The statement "nurses eat their young" has been so often repeated it has become axiomatic. "Lateral" or "horizontal" violence is a very real issue in professional nursing (among other occupations), it has been heavily researched, and various interventions and corrective actions have been initiated with varying levels of success.
There are "zero tolerance policies;" there are defense strategies for new nurses to use to protect themselves. But are we missing half the equation?
Lateral (or horizontal) violence describes how members of an oppressed culture, unable to strike back at their oppressors, instead take out their anger and frustration on the more vulnerable members of their own group. In the nursing profession, this is usually new hires and those newly graduated from nursing school. The consequences of lateral violence are dire: new nurses are often driven out of a particular work environment and perhaps out of the profession altogether. As the current nursing shortage is likely to only worsen, this has grave implications for the accessibility and quality of health care.
As grave as the problem of lateral violence is, all the interventions are directed at the behaviors: how to defend against the behaviors, how to identify and punish perpetrators. Certainly, lateral violence is reprehensible, unacceptable, and professionally self-sabotaging. But what about the other side of the equation?
As lateral violence is endemic to oppressed cultures, shouldn't the issue of oppression be addressed? How might lateral violence be affected if there were other, more benevolent, more productive opportunities to wield power?
Certainly, there are many aspects of professional nursing practice that are non-negotiable: patients require care, competencies must be maintained, and standards must be met. However, it does not necessarily follow that in order to do everything that must be done, every step must be prescribed and every process delineated, with every deviation or innovation at least suspect if not outright punishable.
Nurses, by training and by licence, are independently accountable to the patient and are expected to exercise professional judgement and critical thinking. We are taught to negotiate with patients to develop a plan of care that best meets their needs. However, we are seldom extended the same courtesy.
Work schedules and shift availability is on a take-it-or-work-elsewhere basis, patients are assigned, seldom selected by the nurse. These sorts of problems are hardly unique to nursing, and professions that experience similar working conditions also have similar problems with lateral violence.
For nursing to be a profession, we must be responsible to our patients, our profession, society, and ourselves. As professionals, we have the right to negotiate how we meet each of those responsibilities. Every professional knows that these responsibilities often conflict, and the give-and-take among them is a part of professional reality.
Participating in this negotiation, both collectively as a profession and individually as a professional is the other side of the equation that must be addressed for effective control and eventual eradication of lateral violence. All the interventions addressing behaviors associated with lateral violence must continue to be addressed, but it's past time that addressed the rest of the equation.