What is Lateral Violence in Nursing? (With Examples, How to Deal, & Consequences)


Written By: Darby FaubionDarby Faubion RN, BSN, MBA

Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »»
RN, BSN, MBA


Have you ever worked in a toxic environment or been the victim of discrimination or sabotage at work? Did you feel like nothing you did was good enough because your coworker or supervisor constantly criticized you or tried to undermine you? If so, you may have been the victim of lateral violence in nursing.

Maybe you heard of lateral violence but wonder, “What is lateral violence in nursing?" In this article, I will share information about lateral violence in nursing with you, including giving you examples of it and insight on how to deal with it. Additionally, you will learn about consequences that may occur because of lateral violence among nurses. While not every nurse commits acts of lateral violence, we all can work together to help reduce or prevent its occurrence and create safer work environments that promote better patient, employee, and organizational outcomes.



What Exactly is Lateral Violence in Nursing?


Lateral violence in nursing is deliberate, harmful behavior demonstrated by one nurse toward another in the workplace. Lateral violence may involve overt or covert acts of aggression and could be verbal or nonverbal. This type of violence is defined as nonphysical, hostile, harmful, or aggressive behavior between coworkers.



Lateral Violence vs Bullying: What’s the Difference?


According to the National Center Against Bullying, bullying is defined as “an ongoing and deliberate misuse of power in relationships through repeated verbal, physical, or social behavior that intends to cause physical, social, or psychological harm.” The difference between bullying and lateral violence is that bullying is often repeated behavior or has the potential to be repeated. Lateral violence, on the other hand, may be an isolated event or sporadic behavior.



How Prevalent is Lateral Violence in the Field of Nursing?


Lateral violence in nursing is a serious and prevalent problem. An article published by the National Library of Medicine suggests that, according to some studies, 66.9% of nurses report having experienced some type of lateral violence in their careers. Identifying behaviors that constitute lateral violence is only one step in reducing and preventing its occurrence. It is up to each of us to be proactive about the way we treat one another and work to create awareness of inappropriate behaviors so we can promote better teams and outcomes for the clients we serve, our peers, ourselves, and our profession.



What are the Most Common Examples of Lateral Violence in Nursing?

(The following are the 13 most common examples of acts of lateral violence in nursing and how best nurses can deal with them.)


Example #1: Criticizing a Coworker


About the Act:

A common form of lateral violence in nursing is criticism. One nurse may criticize the way another nurse performs their job, or a supervisor may criticize an employee's performance and skills. Either way, criticism can have far-reaching effects on the individual being criticized, the person doing the criticizing, and the team.

How Best to Deal With It:

If you have ever experienced criticism, you know how disheartening it can be, especially if the person is clearly not acting in your best interest. There is a difference between being rudely critical and offering constructive criticism and knowing the difference is crucial for nurses.

The best way to handle criticism is to be self-aware. While it is normal to feel defensive or hurt by someone else's behavior, knowing the truth about yourself, your abilities, and your job performance can help you overcome those feelings. Depending on the source of the criticism, you may find that talking with the person to hear their perspective is helpful. Remember to be gracious to yourself and avoid dwelling on criticism. Also, knowing when it is time to reach out to supervisors for support is critical to handling criticism that you feel is getting out of hand.


Example #2: Gossiping


About the Act:

Gossiping and spreading rumors about a coworker is one of the most malicious forms of lateral violence in nursing. This type of lateral violence is especially troubling because the person being talked about is usually unaware or not in a position to refute the claims against them. Gossiping often leads to negative judgments or miscalculations about a person’s character. Unfortunately, much of the damage to a person’s reputation caused by gossiping usually cannot be undone.

How Best to Deal With It:

No matter your position or job title, you have the power to stop gossiping. The first and easiest step is to not participate in gossip. If someone comes to you and begins talking about someone else, tell them you do not feel gossiping is appropriate or professional behavior and do not participate in the conversation.

