From the Massachusetts Nurse Newsletter
April 2011 Edition
Often, it is one and the same
By Chris Pontus, MS, RN, COHN-S/CCM
Associate Director of Health & Safety
and Diane Scherrer, MS, RN
Associate Director, Division of Organizing
The topic of bullying has been making headlines, both locally and nationally, since Massachusetts passed legislation this past year to address the problem in the commonwealth’s schools. Since then, the MNA has been receiving numerous calls from both members and non-members who are describing incidents of harassment, bullying and abuse.
The complaints are often the result of a systematic assault, one that is primarily psychological in nature. Bullying is a serious workplace issue for nurses at all levels, as nurses are prone to bullying and being bullied in all specialties and across all sectors.
In an effort to address this issue, the MNA now offers a continuing education class entitled “Lateral Violence and Its Impact on Nursing.” What follows is both an overview of the problem and the MNA’s related CE course.
Lateral violence and its subsets
There are three categories of behaviors that are considered lateral violence: harassment, discrimination and bullying.
Harassment is any form of unwanted behavior that may range from unpleasant remarks to physical violence. Sexual harassment is linked to gender or sexual orientation. Racial harassment is typified by behaviors that are linked to a person’s skin color, cultural background, race, etc. Harassment tends to have a strong physical component in manifested behaviors. Behaviors that include regular following and watching are termed stalking.
Discrimination involves a person being treated differently, and in particular, less favorably because of gender, race, sexual orientation or ability.
Workplace bullying is characterized by many incidents of unjustifiable actions of an individual or group toward a person or group over a long period. Bullying behaviors are persistent, offensive, abusive, threatening, and malicious in nature with the intent to do harm. The person who bullies may be in a position of power (actual or perceived).
“…It is about persistent criticism and personal abuse—both in public and in private— which humiliates and demeans the individual, gradually eroding their sense of self. It is designed to undermine a person’s ability and convince them that they are no longer good at anything.” (Adams and Bray, 1992:49)
Institutional lateral violence
The literature on workplace bullying reveals that supervisors and managers perpetrate much of this behavior on their subordinate staff members.
The root of institutional violence is the absence of respect in the workplace. Because leaders set the tone, the leadership must promote a culture of respect through their words and behaviors. The employer is responsible for setting the example of harmony and collaboration with her/his staff (Stokowski, 2010). In organizations where bullying is allowed, bullying is seen as the cultural norm in the workplace. Consequently, blaming the victim is a means for the employer to avoid responsibility for bullying. An employer may tell a targeted nurse that it is her problem. Therefore, the nurse is held responsible to deal with her “stress problem” while the employer fails to address the institutional culture that supports the bullying of employees.
Structural bullying specifically involves supervisors or line managers taking actions perceived as inequitable or retaliatory involving scheduling, workload assignments or pressuring nurses to not use their earned time.
Where lateral violence is permitted, the institution permits or ignores these behaviors resulting in a hostile work environment.
The Joint Commission has issued Sentinel Event Alerts that address violence and incivility in health care over the past three years (Center, 2011). The Joint Commission’s 2009 sentinel event recommended that health care organizations take steps to end intimidating & disruptive behavior. To accomplish this objective the organization’s process must include defined cultural expectations and the necessary leadership to stop the cycle of abuse (Longo & Sherman, 2007).
Effects of institutional lateral violence
Lateral violence in the workplace is widespread and over time, it results in low morale, high staff turnover, increased absences, clinical errors, and low productivity. Some other effects of lateral violence are:
- Marginalization of the competencies, intelligence and integrity of others
- Reduced self esteem
- Disconnectedness
- Apathy and low morale
- Depression, anxiety and sleep disorders
- Difficulty with motivation
- Difficulty with emotional control
(bursting into tears) - Impaired personal relationships (trust is destroyed, further eroding relationships in the workplace and creating a major obstacle to team building)
Traumatic symtomatology includes:
- Loss of ability to manage everyday situations
- Over-reactive response, such as hypervigilance
- Under-reactive response, such as dissociation and psychic numbing
- Memory dysfunctions
- Activation of brain’s circuit breakers
There are many forms of dissociative responses, including forgetfulness, spacing, speechlessness, depersonalization and derealization, and fugue states. This puts the nurse at great risk of omissions and errors in patient care.
“The overt behavioral manifestations of lateral violence are expressed by infighting among nurses, withholding pertinent information (sabotage), scapegoating, criticism, and failure to respect confidences and privacy.” (Griffin, 2004)
Lateral violence in the workplace creates an unsafe environment where everyone is negatively affected. Co-workers may feel sorry for the nurse being targeted but are fearful of taking action as they worry that they will become the next target. Some may even side with the bully and blame the victim.
The cumulative effect of bullying behavior leaves invisible scars and is an act of violence perpetrated on the targeted nurse. In Social Pain/Physical Pain Overlap Theory (SPOT), researchers have observed that the experience of and anticipation of social pain such as humiliation and exclusion results in a real biological experience similar to that of physical pain (Eisenberger & Liebermann, 2004). Lateral violence behaviors do result in psychiatric injury and trauma that often constitute Post Traumatic Stress Disorder (PTSD) in those targeted as well as in those witnessing the aggressive behavior inflicted on their coworker.
