Nurse Leader in Bullying Education Shares Resource in Gesture of Collaboration: Thank You, Renee Thompson!

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renee thompson SAVE THIS PAGE!  It is a great example of nurses helping nurses and a wonderful resource!

Renee Thompson, MSN, RN, CMSRN, Author of “Do No Harm Applies to Nurses too!” and founder of RTConnections has done a lot of work researching bullying issues in nursing.

As a speaker and communications trainer, she knows how vital healthy collaboration is to the practice of nursing and the safe delivery of healthcare.  With that in mind, she has graciously offered to share her fantastic list of resources in this annotated bibliography she developed in while doing an Independent Study while at the University of Pittsburgh!


1.  Aleccia, J. (2008).  Hospital bullies take a toll on patient safety.

The author is a health writer for MSNBC. In this article, she describes the verbal, sexual, and physical assaults occurring in hospitals and how they lead to adverse outcomes and increasedpatient mortality.  She shares efforts from the Joint Commission to address issues with bullying by holding healthcare organizations accountable for establishing codes of conduct. Their recommendations are to implement better systems to detect bullying, provide civil responses to patients or families that witness the bad behavior. and provide overall training involving basic etiquette.


2.  American Nurses Association (2001). Code for ethics for nurses with interpretative statements. Silver Springs, MD, American Nurses Publishing.

The Code of Ethics with interpretative statements provides the reader with a guideline of expectations for behavior and responsibilities of a professional nurse. The nine provisions provide nurses with the standards of practice expectations for all nurses. Provision 1, in particular, provides the reader with the expectations of respectful behavior towards patients and colleagues, independent of social or economic status. Nurses that demonstrate disrespectful behavior (horizontal violence) are in violation of Provision 1 of the Code of Ethics.


3.  Andersson, L.M., Pearson, C.M. (1999). “Tit for tat? The spiraling effect of incivility in the workplace. Academy of Management Review, 24, 452-457.

In this article, the authors provide the reader with a history of civility in society and the changes towards incivility seen over time. From incivility to antisocial behavior, mistreatment in organizations is described.  The authors explain the incivility spiral as a downward pattern of increasingly disrespectful behaviors seen in organizations. A conceptual framework is used to describe the various points along the spiral including a starting point, tipping point, and secondary spiral.  The authors suggest that certain factors such as temperament, social interaction, and climate impact the speed of the spirals.  They recommend further research to develop a valid and reliable measurement of incivility.


4.  Baldoni, J. (June 13, 2011). You’ve discovered wrongdoing. Now what? Message posted to

This blog offers the reader 4 lessons for leaders to deal with inappropriate behavior. The author uses an example from a scandal involving an accused pedophile priest as a reference for other leaders to follow when dealing with any scandal or inappropriate behavior in the workplace. Overall lessons for the leader are to be actively engaged and to be the role model of appropriate behavior for others.


5.  Bartholomew, K. (2011). Lateral violence in nursing: Breaking the spell. Nurse Together. Retrieved on August 10, 2011, from

The author is well known for her interest and work regarding lateral violence. She offers the reader a description of overt and covert behaviors and shares examples of them in the workplace. Estimates of the prevalence of lateral violence ranges from 46 – 100%.  She offers of plea for organizations to put an end to lateral violence and offers recommendations for elimination of same.


6.  Brinkman, R., Kirschner, R. (2002). Dealing with people you can’t stand. New York, NY, McGraw Hill.

The authors are naturopathic physicians, professional speakers, and corporate trainers. In the book, they share strategies for how to bring out the best in people when they are behaving badly. They describe people in terms of their negative behavior using labels such as “the tank”, “the sniper”, “the yes person”, etc. Deliberate communication strategies are shared for each role and communication style. Individuals are taught strategies that will redirect and eliminate the behavior. The authors also provide tips on using various communication tools to improve overall conditions in the workplace.


