Copyright © 2017 Marilyn Morrison et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. International Journal of Advanced Nursing Studies, 6 (2) (2017) 85-91 International Journal of Advanced Nursing Studies Website: www.sciencepubco.com/index.php/IJANS doi: 10.14419/ijans.v6i2.8264 Research paper Lateral violence among nurses at a Jamaican hospital : a mixed methods study Marilyn F Morrison 1 , Jascinth LM Lindo 1, 2 *, Joyette Aiken 1 , Claudette R. Chin 2 1 The University of the West Indies The UWI School of Nursing 9 Gibraltar Camp Way Mona, Kingston 7, Jamaica 2 Barry University, CNHS, 11300 NE 2nd Avenue, Miami Florida 33161 *Corresponding author E-mail: jlindo@barry.edu Abstract Purpose: In many first-world settings, lateral violence among nurses is pervasive and has been associated with deleterious psychological effects, high staff turnover and negative patient outcomes. This study explored lateral violence among nurses at a Jamaican hospital. Methods: A fixed concurrent QUAN= QUAL mixed method study design was employed. Data were gathered from 114 registered nurses using the 38-item Briles’ Sabotage Savvy self-administered questionnaire and two focus group discussions. Results: Exposure to lateral violence was reported by 96% of participants, and 3/4 rated the exposure as moderate to severe. Nurse Man- agers were the main perpetrators of lateral violence (63%). Lateral violence created a hostile environment, and half of the nurses surveyed indicated an intent to resign. These survey findings were supported by the focus group discussions which yielded themes inclusive of professional disengagement and erosion of team work. Conclusion: The high levels of lateral violence reported in this study indicates an urgent need for the implementation of appropriate workplace violence policies. Reported threats to the healthcare system included poor staff retention and professional disengagement. Highlights: • Lateral violence among nurses is one of the most damaging issues affecting the progress of the nursing profession and is well studied in the developed world. • The attributes of the phenomenon of lateral violence in a low and middle-income country are described in this paper. • Exposure to lateral violence was reported by 96% of participants, forms of lateral violence appeared to be mainly verbal or emotional and nurse managers were the major perpetrators. • Assimilated behavior in response to lateral violence among the nurses included professional disengagement, retaliation, avoidance and intent to resign. • The pervasiveness of lateral violence among the nurses studied indicates the need to implement appropriate workplace violence policies. Keywords: Abuse; Lateral Violence; Sabotage; Bullying; Nursing; Retention 1. Introduction Lateral violence among nurses is one of the most prevalent and damaging issues affecting the progress within the nursing profes- sion today (Blair, 2013). The terms lateral violence and horizontal violence may be used synonymously and are generally described as abuse or hostility within the working environment (Stanley et al. 2007, Wilson et al. 2011). Other terms such as incivility, bullying, relational aggression and workplace violence have also been used to describe the phenomenon of lateral violence (Spiri et al. 2016). Lateral violence can be overt or covert and generally occurs be- tween employees of the same organization. It is often characterized by the presence of several undermining incidents over time (Jack- son et al. 2007). Rosen, Koopman, Gabriel, and Johnson (2017) suggest incivility in the workplace is contagious and highlighted the fact that employees who are victims of lateral violence are likely to treat other employees poorly. The prevalence of lateral violence in the healthcare sector is highest in the nursing profession (Stanley et al. 2007). The Royal College of Nursing (RCN) reported that one in six nurses experience nurse on nurse violence (Royal College of Nursing, 2001) and rates as high as 72% have been reported in Israel (Natan, Hanukayev, & Fares, 2011) and Switzerland (Hahn et al. 2010). Within the United States of America, 65-100% of nurses have been exposed to lateral violence, and many have considered leaving the profession because of its negative impact (McKenna et al. 2003, Johnson 2009, John- son & Rea 2009). Among nurses employed as a United States mil- itary hospital system, 88% of respondents reported encountering some sort of incivility in the workplace (Spiri et al. 2016). Although many nurses experience lateral violence in their profes- sional lives, few speak about it openly. This culture of silence about victimization in the workplace is driven by fear of professional re- percussions (Hippeli, 2009). The failure to report incidents of inci- vility and bullying contributes to the implicit norming of lateral vi- olence among nurses (Blair, 2013). Lateral violence has been asso- ciated with increased staff turnover and resultant high cost of healthcare, as qualified nurses often seek alternate work environ- ments in response to workplace incivility (The Joint Commission, 2008). Other institutional consequences of lateral violence include reduced staff morale, low productivity and compromised patient care (Martin et al. 2007, Wilson et al., 2011). Poor communication