Vertical Violence at BWH is Unacceptable

Much has been made of the issue of lateral violence at BWH. However, there is another problem that contributes directly to the problem of staff nurse-onstaff nurse conflict that is not being adequately addressed, or even mentioned. That problem is vertical violence.

In recent years, there have been a number of studies on the impact of harm done by psychological violence. The study by the International Labor Office is the most in depth one on the subject. It describes vertical violence as when a person in authority is abusive or bullies a subordinate or a peer. Such an individual, through vindictive, cruel, malicious or humiliating behavior, seeks to belittle one or more employees.

The issue of vertical violence, the psychological harassment of staff nurses by nurse managers, is becoming a significant problem at the Brigham. There is a difference between management and harassment, and some of the nurse managers at BWH frequently cross the line - inflicting psychological violence on nurses. This demeaning behavior promotes lateral conflict, where nurses take out their frustrations on each other rather than responding to the actual source. With no support from co-workers, individual nurses can easily feel victimized by management oppression.

Vertical violence, as a means of manipulating and controlling staff nurses, can also include the covert tactics of playing favorites, denial of requests, detrimental shift and rotation scheduling, etc.

Ask the staff nurses on any floor/unit; they will be able to tell you about vertical violence. Some managers make no attempt to hide their disdain for the nurses they do not like. On a regular basis, they are subjected to intimidation over their appropriate use of sick time. Nurses are belittled and condemned. They are told that their illness will cause hardship on co-workers because the sick nurse will not be replaced, thus increasing the workload on an already busy unit. What these managers fail to realize is that their actions create a lack of morale on the floor and this has a negative impact on patient care. It leads to a loss of trust, a decrease in effective communication and it may also increase staff illness rates.

Nursing administration at BWH is focusing on the issue of lateral violence. At annual competencies, nurses are shown a film where one nurse “rolls her eyes” while receiving report from another nurse. This is used to illustrate disrespect as a form of lateral violence in the workplace. There are presently BWH nurse managers who not only roll their eyes when speaking to nurses, but they also spread rumors and divulge confidential about staff to other staff members. Unfortunately, we are not seeing any efforts to investigate or control one of the root causes of lateral violence – the psychological oppression that results from vertical violence. Hospital and Nursing Administration must take a strong stand on this issue in order to increase job satisfaction, promote retention, and improve patient care. They must institute a culture that is free from vertical violence.

Until that happens, what can staff nurses do? First, it must be recognized that any unit with low morale, high sick-time usage, and high staff turnover is probably being managed by a leader who uses oppression and vindictiveness on a regular basis. Staff nurses on these units must make a diligent effort to provide support for each other in order to diffuse the effects of this negative management style. Secondly, nurses should contact their MNA Representative to report all instances of overt and covert vertical violence. The MNA will then present Nursing Administration with regular reports summarizing these detrimental behaviors and identifying the managers most responsible.

If Nursing Administration fails to respond by taking actions against vertical violence, then the MNA will seek other remedies.