7.  Brown, L., Middaugh, D. (2009). Nursing hazing: A costly reality. Medsurg Nursing, 28(5), 305–307.

Authors Lana Brown and Donna Middaugh define and provide examples of nurse hazing in both the academic and acute care setting. Using sociological literature, they describe the phenomena of horizontal violence and its similarities to hazing in a university setting. Costs to healthcare organizations related to hazing are briefly identified.  The authors recommend early identification and manager-led strategies to eliminate hazing in the nursing profession.


8.  Christmas, K. (2007). Workplace abuse: finding solutions. Nursing Economics, 25(6), 365-367.

The author works in the healthcare division of Bernard Hodes, an organization that provides integrated talent solutions. In this article, she describes the impact of workplace abuse on the recruitment and retention of nurses. She recommends organizations adopt a “zero tolerance” for abuse and that the Chief Nursing Officer be the quintessential role model for positive behavior. Raising awareness and holding individuals accountable are identified as key strategies to eliminate workplace abuse.


9.  Clark, C.M. (2008). Student voices on faculty incivility in nursing education. A conceptual model. Nursing Education Perspectives, 29(5), 284–289.

The author is a professor in the nursing department at Boise State University. The article provides the reader withe results from the research she conducted looking at incivility in the academic setting. The author conducted a study to gather students’ perspectives on incivility in their academic preparation. She includes examples of verbatim comments made by students on the topic and shares her insights gained throughout the study. The need to develop best practices regarding incivility in the academic setting and minimize negative emotional responses was, according to the author, the most important finding. She does recognize the limitations of the study because it only includes students’ perspectives and not the perspectives of the teachers. She believes that incivility is an interactive and shared responsibility.


10.  Clark. C. (2008). The dance of incivility in nursing education as described by nursing faculty and students. Advances in Nursing Science, 31(4), 37–54.

The author is a professor in the nursing department at Boise State University. Using the analogy of a dance, she describes the issue of incivility in nursing education as a partnered experience; a dynamic interaction between the teacher and the student.  She provides the reader with a review of the literature and examples of extreme cases of incivility in the academic setting. The author conducted a study looking at both faculty and student experiences with incivility using the Incivility in Nursing Education survey.  The survey included both quantitative and qualitative portions and uncovered factors contributing to student incivility and faculty response. Both student and faculty stress was identified as major contributors of incivility. Through the results of the study, the author developed a conceptual model for fostering civility in nursing education and provides the reader with a detailed description for practice.


11.  Dellasega, C. (2005). Mean girls grown up: adult women who are still queen bees, middle bees, and afraid-to-bees. Hoboken, NJ, John Wiley and Sons.

In this book, Dr. Dellasega provides an in depth look into the issue of bullying from a female gender perspective. She explores why women deal with conflict differently than men and how negative experiences as children can manifest into bullying behaviors as adults. Her extensive research on relational aggression and examples from the victims of bullying provide the reader with a better understanding of today’s bully.  To help protect individuals, she outlines strategies for dealing with women who bully and provides practical methods to counter specific negative behaviors.


12.  Dellasega, C.A. (2009). Bullying among nurses. American Journal of Nursing. 109(1).

The author, a professor in the Department of Humanities in the College of Medicine at Pennsylvania State University, provides the reader a description of relational aggression as a form of workplace bullying. Professor Dellasega is the author of several books regarding relational aggression in females. She explains the definition, outlines the causes, identifies bully behaviors, describes the bully types and makes recommendations for change.  Strategies for the individual nurse and nurse managers are also explored.


13.  Dumont, C., Riggleman, K., Meisinger, S., Lein, A. (2011). Horizontal violence survey. Nursing2011, 4, 9–10.

This article is a national survey to evaluate nurses’ experiences with horizontal violence. The anonymous 26-question multiple-choice survey uses Likert scale, demographic questions ,and open comments to capture the frequency of workplace bullying among nurses.


