Most new nurses are informally given precautionary warnings such as, “Watch out.  Nurses sometimes eat their young.”   While the idea of a nurse bully may be counterintuitive given that nursing is a profession defined by an expected caring nature, nursing literature reveals that the phenomenon known as “horizontal violence” among nurses is well established.  Marcia K. Korow’s recent article “How reflective is our practice?” published in January’s Nursing Management tackles the somewhat uncomfortable subject of unhealthy nurse-to-nurse relationships.

Korow reviews popular theories about the roots of bullying in nursing.  Some scholars have suggested that nurses frequently work in oppressive environments.  A sense of powerlessness may cause nurses to lash out at other nurses in order to gain the perception of control.  Others have argued that hazing practices are common in professions such as nursing in which beginners are expected to “toughen up” quickly.  Korow writes, “There may also be a mentality that seasoned nurses, who may have been treated poorly as novices, have the right to act out to less veteran staff - causing internalization of this behavior as the norm.”  Horizontal violence in the workplace results in decreased job satisfaction and poor staff retention.  It affects the quality of their sleep, eating habits, and personal relationships and compromises the overall mental and physical health of the nurse.

According to one cited study, 81% of harassment incidences involve nursing bosses, 14% involve peers, and 5% involve other staff.  Because this inappropriate behavior is viewed as an accepted if unpleasant aspect of nursing culture, it is under-reported and often inadequately addressed.  New nurses, who occupy the lowest standing in organizational pecking orders, are disproportionately affected.  Fears about poor treatment by colleagues and superiors compromise their professional growth.  If new nurses believe that they will be shamed for appearing ignorant, they will not seek out new clinical information.  Both real and potential bullying can prevent new nurses from developing the experience-acquired skills that improve patient care.     

The author’s suggestions for decreasing the prevalence of workforce bullying are neither specific nor innovative.  Statements like, “We need to focus on our environment and minimize the setting for discord by promoting congeniality and teamwork” are hardly pointed enough to engender her “zero tolerance” ethic.  But perhaps outspoken promotion of the obvious, can’t-we-all-just-get-along approach really could be the most effective in altering environments.  Increased education for nursing students, practicing nurses, and nursing leaders around issues of horizontal violence in the workplace does make sense.  If nothing else, open dialogue lifts the veil of silence which surrounds damaging attitudes within nursing culture.  Graduating student nurses should be explicitly taught that abusive treatment on the job is absolutely unacceptable.

Korow argues for the promotion of a “reflective practices” within nursing on individual, institutional, and professional levels.  She also stresses the need for modeling of respectful, nurturing, supportive relationships by nursing leaders.  While her strategies for combating the problem of bullying in nursing may be too wishy-washy to truly affect change, the mere publication of her article encourages a welcome conversation around a detrimental and often unspoken issue within the profession.

 Reference:

Korow, MK. How reflective is our practice?  Awareness education helps reduce dysfunctional nurse-to-nurse interaction.  Nursing Management.  2008; 37-39.    

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