I know several nursing supervisors and healthcare directors who have implemented a no-gossip policy in their organizations. If you are in a position of authority, by implementing rules about gossiping with clear consequences, you can help stop gossip and foster a healthy work environment.


Example #3: Blaming Others


About the Act:

Another common form of lateral violence in nursing is blaming others for their actions or inaction and the outcome that results from them. When nurses commit lateral violence by using blame, it may be to shift negative attention to someone else. Also, nurses may use blame to discredit another.

How Best to Deal With It:

I remember working my first nursing job at a long-term care facility. After orientation, I transferred to the night shift. I was the only nurse and had two nursing assistants and one housekeeper who worked the shift with me. Although some nights were quiet and work was easy, there were other nights when it seemed like nothing went right.

One day, the Director of Nursing called me to her office to ask why I had not changed the feeding tube bags for some of the residents, as one of the day nurses told her I left the same bag hanging in a few patients' rooms. (The bags were to be changed every 24 hours.) Although I had forgotten to write the date on one of the new bags, I had documented the change in the resident's chart. Also, the package that the new bag was originally in remained in the waste basket in the resident's room. Because I kept my cool, I was able to think quickly and support my claim of changing the bags by showing my documentation and locating the empty bag in the resident's room.

As with any insult, the best way to deal with someone who blames you for something is to know the truth of the situation. Knowing the truth of a situation means you can face blame head-on if you are accused. Also, if you want to build good interprofessional relationships and avoid lateral violence in nursing, you can learn to seek the truth about others and avoid blaming them, even if you feel they are wrong.


Example #4: Sabotage


About the Act:

Unfortunately, not all nurses have great attitudes or want to see their coworkers succeed. Some nurses deliberately try to sabotage their coworkers. Sabotage is a frustrating type of lateral violence in nursing because it involves the act of setting up a negative situation without regard for the consequences others may experience. One way sabotage may occur is when a nursing supervisor sets unrealistic expectations when they know the employee cannot reasonably complete the tasks. Another example is when a team leader delegates a task to a new employee, knowing the employee has not been trained to perform the assigned job.

How Best to Deal With It:

I believe in addressing things as they occur instead of pretending like a problem does not exist. However, the best way of handling this type of lateral violence in nursing depends on the situation.

For instance, some nurses may act in a sabotaging manner because they have heard things about you or feel you do not like them. Although you may not have given them a reason to feel that way, you may need to be a bigger person and try to repair the relationship between you. If you feel comfortable discussing the problem with your coworker, ask them if they are willing to sit with you and discuss the matter privately. You may be surprised at how easily some issues are resolved by a non-confrontational discussion.

If you feel uncomfortable talking one-on-one with your coworker and the issue is not something you can ignore, consider talking to your manager or supervisor and ask them to mediate between you and your coworker.


Example #5: Verbal Affronts


About the Act:

A verbal affront can be a covert or overt act and usually includes making snide remarks, responding in a rude or abrupt manner, or changing the subject when someone else is talking. For example, an example of lateral violence in nursing using verbal affronts could be one nurse making rude or obnoxious comments during shift report. Whether the verbal affront is blatantly apparent or the individual acts in a way that suggests it is not meant to be offensive, it is still a willing act and considered lateral violence.

How Best to Deal With It:

I firmly believe in leading by example. So, I feel one of the best ways to deal with verbal affronts is to not go along with the person doing them and to show respect to others. If you are on the receiving end of verbal affronts, you may want to lash out or say something rude back to the person. However, it has been my experience that the best approach is to redirect the attention of the group to what is going on and not feed into the negative behavior of one person.


Example #6: Infighting


About the Act:

Infighting is known as a hidden conflict or unhealthy competitiveness within an organization. This behavior is one type of lateral violence in nursing that can tear away at the core of team dynamics. Infighting may occur when one nurse feels jealousy or contention for another nurse. It often results in unhealthy competitive behaviors, such as trying to “one-up” another nurse or make themselves look better in the eyes of leaders and other team members.