14.  Felbinger, D. M. (2008). Incivility and bullying in the workplace and nurses shame responses. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37, 234-242. doi:10.111/j.1552-6909.2008.00227.x

The author, an associate professor, provides the reader with insight into the issue of incivility as a precursor to bullying and the subsequent target’s “shame response.”  Characteristics of incivility and bullying are explored and theories shared. She defines bullying as “negative behavior that repeats, establishing a pattern versus a single occurrence”. The author includes recommendations to eliminate incivility and bullying at the individual and administrative levels. Establishing the principles of a healthy work environment identified by the American Association of Critical Care Nurses (AACN) support the author’s recommendations.


15.  Felbinger, D. M. (2009). Bullying, incivility, and disruptive behaviors in the healthcare setting: Identification, impact, and intervention. Frontiers of Health Services Management. 36.

The author is a professor in the College of Nursing at the University of Cincinnati. She describes the negative consequences of incivility on the individual and organization. Disruptive behaviors and characteristics are identified with examples provided by the author.  The author helps the reader distinguish between bullying and incivility with bullying displayed as a repeating pattern.  A look at incivility among disciplines is explored, direct and indirect costs to the organization shared, and intervention strategies suggested. Strategies from the American Association of Critical Care Nurses are recommended to establish a healthy work environment for organizations.




16.  Gallagher, A. (March 21, 2010). Moral distress and moral courage in everyday nursing practice. The Online Journal of Issues in Nursing. 16 (2).

The author is a professor at the University of Surrey in the United Kingdom. She is the Director of the International Centre for Nursing Ethics and provides the reader with a comprehensive look at the concepts of moral distress and moral courage within the context of nursing practice. The author describes the causes of moral distress, factors associated including support, coping strategies, and emotion and physical effects. Moral courage is introduced as an admired virtue necessary to combat the effects of moral distress. She provides examples of moral courage in the workplace and leaves the reader with the question, “Do people know what is the right thing to do? If so, why don’t they?”


17.  Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal for Continuing Education of Nurses, 35(6), 257-263.

Dr. Griffin is a program coordinator at Brigham & Women’s Hospital in Boston, Massachusetts. In this article, she shares the research she conducted on using cognitive rehearsal as a strategy to protect new nurses from lateral violence. Using 26 newly licensed nurses, she provided extensive education on lateral violence during their orientation. Using open discussion and instruction on cognitive rehearsal, the nurses were given cue cards with the appropriate responses to the most common forms of lateral violence. One year later she brought the nurses back together and conducted videotaped focus groups to evaluate their responses. Overall, she found that the nurses in the study were able to de-personalize the negative behaviors of others and that using cognitive rehearsal helped them confront their aggressor.


18.  Griffin, C. (2011). Healthy work environments: Empowerment strategies for medical-surgical nurses dealing with lateral violence. MedSurg Matters, 20(5), 4-5.

The author is well known for her work regarding lateral violence. In this article, she defines lateral violence, its effect on the novice nurse and the strategies medical-surgical nurses can implement including a framework for developing an effective communication model. Through examples, the author highlights the detrimental effects of lateral violence on the individual nurse and the nursing profession.


19.  Guglielmi, C. L. (2010). Embracing the freedom to eliminate disruptive behavior. AORN Journal. 92(4).

The author is the AORN President and a perioperative nurse specialist in Boston, Massachusetts. She describes disruptive behaviors in the OR and how they undermine a culture of safety. The author cites the work done by the Joint Commission who adopted a public stance that addresses disruptive behavior. Her recommendations to create a culture of civility involve individual self-awareness, creating a neutral zone without gossip and negative comments, and implementing a code “purple” for staff to use whenever staff witnesses unprofessional behavior.


20.  Horn, S. (1996). Tongue Fu! How to deflect, disarm, and defuse any verbal conflict. New York, NY, St. Martin’s Press.

