• Be the Voice Against Nurse Bullying

    Author(s): By Thomas Davis, CRNA, MAE

    In-your-face yelling or a punch in the nose are obvious examples of hostile and aggressive behavior; however, the daily manifestations of Lateral Violence in the workplace are often subtler and less obvious.

    In the nursing community, Lateral Violence (LV) is the term adopted for “bullying.” Consequently, an angel of mercilessness who might otherwise be labeled a bully is officially said to be “inflicting lateral violence.” In medsurg nursing, authors Becher and Visovsky describe lateral violence as “hostile, aggressive and harmful behavior by a nurse or group of nurses toward a coworker or group of nurses via attitudes, actions, words and/or behaviors.” Lateral violence often goes beyond things that are done to another person to include things that are not done or that go unseen.

    Recently, an anonymous post by a nurse anesthetist student on the Facebook CRNAs and SRNAs user group page described the meanness directed at him in his clinical training site because of his status as a learner. The student started the post by humanizing himself as an attentive student committed to mastering the skills and the knowledge to become a CRNA. Then he described his personal history – background, family, hobbies. His post went on to inform readers that his clinical training included accusations of being “lazy, stupid, inept, and disrespectful…” and other demeaning allegations. Clearly, he was on the receiving end of outrageous behavior at a clinical training site in which lateral violence is a toxic staple in the culture. Given the opportunity, the student would likely change training sites tomorrow and not look back, and you can be certain that he will never seek employment there.

    Bullying can be subtle

    In-your-face yelling or a punch in the nose are obvious examples of hostile and aggressive behavior; however, the daily manifestations of LV in the workplace are often subtler and less obvious. Here are some examples of behavior that qualify as LV and, over time, will have a toxic effect on your team.

    Overt LV Covert LV
    Name-calling Sabotage
    Intimidation Unfair work assignments
    Blaming Withholding information
    Fault-finding Withholding credit or praise
    Threatening Exclusion from group activities
    Ethnic slurs

    There is a cost associated with allowing lateral violence to exist in your workplace. As noted by nurse educators Becher and Visovsky, all levels of persecution damage the self-esteem of workers, reducing productivity and ultimately having a negative impact on the entire profession. The reputation that “nurses eat their young,” didn’t arise from nowhere; LV is a problem that has been associated with the nursing profession right along with other professions for decades. It’s time to stop LV and turn the corner.

    Avoidance of conflict fuels the flames of lateral violence in workplaces where bullying is tolerated. Rather than confronting an aggressor and drawing a red line, it is easier to turn a blind eye and hope that you are not his next victim. Writing in the CPI blog, Emily Eilers, author and editor for the Crisis Prevention Institute recommends team training that focuses on changing the workplace culture and establishing zero tolerance for bullying. For training to be effective, the team must openly discuss the problem and develop a code of conduct that defines acceptable behavior. Affirming Eilers emphasis on team training, nurse educator Ericka Sanner-Stiehr, PhD, recommends a three-step approach to eliminating lateral violence:

    1. Add lateral violence awareness to the curriculum of teaching programs
    2. Establish and enforce a code of conduct
    3. Role model the respectful, courteous behavior expected of the team.  Your strong leadership combined with commitment to change will position you to transform your workplace culture.

    Stopping lateral violence starts with you

    Make it a priority.  Whether you are the official leader with the title or the opinion leader to whom others listen, draw the line and vow to end lateral violence in your workplace. Show your commitment to culture change by establishing a policy of zero tolerance for LV and confront each offender immediately. During the interview and hiring process, include a discussion of acceptable behavior.

    Discuss bullying at team meetings. An elephant in the room won’t go away until it is acknowledged, and conflict avoidance is akin to feeding the elephant. Dedicate a team meeting to discuss the negative effects of lateral violence and have the team identify areas for improvement. A one-time discussion will not have a lasting effect.  Address the topic repeatedly at subsequent meetings and elicit every person’s commitment to changing attitudes and behavior toward one another.

    Develop and enforce a code of conduct. Once the team understands the dimensions of lateral violence and has committed to change, use a subsequent meeting to develop a Code of Conduct. Reinforce zero tolerance as your policy for addressing covert or overt behavior that violates the Code.

    Simulate triggering scenarios. Help your team find better options for situations that commonly trigger lateral violence. Take time at a team meeting to role play interactions that have generated negative behavior in the past. After completing each scenario, challenge the team to come up with professional and productive ways to more appropriately address the same or similar situation if it arises in the future.

    The CRNA candidate who posted on Facebook knew first-hand the devastating effects associated with being a victim. He perceived himself to be powerless, at the mercy of the sharks swimming around him in the waters – not an optimal training ground. If you allow intimidation, oppression, bullragging or any form of persecution in your workplace, you will have team members, like the student, living each workday in constant fear of the next attack and ready to jump ship at the first opportunity. Be the voice that stops lateral violence. Lead the other voices. Then direct the choir.


    Tom S. Davis, DNAP, CRNA, MAE, is the former Chief of the Division of Nurse Anesthesia at The Johns Hopkins in Baltimore, and former Chief CRNA at (Baylor) Scott and White, Main OR in Temple, TX. Col. Davis, USAF (Ret.), is well-known throughout the Nurse Anesthesia community for his leadership in clinical anesthesia, including developing the first distance education model while on the graduate faculty at Kansas University Medical Center. Recognized for his expertise in team-building across department lines, Tom is a sought-after speaker, educator, author, and leadership trainer. Follow @procrnatom on Twitter.


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