing circles... "Workplace Violence: Do You Have A Plan?", "Impact of Moral Distress on Perceptions of Work Environment and Patients Safety", " Bullying: An Unhealthy Intrusion in the Work Environment", "Silence: A Never Event" were just a few.

And I grieved. 

I grieved for the thousands of nurses broken by workplace violence, bullying, lateral (aka Horizontal) violence and workplace violence delivered at the hands of patients. 

I grieved for my oppressed and subjugated peers. I know it sounds bad - really bad - and for so many, it really is - but it's time to talk about it and delve into why it occurs so frequently in a profession that is consistently ranked as the most honest and ethical by the public.

In my twenties, a manager taught me a valuable life lesson ..."Don't come to me with a problem unless you have a solution." So I'm writing about 'our dirty little secret'. Not to 'slam' nurses - but to share what I have learned, if only to begin the uncomfortable conversation and possibly support those who are experiencing the phenomenon and to prevent future pain to those who are on the frontlines of healthcare delivery. 

Incidentally, ER Nurses are subject to this form of violence at a much higher rate than any other specialty.

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25 years ago, Meissner coined the expression... "Nurses Eat Their Young". I disagree. In my experience, many of my peers have a less discriminatory palate and will "eat" anything that has let their guard down (ie: the nurse who has been on their feet for the past 12 hours and too tired to fight) .

I was 50 years old. An ER nurse for 25 years, it was the lateral violence I experienced at the hands of several young ER nurses that helped cement my decision to leave ER Nursing permanently and try my hand in the ICU. Usually, it was non-verbal, eye-rolling and sarcasm during patient-report at the end of my shift that really got to me. Giving "report" became dreaded. Miffed, badgering and nit-picking nurses who would get their egos massaged by trying to prove just how much more knowlegeable they were. It wasn't just one nasty nurse or one isolated incident. It was repeated several times a week. And it got old.

Wisdom told me that the confrontational report had very little to do with me. It had everything to do with them and their perception of themselves and their personal power. But I was getting to old for this shit and recognized that staying in the ER was not a healthy personal choice for me any longer. I transferred to ICU full-time.

Lateral Violence: Definition.

A consistent pattern of behavior designed to control, diminish or devalue a peer (or group) which creates a risk to health or safety (Farrell, 2005).

Some specific examples are:

• Overt. Name calling, bickering, fault finding, criticism, intimidation, gossip, shouting, blaming, put-downs, raised eye brows
• Covert. Unfair assignments, refusing to help someone, ignoring, making faces behind someone's back, refusing to only work with certain people or not work with others, whining, sabotage, exclusion, fabrication.  See more at: Break the Spell and End Lateral Violence

My experience was minimal compared to many, and I admittedly did not have the skill set (nor the inclination) that was necessary to deal with the problem. I was fortunate enough to have an 'out'. 

Several years earlier, our hospital offered a 6-week program in ICU Nursing. Although I loved being an ER Nurse, I knew the frenetic pace and physical requirements of the job could possibly be impacted as I aged. Attending those classes and gaining some part-time work in ICU nursing was one of my best career decisions made. My personal ICU nurse-nurse experience was by and large, welcoming, supportive and nurturing. It worked for me. 

But for those of you who can't bear the thought of leaving the specialty of where you work, I have a few suggestions...

• Consider creating (or joining) a multidisciplinary departmental committee on Healthy Work Practices.
• Develop a departmental"Safe" word or phrase when you are feeling oppressed or bullied by someone ("Peace").
• Develop a departmental "Safe" word or phrase when you recognize someone is failing to complete job requirements or slacking (ie: "Dude")
• Develop or tweak the current "Code of Conduct"
• Violations in Code of Conduct should include clearly defined disciplinary actions
• Prepare now for an 'out'. 

Now, take a long, hard look in the mirror. Could you be the problem? Maybe it's time to reflect and regroup.

My own, personal 'Year-of-the-bitch" was 1995. It wasn't pretty. And then I gave myself an attitude adjustment. Why was I such a bitch? Just like the experts say... I was feeling oppressed. powerless and silenced. Simple as that. Fortunately, I (hopefully) made amends to those nurses I may have hurt.If not, I am truly sorry. 

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In an effort to promote healthy work practices, I plan on writing about the ways I have learned that we, as nurses can care for ourselves. 

Who knew?

Some of this info I gleaned from the NTI - some I just made up. I hope it helps. I look forward to hearing from you and your experiences in this area as I have learned that "getting your cards on the table" is generally a good place to start when the topic causes discomfort.

ER Nurses: The Cycle of Violence

Lateral Violence and Bullying in the Workplace