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Certified Nursing Assistants and Horizontal Violence in the Workplace

Horizontal violence, sometimes also known as lateral violence, is aggressive behavior, harassment (usually verbal but sometimes even physical), or attempts to sabotage advancement among coworkers on roughly the same organizational level. It is a common problem in many professions, but in nursing it seems to be especially marked.

No one is quite sure why this is, but it is believed to have to do with the fact that health care is a male dominated field in which doctors, often men, are seen as having most of the decision making power and nurses are seen as being “mere” assistants. Though greater egalitarianism is an often mentioned as an ideal, the reality may be that the profession still tends to devalue or undervalue the contributions of nurses and nursing assistants. Thus these professionals can feel oppressed – as though they are at the lower rungs of health care hierarchies and not really respected. This can lead them to express their need for power or autonomy by victimizing or impeding the professional advancement of others at the same or lower levels. They do this because they realize that an expression of anger to higher levels of the hierarchy – i.e. doctors, administrative staff, and so on, will probably be unsuccessful or could even cost them their job.

Though this is often seen to happen among actual nurses, sometimes it is those just below their level – CNA’s, as well as new nurses on the job, that bear the brunt of it. They may be the victims of backstabbing, exclusion, verbal abuse, or in-group political maneuvering coming from the nurse level (technically this would be vertical violence – i.e. coming from above – but it follows the same general pattern). Or the phenomenon may be more genuinely horizontal, coming from other nursing assistants.

Often a new CNA will undergo a kind of “hazing period” in which they are given the least favorable assignments – unpleasant jobs with difficult patients and so on. This in itself doesn’t constitute abuse – rookies often have to pay their dues and somebody has to do the jobs. But if it is so repeated that the CNA genuinely begins to feels debased in self worth, and as though there is no attempt being made to help them advance, that is a problem. It becomes especially unfair if it is coupled with an exaggerated amount of accusation and blame being placed on the CNA for any problems that may occur.

Other forms that horizontal violence takes are just what you might imagine – all kinds of competitive behavior among CNA’s and nurses, rude remarks designed to undermine a CNA’s confidence, cliques of nurses or more experienced CAN staff making new assistants feel excluded, remarks to the effect that a CNA’s concerns are not valid and they should “toughen up” or “get with the program,” attempts to intentionally humiliate a CNA and so on.

None of this is new, it’s as old as group in-fighting itself, but being aware of the patterns it tends to take place in nursing can help you get the edge over it and know what to do when it occurs.So what can a CNA do if he or she encounters this kind of behavior? The main idea is to set a different sort of example. Be kind to your fellow CNA’s yourself, especially ones that don’t seem to have many friends or interactions. A friendly attitude will generally create friendliness in return even if this is not recognized at first.

If it does come down to an actual confrontation of some sort, be it from a nurse or fellow CNA, just backing down is not a good solution. Be polite but firm – if there is something you disagree with or that is obviously unfair, you have the right to express it. Remember that this is, or is supposed to be, part of the job. It’s about communication, not blind obedience. You’re supposed to be instructed by others, not dictated to.
One good technique is to ask an argumentative individual to sit down in some other area than where the confrontation is going on and discuss it. Often the simple shift of place creates a different feel and approach in which the concerns can be restated in less exaggerated terms and discussed.

If reasonable attempts to resolve the situation fail, it may be appropriate to meet with the management of your facility. Tell them the situation and that you don’t feel that it’s part of the job for you to be subjected to it. Ask them to arrange meetings in which you and the other members of your work team can discuss problems.

Another thing you can do is ask the management/staff to institute policies and education that help to combat horizontal (as well as vertical) violence in the workplace. You might suggest that they include lectures on it in classes for CNA’s, institute policies for dealing with it if these seem inadequate, set up employee mentoring (which encourages a greater sense of cooperation between employees), have meetings to discuss any workplace violence concerns, and so on. These actions will serve not only to highlight your own personal situation, but prevent other such situations in the future and bring it to a more generalized awareness.

The problem of workplace violence shouldn’t be just swept under the rug, and this applies to the CNA profession as much as any other, maybe more so since it is fairly common in the industry. Don’t assume that this kind of work environment is just status quo or par for the course. The real key to making a difference in this pattern is to be active in changing workplace conditions not only on a personal level but on a larger scale one. If you take this type of purposeful action you’ll not only be doing yourself a favor but creating a better situation for everyone in your profession as a whole.

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