What is Lateral Violence in Nursing?

Nurses today often are the backbone of a hospital or healthcare organization’s business operations, but lateral violence in nursing is threatening their health and job satisfaction. 

The main responsibility for nursing professionals is their patients’ well-being, from communicating with doctors and performing physical exams to administering medications and updating charts. They not only care and support their patients, but the families of patients too. And this becomes more difficult when there’s a public health emergency or a severe weather event.

Caring for patients, carrying a large workload and dealing with levels of bureaucracy can weigh on nursing professionals. They are working in chaotic, stressful and challenging environments and sometimes they lash out against each other.     

Defining Lateral Violence in Nursing

Lateral (or horizontal) violence is when “nurses covertly or overly directing their dissatisfaction inward toward each other, towards themselves, and toward those less powerful than themselves.” It occurs repeatedly over time as emotional, psychological, physical or sexual abuse. In nursing, lateral violence is generally emotional and psychological abuse and includes unwarranted criticism, belittling, verbal aggression, ostracism, insults and targeted personal jokes. Nurses who are victims also endure excessive scheduling workloads, condescension, scapegoating and backstabbing, as well as their confidentiality is breached and privacy is violated.

Nearly all nurses have been the victims of lateral violence in their careers. Lateral violence sometimes starts as soon as would-be nurses enter the workforce.

  • About half of nursing students in clinical placements either experienced or observed lateral violence
  • 97% of nurses in one survey said lateral violence was a common occurrence
  • Verbal abuse was the most common form
  • One-third of nurses said they experienced lateral violence as verbal abuse by one of their fellow nurses in one of their last five shifts they worked
  • Nurses are likely to leave their employment within six months after they’ve experienced lateral violence for the first time

Nurses who are the victims of lateral violence experience depression, low self-esteem and feelings of incompetence. As a result, they leave their profession, and this is costing healthcare organizations in various ways.

  • The turnover rate for nurses is 17.2% of the total healthcare workforce per year
  • Lateral violence costs hospitals over $4 billion each year because of lost time, productivity and turnover of trained nurses
  • Hospitals lose anywhere between $300,000 and $4 million, including the costs of recruiting, hiring, retaining and training for each nurse who leaves

Lateral violence is becoming one of the reasons nurses leave their profession, causing more work and putting more strain on the nurses who remain on the job. 

A Growing Staffing Epidemic

Even though nursing employment opportunities are growing at a faster rate (15%) than any other occupation, there is a nursing staff shortage that’s reaching epidemic levels. More than 1 million new registered nurses (RNs) will be needed by 2022 to fulfill healthcare needs in the U.S., according to the American Nurses Association (ANA).

Various studies report the healthcare industry is one of the fastest growing sectors in the U.S. economy. It currently employs more than 18 million workers, with RNs, licensed practical nurses (LPNs), nurse practitioners (NPs), licensed vocational nurses (LVNs), personal/home health aides and other nursing professionals making up the largest part of the healthcare industry. There are currently 3.9 million RNs, 4 million home care aides, 270,000 NPs and 724,500 LPNs/LVNs in the U.S.

The influx of patients into the healthcare system, more patients reporting age-related and chronic conditions, an aging nursing workforce and educational bottlenecks are also contributing to a nursing shortfall.

  • 80% of Americans aged 65 and older have at least one chronic conditions, while 68% have two or more
  • Currently there’s about 1 million RNs older than 50, meaning one-third of the workforce will reach retirement age in the next 10 to 15 years
  • Nursing schools recently turned away over 56,000 qualified applicants from undergraduate programs because there wasn’t enough openings

In addition to the need for RNs, there will be a deficit of home health aides (446,300) and a combined shortage of NPs and nursing assistants (125,000) by 2025.

This is impacting how hospitals and healthcare facilities are maintaining their continuity of operations, especially during a public health emergency or disaster. Having enough nurses during and after an event is critical to meet patients’ care. But as nurses struggle with lateral violence, it’s impacting that very responsibility.

Help to Break the Cycle

Lateral violence comes in many forms, both overt and subtle, sometimes making it challenging to recognize and address. The problem is compounded because nurses don’t always report when they’ve experienced this kind of violence, so the true extent of how many nurses endure lateral violence isn’t known. Many nurses believe they’ll be ignored, will get in trouble with supervisors or even make the situation worse. In addition, there’s a perception lateral violence is a rite of passage for nursing professionals.

Nurses may report they are the victim of lateral violence, or witness a peer is a victim, if they know there’s more discretion. But nurses may not have the means to do so. Rave Mobile Safety’s Workplace Safety and Preparedness Report said 61% of respondents would be more likely to report a safety issue if they could do it anonymously. As for healthcare workers, 25% of those who experienced a workplace violence incident didn’t have a way to report it anonymously.

One way for nurses to come forward about lateral violence incidents is to do so through an employee safety app. The app, which would be an extension of a mass notification system, would enable nurses to send a confidential tip through a text message. The two-way messaging feature would allow RNs, NPs, home healthcare workers and others to directly communicate with their organization’s security staff or relevant personnel. It would help them report an incident, along with text and images, discreetly through their smartphones. The employee safety app gives them an opportunity to report an incident without fearing retaliation and put their own safety into their own hands.

These two-way messaging sessions can be routed to a specific department or need, so only the designated team will receive these real-time chats. The assigned team can respond instantly to employees with two-way messages.

In addition to confidential texting, the employee safety app would include an emergency call button so nurses can directly connect with their organization’s security staff or local 9-1-1 if they’re on the road. It would also feature a virtual escort, so nursing professionals can check in with security as they leave or arrive late at night, travel to different campuses and visit patients’ home.  The ability to receive notifications without Wi-Fi, as well as call and content directories with facility information are other features an employee safety app would include.

An employee safety app would help nurses be empowered about their own personal safety, as well as have an easier way to contact their facility’s safety or security personnel if they’re experience lateral violence. It would help nursing professionals feel better connected to their hospital or healthcare facility.

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Kathleen Ohlson
Kathleen Ohlson

Kathleen Ohlson is Rave Mobile Safety’s Content Marketing Manager, writing about federal, K–12 and public safety topics. When she’s not researching or banging away at her keyboard, Kathleen enjoys going to concerts and “playing” general manager for her favorite teams, the Boston Red Sox and the Boston Bruins.

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