Lateral violence among nurses at a Jamaican hospital : a mixed methods study

  • Abstract
  • Keywords
  • References
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  • Abstract

    Purpose: In many first-world settings, lateral violence among nurses is pervasive and has been associated with deleterious psychological effects, high staff turnover and negative patient outcomes. This study explored lateral violence among nurses at a Jamaican hospital.

    Methods: A fixed concurrent QUAN= QUAL mixed method study design was employed. Data were gathered from 114 registered nurses using the 38-item Briles’ Sabotage Savvy self-administered questionnaire and two focus group discussions.

    Results: Exposure to lateral violence was reported by 96% of participants, and 3/4 rated the exposure as moderate to severe. Nurse Managers were the main perpetrators of lateral violence (63%). Lateral violence created a hostile environment, and half of the nurses surveyed indicated an intent to resign. These survey findings were supported by the focus group discussions which yielded themes inclusive of professional disengagement and erosion of team work.

    Conclusion: The high levels of lateral violence reported in this study indicates an urgent need for the implementation of appropriate workplace violence policies. Reported threats to the healthcare system included poor staff retention and professional disengagement.


    • Lateral violence among nurses is one of the most damaging issues affecting the progress of the nursing profession and is well studied in the developed world.
    • The attributes of the phenomenon of lateral violence in a low and middle-income country are described in this paper.
    • Exposure to lateral violence was reported by 96% of participants, forms of lateral violence appeared to be mainly verbal or emotional and nurse managers were the major perpetrators.
    • Assimilated behavior in response to lateral violence among the nurses included professional disengagement, retaliation, avoidance and intent to resign.
    • The pervasiveness of lateral violence among the nurses studied indicates the need to implement appropriate workplace violence policies. 

  • Keywords

    Abuse; Lateral Violence; Sabotage; Bullying; Nursing; Retention

  • References

      [1] Aiken J, Lindo J, Nevins D, Pounall V, Thomas M, Baker -Reid C & Ward E (2012) Lateral Violence in Nursing: The experience in two urban hospitals in Jamaica. In I. Needham, McKenna, K, Kingma, M & Oud, N, (Ed.), Third International Conference on Violence in the Health Sector Linking local initiatives with global learning (pp. 110-113). Amsterdam, the Netherlands: Kavanah.

      [2] BartholomewK (2006) ending nurse-to-nurse hostility: Why nurses eat their young and each other. Marblehead, MA: HC Pro, Inc.

      [3] Blair PL (2013) Lateral violence in nursing. Journal of Emergency Nursing, 39(5), e75-e78.

      [4] Braun V & Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

      [5] Briles J (2007) Snakes at the nursing station. American Nurse Today, 2(8), 52-53.

      [6] Budin WC, Brewer CS, Chao YY & Kovner C (2013) Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of Nursing Scholarship, 45(3), 308-316.

      [7] Dehue F, Bolman C, Völlink T &Pouwelse M (2012). Coping with bullying at work and health related problems. International Journal of Stress Management, 19(3), 175-197.

      [8] Dellasega CA (2009) Bullying among nurses. AJN the American Journal of Nursing, 109(1), 52-58.

      [9] Dunn H (2003) Horizontal violence among nurses in the operating room. AORN Journal, 78(6), 977-988.

      [10] Edward K, Ousey K, Warelow P &Lui S (2014) Nursing and aggression in the workplace: a systematic review. British Journal of Nursing, 23 (12), 653-659.

      [11] Embree JL & White AH (2010) Concept analysis: Nurse‐to‐Nurse lateral violence. Paper presented at the Nursing Forum.

      [12] Freire P (1970) Pedagogy of the oppressed (MB Ramos, Trans.). New York: Continuum, 2007.

      [13] Geig E (2010) Health policy report: Workplace violence legislation. . Ohio Nurse Review, 85(1), 6.

      [14] Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal of Continuing Education in Nursing, 35(6), 257-263.

      [15] Hahn S, Müller M, Needham I, Dassen T, Kok G &HalfensRJ (2010) Factors associated with patient and visitor violence experienced by nurses in general hospitals in Switzerland: a cross‐sectional survey. Journal of Clinical Nursing, 19(23‐24), 3535-3546.

      [16] Hewitt H (2005) Managed Migration: The University of the West Indies School of Nrsing response The Jamaican Nurse, 43, 27-31.

      [17] Hippeli F (2009) Nursing: does it still eat its young, or have we progressed beyond this? Paper presented at the Nursing Forum.

      [18] Jackson D, Firtko A & Edenborough M (2007) Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review. Journal of Advanced Nursing, 60(1), 1-9.