Individual strategies to deal with lateral violence from management
Should you or a co-worker experience workplace lateral violence, immediately obtain support from colleagues at work, friends and family. Connecting with your supportive network will help heal the injuries suffered from abusive incidents. You should also be sure to document and record all incidents of hostile behavior, including names of those who witnessed the interaction and date and time it occurred. Do not meet with the employer alone to address bullying. Instead, contact your bargaining unit chairperson, and work with your MNA labor representative to address the problem with the employer. Do not allow the employer to deny your experience of lateral violence. If you feel you are the victim of such behavior, it is real.
The role of the union
If you belong to an MNA bargaining unit, you already have a system in place to help deal with lateral violence, bullying and harassment. You, your co-workers and your MNA representative can collectively respond with a legally protected voice in order to stop the behaviors that are divisive and harmful to you and your union brothers and sisters. Your union affirms a culture of safety, respect and mutuality that is the foundation of nonviolent, conflict-resolution. Other activities in which the union can be involved include:
- Negotiate for contract language that protects the union’s members from lateral violence (bullying, discrimination, harassment) in the workplace.
- Provide training for union staff and members: facilitate the involvement of members in activities such as task forces or committees that address workplace health and safety including lateral violence.
- Train your bargaining unit’s elected representatives to identify and resolve bullying, including between union members.
Reparation
There are many suggestions for responding to institutional lateral violence. One approach is using a restorative remedy that focuses on addressing behaviors as opposed to a punitive response directed at an individual. The punitive response serves to perpetuate a culture of fear, anger, hostility and complaint. The restorative goal is to break the spiral of aggression in the workplace culture by providing education and support for a culture of civility. For this to be effective, it requires that every person in the workplace be held accountable through shared accountability for maintaining and creating a safe work environment.
"By not blaming those involved and acknowledging the fallibility of all parties it is possible for affected individuals to step back and identify the coercive factors at play that lead individuals to act in aggressive and hostile ways. Making visible transgressions, omissions, collusion, inaction, and the misuse of legitimate authority and processes that perpetuate bullying, the intent of restoration in response to bullying is to create more respectful and healthy environments…In this way, restorative approaches provide opportunities to foster environments where individual and shared accountability, resiliency, and responsibility occur within a system of collegial respect and support." (Hutchinson, 2009)
In some workplaces, an interdisciplinary team consisting of leadership from management and the union as well as the occupational health and safety nurse and other experts initiate the process of creating a culture of civil behavior. The aim is to rebuild social relationships, focus on prevention and repair the harm from lateral violence. This process is also sensitive to acknowledging that changing culture takes time, requiring wisdom, compassion, diligence and patience.
In summary, workplace lateral violence is harmful to the wellbeing of the targeted nurses, their co-workers and the patients for whom they care. Many nurses are reporting that they are assigned unrealistic workloads that compromise their ability to provide safe quality care for their patients. Workplace lateral violence contributes to the fragmentation and marginalization of nurses, as well as causes injury and additional stress. Subjecting nurses to a hostile work environment further increases the risk of omissions and errors in the delivery of patient care.
The union offers nurses a legally protected voice and process to address lateral violence in their workplace. The union provides the opportunity to foster a culture of mutual respect, empathy, and inclusion among its members, which is the antidote to lateral violence. Through the union, you can work in solidarity to ensure that everyone is assured dignity, respect and a safe working environment at all times.
For more information or to schedule the CE program, “Lateral Violence and Its Impact on Nursing,” call the MNA’s Division of Health & Safety.
References
Adams, A., Bray, F. (1992, October). Holding out against workplace harassment and bullying. Personnel Management, 48-50.
Center, D. (2011). Mandates for Patient Safety: Are They Enough to Create a Culture of Civility in Health Care? The Journal of Continuing Education in Nursing. 42(1), 16-17.
Eisenberger, N. I., Liebermann, M. D. (2004). Why Rejection hurts: A common neural alarm system for physical and social pain. Trends in Cognitive Sciences, 8, 294-300.
Griffin, M. (2004). Teaching Cognitive Rehearsal as a Shield for Lateral Violence; An Intervention for Newly Licensed Nurses. The Journal of Continuing Education in Nursing. 35(6), 257-263.
Hutchinson, M. (2009) Restorative approaches to workplace bullying: Educating nurses towards shared responsibility. Contemporary Nurse. 32(1–2): 147–155.
Lewis, L., Kelly, K., Allen, J.G. (2004). Restoring Hope and Trust: An Illustrated Guide To Mastering Trauma. Baltimore, Maryland: Sidran Institute Press.
Longo J., Sherman RO. (2007). Leveling Horizontal Violence. Nursing Management, Mar;38(3):34-37, 50-51.
Rocker, C. (2008). Addressing Nurse-to-Nurse Bullying to Promote Nurse Retention. OJIN: The Online Journal of Issues in Nursing 13(3).
Simons, S., Mawn, B. (2010). Bullying in the Workplace – A Qualitative Study of Newly Licensed Registered Nurses. AAOHN Journal, 58(7), 305-311.
Sitzman, K. (2004). Workplace Bullying. AAOHN Journal, 52(5), 220 Stokowski, L.A. (2010) A Matter of Respect and Dignity: Bullying in the Nursing Profession. Available at: http://www.medscape.com/viewarticle/729474
Wachs, Joy (2009). Workplace Incivility, Bullying, and Mobbing. AAOHN Journal, 57(2), 8.
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