Breaking the Silence on Lateral Hostility in Nursing

Lateral hostility—sometimes referred to as horizontal violence—is an unfortunate and persistent issue in the nursing profession. Despite nursing’s strong ethical foundation and emphasis on compassion, the reality is that nurses don’t always treat each other with the respect and support they extend to their patients.

Understanding what lateral hostility looks like, why it happens, and what can be done about it is the first step in creating healthier, more supportive work environments for all nurses.

What Is Lateral Hostility?

Lateral hostility refers to negative behaviors that nurses direct toward one another within the same level of an organizational hierarchy. It can manifest in many forms, including:

• Gossip or passive-aggressive communication
  
• Undermining or dismissing a colleague’s contributions
  
• Intentional exclusion or isolation
  
• Belittling remarks or sarcasm
  
• Withholding critical information needed for patient care
  
• Sabotaging a peer’s performance
  

These actions might be subtle or overt, but over time, their cumulative effect can be damaging to morale, job satisfaction, and even patient safety.

Why Does It Happen?

The causes of lateral hostility in nursing are complex. Contributing factors may include:

• High-stress environments: Nursing is emotionally and physically demanding, and chronic stress can impact interpersonal behavior.
  
• Hierarchical or competitive cultures: Some workplace environments inadvertently encourage competition over collaboration.
  
• Burnout and fatigue: Emotional exhaustion can reduce empathy and increase frustration with colleagues.
  
• Poor leadership or lack of accountability: When negative behaviors go unchecked, they can become normalized.
  
• Learned behaviors: In some cases, nurses who experience hostility early in their careers may perpetuate it later on.
  

Importantly, lateral hostility is rarely about individual “bad actors”—it often reflects broader issues in workplace culture, systems, and leadership.

The Impact on Nurses and Patients

Lateral hostility doesn’t just hurt feelings—it can have real consequences. Studies show it contributes to:

• Increased nurse turnover and staff shortages
  
• Decreased job satisfaction and engagement
  
• Higher rates of burnout and emotional distress
  
• Reduced collaboration and communication
  
• Compromised patient care and safety
  

When trust and teamwork break down, the ripple effect reaches everyone—from staff members to the patients they care for.

Addressing the Problem

Confronting lateral hostility requires a multi-faceted approach that prioritizes both individual responsibility and organizational change.

1. Awareness and Education

Creating space for conversations about workplace behavior helps break the stigma and silence. Workshops, continuing education courses, and team debriefings can promote understanding and give nurses tools for navigating conflict respectfully.

2. Supportive Leadership

Leaders set the tone. Nurse managers and executives must model respectful communication, call out inappropriate behavior, and support staff when concerns arise. Establishing a zero-tolerance policy is one step—but enforcing it consistently is what builds trust.

3. Clear Reporting Mechanisms

Nurses need safe, confidential ways to report hostile behaviors without fear of retaliation. Follow-up and transparency are key to showing that reports are taken seriously.

4. Building a Culture of Civility

Fostering a workplace culture where kindness, collaboration, and psychological safety are the norm can help prevent hostility before it begins. This includes team-building activities, shared governance models, and recognition of positive peer behaviors.

Moving Forward

No one enters nursing to be part of a hostile work environment. Most nurses want to support and uplift one another—but like any human system, the workplace requires intentional care and honest reflection.

If you’re a nurse experiencing lateral hostility, know that you’re not alone—and that change is possible. And if you’re in a position to lead, even informally, your influence matters more than you may realize. Shifting culture takes time, but it starts with how we treat each other—every shift, every interaction.