How Best to Deal With It:

An essential step in dealing with infighting is to realize that all nurses have something to offer for the betterment of their teams. Instead of looking at our differences as reasons to compete with one another, we must consider the way our differences make our teams unique and strong.

From an administrative standpoint, I believe it is crucial for managers and administrators to foster an environment of healthy growth and development and to encourage team building. When nursing teams have leaders who embrace the diversity of their team members, they learn to appreciate the differences as well, instead of looking at them as problems and reasons to be in competition with one another.


Example #7: Discrimination


About the Act:

Workplace discrimination can take the form of poor employment practices, biases directed toward subordinates or peers, or unfair treatment by a supervisor or peer. It is important to note that one does not have to be in a leadership or management role to discriminate. Discrimination may be directed at a person because of their race, national origin, sexual orientation, religious beliefs, or age.

How Best to Deal With It:

Many people avoid addressing discrimination because they fear it will lead to greater tension. However, as nurses, it is crucial that we recognize and address issues of discrimination in the workplace. There are several ways to deal with this act of lateral violence in nursing, including addressing the problem directly with the person who is discriminating or by talking with your supervisor. In some cases, you may need to file a formal complaint with your company. As a leader in nursing, I believe it is essential that healthcare companies and organizations provide soft skills training and team-building opportunities for managers and supervisors.


Example #8: Using Nonverbal Innuendos


About the Act:

An innuendo is an act of saying or doing something that appears polite and innocent on the surface, but that is meant as an insult or rude comment. Examples of nonverbal innuendos include rolling your eyes or making a face when someone else is talking.

How Best to Deal With It:

It is very frustrating to me to talk to someone else and feel like they are disconnected or unconcerned about what I am saying. Observing nonverbal innuendos is one way to feel lateral violence in nursing, and, unfortunately, you may or may not be able to change someone else's behavior. Although some people may disagree, I feel the best way to deal with this type of lateral violence is to address it directly. If you are talking and someone is using nonverbal innuendos, stop talking and ask the person if they disagree or would like to share their thoughts. Keep in mind that if you choose to address the situation, you must do so in a calm, rational way that reflects respect. In situations like these, it has been my experience that when a person is aware that you have noticed their behavior, they typically stop.


Example #9: Purposely Violating a Coworker’s Privacy


About the Act:

Have you ever confided in a coworker that you felt was your friend, only to have them betray your confidence? Violating a coworker's privacy is another example of lateral violence in nursing. Unfortunately, this kind of lateral violence not only damages the relationship between the victim and the person perpetrating the act, but it also affects the integrity of the interdisciplinary team.

For example, years ago, one of the nurses I worked with and had been friends with for years came to me and told me something very personal about another nurse on our team. What she told me is something that the other nurse told her, expecting the information to be kept private. Although I did not share the information with anyone else and did not entertain the nurse's attempts to talk about our coworker, the incident affected me. It left me wondering if she was willing to talk to me about another coworker, what was she saying to others about me? The experience caused me to second-guess anything I shared with the nurse from that point forward, which strained our relationship.

How Best to Deal With It:

While you cannot force someone else to protect others’ privacy, you can deal with this type of lateral violence in nursing by advocating for others yourself. If someone approaches you and tries to share personal or sensitive information, tell them you prefer not to know. You can make it clear that if the person whose information they want to share wishes for you to know, that person can tell you themselves. This method of approaching lateral violence may seem a bit harsh, but by doing this, you get your point across and may prevent someone from being hurt.


Example #10: Unfair Work Assignments


About the Act:

One example of covert lateral violence in nursing occurs when a nursing supervisor or manager gives unfair work assignments. For example, a supervisor may assign easy patients who require little care to a nurse they are closer to while assigning complex or challenging patient care to another nurse.

