Lateral Hostility in Nursing: What It Is and How to Address It
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Authored by Dr. Pam Vollmer, DNP, RN, AMB-BC, NPD-BC, CEO and Director of Content at CE Ready
What nurses need to know
Lateral hostility in nursing describes negative behaviors that nurses direct toward colleagues at the same organizational level. Also called horizontal violence or nursing incivility, it takes many forms: passive aggression, deliberate exclusion, public humiliation, withholding critical information, and undermining a colleague’s work or reputation. The American Nurses Association identifies workplace incivility as a significant threat to nurse wellbeing, staff retention, and patient safety. Lateral hostility persists in part because it often goes unreported, and in part because high-stress clinical environments can normalize behaviors that would be recognized as unacceptable in other professional settings. Individual nurses can protect themselves through documentation, boundary-setting, and early use of reporting channels. Organizations address it effectively through leadership accountability, clear reporting mechanisms, and CE that builds the communication and conflict resolution skills that healthy teams require. CE Ready is an ANCC-accredited CE provider (P0986) based in St. Petersburg, FL, with courses in communication, professional conduct, and leadership development that support safer, more civil nursing work environments.
She was six months into her first nursing job. She noticed that certain colleagues stopped talking when she entered the break room. Patient information that should have been shared during handoff sometimes wasn’t. When she asked questions, she was met with sighs, eye-rolls, or terse one-word answers. She assumed she was doing something wrong, however she was experiencing lateral hostility in nursing — one of the profession’s most persistent and least-discussed problems.
That experience is not unusual. Lateral hostility affects nurses at every career stage, in every specialty, and in every practice setting. This guide covers what it is, why it happens, and what both individual nurses and organizations can do to address it.
What Is Lateral Hostility in Nursing?
Lateral hostility in nursing refers to hostile, dismissive, or undermining behaviors directed by nurses toward colleagues at the same organizational level. The terms lateral violence and horizontal violence describe the same phenomenon. All three are distinct from top-down bullying by supervisors, though the two can coexist in the same environment.
The behaviors that constitute lateral hostility range from subtle to overt. What makes the subtle forms particularly damaging is that they often go unrecognized — by the target, by bystanders, and by leadership — until they’ve accumulated into a pattern with significant professional and clinical consequences.
The table below organizes common forms of lateral hostility by type, with examples and the primary impact each tends to produce.
| Form | Examples | Primary Impact |
| Passive aggression | Eye-rolling, sighing, dismissive gestures, ignoring | Self-doubt, anxiety, isolation |
| Deliberate exclusion | Withheld invitations, ignored in conversations, social isolation | Professional marginalization, loneliness |
| Verbal hostility | Public criticism, sarcasm, demeaning comments, condescension | Humiliation, loss of confidence |
| Information withholding | Incomplete handoffs, blocked access to orientation support, deliberate gaps in communication | Direct patient safety risk, professional failure |
| Sabotage | Undermining contributions, spreading rumors, taking credit for work | Reputation damage, career harm |
| Excessive workload targeting | Deliberately assigning unfair workloads, denying assistance | Burnout, increased error risk, resentment |
Information withholding deserves particular attention. Unlike other forms of lateral hostility, it creates direct patient safety risk by introducing gaps into care that newer or less experienced nurses may not recognize or know how to compensate for on their own.
Why Lateral Hostility Happens in Nursing
Understanding why lateral hostility occurs in nursing environments doesn’t excuse it. It does, however, identify the conditions that make it more likely and the leverage points where intervention produces real change.
High-stress clinical environments place nurses under sustained physical and emotional demands. Chronic stress reduces empathy, shortens patience, and increases interpersonal friction. Furthermore, when that stress goes unaddressed at the organizational level, it tends to flow sideways toward colleagues rather than upward toward leadership.
Burnout and emotional exhaustion reduce the emotional resources nurses need to maintain respectful, supportive colleague relationships. A nurse who is depleted has less capacity for the kind of generosity and patience that healthy team dynamics require. Additionally, burnout often coincides with cynicism about the profession itself, which can manifest as resentment toward newer nurses who still hold the enthusiasm the burned-out nurse has lost.
Hierarchical or competitive cultures in some healthcare settings inadvertently encourage nurses to compete for recognition, preferred assignments, or advancement opportunities. Consequently, collaboration gives way to competition, and peers start treating each other as rivals rather than teammates.
Poor leadership and lack of accountability allow hostile behavior to persist long after it should have been addressed. When nurses observe that lateral hostility goes unchallenged — that the colleague who regularly undermines others faces no consequences — the behavior becomes normalized. Over time, it becomes embedded in unit culture rather than recognized as a violation of professional standards.