Sam Horn is a consultant, speaker and the author of many books involving bullying. In this book, she describes her Tongue Fu® approach to dealing with difficult people. She provides an in -depth and often humorous description of the most common situations involving negative verbal communication. For each negative interaction, she shares tangible strategies to redirect and disarm the bully.  Each chapter provides the reader with “words to use” and “words to lose” for the most common negative situations. The author adopts many Tongue Fu-isms throughout the book and encourages readers to practice using them in their work environment.


21.  Hutton, S.A. (2006). Workplace incivility: State of the science. The Journal of Nursing Administration, 36, 22-27.

The author is a master trainer on prevention and management of disruptive behaviors for the VA Health System. In this article, he informs the reader of the high cost of workplace violence and shares research conducted involving several perspectives regarding incivility: theoretical use  of the incivility spiral concept; the societal perspective looking at role separation along gender and socio-cultural lines; the legal perspective looking at the impact of workplace incivility in the legal workplace; the academic perspective using student incivility towards teachers; and the healthcare perspective focusing on interpersonal aggression. The author recommends continued research, a standardization of the definition of workplace incivility, and a focus on interventions.


22.  Johnson, S.L., Rea, R.E. (2009). Workplace Bullying. Concerns for nurse leaders. Journal for Nursing Administration, 39(2), 84–90.

The authors examine the effects of workplace bullying through a study conducted to describe nurses’ experience with bullying. Using a descriptive study design, they uncover the existence of bullying in the workplace and its detrimental effects on retention of work environment. Using the Negative Acts Questionnaire-Revised, the author identifies the prevalence and negative behaviors described by participants. The author challenges nursing leaders to examine their own behavior first and then foster an environment of open communication and collaboration.


23.  Johnson, S.L. (2009). International perspectives on workplace bullying among nurses: A review. International Nursing Review, 56(1), 34-40.

At the time of printing, the author was a PhD student at the University of Washington in Tacoma, Washington.  The purpose of the article was to understand and examine the nursing literature on workplace bullying. She conducted a comprehensive literature review on the definition of terms, scope of the problem, and consequences of workplace bullying including health effects, social effects, impact to patients and attrition rates. Theories regarding the causes are explored and include a closer look at leadership styled, organizational volatility, and hierarchy. The author shares solutions, but also identifies the need for more research in this area.


24.  Johnston, M., Phanhtharath, P., Jackson, B.S. (2009). The bullying aspect of workplace violence in nursing. Critical Care Nursing Quarterly 32(4).

The authors provide the reader with an in-depth look at the prevalence of workplace violence, the initiation of the terms, factors that contribute to bullying behavior, and the recommendations to address and eliminate.  The reader learns how the term “horizontal violence” was created and by whom.


25.  Jones, C.B., Gates, M. (2007). The costs and benefits of nurse turnover: A business case for nurse retention. The Online Journal of Issues in Nursing, 12(3).

The authors provide the reader with a business case for organizations to focus on nurse retention strategies. The authors quantify the monies lost through nursing turnover ($22,000 – $64,000 per nurse) and identify retention benefits that support the costs spent on retention initiatives. Improving the nurses’ work environment was recognized as difficult to quantify, but important to overall nursing retention and cost savings.  Both authors are doctoral prepared and have experience in healthcare finance.


26.  Kelly, D. (2006). Workplace bullying, women and workchoices. Research Online. Retrieved on August 10, 2011, from

In this paper, the author examines workplace bullying in the context of the 2006 Workchoices legislation, enacted in Australia. The author proposes that the legislation’s intent, to reduce the incidence of bullying, has actually enabled employers to condone and encourage bullying. Shifting the burden from external to internal regulation can leave the targets of bullying, especially the female worker who is already disadvantaged, vulnerable to toxic organization – now, without oversight. She presents a comprehensive review of the literature to support the notion that bullying is under-reported, perceived differently between genders, and is an organization problem with 70-80% of the perpetrators of bullying being the managers. Factors affecting the incidence of bullying at the micro and macro level are discussed as she relates the legislation to the “Swiss Cheese Model” for enabling and preventing bullying. Her recommendation is for further research involving how CEOs and managers could take greater responsibility in identifying and eliminating bullying in the workplace.


