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Dis-Belief Runs Rampant

Nurses in conflict

I wish I had a nickel for every shocked look of dismay I’ve witnessed when I explain to people about “nurse-on-nurse” behavior.  The fact that nurses would be disrespectful and condescending toward a colleague seems counterintuitive for the profession that is recognized as being the most caring and trusted.  Actually most nurses are. It’s just a minority that causes major problems for other individuals and the profession in general.

After I describe “disruptive behavior”, “lateral violence”, “horizontal violence”, or whatever the label these actions are given, unfortunately many folks have an “aha” moment when they realize that they, or someone they know, actually have witnessed this type of behavior.

There’s my friend who asked a nurse entering her room for an extra towel for drying her hair only to be told that she wasn’t the “towel” nurse and that that other nurse should have been in to bring extra towels a couple of hours ago. (Backstabbing)

Or a neighbor who almost fell during physical therapy because the two nurses assisting him were so animated in their indignation of someone getting a more desirable work schedule that they forgot to hold tight to his safety belt. (Infighting)

Or one of my colleagues’  conflict management professors who had to call 911 while in labor because two nurses got in an argument when one realized the other didn’t share information about a doctor’s order  and actually came to blows outside the labor room. Maybe some other time the professor would have jumped up and offered her superb mediation skills, but delivery was only moments away!

Disruptive behaviors particularly impact new nurses – newly licensed, new to the specific unit or facility. In fact, research suggests some 60% of newly licensed nurses will leave their first job within six month because of harassment by seasoned nurses.*  The retort is likely to be, “It happened to me, why shouldn’t these new nurses have to go through the same rite of passage.”  (Bullying)

My first response would be, “Wouldn’t it have been nice if this hadn’t been our culture?” But the most important response is,  “Because too much is at stake: patient safety and the need for any one of our colleagues, but especially our newest nurses, to feel accepted and confident enough to ask for help when they may have questions about elements of patient care.”

The following is a list of the most common disruptive behaviors seen in healthcare:*

  1. Nonverbal innuendo (raising of eyebrows,  face-making)
  2. Verbal affront (covert or overt, snide remarks, lack of openness, abrupt responses)
  3. Undermining activities (turning away, not available)
  4. Withholding information  (about practice or patient)
  5. Sabotage (deliberately setting up a negative situation)
  6. Infighting (bickering with peers)
  7. Scapegoating (attributing all that goes wrong to one individual)
  8. Backstabbing (complaining to others but not speaking directly to that individual).
  9. Failure to respect privacy.
  10. Broken confidences.

For both the public being served by healthcare professionals, as well as the professionals themselves, awareness that these behaviors exist and the ability to recognize disruptive behaviors and name them, are the first steps needed to reduce incivility in a healthcare environment.

*Resource: Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of Continuing Education in Nursing. 35(6), 1-7.