The Dark Side of Nursing: My Experience with Lateral Violence

Yet again, nurses have been chosen as America’s most trusted profession. Increasingly, nurses are depicted as honest, trustworthy, and compassionate. Notably, Johnson and Johnson’s campaign for nursing advertisements tug on the audiences’ heartstrings evoking feelings of love and portrays nursing as emotionally satisfying. With the always changing health care atmosphere and the rise of the baby boomers, nurses are needed more than ever. Accordingly, projected growths of 26% by the Bureau of Labor and Statistics and attractive job opportunities lure swarms of individuals.  In spite of nursing’s increasing popularity, media outlets have failed to report a rising development in the nursing arena, which are increasing accounts of lateral violence and burnout among new graduates. Above all, it is concerning that the most respected profession participates in a culture of negativity and intimidation.

Experiences of lateral violence among new graduate nurses may be obvious or cloaked. Circumstances may range on a continuum from intimidation or segregation to verbal abuse. Considering health care’s standing, is it not paramount to provide a healthy work environment that promotes professional development and one that increases new graduate's retention? Unfortunately, as a new graduate, I have experienced lateral violence. Hopefully, my experience will motivate others to take a stand to end lateral violence among new graduates.

A Hard Dose of Reality

Fresh from NCLEX, I accepted an offer as a staff nurse in an intensive care unit at a major metropolitan hospital and I was excited about the prospect of working as a nurse saving lives. I envisioned that I would be the relative nurse version of Christina Yang from ABC's medical drama Grey's Anatomy because I am smart, perceptive, and daring. My first week of hospital orientation was composed of signing mundane paperwork, listening to lectures on professionalism, and hearing stories of cautionary tales about how posts on Facebook may threaten employment and risk termination. Throughout these discussions, my future co-workers and I spoke of our career goals and our expectations of our different ambitions. I imagined that the nursing staff on the unit would be caring and I would be tenderly swept under the wings of my nursing preceptor. However, the second week of the hospital orientation proved to reveal the unit’s true and raw nature. Subsequently, I realized that a single expectation proved exact since the unit was intense, fast-paced, and provided endless opportunities to learn. Yet, I discovered that several of the nursing staff were not as caring as I had predicted nor were they considerately receptive toward new nurses. At first, I considered that my feelings of ambivalence might have stemmed from my initial introduction. But future events led to feelings of heartbreak, anxiety, and self-doubt.  Surprisingly, neither my education nor a training guide could have prepared me for arising events.           

Preceptor Conflict

Week 3, I was paired with a seasoned and expert clinician who was known to possess a wealth of knowledge. She was an excellent preceptor with regard to experience and academia. However, fundamental qualities of tact and patience appeared to be lacking. From the beginning our pairing led to an unstable relationship of humiliation, verbal attacks, and dissatisfaction. Particularly, my preceptor’s mercurial attitude was very difficult to gauge. At times she would be kind and understanding. Each work day, I experienced anxiety because I could not anticipate which personality I would encounter. One day during lunch, my preceptor communicated a negative situation she had encountered as a young nurse. During her reflection, I pondered, “Why continue this vicious cycle of lateral violence?” 

One day, in particular, she was noticeably moody and her disdain was virtually palpable. That day, we were assigned the sickest patient who was receiving Vasopressin, Epinephrine, Levophed and hemodialysis. Certainly, as a new nurse I did not work as efficiently as my preceptor. Nevertheless, I did complete my tasks. Once I completed administration of the patient's medication, I quickly began charting my patient’s physical assessment and medication administration on the EMAR. Upon my completion, I informed her that I had submitted my assessment for evaluation. Her analysis noted that I failed to chart the status of the patient’s catheter. From there, she expressed disappointment and remarked, "I don't know what I am going to do with you." To some readers, those words may not appear humiliating. Except, imagine that this is your 4th week as a nurse and that remark was aired in the presence of colleagues. That very instance, I questioned whether I was skilled enough to work as a nurse and if I had chosen the wrong career. Each day, I left work saddened and dissatisfied with my performance.         