27.  Kupperschmidt, B, Kientz, E., Ward, J. Reinholz, B. (2010). A healthy work environment. It begins with you. The Online Journal of Nursing Issues in Nursing, 15(1), 1-10.

Using Parson’s Theory of Human Becoming, the authors identify skilled communication as the primary means to improve work environments. They describe the 5 essential factors for becoming a skilled communicator: becoming aware of self-deception, being reflective, authentic, mindful, and candid. Recommendations from the American Association of Critical Care Nurses provide support for improving nurses’ communication. The authors recognize that although the focus of their article was the individual nurse, they suggest that the role of the manager is also important in decreasing workplace conflicts.


28.  Lachman, V.D. (2007). Moral courage in action: Case studies. MEDSURG Nursing, 16(4).

The author is an Associate Professor at Drexel University. She provides the reader with a definition of moral courage and the different types of situations in which nurses find themselves.  She includes dealing with a dying patient, handling a family disruption, confronting bullying, and confronting unethical behavior as requiring moral courage. When confronting bullying behavior, the author provides an example, includes elements from the ANA Code of Ethics, and provides suggestions for resolution.


29.  Leiper, J. (2005). Nurse against nurse: How to stop horizontal violence. Nursing2005. 35(3).

This article provides the reader with theories to explain horizontal violence (nursing as an oppressed discipline, disenfranchising work practices, low self-esteem, easy targets, and hierarchical abuse), ways for the victim to cope, and strategies for nurses to control their anger in the work environment. The author recommends that organizations “take a stand” against horizontal violence and institute policies to address and eliminate such behavior.


30.  Lewis, M.A. (2006). Nurse bullying: organizational considerations in the maintenance and perpetration of health care bullying cultures. Journal of Nursing Management, 14, 52-58.

The author wrote the article as part of his doctoral research in nurse bullying. His primary focus was on identifying the cause from a sociological perspective. He explores bullying activities through interactive vignettes and examples. Bully awareness was identified as an important component to bully negotiations. The author suggests that nurse managers need help to heighten awareness of bullying and support to eliminate it in the workplace.


31.  Longo, J., Sherman, R.O. (2007). Leveling horizontal violence. Nursing Management, 38(3). 34-47, 50-51.

The intent of this article is to provide the reader with an understanding of the detrimental effects of horizontal violence on both recruitment and retention; and potential costs to an organization. The authors define the term horizontal violence and include overt and covert characteristics, share possible theories including nursing as an oppressed profession, and describe the effects on retention and recruitment. The authors discuss the culture as either condoning or stopping the cycle and provide the reader with steps to eliminate the behaviors.  Ultimately, the authors suggest that horizontal violence be viewed as both a performance and a competency issue and recommend that organizations set cultural expectations to eliminate it.


32.  Lutgen-Sandvik, P., Tracy, S.J., Alberts, J.K. (2007). Burned by bullying in the American workplace: Prevalence, perception, degree, and impact. Journal of Management Studies, 44, 837-862.

This article shares research conducted to examine the occurrence of bullying in the workplace and the detrimental effects on employees. The authors surveyed workers across the United States and discover that bullying occurs in gradations, is persistent, and can impact persons who witness bullying behavior even though they may not actually be the target.


33.   McKenna, B.G, et al. (2003). Horizontal Violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96.

The author is a professor in the school of nursing at the University of Auckland in New Zealand. At the time of this publication, the author identified the lack of research concerning horizontal violence in the new graduate nurse population and sought to validate the issue.  Using an anonymous survey, she assessed new graduate experiences with interpersonal conflict, distressing experiences, overall distress felt, and whether or not there were any training programs offered to combat horizontal violence. As she predicted, the incidence of horizontal violence in the new graduate nurse population was high without adequate coping resources.


34.  Murray, J.S. (2009). Workplace bullying in nursing: A problem that can’t be ignored. MEDSURG Nursing Journal, 18(5), 273-276.

