UW Health,Ambulatory Education,Educational Opportunities,Grand Rounds,Nursing Grand Round Presentation Video Archive 2012,Clinical Grand Rounds 2012,09/25/2012 - Lateral Violence: Stories and Strategies from the Front Line of Health Care,Resources


Presentation - UW Health, Ambulatory Education, Educational Opportunities, Grand Rounds, Nursing Grand Round Presentation Video Archive 2012, Clinical Grand Rounds 2012, 09/25/2012 - Lateral Violence: Stories and Strategies from the Front Line of Health Care, Resources

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Nursing Grand Rounds
Lateral Violence

Stories and Strategies
from the Front Line of
Health Care
Deanna Blanchard, MSN, RN-BC
Beth Houlahan, MSN, RN, CENP
Claire Johnson, BSN, RN
Nathan Whitman, MS, RN, PMHCNS-BC
Lynnda Zibell Milsap, MS, RN, PMHCNS-BC

Beth Houlahan,
Senior Vice President, CNO.

The participants will verbalize an understanding of
nursing leadership’s stance on lateral violence.

Participants will recognize three different types of lateral
violence and bullying behaviors.

Participants will verbalized three ways that lateral
violence or bullying can affect patient care.

Participants will verbalize three strategies to help
address lateral violence and bullying behaviors.

If Russell Wilson of the Seahawks throws the ball in the
end zone and a Green Bay Packer catches it, what
1 2
1. The Seahawks
2. Green Bay scores

A new nurse…
• I find it gets pretty bad at report time...the most
criticism, avoiding eye contact,
arguing...bickering after I have taken the train
for over 1 hour to get to the patients at my job
for the 12 hour night shift...then taking the
train back home in the morning...nobody is
running me out though...I stand my
ground....I'll see to it…..the bully will go....and
I will be staying...

What is lateral violence?
Working definitions
• Bullying vs lateral violence
• Defined by typical behaviors
• Impacts individuals involved
• Cyclic in nature
• Nursing and Lateral Violence

What are typical behaviors of lateral
• Overt:
– Bullying behaviors
– Excessive criticism
– Insults, verbal abuse
– Intimidation
– Belittling

• Covert
– Withholding
– Talking behind ones
– Unreasonable
– Denied opportunities
– Undermining
– Infighting
– Scapegoating
– Backstabbing
– Failure to respect
– Broken confidences


Within the last 3 months how many times have
you witnessed lateral violence?
1. Never
2. Once a month
3. Once a week
4. Several times a
5. Every day

1 2 3 4 5
0% 0% 0%0%0%

Who is targeted?
• Different from the norm
–Demographic factors
–Social factors
–New nurses
–Older nurses

Why do people commit lateral violence?

• Lack of confidence/self esteem
• Never been addressed
• Culture of nursing
• It is effective
• Don’t realize it
• Power
• “Protected status”

In the last 3 months how many times have you left work
feeling bad about an interaction with a coworker?
1. Never
2. Once a month
3. Once a week
4. Several times a
5. Every day
1 2 3 4 5
0% 0% 0%0%0%

Why is this important to patient care?
• Patient Care: direct, indirect, performance
• The Joint Commission
• Your profession
• Your life

Nurse impact
• Manifestations of lateral violence

• Physical

• Emotional

• Behavioral

Lateral violence-the impact on decision
making and performance
Zibell-Milsap 2012

I believe nurses do not speak up about lateral violence
because of fear of retaliation.
1. Strongly Agree
2. Agree
3. Disagree
4. Strongly
1 2 3 4
0% 0%0%0%

Cycle of lateral violence
Zibell-Milsap 2012

Incidents of bullying/lateral violence are common
in my work setting.
1. Strongly Agree
2. Agree
3. Disagree
4. Strongly
1 2 3 4
0% 0%0%0%

Policy 9.27: Equal Employment Opportunity and No
• “UWHC does not tolerate discourteous or
disrespectful conduct by employees in the
workplace. This includes, but is not limited to,
disruptive, offensive, intimidating, disrespectful,
or other behaviors that create a risk to the health
and safety of employees and patients.”
• Policy 9.58 Workplace Violence Report…
• Policy 9.05 Work Rules UWHC Authority…

In the last three months I have participated in
lateral violence towards others.
1. Never
2. Once a month
3. Once a week
4. Several times a
5. Every day

1 2 3 4 5
0% 0% 0%0%0%

How do we deal with it?
• EBP:
– Recognition
– No tolerance policies
– No retaliation policies
– Communication
• EBP: Education: Institution, Department, Unit/Clinic
• What can you do? As a Nurse Clinician, Nurse
Manager, CTL, CNS, Administration?
• Are you the problem?


Strategies: things to consider
• Anxiety

• Anxiety should

• Skill set: Practice

• Rehearsal/Start small

• Re-frame it

From my perspective the group that could have the most
impact to decrease lateral violence at UWHC is…
1. Upper
2. Nurse Clinicians
3. Care Team
4. MDs/Residents
5. Nurse Managers

1 2 3 4 5
0% 0% 0%0%0%

Strategies that work
First, recognize it.
• Address immediately; interrupt the
• Avoid excuses/rationalization
• Take ownership, value your profession
and environment.

Specific skills strategies that work
• Anxiety reduction techniques
• Cognitive rehearsal techniques
• Assertive communication skills
• Stand together: requires culture support
• Speak up, change culture
• Don’t contribute
• Conflict resolution
• People may not know

• UWHC: NM, CNS, CTL, Senior Team Member,
Human Resources.

• ANA http://ananursece.healthstream.com/ offers
Free CE on Lateral Violence.

• AACN's Healthy Work Environments Initiative

• Academy: Crucial Conversations

• Psychiatric Clinical Nurse Specialist:
individual, group, unit education.

• Books:
– Since Strangling isn’t an Option: Dealing with
Difficult People, Sandra Crowe.
– Nonviolent Communication: A Language for
Life: Marshall Rosenberg.


You can address lateral violence and bullying
but little will actually change.
1. Strongly Agree
2. Agree
3. Disagree
4. Strongly Disagree
1 2 3 4
0% 0%0%0%


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