How Lateral Violence Can Impact the Work Environment
Lateral Violence and the Work Environment
Lateral violence — defined as non-physical, hostile, aggressive, or harmful behavior between coworkers of the same peer group — profoundly impacts the work environment by eroding psychological safety, destroying team cohesion, compromising patient safety, accelerating nurse turnover, and creating a toxic organizational culture that undermines the quality of healthcare delivery at every level. Its consequences extend far beyond the individual victim-perpetrator relationship, producing ripple effects across staffing stability, financial sustainability, communication infrastructure, ethical climate, and the overall quality of patient care.
Defining Lateral Violence in Healthcare Settings
Lateral violence (LV), which belongs to internal workplace violence, refers to inter-group conflict manifested by sabotage, infighting, scapegoating, criticism, and other explicit and implicit non-physical hostilities. It focuses on the negative behavior between peers with the same social status in the work environment — that is, intimidation behaviors between peers. The nursing profession has characteristics of heavy workload and cumbersome work content, making nurses prone to psychological and physiological stress responses in high-stress situations. HealthySimulation.com
Nurse-to-nurse horizontal violence refers to disruptive, aggressive, or hostile behaviors — whether occasional or recurrent — that occur among nurses of the same hierarchical level within healthcare settings. These behaviors can take various forms, ranging from verbal hostility to physical aggression with the intent to degrade or demean the recipient. Most authors classify horizontal violence into physical, psychological, and verbal types. Some studies further distinguish between overt and covert violence, where overt violence includes insults, threats, and workplace sabotage, while covert violence manifests through microaggressions, social exclusion, and the deliberate withholding of critical information. OnlineNursingPapers
Prevalence of Lateral Violence
The scope of lateral violence in nursing is alarming. Workplace incivility among peers accounts for values higher than 75%, while lateral violence has a prevalence ranging from 1% to 87.4% and bullying prevalence varies between 2.4% and 81%. Physical and mental sequelae can affect up to 75% of the victims. kaplan.com
The prevalence of inter-nurse lateral violence reported in current studies is inconsistent, ranging from 7% to 83%. The nursing profession has the characteristics of heavy workload and cumbersome work content, creating conditions where nurses vent their dissatisfaction to colleagues, resulting in internal violence. HealthySimulation.com These figures confirm that lateral violence is not an occasional aberration but a systemic feature of many healthcare environments.
Impact on Psychological Well-Being
One of the most immediate consequences of lateral violence is the severe psychological harm it inflicts on targeted nurses. The 10% of bullied nurses develop Post-Traumatic Stress Disorder symptoms. Bullying is a predictive factor for burnout and shows a negative correlation with job efficiency. Victims of bullying recorded absenteeism 1.5 times higher in comparison to non-victimized peers. kaplan.com
Workplace violence is a social problem present in virtually all work environments, but its prevalence in healthcare settings stands out, being perceived as something inherent to the job. The psychological burden of lateral violence includes anxiety, depression, diminished self-esteem, and social withdrawal, with downstream effects on both professional performance and personal life quality. Studocu
Individuals exposed to psychological abuse such as workplace bullying experience physical, mental, and social issues due to elevated levels of stress and anxiety. Workplace violence and its health consequences must be investigated further to foster a healthy and safe working environment, which may reduce nurse turnover and improve staffing shortages. Kaplan
Impact on Job Burnout
Lateral violence is a powerful and well-documented driver of occupational burnout. Research indicates that inter-nurse horizontal violence is a significant predictor of job burnout, with a positive correlation between the two. Psychological detachment has been identified as playing a partial mediating role in the association between inter-nurse horizontal violence and job burnout, with the mediating effect accounting for 44.73% of the total effect. Furthermore, a sense of professional mission weakens the negative prediction of horizontal violence on psychological detachment. AceMyHomework
In a systematic review and meta-analysis of 85 studies including 288,581 nurses, nurse burnout was associated with a lower patient safety climate and patient safety grade, more nosocomial infections, patient falls, medication errors and adverse events, lower patient satisfaction ratings, and lower nurse-assessed quality of care. These associations were consistent across nurse age, sex, work experience, and geography. Ihumassignments
Impact on Nurse Turnover
