1. Anthony, Maureen PhD, RN

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A former student called me recently. For the first year after she graduated with a bachelor's degree in nursing, she worked as a nurse on a medical-surgical unit in a hospital. Feeling confident in her newly acquired skills, she transferred to the intensive care unit (ICU) in the same hospital. She was calling for my advice, but perhaps more to vent her frustration. She related to me what she perceived to be devastating lateral violence from several nurses who had worked in the ICU for many years. "I feel incompetent - worse that when I was a nursing student" she wailed. She described these nurses as "ready to pounce" at her every move. When she asked a question, they told her she needed to be more independent and better able to find information on her own. She "lacked critical thinking skills." When she attempted to be independent and problem solve, she was accused of being reckless and unsafe. It was, it seemed to her, a no-win situation. She was contemplating leaving the hospital and starting fresh somewhere else. She wanted to know if I thought home care was right for her.

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Lateral violence, also known as horizontal violence, bullying, or incivility, is perpetrated by nurses against fellow nurses. It typically results in emotional and psychological harm to victims, workflow disruption, managerial problems, high turnover among nurses, and can cause harm to patients through poor communication. Why does this seem to be a persistent problem in nursing? Is it a problem for other healthcare providers? Or do only nurses "eat their young"? Let's look at the historical roots of nursing to see if we find answers. Nursing is a profession that had its beginnings in religious orders and the military. Long before Florence Nightingale conceived of the idea of a professional nursing workforce, sick people were cared for by religious orders, men and women who devoted their lives to caring for the sick and poor. After all, anyone of any means would have been cared for in their own homes by family members. Only the desperately poverty stricken were cared for by strangers. When Florence Nightingale formed a group of women to care for British soldiers fighting in the Crimean War, she recruited several middle class women who showed aptitude for this kind of work, but also turned to the experts-religious Sisters who had been doing this work for many years. As you can see, nursing has one foot in the military, and the other in the religious orders-two groups that are anything but "warm and fuzzy." Strict hierarchical structures and unquestioning obedience expected of members of military and religious groups have likely been handed down from generation to generation, contributing to the current situation described by my former student.


So the question is, how do we reverse this? What can each and every one of us do to ensure a safe work environment? Is continually moving to greener pastures going to solve the problem? I don't think so. We all must do our part. I advised my student to remain in the ICU. To gravitate to the nurses who were nurturing and helpful, to not let the bullies win. When ridiculed for asking a reasonable question, to say in a confident voice, "I'm sorry you feel I am incompetent for asking this question, but patient safety is my priority." There comes a time when it is reasonable to approach the unit manager. Relate your story in a self-assured manner that portrays a mature professional. Seek the manager's advise prior to asking him/her to step in. They are probably well aware of the situation and have dealt with it before, and will likely have words of wisdom.


I told her one of my favorite sayings is "success is the best revenge." Stay and become the best ICU nurse! Although the bullies are plotting their next move, get certified as a critical care nurse. Gain experience on hospital committees. Become active in the local and national critical care organization. As much as I would love to see this bright, energetic nurse come to home care, I don't want it to be because she's running from something. I want her to come for the right reasons-because she wants a more autonomous role in patient care, because she feels she has mastered the assessment skills necessary to safely transition patients from hospital to home, because she understands failure to rescue-and knows how to intervene in a timely manner. The practice environment of home care should act as a magnet, not a safe haven.


Let's all do our part to make healthcare a nurturing environment for new clinicians. What better legacy could we leave?


Best wishes,

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