It’s been a stressful day at work — nothing new. Your patient fell, an I.V. line became occluded right when you were ready to hang a blood infusion, and a patient’s family became angry with you. We all experience stressful days, but unfortunately, sometimes we take our stress out on each other. Too often, this ineffective way of identifying and managing stress leads nurses to engage in lateral violence.
Lateral violence is identified and described by the American Nursing Association as acts between colleagues that include covert or overt aggression. These acts of displaced stress can create a tense work environment, psychological anguish, and may even lead some nurses to quit their jobs or abandon their profession all together. The unnecessary outcomes of lateral violence require that we, as professional nurses, proactively seek out meaningful methods to identify and reduce its formation and occurrence. The first step in this endeavor is to examine and develop our emotional intelligence (EI).
What is EI?
EI is the ability to understand and control our own emotions while reading and adjusting to the emotions of others. The behaviors and traits of people who have strong EI levels are also the behaviors and traits of people who are less likely to engage in lateral violence. There are other benefits too. For example, a study conducted with ICU nurses demonstrated that EI education increased nurses’ general health.
Improving EI skills
A study by Sharif and colleagues reported that EI can be taught, meaning we all have the potential to increase our self-awareness, self-regulation, and empathy. Strengthening these aspects of EI can help us to not only understand ourselves, but also how our emotions impact our colleagues.
The first step is to educate ourselves about EI. Next, we must adapt our daily culture to incorporate EI into our practice. Nurses are, after all, nothing if not adaptable. We have gone from paper charting to electronic charting, from wet-to-dry dressings to better wound care options, and from provider-centered interventions to patient-centered, evidence-based practice.
This adaptation requires the use of three tools: purposeful reflection, improvisation, and empathy.
Self-awareness occurs when we engage in purposeful reflection, viewing a situation from multiple angles with the intent to learn and improve decision making.
Take a moment to think about a recent situation when an interaction or conversation did not go well. What started it? What were you feeling at the time? Did you have a long day at work? Did you expect this person to say something you didn’t want to hear? Did someone approach you and demand an immediate conversation?
Now remove yourself from that moment and think of yourself as another person looking in. If you removed the emotions, what was that conversation truly about? Was fear involved? Were you put in a situation that should have been handled at another time? Reflecting purposefully on the situation enables you to recognize the irrational responses.
Purposeful reflection also enables you to identify negative patterns, called triggers. Learning to recognize triggers may prevent unfavorable situations or reactions. Purposeful reflection, when done consistently will aid in reducing negative energy, cut short the conflict, and possibly prevent tense situations. Once you make purposeful reflection a habit, you can then use improvisation to process conflicts on the spot and provide thoughtful feedback.
Applying improvisation skills can help us to control our emotions and can teach us to notice the difference between reactive words and thoughtful words. Here are the steps of improvisation in a situation:
- Be present in the conversation. This can be achieved by counting to 10 before speaking. Counting to 10 releases the limbic system of the body from the flight or fight emotion, so we can be more thoughtful.
- Listen to the other person in the situation.
- Eliminate bias and establish an objective or overall goal for the situation. For example, in nursing we may need to stop thinking how the situation affects us and think about how it affects the patient.
- Be encouraging even if you don’t agree with someone. Try to find a positive spin on another person’s view before sharing your own opinions.
- Seek to provide the necessary feedback that will allow the other person to walk away knowing they were heard, whether or not an agreement was made.
Once you’ve honed the tools of purposeful reflection and improvisation, you can develop a stronger sense of empathy.
Empathy, the process of walking in another’s shoes, moves us away from focusing on ourselves and towards thinking about the needs of others. It is a fundamental aspect of social interaction. As nurses, we consistently do this with our patients, but rarely do it with our co-workers. If the previous shift’s staff caused a problem that you want to discuss with them, you must protect yourself from letting your emotions become reactive and ask yourself, why am I so angry?
Empathy begins with listening. Begin to discuss the situation with the nurse from the last shift by asking an open-ended question. For example say, “How was your night?” Then listen: Your co-worker may share that he or she had a significant problem on the shift. Follow through the conversation to better understand why this co-worker was unable to complete a task or complete a task correctly. Do not listen to solve a problem, do not listen to think about how this affects you, but rather listen with an open mind as it may present an opportunity to learn or an opening to pose clarifying questions.
An agent of change
By developing and sharing the tools of EI—purposeful reflection, improvisation, and empathy—you can be an agent of change. Being a leader has many challenges, but when others see how calmly you manage yourself, aggressive co-workers, and tense situations, they will be inspired.
American Nurses Association. Bullying and workplace violence. 2015.
Caldwell L, Grobbel C. The importance of reflective practice in nursing. Int J Caring Sci. 2013;6(3):319-26.
Martos M, Lopez-Zafra E, Pulido-Martos M, et al. Are emotional intelligent workers also more empathic? Scand J Psychol. 2013;54(5):407-14.
Sharif F, Rezaie S, Keshavarzi S, et al. Teaching emotional intelligence to intensive care unit nurses and their general health: a randomized clinical trial. Int J Occup Environ Med. 2013;4(3):141-8.
Tara Slagle is a course mentor for Western Governor’s University in Salt Lake City, Utah, and a clinical educator at Hanover Hospital in Hanover, Pennsylvania.
Dear Ms. Gelinas,
In the June 2016 issue, Tara Slagle, MSN, BSN, RN, wrote an article entitled “Practicing Emotional Intelligence May Help Reduce Lateral Violence”. The article personally moved me because I only began practicing as a registered nurse last year and I have been a victim of lateral violence. The article discusses how lateral violence can create such personal anguish that nurses feel forced to leave their job or the profession altogether. There have been many times in my short tenure that I considered quitting my job and even questioned if nursing was the profession for me. After to talking to veteran colleagues, I realized that I was not alone in my experience.
The Nursing Solutions, Inc. (NSI) 2016 National Healthcare Retention & RN Staffing Report states the hospital turnover rate for 2015 is 17.1%. The turnover rate for register nurses is 17.2%, an increase from 2014’s 16.4%. The NSI also states that 29.2% of RNs will leave their job within a year. Immediate management and workload/staffing ratios are listed among the top ten reasons why RNs voluntarily resign.
I believe if more nurses improved their emotional intelligence using the tools Slagle described the turnover rate for new nurses would decrease. Beginning a career as a new nurse is a daunting experience. Working with individuals that inappropriately displace their stress makes the transition all the more intimidating. Improving emotional intelligence skills will provide a less tense work environment for all nurses, regardless of tenure.
Tiara J. Gray, RN
A very thoughtful and straightforward article. Thank you for this Tara.