The Disruptive Force of Lateral Violence in the Health Care Setting
The Disruptive Force of Lateral Violence in the Health Care Setting
Lateral violence in the health care workplace is costly, destructive, and, ultimately, places patients at risk of diminished health care. According to Murray, lateral violence by nurses in the health care workplace is estimated to cost more than $4 billion dollars each year because of lost time, productivity, and turnover of trained staff. Given the nature of lateral violence, and the great likelihood that it is unrecognized and underestimated because of a lack of reporting, losses are probably greatly underestimated.
Nurses who are the victims of lateral violence experience loss of self-worth, an increased sense of ineptitude, depression, and despair. It is not surprising, then, that, because of the psychological destructiveness of lateral violence, nurses are likely to leave their employment within 6 months after the first victimization. When nurses leave their employment because of lateral violence, it often leaves a gap in the care team, thereby increasing workloads and contributing to diminished morale. The loss of 1 nurse has been estimated to cost the health care organization nearly 2 times the nurse's salary. Furthermore, replacement costs are estimated to be between $22,000 for a new nurse and $64,000 for an experienced nurse. Elsewhere, Jones estimates that the replacement cost of a trained nurse is 1.3 times salary. In a comprehensive study of attrition in the nursing workforce, Price Waterhouse Cooper found that for each percentage point of nursing workforce attrition, hospitals lose anywhere between $300,000 and $4 million, given the costs of recruiting, hiring, retaining, and training represented by each nurse terminating employment.
Lateral violence also contributes to declines in effective health care. When nurses working in the same unit have negatively charged relations, patient safety is put at risk vis-à-vis increases in medical errors. The abuse, in the form of psychological/emotional and threat of or actual physical harm, creates an unsafe work environment in which the abused adopts avoidant behaviors to cope with high stress, anxiety, and fear. Avoidant behaviors may include escape (sick leave, tardiness, and absence from assigned work) and partial avoidance (disassociation by mentally withdrawing, self-anesthetization through drug and alcohol use, or through complete avoidance in the form of resigning from employment). Furthermore, the abuser often uses misinformation, withholding of information, and redirection of communication in ways that target the victim but vicariously negatively impact the patient. Lateral violence undermines the requisite professional relationships needed for effective communication to ensure efficacious health care. Inherently, when lateral violence occurs, "all meaningful communication is essentially stopped."
In addition to negative patterns of communication that either rely on or cause misinformation in the caregiving process, lateral violence is likely to also cause medical errors by the victim. In the context of fear, high anxiety, and stress created by lateral violence, the abused nurse is more likely to cause harm to a patient. Furthermore, lateral violence affects the quality of health care when disruption to staffing occurs because of absenteeism and staff turnover.
Impact
Lateral violence in the health care workplace is costly, destructive, and, ultimately, places patients at risk of diminished health care. According to Murray, lateral violence by nurses in the health care workplace is estimated to cost more than $4 billion dollars each year because of lost time, productivity, and turnover of trained staff. Given the nature of lateral violence, and the great likelihood that it is unrecognized and underestimated because of a lack of reporting, losses are probably greatly underestimated.
Nurses who are the victims of lateral violence experience loss of self-worth, an increased sense of ineptitude, depression, and despair. It is not surprising, then, that, because of the psychological destructiveness of lateral violence, nurses are likely to leave their employment within 6 months after the first victimization. When nurses leave their employment because of lateral violence, it often leaves a gap in the care team, thereby increasing workloads and contributing to diminished morale. The loss of 1 nurse has been estimated to cost the health care organization nearly 2 times the nurse's salary. Furthermore, replacement costs are estimated to be between $22,000 for a new nurse and $64,000 for an experienced nurse. Elsewhere, Jones estimates that the replacement cost of a trained nurse is 1.3 times salary. In a comprehensive study of attrition in the nursing workforce, Price Waterhouse Cooper found that for each percentage point of nursing workforce attrition, hospitals lose anywhere between $300,000 and $4 million, given the costs of recruiting, hiring, retaining, and training represented by each nurse terminating employment.
Lateral violence also contributes to declines in effective health care. When nurses working in the same unit have negatively charged relations, patient safety is put at risk vis-à-vis increases in medical errors. The abuse, in the form of psychological/emotional and threat of or actual physical harm, creates an unsafe work environment in which the abused adopts avoidant behaviors to cope with high stress, anxiety, and fear. Avoidant behaviors may include escape (sick leave, tardiness, and absence from assigned work) and partial avoidance (disassociation by mentally withdrawing, self-anesthetization through drug and alcohol use, or through complete avoidance in the form of resigning from employment). Furthermore, the abuser often uses misinformation, withholding of information, and redirection of communication in ways that target the victim but vicariously negatively impact the patient. Lateral violence undermines the requisite professional relationships needed for effective communication to ensure efficacious health care. Inherently, when lateral violence occurs, "all meaningful communication is essentially stopped."
In addition to negative patterns of communication that either rely on or cause misinformation in the caregiving process, lateral violence is likely to also cause medical errors by the victim. In the context of fear, high anxiety, and stress created by lateral violence, the abused nurse is more likely to cause harm to a patient. Furthermore, lateral violence affects the quality of health care when disruption to staffing occurs because of absenteeism and staff turnover.