The author provides a thorough definition of workplace bullying and suggests that nurses can help themselves by learning strategies to support each other. Recommendations from The Joint Commission on hostile behavior, the Code of Ethics mandates on unethical behavior and the model for healthy work environments from the ANA are explored.


35.  Murray, J.S. (2009). Workplace bullying in nursing: A problem that can’t be ignored. MEDSURG Nursing Journal. 18(5).

Colonel John Murray is the Director of Education at the Capitol Region Medical Center in Bethesda,Maryland. He is also the President of the Federal Nurses Association and views workplace bullying as a serious problem facing nurses today.  He explains why nurses bully, referring to the “white wall of silence” that exists to protect the bully.  Dr. Murray provides the reader with common bully behaviors, and consequences to the individual and to the organization. He provides strategies to protect nurses from the affects of bullying and recommends instituting and enforcing codes of conduct in organizations. He cites the American Nurses Association’s healthy work environment recommendations as a guideline to eliminating bullying.


36.  Myer, J.R. (2006). Elements of Behavior. NC State University. General Entomology ENT 425.

The content was from a course on Entomology at North Carolina State University. The author is a faculty member in the Department of Entomology. In this chapter, the basics of behavior are discussed: innate, learned, and complex. The author describes the 3 types from the perspective of animals using insects to illustrate the differences. Understanding behavior from this perspective helps to understand human behaviors.


37.  Patterson, K. Grenny, J., McMillan, R., Switzler, A. (2002). Crucial Conversations. Tools for talking when stakes are high. New York, NY, McGraw-Hill.

The authors are members of VitalSmarts™ and were involved in writing several other publications involving human behavior and communication.  In Crucial Conversations, they help the reader to identify situations in which a “crucial conversation” needs to occur. The types of conversations and environments where they take place transcend beyond the healthcare arena. By illustrating the emotional involvement that exists in uncomfortable situations, they help the reader learn to objectively communicate, take action, and problem- solve.


38.  Quine, L. (2001). Workplace bullying in nurses. Journal of Health Psychology, 6(1), 73-84.

The author works in the Centre for Research in Health Behaviours, Department of Psychology in Canterbury, United Kingdom. Her research predominantly focuses on occupational health, stress ,and the application of social cognitive models in health-related behavior.  The article summarizes the research she conducted concerning bullying in community hospitals among nurses. She identifies the prevalence of bullying, the association of bullying behaviors to occupational health issues, and whether or not there is support at work for the victims of bullying. Her results show that almost half of all nurses are bullied in some way and that support at work does help to decrease the adverse occupational health effects.


39.  Ramos, M.C. (2006). Eliminate destructive behaviors through example and evidence. Nursing Management, 37(9), 34-41.

This article focuses on bullying from an organizational perspective and identifies administration as the key to eliminating it within the work environment. She cites the work from the American Nurses Association on conflict resolution and the Joint Commission’s “zero-tolerance” plan of action, however says that organizations are still not addressing the problem. She recommends a thorough investigation into each allegation of bullying with administrative support for policy writing, holding people accountable for behaviors, and for following through on consequences.


40.  Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing, 43(4). 395-401.

Dr. Randle is a lecturer at the School of Nursing and Medical School at Queen’s Medical Centre, Nottingham, United Kingdom. In this article, she presents her research involving the relationship between self-esteem and bullying behavior. She conducted a 3-year qualitative study using a grounded theory approach to explore self-esteem in student nurses. The results showed that students, who witnessed bullying by qualified nurses, subsequently, took on similar behaviors. The author suggests that radical social and structural changes are needed if the problem is ever going to be eliminated.


41.  Rowell, P.A. (2005). Being a ‘target’ at work or William Tell ads how the apple felt. Journal of Nursing Administration, 35(9). 377-379.