Learned behavior across generations represents perhaps the most insidious mechanism. Nurses who experience lateral hostility early in their careers sometimes replicate it later, often unconsciously. The dynamic has been captured in the phrase “nurses eat their young” — a phrase that reflects a real pattern with roots in how early professional experiences shape expectations about how colleagues treat one another.
The Impact on Nurses and Patient Safety
Lateral hostility in nursing causes harm at both the individual and systems level. Research in the Journal of Nursing Management shows that nurses experiencing lateral hostility report significantly higher burnout rates, lower job satisfaction, and stronger intention to leave their positions than colleagues who do not. Turnover driven by hostile work environments creates staffing shortages, increases cost-per-hire, and disrupts care continuity — consequences that extend well beyond the nurses directly involved.
At the patient safety level, the connection is direct. The Joint Commission has issued formal guidance connecting disruptive behavior and bullying in healthcare to preventable patient harm. When information doesn’t flow freely between team members — because hostility has damaged trust or communication — clinical errors become more likely. Nurses who fear mockery or dismissal become reluctant to raise concerns, ask questions, or report near-misses. That silence is dangerous.
The American Association of Critical-Care Nurses identifies a healthy work environment as essential to optimal patient outcomes and professional fulfillment. Their Healthy Work Environment standards place skilled communication and true collaboration at the center of safe, effective nursing practice. Lateral hostility undermines both.
Additionally, lateral hostility affects those who witness it, not only those who experience it directly. Bystanders in environments where hostile behavior is tolerated report elevated stress and disengagement. They also experience the ethical burden of watching a colleague be mistreated without feeling empowered to intervene.
What Nurses Can Do When They Experience Lateral Hostility
Individual nurses facing lateral hostility have several options, and most situations benefit from a layered approach rather than a single response.
Document specific incidents. Keep a written record of dates, times, locations, the behavior observed, any witnesses present, and the impact on your work or wellbeing. Specific documentation carries far more weight in formal reporting processes than general impressions. Furthermore, documenting incidents as they occur helps you recognize patterns that might otherwise seem isolated.
Name the behavior directly when safe to do so. In some situations, a calm, clear statement to the colleague involved can interrupt the pattern. Something like “I noticed that my question wasn’t answered during handoff — can we talk about how we share patient information?” gives the other person an opportunity to correct the behavior without escalating to formal channels. This approach works best when the behavior is relatively mild and the relationship allows for direct conversation.
Use reporting mechanisms. If direct conversation isn’t possible or hasn’t produced change, formal reporting through your charge nurse, nurse manager, or HR department is appropriate. Before reporting, review your organization’s reporting process and bring your documentation. Additionally, many organizations offer employee assistance programs that provide confidential support during the reporting process.
Seek peer support and mentorship. Lateral hostility is isolating by design. Connecting with a trusted colleague, mentor, or professional organization provides both practical guidance and the professional affirmation that hostile behavior aims to undermine. For guidance on building a support structure within your career, see CE Ready’s nurse professional development guide.
Protect your own wellbeing. Sustained exposure to workplace hostility affects mental health significantly. Maintaining boundaries around your emotional energy, seeking support from trusted colleagues or mental health resources, and attending to self-care practices are not optional extras when navigating a hostile work environment. For evidence-based strategies specific to nursing, see CE Ready’s self-care for nurses guide.
What Organizations Must Do to Address Lateral Hostility
Individual responses to lateral hostility are necessary but not sufficient. Lasting change requires organizational commitment at the leadership and systems level.
Leadership accountability is the foundation. Nurse managers and executives who tolerate lateral hostility — whether through inaction, minimization, or failure to follow through on reports — signal to the entire unit that the behavior is acceptable. By contrast, leaders who name the behavior, take reports seriously, and apply consistent consequences build the psychological safety that allows hostile behavior to be challenged rather than endured.
Clear, accessible reporting mechanisms matter. Nurses need safe, confidential pathways to report hostile behavior without fear of retaliation. Creating a formal reporting process carries value only when leadership responds to reports consistently, follows up with the person who submitted the concern, and demonstrates that each report resulted in a considered response. Transparency about how reports are handled reinforces that the mechanism is genuine rather than performative.
Education and training create shared language. Many nurses lack the vocabulary to identify lateral hostility clearly, which makes it harder to report and harder to address. CE covering workplace incivility, communication skills, and conflict resolution gives entire teams a shared framework. When a unit has a common understanding of what healthy versus unhealthy workplace behavior looks like, calling out lateral hostility becomes more straightforward for everyone involved. The ANCC Magnet Recognition Program explicitly evaluates nursing work environment quality as a component of exemplary professional practice.
