A year ago, my editorial1 addressed the issue of lateral (ie, horizontal) hostility within nursing, defined as various “unkind, discourteous, antagonistic interactions” between nurses who work at comparable organizational levels and commonly characterized as divisive backbiting and infighting. As noted in that editorial, although a recent report from the American Association of Critical-Care Nurses (AACN) revealed that 66% or more of interactions between critical care nurses are described as respectful and supportive, the other 33% were depicted as only fair or poor.2 Because the AACN article neither detailed nor summarized the nature or extent of those problematic interactions, my April 2007 editorial afforded some background information on this issue and offered readers an opportunity to describe their personal experiences with lateral hostility in an online survey posted to the CCN Web site. The purpose of the survey was to identify the nature and extent of the problem of lateral hostility among critical care nurses. In this editorial, I report a summary of those survey results.
Survey on Lateral Hostility
The survey, presented in Figure 1, consisted of 3 items that related to the following aspects of lateral hostility:
The forms of lateral hostility critical care nurses experience
The form of lateral hostility that would most negatively affect a critical care nurse’s decision to continue practicing nursing
Survey Response Window and Respondents
Readers could participate in the online survey from the time of the publication of the editorial in April 2007 until September 15, 2007. During this period, 96 readers provided input for the survey.
Nature and Extent of Lateral Hostility Experienced by Critical Care Nurses
The data related to survey item 1 (Figure 1) provide answers to a number of relevant questions:
Which expression of lateral hostility is most frequently experienced by critical care nurses?
What are the 5 most common forms of lateral hostility experienced by critical care nurses?
What is the relative incidence of various forms of lateral hostility experienced by critical care nurses?
What other expressions of lateral hostility (beyond the 23 listed in item 1) do critical care nurses experience?
Most Common Form of Lateral Hostility
The single most common form of lateral hostility experienced by critical care nurses was identified by 64 of the 96 respondents (67%) as follows:
Complaints shared with others without first discussion with you
5 Most Frequently Experienced Forms of Lateral Hostility
The top 5 expressions of lateral hostility reported by critical care nurses are summarized in Table 1. Many of these manifestations employ despicable communication techniques subtly yet effectively to subjugate, distance, isolate, and disrespect other nurses.
Relative Incidence of Various Forms of Lateral Hostility
All of the 23 forms of lateral hostility included in item 1 of the survey were reported by survey respondents. The experience of these factors reported by critical care nurses ranged from a low of 18% for the least often experienced factor (Reneging on previous commitment) to a high of 67% for the most frequently reported factor (Complaints shared with others without first discussion with you). Figure 2 displays the full spectrum of forms of lateral hostility reported by critical care nurses in relative order of frequency.
Other Expressions of Lateral Hostility
At the end of item 1, respondents could add any other types of hostility they had experienced that were not included among the 23 listed. These additions included the following:
Lying for personal advancement
Bullying during report
Bullying in response to changed assignment, refusing patient assignments
Passive-aggressive and retaliatory behaviors
Demotion, suspension, termination
Enabling of coworker substance abuse (covering up the behavior of impaired nurses or looking the other way)
Lateral Hostility That Would Most Negatively Affect Decision to Continue Practicing Nursing
Item 2 in the survey (Figure 1) was included to help distinguish which of these various forms of hostility would have the most detrimental effect on the individual critical care nurse’s willingness to continue practicing nursing—ie, what type of hostility would drive this nurse out of nursing?
The results reveal areas of considerable concern as well as at least one glimmer of encouragement. Among the 79 replies to this item, no more than 8 respondents identified any particular expression of hostility as having this profound an effect on their willingness to continue their nursing career (Figure 3). And, perhaps most encouraging, immediately following the 2 factors tying for most detrimental in driving nurses out of their profession, respondents inserted the unsolicited reply of “None” to suggest that despite enduring slights of this nature from some coworkers, there is a segment of critical care nurses who are not about to capitulate from nursing in response to that type of behavior. As these critical care nurses so aptly communicated, “none” of those factors will precipitate their departure from nursing. Beyond this group of stalwart replies, however, a wide array of bad-mouthing, isolating, and polarizing behaviors join forces to exert the greatest potential for severing the ties between critical care nurses and critical care nursing.
Item 3 was a purely open-ended item intended to capture anything else the participant wished to convey related to this issue. Of the 96 survey respondents, 40 offered additional comments. Except for eliminating some comments unrelated to this topic area and editing for brevity, I will let these words speak for themselves (Table 2).
Although 96 survey respondents hardly represent a legitimate sampling of all critical care nurses, the reported experiences of these nurses with hostility originating from their peers reflect an ugly, divisive, and demoralizing blight on clinical practice in our area. Even with this meager and unscientific volume of documentation, efforts can be launched to confirm whether this problem exists at your facility, and, if so, to initiate generation of a clear and full mandate for zero-tolerance of these behaviors as described in AACN’s position statement on staff abuse.3