At the time of publication, Dr. Rowell was a Senior Policy Fellow at the American Nurses Association in Silver Springs, Maryland. In this article, she describes bullying as involving

psychological or physical abuse.  She shares estimates that indicate most bullies are bosses, but that not all bullies have a formal position of authority.  The targets of bullies are profiled, effects to the individual and organization discussed, and strategies to eliminate are shared.


42.  Sheridan-Leos, N. (2008). Understanding lateral violence in nursing. Clinical Journal of Oncology Nursing. 12(3).

The author provides the reader with a description of lateral violence, overt and covert behaviors, current theories related to cause, effects on staff, patient safety and organizational health, and strategies to overcome. She uses the term “carefronting” as a term that describes the concepts of respect, forgiveness, and courage to confront hostility in the workplace. The author identifies a lack of research involving lateral violence within the oncology nurse specialty, however, assumes similar findings as with other nursing specialties.


43.  Sincox, A.K., Fitzpatrick, M. (2009).  Lateral violence: Calling out the elephant in the room. Retrieved June 13, 2011 from

The authors describe their experiences with lateral violence within the student nurse population.  They presented the work done by Martha Griffin, RN, PhD, a nationally recognized expert on lateral violence. Behaviors were identified, student examples were shared, and a call to expose the “elephant in the room” was recommended as a means to end the hostile behavior in nursing.


44.  Sofield, L., Salmond, S.W. (2003). Workplace violence: A focus on verbal abuse and intent to leave the organization. Orthopaedic Nursing, 22, 274-283.

The authors share the results of their research on verbal abuse and intent to leave an organization. Using mailed questionnaires  to a random sampling of nurses, information was obtained indicating that more than 90% of nurses experienced verbal abuse in the previous month. The most common source of this abuse was from physicians. Of the nurses reporting verbal abuse, more than half were not comfortable reporting it.  The researchers achieved statistical significance for intent to leave if the nurse experienced verbal abuse. They recommend organizations adopt a zero-tolerance for the behavior and provide education and support to help nurses confront and respond to the verbal abuse.


45.  Stanley, K.M., Martin, M.M., Michel, Y., Welton, J.M. (2007). Examining lateral violence in the nursing workforce. Issues in Mental Health Nursing, 28. 1247–1265.

The authors sought to measure the existence and perception of the seriousness of lateral violence in the workplace. After conducting an extensive review of the literature, the authors developed a survey using scaled and open-ended questions to elicit both quantitative and qualitative results. Respondents identified oppressed situations and the role of an ongoing mediator to deal with lateral violence. New nurses were identified as especially vulnerable, but were also the most committed to ending lateral violence. The authors suggest the study results offer hope that the younger generations may be the key to eliminate lateral violence and provide the reader with suggested interventions.


46.  Stokowski, L.A. (2011, March 24). The downward spiral: Incivility in nursing. Medscape. Retrieved on August 10, 2011, from

This article is a summary of an interview conducted by the editor of Medscape’s, “Ask the Experts” column. The interview sought to understand the issue of incivility in nursing by asking two nurse researchers, who are leaders on the topic. They describe terminology used and have created a model to describe the “Continuum of Incivility” with behaviors ranging from low risk-disruptive behaviors, to high risk-threatening behaviors. A heavy focus on incivility in the classroom is presented with strategies to reduce incidence explored. The authors conclude that due to the long work days in close proximity to co-workers, it’s easy to fall into patterns of damaging behaviors, but that including corresponding consequences can help to prevent incivility in any setting.


47.  Stokowski, L.A. (2010, September 30). A matter of respect and dignity: Bullying in the nursing profession. Medscape. Retrieved on August 10, 2011, from

This article is a summary of an interview conducted by the editor of Medscape’s “Ask the Experts – Advanced Practice Nurses.” The editor sought to understand the issue of bullying in the nursing profession and interviewed Cheryl Dellasega, the author of Girl Wars and Mean Girls Grown Up.  Dr. Dellasega is known for her research on female aggression and provides the reader with an understanding of workplace bullying, the incidence of bullying, the motivation behind bullying with descriptions, how bullies choose their victims, and the manifestations of bullying.  She explains the effects of bullying on the individual, consequences in the workplace, and strategies to eliminate it.


