We have all heard stories of the tension and aggression created by hierarchies in the healthcare system: physicians and administrators bullying and abusing the all-too-undervalued nurses.

Unfortunately, these acts of hostility can additionally come from within the nursing ranks, themselves. Lateral violence in nursing (sometimes referred to as “hazing” or “incivility”) is a devastating, disruptive, and too-often ignored problem which has been faced by an estimated 46% of practicing nurses. It is believed by some that the “antiquated hierarchical structure” of hospital culture has contributed to the perpetuation of hostility between nurses, to the point where it is as ingrained in nursing culture as it is in college fraternities.

The consequence of interpersonal bullying in a healthcare setting can sometimes put careers, even the lives of patients, on the line. When nurses are fighting nurses, no one wins. But with awareness, personal responsibility, and deliberate systemic change, it may be a torch we can finally bury.

What Causes Lateral Hostility in Nursing?

The short answer to the question posed above is also the easiest: the old pick on the young, the strong on the weak, the experienced on the novice. It must follow that larger hierarchies within hospital organizations create smaller hierarchies in each of the different departments. Older, more experienced nurses may dominate younger nurses, or new graduates, to enforce the social ladders created by an overculture which is dependent on rank. No one wants to be at the bottom of the food chain, so everyone has to fight for their superior standing.

More complicated than it may seem, lateral violence in nursing is a phenomenon rich with opportunities for social analysis. A career traditionally held by women, gender politics and sexism still manage to demean and devalue the nursing profession by writing it off as “women’s work”. This devaluation would deal a blow to anyone’s self-esteem and appreciation of their own job performance, leading to insecurity and unnecessary stress.

Power imbalances, devaluation, in addition to an often untenable and overburdening workload can facilitate a feeling of powerlessness for many nurses. Overworked, underpaid, under-appreciated nurses may choose to take out their stress and feelings of inferiority on the easiest target: other, perhaps less experienced nurses.

The Consequences of Lateral Hostility in Patient Care

Patients, wards, organizations as a whole, and of course nurses themselves suffer as a consequence of lateral violence in nursing. Turnover rates among nursing staff as a result of bullying and other factors are larger than almost any other industry at 17.2%, costing hospitals and other healthcare facilities as much as $58,400 for each nurse who leaves their job.

In addition to the immense financial burden this creates, a nurse’s care abilities are compromised as a result of the previously discussed devaluation and loss of self-esteem. Disengaged, dispassionate, fearful nurses are unable to give quality care to their patients, handle multi-tasking and fast-paced work environments well, or attend to their own needs and wellbeing.

Nursing is described by many in the field as more than just a job: it is a life calling, a passion, and a labor of love. Nurses have a wealth of medical knowledge, hard-earned by years of study and training. In addition, they are emotionally intelligent, kind, and socially adept professionals who tend to the whole patient. Nurses see to the physical, emotional, and sometimes spiritual needs of all in their care. And it is nearly impossible for any nurse suffering at the hands of other nurses, and problematic organizational structures, to deliver quality care of this magnitude and significance to their patients.

How to Prevent Lateral Hostility

Unfortunately, there is no one simple solution to the problem of lateral violence in nursing. Prevention is a responsibility shared by all professionals working in the medical industry. For nurses who are experiencing bullying at the hands of fellow nurses, it is important to report all violence and hostile actions when they occur. Legal precedent has been set in most states which protect whistleblowers, organizers, and even nurses who break their contract due to bullying in the workplace. Awareness and advocacy are important first steps in finding a remedy for this festering wound.

Those in positions of greater power, i.e hospital administrators, physicians, and nurse practitioners and supervisors, must maintain acute awareness of potential lateral hostility, and work to undo cultures of hierarchy and dominance within their given organization.

Lateral hostility and violence in nursing is a complex issue which merits further research, and indicates a need to restructure hierarchical health care organizations. Nurses are the spine of all health care operations, and deserve to be adequately valued and protected. An end to bullying and aggression between nurses will benefit not only patients and hospitals, but additionally the greater public as a whole.

Every nurse should make sure that they are doing their very best to take care of themselves, both at home and at work. For advice and tips on self-care best practices, check out another article from Medely, How to Maintain Work Life Balance as a NurseMedely is a platform that helps nurses set their own schedules and work on their own terms by delivering per-diem opportunities right to your phone. If you want a schedule that’s easier on your nerves, you can sign up here for free.