Lateral Violence in Nursing: How to Respond

Lateral violence is easiest to address when you name it early, respond calmly and specifically, write down what happened, and escalate through the right channels when it continues or affects patient care. You do not have to accept it as a rite of passage, and you do not have to handle it alone.

What lateral violence looks like

Lateral violence, also called horizontal violence, is hostile, demeaning or undermining behavior between colleagues at a similar level, such as nurse to nurse. It is usually not physical. It tends to look like:

• Eye-rolling, sighing or sarcastic comments when you ask a question
• Criticizing you in front of patients, families or coworkers
• Gossip, rumors or talking about you as soon as you leave the room
• Withholding information you need, such as leaving key details out of report
• Refusing to help when you are clearly overwhelmed, or handing you an unfair assignment on purpose
• Leaving you out of breaks, conversations or unit activities
• Undermining your decisions or going over your head without talking to you

The phrase "nurses eat their young" exists for a reason, but lateral violence affects experienced nurses too, including travelers, float nurses and anyone new to a unit.

One bad moment is not necessarily a pattern. Everyone snaps occasionally during a terrible shift. The concern is repeated behavior, or a single incident serious enough to affect your safety or your patients.

Respond in the moment

You do not need a perfect comeback. You need a short, calm statement that names the behavior and brings the focus back to the work.

• "I'd like to talk about this, but not in front of the patient. Can we step out?"
• "I asked because I want to get it right. Can you show me?"
• "It sounds like you're frustrated. What do you need from me right now?"
• "I didn't get that in report. What else should I know about this patient?"
• "I'm not okay with being spoken to that way. Let's talk when we've both had a minute."

Keep your voice even and your body language neutral. If you are too upset to speak, it is fine to say "I need a minute" and walk away. Responding later still counts.

Have the private conversation

If the same person keeps doing the same thing, a direct conversation often helps more than you would expect. Some people truly do not realize how they come across.

1. Pick a private, calm time, not in the middle of a crisis or in the hallway.
2. Describe the behavior, not the person. "In report this morning, you said 'figure it out yourself' when I asked about the drip."
3. Name the impact. "I didn't have what I needed, and that affects patient care."
4. Ask for what you need. "When I ask a question, I need an answer or a pointer to someone who can help."
5. Listen. There may be context you are missing, even though it does not excuse the behavior.

If the conversation does not feel safe, or the behavior is threatening, skip this step and escalate.

Document it

Keep your own record, separate from the patient chart and off work devices. For each incident, note:

• Date, time and location
• What was said or done, in exact words where you can
• Who was present
• How it affected you or patient care
• What you did in response

A factual record makes it much easier to describe a pattern to a manager or HR, and it helps you see whether things are getting better.

Escalate when needed

If the behavior continues or affects patient safety, take it up the chain. The usual path is your charge nurse, then your nurse manager, then HR or your organization's ethics or compliance line. If you have a union, your representative can explain how the process works under your contract. Many employers have a code of conduct or anti-bullying policy; ask for it and refer to it when you report.

If an incident put a patient at risk, such as information withheld during handoff, also use your facility's safety or incident reporting system. That keeps the focus on patient care rather than personalities.

Be a good bystander

You can shift a unit's culture from where you stand. When you see a colleague being belittled, you can:

• Interrupt with a neutral request: "Hey, can you help me with something?"
• Check in afterward: "That wasn't okay. Are you alright?"
• Back them up if they report it, by sharing what you saw

Check your own habits too. Stress makes all of us shorter with each other. Precepting is a great place to set the tone for the next generation of nurses; see How to Be a Good Nurse Preceptor.

Protect yourself

Repeated hostility takes a toll: dreading your shifts, replaying conversations, sleeping badly. Talk to people you trust, use your employee assistance program, and try these stress management techniques. Talking with nurses outside your unit helps too, and you can post anonymously in the NurseTide community if you want advice without being identified. The New Grad Nurses group is full of people who have dealt with this and come through it.

When it is time to leave

Sometimes a unit's culture will not change, no matter what you do. If management ignores reports, the behavior is constant or your health is suffering, leaving is a reasonable choice, not a failure.

Before you take your next job, ask about culture directly in the interview. These questions to ask at the end of a nursing job interview can help you learn how a unit treats new staff. When you are ready to move on, How to Resign From a Nursing Job covers leaving professionally, and NurseTide's nursing jobs show the pay up front so you can compare options quickly.

Next step

Before you accept your next position, read what nurses say about unit culture and management in NurseTide's workplace reviews.

General information for nurses, not medical, legal, tax or financial advice. Follow your facility's policies, your state board of nursing and the terms of your employer or contract.