Paper on the Article Examining Lateral Violence in the Nursing Workforce

“Examining Lateral Violence in the Nursing Workforce”, is an article that discussed a study that was performed to determine the presence and effects of lateral violence in the nursing workplace. This article stated, “LV is described as nurse-on-nurse aggression and inter-group conflict (Duffy, 1995; Farrell, 1997).” A survey was developed based on this definition with a collaborative team at a tertiary care medical center. The purpose of this survey was to determine if LV existed on the units so that the nurses and nurse leaders would be able to make the appropriate changes to put an end to it.

In developing this survey, “twenty-three ordered or dichotomous items were written as descriptions of potential occurrences or causes of LV (Simons, 2010).” Demographics such as age, gender and years of experience in the nursing field were all incorporated in this study. They also included open-ended sections so that nurses would be able to give specific examples of instances of LV on their units and suggestions for improvement. This survey was given from June to July 2004 using a confidential website that was accessible to the nurses on and off the units. Perceived seriousness, oppressors, and mediators were the three constructs used to analysis of this study. The sample for this study was taken from 1,850 RNs on 35 inpatient units in the Southeast. The nurses were invited to participate in this study by sending out emails and using the help of their nurse managers to spread the word. The nurses were provided with a definition of LV and then given the questionnaire to answer on the site (Simons, 2010).

Of the 1,850 nurses that were given the survey, 633 responded with a response rate of 36%. Although the study showed that 75% of the nurses answered that they were treated with respect from their coworkers, 46% indicated that LV did exist on their units and that it was at times “very serious” or “somewhat serious” (Simons, 2010).” This study also found that 28% of the nurses felt safe in reporting LV, but 25% were afraid of the retaliation that would take place if they reported it. This shows that LV was actually present among these nurses and that some of them could not even do anything about it because they did not feel safe enough to tell others about it taking place. The survey also found that 14% of the nurses felt that LV contributed to their decision in leaving a nursing job. In the narrative parts of the questionnaire, 18% gave specific examples of LV that took place on their units. They gave examples of nurses being rude to one another and how new nurses were often “tested” and treated poorly by the older nurses on their floor. The study also showed that, “The largest number of open-ended comments expressed the opinion that education and effective leadership mediate oppressive and negative behaviors. Conversely, respondents observed that ineffective leadership exacerbates LV in the workplace (Simons, 2010).” This shows that some of the nurses felt that more education needs to be presented to staff on these units about LV and their nurse leaders need to take more responsibility in intervening with this issue (Simons, 2010).

This article also discussed some of the limitations of this study. The study had potential sampling errors because of the possibility of not representing the population in an accurate way. It also did not have many respondents, from lack of effort from the nurse managers to spread the word and lack of the nurses to partake in it (Simons, 2010). The article then discussed the findings of the study and its significance in nursing. “An important revelation of this study was the contribution of LV to stress and tension in the workplace (Simons, 2010).” The study provided an opportunity for nurses to identify LV and the effects it had on them individually and as a whole. This study was also important because it allowed respondents to offer suggestions of how to deal with this issue and the importance of management in dealing with it. The respondents had stated that they felt it was important for the nurse managers on their floor to develop standards for behaviors. “Many respondents suggested initiation of a zero tolerance policy for LV with everyone held fully accountable for their behavior (Simons, 2010).” Lastly this study showed that change is possible in dealing with the issue of LV based on the suggestions the respondents (Simons, 2010).

The article also discussed some nursing implications related to this study. One of the main issues was the reluctance of nurses to report the incidences of LV because of the fear of retaliation from their coworkers. If no one is willing to speak up then this problem cannot be solved. Another implication was the factors of stress on the unit, coworker relationships, and nurse competency levels that influenced the retention of nurses which leads to the turnover rates. Lastly, the information from this study showed that in order to fix the issue of LV, nurse managers need to step up and take responsibility intervening with the behaviors of their staff (Simons, 2010).