A systematic review and meta-analysis examining the relationship between horizontal violence and turnover intention in nurses found a low-positive correlation with turnover intention (pooled r = 0.32 [0.29–0.34]) across 14 studies involving 6,472 nurses. This finding confirms that horizontal violence is a consistent and significant contributor to nurses’ intentions to leave their positions. Kaplan
Among bullied nurses with length of service lower than five years, 78.5% resigned to move to other jobs. This turnover compounds an already critical nursing shortage, representing a significant expenditure in initial training and institutional investment that will not be recouped by the organization. kaplan.com
Impact on Patient Safety
Horizontal violence negatively impacts patient safety by disrupting workflow efficiency and fostering a toxic work environment. It contributes to communication failures and impairs clinical judgment, which has been linked to increased patient mortality, complication rates, and readmissions. OnlineNursingPapers
Of the 105 studies analyzed in a PRISMA-guided integrative review searching Web of Science, PubMed, and CINAHL using the keywords patient safety, nursing, horizontal violence, and lateral violence — 29 were ultimately extracted, with 27 indicating a direct link between horizontal and/or lateral violence and patient safety outcomes. USA Nursing Papers
Incivility is a barrier to safe and high-quality patient care in hospitals because acts of incivility — from patient-to-provider violence to peer-to-peer bullying — erode the core of the care environment and negatively impact an organization’s culture of safety. Incivility also results in nurse burnout, decreased job performance, and lower patient safety. A reduction of incivility in hospitals can improve nurses’ quality of life and improve the quality of care delivered. Kaplan
Impact on Organizational Culture and Communication
From a theoretical perspective, horizontal violence in nursing is not just an interpersonal issue but is deeply embedded in the organizational structure and power dynamics within healthcare. Freire’s theory of oppression describes how subordinated groups internalize their position and reproduce oppression within their group instead of challenging those in power. The historical evolution of nursing exemplifies this pattern, as the professionalization and bureaucratization of healthcare systems under a medical model led to the increased subordination of nurses. OnlineNursingPapers
Prevention of workplace incivility, lateral violence, and bullying among nurses should start from spreading information inside continuing educational settings and university nursing courses. There is a lack of evidence about policies and programs to eradicate these behaviors in healthcare, underscoring the urgent need for structured, evidence-based organizational intervention at both the leadership and systems level. Ihumanassignmenthelp
In summary, lateral violence in the work environment is a multidimensional crisis that requires immediate, sustained, and evidence-based organizational action — not only to protect nurses from profound psychological, professional, and physical harm but to preserve the safety, quality, and ethical integrity of patient care across all healthcare settings.
References
Fujii, R., Pellegrino, L., Traini, G. V., & Di Palma, G. (2025). Implications of nursing peer violence on patient safety: An integrative review. International Nursing Review, 72(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC12224223/
Zhang, Y., Cai, J., Yin, R., Qin, S., Wang, H., Shi, X., & Mao, L. (2022). Prevalence of lateral violence in nurse workplace: A systematic review and meta-analysis. BMJ Open, 12(3), e054014. https://pmc.ncbi.nlm.nih.gov/articles/PMC8966576/
Vidal-Alves, M. J., Pina, D., Ruiz-Hernández, J. A., Puente-López, E., Paniagua, B., & Martínez-Jarreta, B. (2022). (Un)Broken: Lateral violence among hospital nurses, user violence, burnout, and general health: A structural equation modeling analysis. Frontiers in Medicine, 9, 1045574. https://pmc.ncbi.nlm.nih.gov/articles/PMC9729731/
Spiri, W. C., & MacPhee, M. (2019). Workplace incivility, lateral violence and bullying among nurses: A review about their prevalence and related factors. Acta Paul Enferm, 32(1). https://pmc.ncbi.nlm.nih.gov/articles/PMC6357596/
Reguera-Carrasco, J. M., Pérez-García, E., & González-Gil, M. T. (2025). Understanding the predisposing factors of nurse-to-nurse horizontal violence in hospital settings: An integrative review. Journal of Clinical Nursing. https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834
Zhang, Y., Yin, R., Lu, J., Cai, J., Wang, H., Shi, X., & Mao, L. (2022). Association between horizontal violence and turnover intention in nurses: A systematic review and meta-analysis. Frontiers in Public Health, 10, 964629. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.964629/full
Li, L. Z., Yang, P., Singer, S. J., Pfeffer, J., Mathur, M. B., & Shanafelt, T. (2024). Nurse burnout and patient safety, satisfaction, and quality of care: A systematic review and meta-analysis. JAMA Network Open, 7(11), e2443059. https://pmc.ncbi.nlm.nih.gov/articles/PMC11539016/
Bambi, S., Foà, C., De Felippis, C., Lucchini, A., Guazzini, A., & Rasero, L. (2019). Preventing workplace incivility, lateral violence and bullying between nurses: A narrative literature review. Acta Paul Enferm, 32(1). https://pmc.ncbi.nlm.nih.gov/articles/PMC6357576/
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