48.  Taylor, B. (2001). Identifying and transforming dysfunctional nurse-nurse relationships through reflective practice and action research. International Journal of Nursing Practice, 7, 406–413.

The author is a professor of nursing at Southern Cross University in Lismore, Australia. The aim of the author’s research was to use reflective practice in order to raise awareness of problems that occur in the nurses’ work environment. The author used a qualitative approach with a small population of nurses to determine if using three-stage problem-solving cycles involving reflective journaling, open discussion, and developing strategies decreased dysfunctional nurse-nurse relationships.


49.  The Joint Commission. (2008). Behaviors that undermine a culture of safety. Sentinel Event Alert. 40, 1-3.

This sentinel event alert by The Joint Commission sent a message to leaders of healthcare organizations to identify and eliminate disruptive behavior in the workplace, citing increased medical errors and poor patient outcomes as a result. Based on this alert and the work from the Institute of Medicine on medical errors, organizations were encouraged to adopt a zero-tolerance for disruptive behaviors as a strategy to reduce the number of medical errors causing harm to patients.  The Joint Commission provides organizations with recommendations for policy changes, education, and conduct.


50.  Thomas, S.P. (2003). Professional development. Horizontal hostility: Nurses against themselves: How to resolve this threat to retention. American Journal of Nursing, 103(10), 87-88.

The author identifies the various terms to describe nurse-to-nurse aggression and uses the term “horizontal hostility” as a term to adequately describe the stress and burnout it causes.  She explains the sabotage existing in the workplace by nurses who engage in acts of hazing and lack of support. Dr. Thomas discusses the theories behind why horizontal hostility occurs citing nursing as an oppressed profession as primary. She offers solutions for nurses and organizations to take action against horizontal hostility to preserve retention.


51.  Vessey, J.A., Demarco, R.F., Gaffney, D.A., Budin, W.C. (2009). Bullying of staff registered nurse in the workplace: A preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. Journal of Professional Nursing, 25(5), 299-306.

The authors share the results of their research to validate the perceptions of frequency and patterns of bullying behavior. Using a descriptive survey, they sought to understand what nurse groups are bullied most often, who is committing the bullying, and what mechanisms are used to address the problem. Their results indicate that senior nurses of the same group bully staff nurses working on medical surgical units most. Discussions with family and friends were the mechanisms used most often to address the issue. The authors strongly recommend specific interventions to address the issue of bullying, especially among newer nurses due to the significant workforce and workplace issues.


52.  Wachs, J. (2009). Workplace incivility, bullying, and mobbing. Journal of American Association of Occupational Health Nurses, 57(2). 88.

Dr. Wachs is a professor in the Department of Family/Community Nursing at East Tennessee State University. In her article, she describes the effects of bullying and mobbing on the workforce and in organizations.


53.  Watson, S., Hinton, A. (September 11, 2010). Observations of behavior on the grey wolf. Message posted to

The authors present their observations of the gray wolf’s behavior, particularly with the hierarchies of the pack. Acts of dominance (alpha) and submissiveness (omega) are key behaviors seen among the wolves, creating their societal infrastructure.  The authors’ share stories about their experiences with a pack of wolves in Yellowstone National Park. Although the authors do not relate wolf behavior to human behavior, the leadership hierarchies serve as an analogy to the behaviors seen in current work infrastructures.


54.  World, H. (2008). Lateral violence can end nursing careers. Management & Leadership Specialty Guide.

The author is a freelance writer and provides the reader with an understanding of how serious the issue of lateral violence is in the nursing profession. She cites the works done by Martha Griffin, Sandra Thomas, Pam Marshall, and Katherine Bartholomew in describing the gravity of the issue. The author shines a light on the widespread problem and shares examples with the reader.


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