1. Morse, Kate J. RN, CCRN, CRNP, MSN

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In nursing, lateral violence generally takes the form of psychological harassment evidenced by verbal abuse, intimidation, exclusion, unfair assignments, denial of access to opportunities, and withholding of information. It can be subtle or overt. This applies to interactions between professional colleagues at the same organizational level.

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New staff nurses may be at increased risk for lateral violence, but it can impact all practitioners. Lateral or horizontal violence may mean something different to all of us. The bottom line is, if the end result is that the recipients of the behavior are offended or their ability to perform their job is undermined, it should be considered inappropriate behavior and lateral violence.


The interactions between critical care nurses have been described in the literature.1 In a 2006 study, the majority of staff nurses (72%) in critical care areas rated the quality of their interactions with RNs in their own unit as excellent or good, 25% rated the interactions as fair, and 3% as poor.1 When asked if they had personally experienced verbal abuse from another RN in the past year, 18% indicated that they had. This study described the vast majority of interactions with other RNs as positive, but highlights that negative interactions still occur and require our attention.


The critical care environment is a stressful practice arena and it is important not to contribute to the stress with incidents of lateral violence. The resulting outcome can be realized in increased staff turnover, worsening nursing shortage and downstream amplified financial costs to the institution. It is our professional responsibility to assess our work environment.


In 2005, the AACN Standards for Establishing and Sustaining Healthy Work Environments identified six essential standards: skilled communication, authentic leadership, meaningful recognition, true collaboration, effective decision making, and appropriate staffing.2 All these elements overlap and impact the end result-a healthy work environment. Skilled communication should be viewed of equal importance to clinical excellence. This shift addresses those wonderfully clinically astute nurses who have less than ideal communication styles and are challenging to new staff. The adoption of a zero-tolerance policy for lateral violence is a keystone to success.


The first step is to recognize that lateral violence may be occurring in your unit. The second step is to respond to it. Education and a commitment on the part of administration and staff alike will contribute to a successful change. The concept of cognitive rehearsal can be a valuable tool. This technique uses cognitive thought processes, in which the individual retains that information in his or her mind, and considers it without acting on it. This reduces the chances of responding with aggression and escalating the situation.


Education of all and a zero-tolerance policy throughout the institution are paramount to making this a successful culture change.


Kate J. Morse, RN, CCRN, CRNP, MSN


Editor-in-Chief, Assistant Clinical Professor, Acute Care Nurse Practitioner Tract Coordinator Critical Care Nurse Practitioner, Chester County Hospital West Chester, Pa.




1. Ulrich BT, Lavandero R, Hart KA, et al. Critical care nurses' work environments: a baseline status report. Crit Care Nurse. 2006;26(5):46-50, 52-57. [Context Link]


2. American Association of Critical Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Aliso Viejo, Calif: American Association of Critical Care Nurses; 2005. Available at: Accessed February 12, 2008. [Context Link]