The colloquial phrase “nurses eat their young” describes a harmful pattern of behavior within healthcare. This phenomenon, which often targets new nurses and students, is professionally termed horizontal violence or lateral violence. It is a serious form of workplace aggression occurring between colleagues of roughly equal professional standing. Understanding this pattern is necessary because it threatens the professional well-being of nurses and the overall stability of the healthcare workforce. This behavior is a deep-seated problem requiring examination of its origins, triggers, effects, and necessary organizational change.
Defining Horizontal Violence in Nursing
Horizontal violence (HV) is defined as aggression, hostility, or bullying directed toward a peer or coworker, often manifesting as non-physical, passive-aggressive behaviors. This peer-to-peer mistreatment is distinct from vertical violence, which involves a power differential, such as a manager bullying a subordinate. These behaviors are frequently subtle, occurring repeatedly over time to create a cumulatively hostile and toxic work environment.
Withholding Information
One common manifestation involves the intentional withholding of information a colleague needs to safely perform their duties. This sabotage includes deliberately failing to pass on necessary patient updates during shift reports or neglecting to inform a coworker of a new policy change. Such actions put the targeted nurse at a disadvantage, increasing the likelihood of error.
Exclusion and Shunning
Another form of HV is the purposeful exclusion of a coworker from professional or social interactions. This can involve shunning, ignoring a nurse when they ask a question, or forming cliques that exclude a target from team meetings or lunch breaks. The isolation undermines the nurse’s sense of belonging and denies them access to the informal knowledge network necessary for effective practice.
Excessive Criticism and Gossip
Aggressors may engage in excessive criticism, public humiliation, or verbal remarks intended to demean a peer. This includes sarcastic comments, shouting, or using a patronizing tone when addressing a colleague in front of others. Spreading malicious gossip or talking poorly about a colleague behind their back damages professional reputations and creates an atmosphere of distrust.
Sabotage and Unmanageable Workloads
Sabotage involves setting a colleague up for failure, such as the deliberate misplacement of supplies or the manipulation of work assignments. A nurse may be allocated an unrealistically heavy workload for a single shift, knowing the resulting stress will lead to mistakes. These actions are designed to undermine the target’s competence and confidence.
The Historical and Cultural Roots of Workplace Hostility
The origins of horizontal violence are deeply embedded in the historical and cultural context of the nursing profession. Nursing has long been situated in a rigid, male-dominated hospital hierarchy, positioning nurses as subordinate to physicians and administrators who hold greater power. This resulting lack of control over professional practice is a significant factor in the development of peer aggression.
This lack of power aligns with the Oppressed Group Behavior Theory. This theory posits that marginalized groups may internalize frustration from their subordinate status and redirect that aggression inward toward their peers. Instead of confronting the external system that limits their authority, nurses attack those perceived as less powerful, such as new graduates or less experienced staff. This fosters a culture where aggression becomes an accepted coping mechanism.
The historical military-like structure within nursing education and hospital administration cemented a culture of rigid discipline. This legacy perpetuates a mindset that new nurses must endure a “rite of passage” or “hazing” period to earn respect. This belief system normalizes peer-to-peer hostility as an inevitable part of professional socialization.
Current Operational Factors Fueling the Behavior
Immediate operational factors within modern healthcare settings fuel horizontal violence. The high-stress, fast-paced nature of hospitals reduces empathy and increases emotional exhaustion among staff. Chronic understaffing means experienced nurses consistently manage demanding workloads and high patient acuity levels.
This continuous pressure creates a “survival mode” environment. Veteran nurses may view new hires not as resources, but as added burdens that strain their limited capacity. The perception that new nurses are underprepared or require extensive support translates into resentment and hostility. Heavy workloads and insufficient resources push nurses past their limits, expressing suppressed frustration as aggression toward colleagues.
A culture of poor management accountability allows this behavior to persist. When organizational leaders fail to address reported incidents decisively, it signals that hostility is tolerated or expected. This permissive culture contributes to an environment where disruptive behaviors are normalized and become a mechanism for some staff to exert informal power. The lack of standardized conflict resolution training exacerbates the problem, leaving nurses ill-equipped to manage interpersonal stress constructively.
The Devastating Impact on New Nurses and Patient Care
The consequences of horizontal violence compromise the stability of the nursing workforce and the quality of patient care. New graduate nurses are disproportionately affected and often leave their first job due to a hostile work environment, contributing to high turnover rates. Research suggests that approximately 60% of new graduate nurses leave their positions within six months of hire, with horizontal violence being a primary factor.
The psychological toll on the targeted nurse often leads to anxiety, depression, and diminished professional confidence. Nurses subjected to peer aggression frequently report symptoms such as post-traumatic stress disorder, chronic insomnia, and negative self-image. This emotional distress directly impacts job performance, increasing the likelihood of mistakes, absenteeism, and reduced productivity.
The behavior also negatively impacts patient safety and the quality of care delivery. When nurses are afraid to ask questions or seek clarification for fear of ridicule, they may rely on incomplete information, increasing the risk of errors. A fractured care team preoccupied with internal conflict cannot provide optimal patient care. High turnover also imposes a significant financial burden on healthcare organizations, as replacing a single registered nurse costs tens of thousands of dollars.
Strategies for Navigating a Hostile Workplace
Nurses who experience horizontal violence can adopt specific strategies to protect their professional standing and personal well-being.
Individual Strategies
Establish firm, professional boundaries by clearly and calmly articulating expectations for respectful communication to the aggressor. This response should be non-confrontational but definitive, reinforcing that the aggressive behavior is unacceptable.
Carefully and objectively document all incidents, including the date, time, location, exact words or actions used, and the names of any witnesses. This provides concrete evidence should formal reporting become necessary.
Seek out mentorship from a trusted, experienced nurse outside the immediate unit or department to provide psychological support and unbiased professional guidance.
Utilize resources like the Employee Assistance Program (EAP), which offers confidential counseling and support services to manage anxiety and stress.
Use established reporting channels when self-protection strategies are insufficient, ensuring awareness of the procedure for reporting peer aggression to management or human resources without fear of retaliation.
Systemic Solutions for Eradicating the Culture
Eradicating the culture of horizontal violence requires a top-down, organization-wide commitment to structural reform and accountability.
Organizational Reforms
Implement and strictly enforce clear, zero-tolerance policies that define horizontal violence and outline progressive disciplinary actions, including termination. This policy must be consistently applied across all roles and levels.
Require leadership to model respectful communication and ensure managers are approachable and responsive to staff concerns.
Hold senior staff and managers accountable for ignoring or perpetuating a hostile environment. Accountability measures can include linking respectful conduct to yearly performance evaluations and eligibility for merit raises.
Integrate mandatory, comprehensive training programs focused on professional conduct, conflict resolution, and stress management into staff development for all employees.
Implement formal mentorship programs where new nurses are paired with supportive, trained mentors, providing a structured support system that counters isolation.
Provide safe and confidential reporting mechanisms, such as anonymous surveys or a dedicated third-party reporting line, to encourage staff to report incidents without fear of professional reprisal.