Lateral Violence in Nursing

In January 2009, Nursing Administration at Spartanburg Regional Healthcare System (SRHS) joined forces with the Nursing Education and Human Resources departments to take an in-depth look at the causes of nursing turnover within our organization and to develop strategies to improve our overall nursing retention rates.

After an intense analysis of the nursing turnover data and an extensive review of the nursing literature, several opportunities to improve nursing retention within our organization were identified by this taskforce.

One of the most surprising (and challenging) issues discovered by the taskforce was the fact that some nurses were choosing to leave our organization due to unbearable conflict with their colleagues and/or direct supervisor.

This discovery seemed paradoxical!

The central focus of the nursing profession is caring; yet interpersonal conflict among nurses in the workplace was significantly impacting SRHS’s nursing turnover rates.

The old adage seemed true– nurses do eat their young!


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Uncovering the Issues

After continued literature review, our retention taskforce soon discovered that the issue of interpersonal conflict among nurses in the workplace, or lateral violence, was not unique to SRHS.

The effect of lateral violence on the nursing profession has been reported in the nursing literature for more than 20 years.

Impaired personal relationships among nurses in the workplace can undermine the organization’s culture of safety by leading to errors, accidents, and poor work performance.

Lateral violence also drains nurses of their energy and challenges an organization’s attempt to create a satisfied nursing workforce.

Raising Awareness Among Staff

Our taskforce soon learned that Upstate AHEC had recently been awarded a grant from the Nursing, Education, Practice and Retention Program (NEPR), part of the Department of Health Resources and Service Administration (HRSA), to address the issue of lateral violence among nurses in South Carolina.

The purpose of this grant was to provide a training program for registered nurses directed toward raising awareness of lateral violence.

By raising nurses’ awareness of the issues and behaviors of lateral violence, it is hoped that the destructive cycle of this behavior can be broken.

This heightened awareness will in turn allow nurses to feel empowered to bring about significant change in their working relationships and their overall work environment.

Our taskforce immediately contacted Upstate AHEC and began a collaborative education initiative on lateral violence within our organization.

Initial lateral violence educational sessions began in April 2009 and were targeted toward our nursing leaders, such as nursing directors, nurse managers, clinical unit educators and charge nurses.

Response to the first lateral violence educational sessions was phenomenal!

Our nursing leaders were relieved to learn that they were not alone in their struggles to deal with destructive behaviors among their staff.

Through the lateral violence classes that were provided by Upstate AHEC, our nursing leaders not only learned how to recognize lateral violence behaviors in the workplace, they also were taught effective ways in which to deal with these aggressive behaviors.

Transforming Our Culture

By August 2009, Upstate AHEC, as outlined in their HRSA grant, had provided several train-the-trainer sessions for key SRHS employees, which positioned us to assume internal responsibility for continuing lateral violence education within our organization.

Although the original target audience for the lateral violence education at SRHS was intended to be nursing personnel, the news of the success of the classes quickly spread throughout other departments within the organization.

As a result of popular demand, lateral violence educational classes were developed for allied personnel.

We soon found ourselves teaching 6-9 lateral violence classes per month for a wide variety of hospital employees, often with an overflowing audience.

Lateral violence classes continue to be offered several times each month for all SRHS employees. Class attendance remains high and as of our last count, we have provided lateral violence education to more than 3,000 nursing and allied personnel.

Also, as part of the SRHS taskforce’s goal to change the organizational climate that supports this behavior, lateral violence class content has also been threaded through various other educational programs within the organization, such as general hospital orientation and nursing preceptor workshops.

Measuring Success

In February 2010, as a result of the heightened awareness of lateral violence behaviors in the workplace at SRHS, a key component was added to the bi-annual employee survey.


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An 11-item Likert scale questionnaire was incorporated into the employee survey to measure the employee’s perceptions of the existence of violent behaviors in the workplace:

  • infighting, bickering;
  • scapegoating, blaming others;
  • backstabbing, malicious gossiping, not respecting privacy;
  • destructive criticizing, bullying;
  • sabotage;
  • snide remarks, curt responses, lack of openness;
  • making negative faces or gestures;
  • turning away, ignoring;
  • withholding useful information, secretiveness;
  • avoiding, not being available;
  • generally rude behavior.

As of January 2011, nursing alone has seen a 21 percent reduction in lateral violence behaviors in the workplace at SRHS, as measured by the employee survey.

Organizational Impact

By raising employees’ awareness of the issues and behaviors of lateral violence, SRHS has seen a significant culture change within our organization.

This culture change has not only decreased the negative effects of lateral violence on nursing retention, it has empowered nurses as well as allied personnel to bring about significant change in their working relationships and their overall work environment.

Sherri H. Stroud is Director, Cardiovascular Services, Spartanburg Regional Healthcare System, Spartanburg, SC.

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