Building a culture of civility goes beyond policy. Zero-tolerance policies matter. Consistent enforcement matters more. And beyond enforcement, organizations that invest in team-building, shared governance, peer recognition programs, and genuine staff wellbeing initiatives create the positive relational conditions that make lateral hostility harder to sustain. Culture doesn’t change through policy alone. It changes through repeated, visible choices by leaders and peers about how to treat one another.
Frequently Asked Questions About Lateral Hostility in Nursing
What is the difference between lateral hostility and bullying in nursing?
Lateral hostility in nursing describes hostile behavior between colleagues at the same organizational level — peer-to-peer. Bullying typically describes a power imbalance, often from a supervisor or senior colleague toward someone with less institutional power. Both are harmful, both compromise patient safety, and both require organizational response. In practice, the two can overlap in environments where senior nurses target newer colleagues. The mechanisms for addressing both involve documentation, reporting, and organizational accountability at the leadership level.
Why is lateral hostility so common in nursing?
Lateral hostility persists in nursing for several interconnected reasons. High-stress clinical environments reduce interpersonal patience. Burnout diminishes empathy. Competitive or hierarchical cultures create conditions where peers feel like rivals. Poor leadership allows hostile behavior to go unchallenged long enough to become normalized. And in some cases, nurses who experienced lateral hostility early in their careers replicate it later — not necessarily intentionally, but as a reflection of what they learned about how colleagues are treated. Addressing these root causes requires both individual and organizational responses.
What should I do if I witness lateral hostility between colleagues?
Bystander intervention is one of the most effective mechanisms for interrupting lateral hostility. You don’t need to confront the behavior aggressively. Simple acknowledgment — checking in with the targeted colleague, naming what you observed in a calm follow-up conversation, or supporting a colleague who wants to report — makes a meaningful difference. Additionally, organizations with active bystander training programs see higher rates of early intervention and lower rates of escalated lateral hostility. If your organization doesn’t offer this training, raising it as a CE or professional development need is an appropriate advocacy step.
Does lateral hostility affect patient care?
Yes, directly. The Joint Commission has issued formal guidance connecting disruptive behavior and bullying in healthcare to preventable patient harm. When lateral hostility damages trust between team members, communication breaks down. Nurses who fear mockery or dismissal become reluctant to raise concerns, ask questions, or report near-misses. That reluctance creates clinical risk. Safe patient care requires that all team members feel comfortable communicating openly — and lateral hostility actively undermines that condition.
How can continuing education help address lateral hostility?
CE in communication skills, conflict resolution, professional conduct, and leadership development directly addresses the competencies that healthy work environments require. When nursing teams share a common vocabulary for identifying and addressing hostile behavior, early intervention becomes more likely. CE also supports the leadership development that nurse managers need to respond effectively to lateral hostility rather than allowing it to persist through inaction. For CE options that support communication and conflict resolution skills, see CE Ready’s course catalog.
Can lateral hostility cause PTSD or lasting psychological harm?
Research supports that sustained workplace hostility can produce symptoms consistent with occupational trauma, including anxiety, depression, hypervigilance, and in some cases post-traumatic stress. Nurses who experience prolonged lateral hostility without organizational support are at elevated risk for burnout, career disengagement, and voluntary departure from the profession. If you are experiencing significant psychological distress related to workplace hostility, consulting a mental health professional is appropriate and important. Employee assistance programs, which most healthcare employers offer, provide confidential access to counseling services as a starting point.
Build Healthier Nursing Work Environments with CE Ready
CE Ready is an ANCC-accredited CE provider (P0986) based in St. Petersburg, FL, with CE courses in communication, conflict resolution, professional conduct, and nurse leadership development. These courses support individual nurses in building the skills to navigate difficult workplace dynamics and support organizations in creating the shared competency foundation that healthy work environments require. Every course awards clearly stated ANCC contact hours and reports automatically to CE Broker in participating states.
Browse CE Ready’s full course catalog at ceready.com/courses/ and find CE that builds the professional skills your workplace environment needs.
References
American Association of Critical-Care Nurses. (2024). Healthy work environment standards. https://www.aacn.org/nursing-excellence/healthy-work-environments
American Nurses Association. (2024). Workplace violence and incivility. https://www.nursingworld.org/
American Nurses Credentialing Center. (2024). Magnet recognition program. https://www.nursingworld.org/organizational-programs/magnet/
Journal of Nursing Management. (2024). Wiley Online Library. https://onlinelibrary.wiley.com/journal/13652834
National Council of State Boards of Nursing. (2024). Nursing professional conduct. https://www.ncsbn.org/
The Joint Commission. (2024). Sentinel event alert: Bullying and disruptive behavior. https://www.jointcommission.org/