Lateral Violence: Learning How to Stand Your Ground

      The +American Nurses Association defines lateral violence as an aggressive act that occurs between colleagues, and can be either overt or covert. (1) It is more often a psychological, rather than physical, form of relational aggression. Some examples of lateral violence, as described by the Academy of Medical-Surgical Nurses, include (2):

• Intimidating behavior
• Mockery
• Inflammatory angry outbursts
• Insults, ridicule, patronizing, or condescending language
• Gossiping or spreading unfounded rumors
• Humiliation
• Exclusion or isolation

"Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net".

     This week, I had my first encounter with lateral violence as a nurse. During the course of my day shift, I had to make a decision regarding a patient's plan of care. All of my available options would result in the night nurse needing to administer either antibiotics, blood product, or both. After consulting with my preceptor, as well as my patient, a decision was made to proceed with administration of the IV antibiotics. This choice left the night nurse with having to administer blood product at the start of her shift (though my intention was to try very hard to start the blood product myself before end of shift, so that I could at least make her start of shift less difficult).

      During handoff, the night nurse (who knew I was a new graduate nurse, orienting on this unit for the first time) said she had seen the orders for the blood products, and asked if I they were completed. As I began to explain to her my decision to start with the antibiotics, she heaved a big sigh of exasperation and announced to both myself and my preceptor that she, "was sorry to sound like a bitch, but it was completely ridiculous that the patient didn't have her blood done the minute it was ordered." Without waiting for me to reply, she jumped from her chair and headed towards the patient room, admonishing me as we walked that, "I know you're new, but that decision was stupid. Plus, now I have to start my shift being stuck in a patient room while I get her blood started.

     After introducing the night nurse, and saying good night to the patient, we left the room together. I tried once more to explain what lead to my decision, or to even give the nurse more information on the patient, but she had already left my side to rejoin a group of night nurses. As I was returning to my station, I noticed her gesturing towards me, then the patient room we had just left, and rolling her eyes dramatically. It made me feel very self-conscious.

     I reviewed what had happened with my preceptor, and we both revisited the day. She concluded I hadn't made a wrong decision, just a decision that the night nurse wasn't happy about.

     The next morning, the night nurse made a point of giving report to my preceptor only. She didn't once look at me, or direct any of her handoff to me.

     A few hours into shift, our nurse manager came to my preceptor for more information on what had happened last night. Apparently, the night nurse reported me for having intentionally pushed off a task on a later shift. When I heard that, I felt my stomach knot up and my heart clench! That sort of behavior is something I would never do, and to have been accused of it made me angry! So, I stood my ground, and I laid out my case. After hearing the full story, and getting confirmation from my preceptor on its accuracy, the manager told me not to worry. As my preceptor had said, my decision wasn't wrong, it just wasn't what the night nurse would have preferred.

     I don't think the nurse in question will be spoken to about her behavior. Or if she has, there wasn't any follow up with me about it. But I do know that as a new graduate nurse, I did the right thing. I took the time to evaluate my course of action - what would be best for the patient? What are my options in terms of safe medication practices? Hanging blood product and antibiotics at the same time on a new patient with no previous history of transfusions seemed like an unsafe idea to me. And I confirmed my plan of care with my preceptor, an experienced nurse of 16 years, who agreed with my care plan. Was my choice one that made the night nurse's life easier? No. Hanging two units of blood at the start of a shift is always going to be daunting and time consuming. But was it appropriate for my patient? Yes.

    Here's how to Stand Your Ground as a new graduate nurse:

• Evaluate the Situation: Ask yourself - Was I following my facilities policies and procedures? Were the needs of my patient my top priority? Did I have other options available to me?
• Remain Professional: Just because a coworker is being a bully, does not mean that you should sink to their level. Stay calm, explain your choice of action, and don't be afraid to tell them if their behavior is inappropriate.
• Talk to Your Manager: If a coworker is being hostile, or humiliating, or exclusionary, talk to your manager. Behavior like that is not okay.
• Move On: Try not to dwell on the situation when you get home. Vent to a friend or loved one if you feel it will help, but then try to find a relaxing activity to get your mind off the interaction. Don't let a bully ruin your peace of mind.

      Being a new nurse is scary. We have spent years learning difficult information and acquiring skills that will help us to help others along their journey to renewed health. We take on the immense responsibility of keeping those in our care safe. We save lives. It can all feel like a lot of pressure, and we are our own worst critics.

      New nurses draw so much strength from our coworkers. Our fellow nurses know where we've come from, what we just survived by successfully graduating from nursing school. They allow us to ask questions, and give guidance when we feel lost or confused. Working together, our community keeps itself moving forward by giving back to the next generation of nurses. Our profession cannot survive without teamwork and a kind of synergy that pushes us to thrive.

      So please, make the effort to be someone worth working with. Share, support, encourage your coworkers! And don't let the few mean ones you may encounter dampen your spirits. They aren't worth the worries, and you have better things to do with your time anyway.

      Stand strong everyone, and here's to a happy tomorrow! ☺




References:
1. Lateral Violence and Bullying in Nursing. (2011, January 1). Lateral Violence and Bullying in Nursing. Retrieved July 27, 2014, from http://www.nursingworld.org/Mobile/Nursing-Factsheets/lateral-violence-and-bullying-in-nursing.html

2. Workplace Bullying and Lateral Violence among Nurses. (n.d.). . Retrieved July 27, 2014, from https://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/AMSN-HWE-Bullying.pdf