…And the Cycle Repeats

The following week, my preceptor and I were assigned different work patterns because I was scheduled to speak as a podium presenter at a national nursing conference in New Orleans. So, I was assigned to work with another nurse. Particularly, my new preceptor was esteemed as one of the best nurses on the unit; though he was branded as giving new nurses a difficult experience. At that time, I was unaware of his reputation and I welcomed the chance to work with a new coworker for a week. Quickly and early on during our shift, I recognized that this might develop into similar situations that I had experienced with my original preceptor. Within an hour together, he suggested that my assigned preceptor had poorly instructed me. To continue, he remarked, “For what it is worth you can accept or not accept what you will learn when you are with me”.

From that moment on, to say the least, our week together continued to add towards my waning confidence. Several times during the week, he snapped his fingers at me in likelihood to encourage me to improve my pace. In my eyes that particular gesture was demeaning and I reached my threshold. I became emotionally exhausted. During my lunch break, I called my mother crying and overwhelmed, and I expressed that I could not continue to work under these stressful conditions. In the midst of our conversation, my mother encouraged me to speak with one of my former-nursing professors because she may steer me in the right direction. After the end of my shift, I alerted my instructor of my situation and she advised me to speak with my nurse manager regarding my feelings concerning experiences with my preceptors.

Consequently, I spoke with my manager and expressed my sentiments. However, I did not receive the reply I anticipated. In fact, my nurse manager articulated that I happened to be the first co-worker to express reports of these occurrences. Moreover, she shared that if she was my preceptor that she may have used similar teaching methods. The shock and bewilderment of her reply proved to be overwhelming. Additionally, she voiced that it would be extremely difficult to work on this particular unit while I was enrolled in graduate school. As I exited her office, I was stricken with a sense of abandonment and discouragement. At that moment, I made the conscious decision to resign my nursing position and focus all of my energy on graduate school.

Resolution

Once I expressed my thoughts to my former professor and other mentors, they intensely communicated that I should request a transfer and refrain from departing my position as a staff nurse.  With their guidance, I requested a transfer to another division. At that very moment, I was overwhelmed, emotionally exhausted, and certain that my sanity was teetering on the edge. Consequently, I felt that following this path I had nothing to lose. The next step was communicating with my manager and requesting a transfer. Soon after, I asked if she would grant my request. Once I explained my rationale behind my decision she was shocked. Moreover, she expressed that I had shown no clinical signs that would justify my choice. Actually, she communicated that my preceptors articulated that my orientation was going well and I had shown great potential and growth during my orientation. In the end, she granted my request. If I had been shown emotional support and guidance from my preceptor perhaps decisions may have been different and my experience may have been positive.    

Authors of the article “New Graduate Nurses’ Experience of Bullying and Burnout” published in the Journal of Advanced Nursing noted that new graduates experiencing lateral violence expressed “feelings of fear, sadness, depression, frustration, mistrust, and nervousness.” Moreover, the article identified that “66% of new graduates experienced severe burnout primarily related to disempowering workplace conditions.”  So, as nurses and individuals how do we end and prevent incidences of lateral violence? Below, I have listed methods to generate change.

  • Develop and enforce a strict zero tolerance policy
  • Develop education programs to identify bullies and provide individuals the opportunity of remediation
  • Provide support services and resources for new graduates to ease his or hers transition to the unit
  • Make new staff feel welcomed or relaxed
  • Treat all staff fairly! 

I encourage you to share your experiences and how you handled or may handle similar experiences. Or, share how you have stood up for a fellow colleague in a situation you recognized as unjust.  As individuals standing together for a cause, we can inspire change!

 

16 comments

Thanks for sharing you story, it was very insiteful. As a nursing student your story has opened my eyes to see the realistic view of nursing. I have a few questions I would like to ask. 