Lastly, the article offered some suggested interventions based on the findings of the study. The article suggested that education about this issue needs to be provided to the nurses and possibly given in a ½ day workshop that they could all attend. The workshop can help nurses identify LV and take the proper initiative to put an end to it. “It is as a result of this intervention that staff may being to find their individual and collective voice and reclaim agency as part of their professional role (Simons, 2010).” The article also stated that, “The development of standards that hold all leaders and employees accountable for workplace behavior and the implementation of corrective measures will strengthen the likelihood of success in changing unit culture (Simons, 2010).” “A New, Four-Item Instrument to Measure Workplace Bullying”, is an article that discussed a study that was done to determine the presence and effects of bullying in the nursing workplace. The article discussed the presence of bullying in nursing and based the study on the Negative Acts Questionnaire (NAQ-R), an instrument that had been used to detect bullying in different parts of the world. “The purpose of this study was to replicate dimensions previously found using the NAQ-R and to use data reduction, reliability, and regression analysis to assess dimensionality and to determine the most effective and efficient measurement tool for use with a United States nursing population (Stanley, 2007).”

For this study the NAQ-R was modified and converted to the NAQR-US version of the instrument. This survey consisted of 22 items and each item listed 5 response options to the bullying behavior described (never, now and then, monthly, weekly, and daily). The sample was taken from a group of non-managerial RNs in Massachusetts, and these nurses were found through the Massachusetts Board of Registration in Nursing. The nurses were given the definition of bullying on the survey along with the questions. The survey was given out in 2004 to nurses who became licenses in Massachusetts in 2001,2002, and 2003. A sample of 1000 nurses were drawn and 511 completed the survey with a response rate of 51.1% (Stanley, 2007).

“Factor and principal component analysis and reliability analysis were used to identify any underlying dimensions of bullying that might be present (Stanley, 2007).” The results showed that 71% linked bullying to the unmanageable workload they were given and 58% reported bullying with instances of being ignored from coworkers. A majority of the nurses responded with some degree of bullying taking place at their workplaces and only 6% responded “never” to all 22 of the items on the questionnaire. The study also found that 74% reported that bullying occurred in some way between coworkers. “The middle 50% of these scores fell in the range .9-2.1 which suggest that, over a 6 month period, the middle 50% of participants experienced between 8 and 125 bullying behaviors (Stanley, 2007).” Results also showed that 48% answered “strongly agree” or “agree” on the questions regarding dissatisfaction at work (Stanley, 2007).

The article then discussed some of its limitations. It stated that a 4 item questionnaire may be easier when performing the study because it takes less time and listed some of the limitations of this study. There was a possibility of bias amongst the sample taken because the survey was only performed by those who were willing to be respondents. It was also questioned whether this sample was an accurate measure of the population of nurses since it only included those in Massachusetts. There was also a question if gender played a role, since 93% of the respondents were women in this study. It was questioned whether or not the study would be better if it only included those who experienced bullying in their workplace, but it stated, “Finally we do not believe it was necessary for respondents to experience the construct(s) involved to contribute meaningful data- only that they accurately reported the frequency of occurrences (Stanley, 2007).” Overall, the article concluded that bullying had negative effects of the workplaces of nurses in the U.S. and that there needs to be interventions in order to fix it and stop the turnover of jobs causing the nursing shortages. It also stated that a 4 item questionnaire would be of better use since it would be easier and less time consuming on both the researchers and the participating nurses. Finally, it concluded that more research needed to be done in order to see if there are differences among different populations of nurses (Stanley, 2007).

Both of these articles provide information based on similar studies done to determine the presence and negative effects of both bullying and lateral violence in nurse work places. The studies of these articles were very similar because they each used questionnaires that were provided to random samples of nurses. They also both each gave a definition of lateral violence or bullying with the survey so the nurses would become familiar with the terms and able to identify the behaviors in their work surroundings. The results of these two studies were also very similar. Both of them showed results of nurses responding that LV and bullying did exist at work and often caused stress and poor relationships between coworkers because of the lack of respect. The results of both studies also showed that this uneasy work environment caused nurses to feel unsatisfied with their jobs resulting in turnover rates and nursing shortages. These articles are significant because not only do they show that bullying and LV are present, but that these issues greatly affect nurses as individuals and as groups in a negative way. It is important that for nurses to take the results of these studies and discussions of these articles into consideration so that they themselves can become educated. If more nurses are aware and able to identify this problem, a higher rate of success can be achieved on working on putting an end to it.