What Is Lateral Violence in Healthcare? Overview and FAQ

Nurses experience and witness a range of harmful behaviors in the workplace. While some of these acts can be committed by patients and visitors, many nurses also are victims of psychological harm from their own colleagues. When interpersonal conflicts build up between peers without proper intervention, this can lead to what’s known as lateral violence.

It’s important for nursing leaders to understand how to identify this type of peer-to-peer violence and proactively work to prevent it. In this guide, we’ll provide an overview of what lateral/horizontal violence is, how it differs from other types of workplace violence, and provide strategies to help eliminate this common issue affecting the industry.

What Is Lateral Violence? Definition in Nursing

Lateral or horizontal violence refers to peer-to-peer, passive aggressive behaviors that result in hostility. These behaviors are often subtle, occurring in isolation from one another but repeated over time to cumulatively make someone feel threatened. In nursing, examples of this kind of violence range widely but can include:

• Talking poorly about colleagues behind their backs
• Ignoring colleagues or socially/professionally excluding them
• Intentionally denying colleagues information they should have
• Displaying overt signs of disinterest toward colleagues
• Verbally degrading or discouraging colleagues

Lateral workplace violence most often stems from personal biases. Studies examining the intent behind these acts have linked them to feelings of rivalry, jealousy, or prejudices based on physical appearance.

Lateral Violence vs. Bullying

While lateral/horizontal violence and bullying are sometimes used synonymously, there are important differences between the two. Horizontal violence manifests as gradual, psychological harm while bullying refers to outright aggression and repeated insults. Bullying is also more often caused by a power imbalance, unlike horizontal violence which occurs between peers of the same status.

Lateral Violence vs. Workplace Incivility

Incivility is also a common issue that’s important to distinguish from other types of workplace violence. Unlike lateral/horizontal violence and bullying — which both stem from an intent to harm others — incivility umbrellas a range of disrespectful behaviors that may not always have a negative intent.

What Are the Impacts of Lateral Workplace Violence?

Unfortunately, lateral/horizontal violence is quite common among nurses. The prevalence varies greatly from facility to facility, but some studies have estimated that up to 83% of nurses have been victims of lateral workplace violence while roughly 90% have witnessed related acts.

When left unaddressed, nurses who experience lateral workplace violence often suffer long-term mental health impacts, developing symptoms of anxiety, depression, and other stress-induced feelings. This can also lead to increased turnover and may even drive nurses away from the profession altogether.

How to Prevent Lateral Workplace Violence: 3 Strategies

As a nursing leader, proactively addressing lateral workplace violence is a crucial way to protect your staff. This requires a comprehensive, multifaceted strategy to sustain a healthy work environment over time. Follow these evidence-based strategies to foster a more respectful culture and dissuade acts of peer-to-peer violence.

1. Implement Training Programs That Build Collegiality

As lateral/horizontal violence is often driven by a poor work culture, an important first step is to build a foundation for a healthier environment. Implement mandatory training programs that not only raise awareness to negative behaviors, but also build trust and communication between your staff. Studies have shown that these programs should focus on:

• Demonstrative role-play that increases recognition of how victims feel
• Education on how to communicate assertively and de-escalate situations
• Providing a safe space for nurses to hold and practice difficult conversations

2. Lead by Example and Stay Involved With Your Team

It’s crucial for nursing leaders to set an example for their staff and intervene as objectively as possible when incidents occur. Treating all your staff respectfully, avoiding favoritism, and leading with transparency can help diffuse feelings of rivalry or competition that often feed into horizontal violence.

Additionally, it’s important for staff to feel that they can rely on their leaders for support. Have an open-door policy and remain available for staff who want to discuss concerns about the work culture. This can foster better communication and allow you to intervene more quickly and appropriately when incidents occur.

The American Organization for Nursing Leadership provides a number of additional resources and toolkits designed to help leaders prevent workplace violence.

3. Maintain Accountability Through Reporting Systems

Finally, it’s important for nurses who conduct harmful acts to be held accountable. Implement a strong reporting system to reinforce a zero-tolerance policy regarding lateral workplace violence. Follow these evidence-based tips to make your reporting system as effective as possible:

• Keep reports confidential to alleviate victims’ fears of retaliation.
• Clearly outline and educate staff about the consequences of perpetrating harmful acts.
• Create a diverse task force of HR, administrative, and nursing staff to review reports.

Build a Culture of Safety for Both Patients and Staff

Looking for other practical ways to prevent lateral violence and build a culture of safety? IntelyCare is here to help. Get free and on-demand expert insights from a team of nurses with first-hand industry experience.