1. Would you advise a newly graduated nurse to accept a job offer as a trama nurse in a major city?

2. What advise would you give to a new nurse starting her first day of work?

Hi Jasmine, and thank you for your interest. If you are really interested in the trauma unit, I urge you to do your research. For instance, determine the new nurse retention percentage. If the unit has a high turnover rate, there may be some underlying concerns. Also, asks questions. If you know someone that works in that particular unit or institution, ask about the unit's culture and patient population. To answer your second question, I would suggest that you go into your first job with an open mind, a kind spirit, and the undying desire to learn. Each day you will be presented with new challenges so be prepared to be challenged emotionally, physically, and socially. I hope that everything goes well with your search, and I hope you continue to read the blogs posted on the MinorityNurse.com!

Hi Ashley, thanks for sharing your story. I do a lot or work with nurses and with Lateral Violence. I was not surprised that your preceptors lacked insight to the way in which they interacted with you. Often bullies have no idea that they are expressing negative communication and do not think that they are being bullies or being violent to co-workers. I think we should promote low level resolution, talking to the person that we are having trouble with. Once Mangers get involved, they have the unenvious task of listening to both individuals and having to choose a side, and in the meantime, if they do not choose the 'vicitm' of the bullying, they can also be seen as promoting or supporting the bullying behaviour and the culture of the environment.

Zero Tolerance Policies (ZTP) often come from the top down, and can be seen as management bullying everyone to adopt a certain norm. With ZTPs, management can ultimately decide who the bully is, and what punishment should be handed out and these negative consequences can have repercussions if the nurse being punished does not recognize their behaviour as being bullying.

Nurses, preceptors, and students need good communication skills, enforced and reinforced through practice, to be able to express themselves to their colleagues, to work through the tough conversations that really matter. These are the services and resources that should be focused on. 

Developing and adopting 'commitment to co-workers’ type documents can go a long way to support positive work environments. Creating safe places at work where staff can communicate with one another also goes a long way to support healthy workplaces and healthy teams.

Ultimately, a strong team becomes a great place to work, where staff stay, and where patients get better quicker with less negative outcomes.

Thanks for your story once again, developing dialogue to discuss lateral violence helps all nurses and makes us all better caregivers.

 I also liked the image that you used, also on a book that refer to called "Real Nurses and Others: Racism in Nursing".

Hello, and thank you for your candid and informative response. In particular, I am interested in developing a policy and presenting it to my nursing congress. Also, your comments have sparked my interest to conduct further research regarding lateral violence among minorities. Have you experienced any instances of lateral violence? Again, thank you for your reply, and I hope to hear from you in the coming weeks.

Hello, and thank you for your candid and informative response. In particular, I am interested in developing a policy and presenting it to my nursing congress. Also, your comments have sparked my interest to conduct further research regarding lateral violence among minorities. Have you experienced any instances of lateral violence? Again, thank you for your reply, and I hope to hear from you in the coming weeks.

Ms. Wagner, I must say that this piece was extremely well written.  While your experience catered to your chosen profession and is thereby considered to be systemic, I see pandemic implications for a plethora of workplaces in and out of the medical field.  I applaud the bold and veracious manner in which you seek to tackle this issue and I sincerely hope that it inspires others in much the same way as it has done for me.

Hello, Mr. Turk. and thank you for your reply. It was delightful to hear your response.  In your profession, have you observed or encounter similar occurrences? If so, what course action would be implemented to deescalate the situation; furthermore, will you define the implications for offenders? Again, thank you for your reply. Hope to hear from you soon!

Hello Miss Wagner. What are your suggestions for considering where to begin a career as a new nurse?

You have raised an important issue..Thanks for sharing..I would like to read more current affairs from this blog..keep posting.. Acne

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The Dark Side of Nursing: My Experience with Lateral Violence. - See more at: http://www.minoritynurse.com/blog/ashley-wagner/dark-side-nursing-my-exp...
The Dark Side of Nursing: My Experience with Lateral Violence. - See more at: http://www.minoritynurse.com/blog/ashley-wagner/dark-side-nursing-my-exp...

The dark side of Nursing
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