      [19] Johnson SL (2009) International perspectives on workplace bullying among nurses: a review. International Nursing Review, 56(1), 34-40.

      [20] Johnson SL & Rea RE (2009) Workplace bullying: Concerns for nurse leaders. Journal of Nursing Administration, 39(2), 84-90.

      [21] Lewis SE (2006) Recognition of workplace bullying: A qualitative study of women targets in the public sector. Journal of Community & Applied Social Psychology, 16 (2), 119-135.

      [22] Lim FA& Bernstein I (2014) Civility and workplace bullying: Resonance of Nightingale's persona and current best practices. Nursing Forum, 49(2), 124-129.

      [23] Lindo J, Nevins D, Aiken J, Pounall V, Thomas M, Reid-Baker C &Ward E(2012) Strategies for the mitigation of workplace violence in a Jamaican hospital In I. Needham., K. McKenna, M. Kingma& N. Oud (Eds.), Third International Conference on Violence in the Health Sector Linking local initiatives with global learning (pp. 359-362). Amsterdam, The Netherlands: Kavanah

      [24] Longo J (2007) Horizontal violence among nursing students. Archives of Psychiatric Nursing, 21(3), 177-178.

      [25] Martin A, Gray C & Adam A (2007) Nurses’ responses to workplace verbal abuse: a scenario study of the impact of situational and individual factors. Research and Practice in Human Resource Management, 15(2), 41-61.

      [26] McKenna BG, Smith NA, Poole SJ & Coverdale JH (2003) Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96.

      [27] Natan MB, Hanukayev A & Fares S (2011) Factors affecting Israeli nurses' reports of violence perpetrated against them in the workplace: A test of the theory of planned behaviour. International Journal of Nursing Practice, 17(2), 141-150.

      [28] Purpora C &Blegen MA (2012) Horizontal violence and the quality and safety of patient care: A conceptual model. Nursing Research and Practice, 2012.

      [29] Raosoft Inc. (2004). Sample size calculator. Retrieved June 15, 2012, from

      [30] RNAO (2008) Position Statement: Violence against nurses – ‘Zero’ tolerance for violence against nurses and nursing students. Retrieved June 20, 2012, from

      [31] Rocker CF (2008) Addressing nurse-to-nurse bullying to promote nurse retention. Online Journal of Issues in Nursing, 13(3). doi: 10.3912/ojin.vol13no03ppt05

      [32] RosenCC, Koopman J, Gabriel AS & Johnson RE (2017) Uncivil behaviour in the workplace causes mental fatigue and is contagious. LSE Business Review.

      [33] Royal College of nursing (2001) dealing with bullying and harassment at work: A guide for RNC Members. RNC, London

      [34] Scarlett BL (2009) Factors influencing nursing as a career choice and the retention of nurses in the profession in Jamaica. (Doctoral Dissertation).

      [35] Spector PE, Zhou ZE & Che XX (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies, 51(1), 72-84.

      [36] Spiri C, Brantley M & McGuire J (2016) Incivility in the workplace: A study of nursing staff in the Military Health System. Journal of Nursing Education and Practice, 7(3), 40.

      [37] Stanley KM, Martin MM, Michel Y, Welton J M & Nemeth LS (2007) Examining lateral violence in the nursing workforce. Issues in Mental Health Nursing, 28(11), 1247-1265.

      [38] The Joint Commission (2008, 2016) Behaviors that undermine a culture of safety. Retrieved June 30, 2017, from http://www.jointcommission

      [39] Thomas SP & Burk R (2009) junior nursing students' experiences of vertical violence during clinical rotations. Nursing Outlook, 57(4), 226-231.

      [40] TrybouJ, Malfait S, Gemmel P & Clays E (2015) Nursing staff and their team: Impact on intention to leave. International Nursing Review, 62(4), 489-496.

      [41] Vessey JA, DeMarco R &DiFazio R (2010) Bullying, harassment, and horizontal violence in the nursing workforce the state of the Science. Annual Review of Nursing Research, 28(1), 133-157.

      [42] Wilson BL, Diedrich A, Phelps CL & Choi M (2011) Bullies at work: The impact of horizontal hostility in the hospital setting and intent to leave. Journal of Nursing Administration, 41(11), 453-458.

      [43] World Bank (2009) Crime, violence, and development: Trends, costs, and policy options in the Caribbean. A joint report by the United Nations Office on Drugs and Crime and the Latin America and the Caribbean Region of the World Bank. Washington: DC.




Article ID: 8264
DOI: 10.14419/ijans.v6i2.8264

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