Ethics and Professional Misconduct

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Lateral Violence in the Perioperative Setting
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LORRAINE BIGONY, RN, BSN, CNOR, ONC; TAMMY G. LIPKE, RN, BSN; ASHLEY LUNDBERG, RN, BSN; CARRIE A. MCGRAW, RN, BSN; GRETCHEN L. PAGAC, RN, BSN, CNOR; ANNE ROGERS, LCDR, RN, BSN, CLNC

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ateral violence, also known as nurse-to-nurse violence or bullying, is disruptive behavior that interferes with effective health care communication and thus threatens a culture of patient safety. Lateral violence is counterproductive to quality health care and has a negative effect on the health and well-being of health care professionals as well. Bullying has been defined as an offensive, abusive, intimidating, malicious or insulting behavior or abuse of power conducted by an individual or group against others, which makes the recipient feel upset, threatened, humiliated, or vulnerable [and] which undermines their self-confidence and may cause them to suffer stress.1(p10) Likewise, lateral violence in nursing

ABSTRACT
Lateral violence is disruptive, bullying, intimidating, or unsettling behavior that occurs between nurses in the workplace. The perioperative setting fosters lateral violence because of the inherent stress of performing surgery; high patient acuity; a shortage of experienced personnel; work demands; and the restriction and isolation of the OR, which allows negative behaviors to be concealed more easily. Lateral violence affects nurses’ health and well-being and their ability to care for patients. Interventions to reduce lateral violence include empowerment of staff members and zero tolerance for lateral violence. Key words: lateral violence, nurse-to-nurse violence, workplace abuse, bullying, verbal abuse. AORN J 89 (April 2009) 688-696. © AORN, Inc, 2009.

includes physical, verbal, and emotional abuse by one nurse against another. Lateral violence can be manifested in verbal and nonverbal behaviors. Examples of common lateral violence behaviors include: • nonverbal innuendo (eg, behavior that may disregard or minimize another nurse such as eye-rolling or eyebrow raising); • verbal affronts; • undermining activities; • withholding of information; • sabotage; • infighting; • scapegoating; • backstabbing; • failure to respect privacy; and • broken confidences.2 The Center for American Nurses position statement on lateral violence asserts that these behaviors are “toxic to the nursing profession”3(p1) and contribute to an organization’s inability to retain quality staff members. This is of particular concern at a time when there is a shortage of qualified nursing professionals. The Joint Commission revealed in a survey that 77% of respondents had witnessed disruptive behavior in physicians and 65% had seen similar behavior in nurses.4 The Joint Commission survey reported that nurses are primarily bullied by physicians; however, nurse-to-nurse indicates that continuing education contact hours are available for this activity. Earn the contact hours by reading this article and taking the examination on pages 697–698 and then completing the answer sheet and learner evaluation on pages 699–700. The continuing education credits for this article expire April 30, 2012. You also may access this article online at http://www.aornjournal.org.

688 • AORN JOURNAL • APRIL 2009, VOL 89, NO 4

© AORN, Inc, 2009

Bigony — Lipke — Lundberg — McGraw — Pagac — Rogers

APRIL 2009, VOL 89, NO 4

hostility, was not an uncommon finding. Additionally, the Joint Commission reported that a survey conducted by the American College of Physician Executives revealed that 38.9% of respondents admitted that physicians who generate high amounts of revenue are treated leniently when they exhibit negative behavior.5,6 This may contribute to the idea that lateral violence is an accepted part of the OR culture and must be tolerated. Although correction of physician issues is organizationally driven, nurses must take the lead in addressing the lateral violence or bullying behaviors that occur in...
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