Do Nurses Still “Eat Their Young?”

June 21st, 2011

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By , BSN, RN

Nurses eat their young,” was a warning repeated far too often when I went to nursing school. And when I announced I wanted to work in the operating room, it seemed nursing instructors and colleagues echoed the phrase even louder. In job interviews, I questioned hospitals' policies towards such behavior and was reassured repeatedly that aggression like that was not tolerated. And then I lived it. What you may find surprising is this didn’t take place in the old days of nursing. I graduated from nursing school in 2001, and those bad behaviors were alive and well…and they still are today.

It’s been called “nursing’s little secret.” The terms “nurse-on-nurse aggression” and “lateral violence” are new, formal names for the activity, but, when you get right down to it, it’s old fashioned bullying, and it’s not acceptable.

Bullying is everywhere in the news. Children are set on fire by their classmates, teens are harassed so badly they take their own lives, rumors are spread via social media, and careers may end. Bullying has become the cause célèbre and finally, nurses are starting to pay attention.

Lateral Violence in Nursing

Lateral violence in nursing encompasses everything from casual, thoughtless acts that leave psychological scars to abuse that is intentionally designed to harm, intimidate or humiliate others. For decades, nurses have been subject to emotional attacks from peers in the workplace with little to no understanding of why they happen or how to prevent them.

There are several theories related to nurse-on-nurse aggression. In an American Nurse Association (ANA) continuing education program (CE) on lateral violence, Patricia H. Rowell, PhD, RN, author of the unit, cites abusive and demeaning behaviors towards students and new graduates, an individual’s personal sense of entitlement, and oppressed group behavior when one group believes it has been excluded from the power structure.

"Nurses eat their young" is an expression of the first theory cited. As an example, on my first day working in an operating room as a scrub nurse, I was attempting to gown and glove the incoming surgeon. I didn't get it right. My preceptor, an experienced OR nurse swooped down on me, grabbed the gown out of my hands and loudly proclaimed, "What's wrong with you, haven't you ever done this before?" It was humiliating, despite the fact that I had not ever gowned someone before, a fact she already knew. These kinds of attacks happen all over the hospital.

Nursing instructors berate students for not coming to work, despite being ill with a doctor's note. When teaching new nurses, preceptors often exclaim, "see one, do one, teach one" while demonstrating a new procedure, anything from sterile gloving to hanging blood. They will demand the new nurse watch them do the technique, perform it themselves once, and then show it to someone else. The preceptor will berate the new nurse when she doesn't get the action exactly right the next time. Realistically, people have different learning aptitudes, and "see one, do one, teach one" is not enough exposure for many people.

The same types of behaviors can occur toward other nurses if they vary from the “group norm.” Regardless of the nurse’s status, undercutting behaviors and demeaning words hurt all nurses and establish a toxic workplace.

Entitlement is the next reason cited for bad behavior among peer nurses. This sense of entitlement, such as having an assistive person solely for themselves or not working overtime are examples of such behaviors. An individual expecting special attention and privileges — when others are working equally hard with no such privileges — can become a target of lateral violence.

Dr. Martha Griffin, RN, an activist and nurse educator, believes that lateral violence is the result of oppressed group behavior — when one group believes it has been excluded from the power structure. Griffin believes that nurses have little control over their work environment and yet are held accountable, resulting in personal stress. The member of the oppressed group is abusive to peers and those individuals with lesser status because she fears addressing the source of the stress.

The Joint Commission Responds

In January, 2009, new standards were enacted by The Joint Commission requiring more than 15,000 accredited health care organizations to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable behavior. The Commission warned that rude language and hostile behavior among health care professionals goes beyond being unpleasant and poses a serious threat to patient safety and overall quality of care.

Verbal outbursts, condescending attitudes, refusing to take part in assigned duties and physical threats all create breakdowns in the teamwork, communication and collaboration necessary to deliver patient care. The Joint Commission even addressed the problem of workplace bullying in its sentinel event alerts, in 2009.

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response.

The Commissions' Sentinel Event Alert recommends that health care organizations take specific steps to prevent these occurrences, including the following:

  • Educate all health care team members about professional behavior, including training in basics such as being courteous during telephone interactions, business etiquette and general people skills.
  • Hold all team members accountable for modeling desirable behaviors.
  • Enforce the code of conduct consistently and equitably.
  • Establish a comprehensive approach to addressing intimidating and disruptive behaviors that includes a zero tolerance policy. Encourage strong involvement and support from physician leadership.
  • Reduce fears of retribution against those who report intimidating and disruptive behaviors.
  • Empathize with and apologizing to patients and families who are involved in or witness intimidating or disruptive behaviors.
  • Determine how and when disciplinary actions should begin.
  • Develop a system to detect and receive reports of unprofessional behavior.
  • Use non-confrontational interaction strategies to address intimidating and disruptive behaviors within the context of an organizational commitment to the health and well-being of all staff and patients.

Bullying exists all over the hospitals, between physicians and nurses, nurses and nurses, managers and staff. It isn't only the "young" being eaten anymore. In this age of technology, younger nurses often hold advantage over the seasoned professionals. The new grads may not be able to manage seven patients at one time, but they understand Electronic Medical Records (EMR), smart phones and digital equipment and are being called upon to help their older counterparts. No eye-rolling or condescending tones are needed.

As professionals, we need to reassess our behavior towards our colleagues. And as nurses, we are supposed to be caregivers, not just to our patients but to each other. As preceptors, we should foster the self esteem of the women and men coming into our fields, taking our places, and probably taking care of us one day. Bullying destroys the ability to perform. It is at best distracting and at worst destructive.

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