How Best to Deal With It:

When I worked in administrative positions, it did not take long for me to learn which nurses could handle more challenging patients and which ones needed fewer complex tasks or assignments, and I made assignments accordingly. Although my intentions were not to make one person feel overwhelmed, I realize more clearly now that it can be frustrating when you are the one with a heavy workload while others seem to be skating by.

If you are faced with getting unfair work assignments, the first step I recommend taking is to talk to your supervisor. While some unfair assignments may be intentional, others may not be meant to single you out or make you feel overwhelmed. Be honest with your manager about how you feel and ask if changes can be made. After talking with your supervisor, if the issue continues, consider going up your chain of command to try to have the issue resolved.


Example #11: Withholding Important Information


About the Act:

Another form of lateral violence in nursing is when nurses withhold vital information from coworkers. This type of lateral violence is especially troubling to me because, as a nurse and educator, I know, understand, and stress the importance of effective communication among team members. When nurses withhold information from coworkers, it does more than affect the professional relationship. It can negatively impact patient care and outcomes, and this is one of the reasons I feel it is one of the most selfish acts of lateral violence that can occur in nursing.

How Best to Deal With It:

The best way to deal with this act of lateral violence is to initiate and encourage open dialogue between yourself and your team members. If you feel information is being withheld, ask direct questions about the patient or situation. When you ask questions, the person withholding information usually feels obligated to answer. Conversely, if you avoid asking questions, the person could continue their behavior, resulting in poor outcomes for patients, your team, and your organization.


Example #12: Refusing to Offer Guidance or Help


About the Act:

As nurses, we should not only adopt an attitude of continual learning but also be willing to help our peers and team members when possible. Nurses who refuse to offer help or guidance (for whatever reason) are demonstrating another blatant act of lateral violence in nursing. Just like withholding information, refusing to assist others by helping or guiding them affects more than the nurses involved. This type of behavior can have negative consequences on the entire interprofessional team and the hospital or healthcare facility.

How Best to Deal With It:

I believe the best way to deal with this type of lateral violence in the nursing profession is to be the type of nurse others can look to for guidance and help. You do not have to have a job in leadership or administration to demonstrate leadership qualities. By stepping up and being the type of nurse who is willing to work with, guide, help, and encourage others, we set a standard for what the rest of our team should do, and typically, others follow our lead.


Example #13: Intimidation


About the Act:

I remember one of the first times I felt intimidated by a coworker in a supervisory position. I was a nurse much younger than I am now, and she had several years of experience more than me. When I first began working with this nurse, I thought our personalities just clashed and that I needed to get to know her better. However, with time, I realized I was not the only person who had problems with her.

This nurse often screamed, cursed, and insulted me and other nurses on our team. She also had a habit of giving assignments to us without regard to our experience or expertise. At the time, I did not realize that her behavior was a type of lateral violence in nursing.

How Best to Deal With It:

Dealing with intimidating behavior can make you feel overwhelmed and anxious. Depending on the source of intimidation, it may leave you feeling as though you prefer to run away instead of facing the issue directly. However, facing the situation head-on is the best way to deal with this type of lateral violence.

If you feel intimidated by a peer, the first step is to bring the behavior to their attention and clearly state that you feel uncomfortable with what they are saying and doing. If the situation is not quickly resolved between you and the peer, you may need to seek assistance from a manager or team leader.

On the other hand, if a supervisor is the one intimidating you, you may find it is necessary to go higher up in the chain of command, perhaps to a Director of Nursing or administrator. The important thing is that you do not normalize or disregard their behavior because, in these situations, that behavior usually worsens.



7 Major Consequences of Lateral Violence in Nursing


Lateral violence in nursing can lead to some pretty profound consequences. By recognizing the behaviors that constitute lateral violence, we can implement measures to prevent or stop them. Without intervention, however, patients, nurses, and organizations suffer. The following are seven major consequences of lateral violence in nursing.

Consequence #1: Reduced Quality of Patient Care

Lateral violence in nursing often leads nurses to feel detached, which impacts job performance. If the ability to address patient needs is compromised, it often results in reduced quality of care. Lower quality of care means an increased risk of adverse patient outcomes.

