By Allison Flynn, BSN, RN

Any nurse who's been around for more than a minute has heard the intimidating phrase: "Nurses eat their young." It's hard to imagine how this phrase could become so popular within a profession that's known for being caring and selfless. Yet, many nurses both new and experienced report a significant lack of support and even bullying in their places of employment. This toxicity is often referred to as lateral violence, meaning aggressive behaviors happening internally between colleagues. These behaviors may be seen nurse to nurse or between nurses and supervisors. There may be several explanations as to what is behind lateral violence in nursing. Most important is knowing what you can do if you are affected by workplace violence.

Nurse as Wounded Healer

In one study, researchers applied the Theory of the Nurse as Wounded Healer to lateral violence in nursing. The theory, developed by Marion Conti O'Hare, states that individuals are drawn to specific professions, such as nursing, by a desire to relieve individual suffering after experiencing or witnessing traumatic events in their own lives. When the individual's coping with trauma is effective, the pain is transformed into healing.

When coping is ineffective and remains unresolved, that individual functions as a "walking wounded" and experiences problems in their social and work relationships. Applied to lateral violence in nursing, these wounds may be caused by work-related stressors such as witnessing or experiencing lateral violence in the workplace. If this is a regular and unresolved occurrence, soon the nursing staff may become inundated with the walking wounded.

According to O'Hare, in order to effectively resolve this trauma, the nurse must first recognize and examine the trauma and transform the pain into a manageable state. The final step, transcendence, allows for insight and learning from past trauma that can be used to help others with individual pain and suffering. Only then, can the nurse become a wounded healer.

High Stress Work

One article reported stress and burnout levels among nursing staff in the U.K. were higher than members serving in the armed forces. A survey sent to participants in Britain's health care system revealed nurses scored 1.5 times higher in stress levels than the average for soldiers after war zone trauma and twice as high as individuals working in emergency services. It was thought that nurses had higher stress scores because their line of work did not have the same degree of stress recognition as other stressful occupations, therefore the support for nurses to process their emotional reactions to their work was considered an abnormal response. What this translated to among participants in the study was low morale and high burnout rates in the workplace.

An Oppressed Group

A study suggested nurses working in hospital settings are an oppressed group, influenced by medical hierarchies in which nurses lack power and control. This can lead to a high level of vulnerability among nurses to workplace aggression as well as a pervasive individual level of negative self-concept. Oppressed group behaviors may occur when the powerless are fearful and silent when encountering authority, resulting in anger and aggression toward members of one's own group. Low levels of social support can exacerbate this internal emotional abuse, leading to further low self-esteem and social isolation.

What You Can Do

Calling out workplace violence when it occurs is important in order to help resolve inappropriate and potentially harmful behaviors. Having an honest discussion with a colleague about aggressive behavior can help bring awareness to the issue while also communicating that this type of behavior will not be tolerated at work.

It can be a little trickier when unprofessional behavior is coming from a nurse manager or someone you may report to on a daily basis. Some nurses may feel comfortable addressing the issue directly with their manager. If this seems intimidating, there are other ways to go about resolving a conflict such as reporting the behavior to your manager's supervisor or finding out about your institution's policies for reporting workplace violence.

Everyone should be held accountable for unprofessional behavior, especially when that behavior causes others emotional distress. Addressing workplace violence is the first step to helping create a healthy environment for nurses.