Consequence #2: Moral Distress

Nurses naturally expect to work in a civil, safe work environment, free from any type of bullying or violence. Unfortunately, when lateral violence in nursing occurs, it leaves nurses feeling as if their integrity and safety are threatened, which leads to feelings of moral distress. Moral distress leads to a hostile work environment, reduced quality of patient care, and increased risk of nurses leaving their jobs.

Consequence #3: Healthcare Facilities/Organizations Suffer Financially

Unfortunately, the consequences of lateral violence in nursing extend beyond the person committing the act and the victim. When lateral violence is a problem in a healthcare facility, and nurses leave their jobs, the facilities are faced with training new staff to take their place. Some research indicates that the loss of one nurse can cost an organization twice that nurse’s salary to replace and train new employees.

Consequence #4: High Employee Turnover

Some nurses feel the emotional and physical stress that occurs because of lateral violence is too much to bear, and many leave their jobs looking for something better. When lateral violence in nursing occurs, and especially if management does not handle the situation, it can lead to increased turnover among nursing staff. Unfortunately, when this occurs, it can have a snowball effect, making stress in the workplace higher due to staffing shortages.

Consequence #5: Loss of Job

One dire consequence of lateral violence in nursing is job loss. As education about bullying and other forms of workplace violence increases, many employers have adopted a zero-tolerance policy for people who commit these infractions. To some people, termination from work may seem unfair, but when you consider the effects lateral violence has on individuals, teams, and organizations, it is clear that sometimes drastic measures must be taken.

Consequence #6: Compromised Physical Health

Victims of lateral violence in nursing may also experience physical symptoms and illnesses. For example, some people report high blood pressure, gastrointestinal issues, headaches, and insomnia. Some victims of lateral violence report symptoms consistent with post-traumatic stress disorder (PTSD), such as anxiety, suicidal thoughts, development of substance use disorders.

Consequence #7: Negative Self-Image

It is common for people who are victims of lateral violence in nursing to experience a negative self-image. My friend, Sarah, once shared with me that she worked with a group of nurses who singled her out and bullied and intimidated her when she was a new nurse. Sarah told me that the other nurses had more experience than her and that they had their "own way of doing things."

Because Sarah chose to do things the way she was taught in nursing school instead of the way the other nurses did, they often gave her a tough time. She told me that it did not take long before she began second-guessing whether she knew enough to be a good nurse or if it was the right profession for her. Sarah eventually found another nursing job where she thrived. However, if she had stayed in a negative environment, who knows if she would have stayed in nursing or found something altogether different to do?



My Final Thoughts


If you have experienced gossip, exclusion, or intimidation as a nurse, you have experienced lateral violence in nursing. Maybe you heard the term before but wondered not only what is lateral violence in nursing, but what can be done about it? While none of us can control someone else’s behavior, we all have the responsibility of treating others fairly and advocating for peers who are being treated unjustly. In fact, failure to do so and instead participating in lateral violence is a violation of the American Nurses Associatoin Code of Ethics. With more than 20 years of experience as a nurse and healthcare educator, I can say with certainty that the only way to stop lateral violence among nurses is for each of us to do our part to improve communication and foster healthy relationships.



List Of Sources Used For This Article


1. NCAB.org.au
2. Spector PE, Zhou ZE, Che XX. Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. Int J Nurs Stud. 2014;51(1):72–84. [PubMed]
3. Steps to Handle Criticism at Work | Indeed.com
4. The Nurse’s Role in Addressing Discrimination: Protecting and Promoting Inclusive Strategies in Practice Settings, Policy, and Advocacy (nursingworld.org)
5. The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention (Jones, Cheryl Bland, RN, PhD, FAAN; Gates, Michael, RN, PhD.; Online Journal of Issues in Nursing)
6. American Nurses Association (nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses)


Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and Allied Health educator with over twenty years of experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).