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Lateral Violence in Nursing and the Theory of the Nurse as
Wounded
Healer.
Christie, Wanda; Jones, Sara
Arkansas Tech University, Russellville, AR
Assistant Professor and Psychiatric/Mental Health Specialty
Coordinator, University of Arkansas for Medical Sciences
(UAMS)
College of Nursing, Little Rock, AR
Online Journal of Issues in Nursing (ONLINE J ISSUES
NURS),
Jan2014; 19(1): 1-1. (1p)
Journal Article - anecdote
English
Work Environment -- Psychosocial Factors
Bullying -- Prevention and Control -- In Adulthood
Nurses -- Psychosocial Factors
Nursing Theory
Adult; Violence -- Classification; Students, Nursing; New
Graduate
Nurses; Job Satisfaction; Stress, Psychological; Burnout,
Professional --
Risk Factors; Patient Safety; Human Development; Empathy;
Metaphor
Lateral violence (LV), a deliberate and harmful behavior
demonstrated in
the workplace by one employee to another, is a significant
problem in

the nursing profession. The many harmful effects of LV
negatively
impact both the work environment and the nurse’s ability to
deliver
optimal patient care. In this article, the authors explain how
Conti-
O’Hare’s Theory of the Nurse as Wounded Healer can be used
in
situations of lateral violence to resolve personal and/or
professional
pain, build therapeutic relationships, and promote positive work
environments. A working model of the theory is applied to the
experience of LV in nursing to demonstrate the nurse’s path
from being
the ‘walking wounded’ to becoming a ‘wounded healer.’
Implications of
this theory for promoting the process of healing and creating an
environment that disenables violence are presented; an example
is
provided. The authors conclude that both practitioners and
managers
must be aware of the occurrence of LV and of the need for
healing. They
note that the ‘journey of the walking wounded’ is an ideal
pathway to
bring about this healing. As nurses promote health in their
patients, they
must also promote health in themselves and one another.
Core Nursing; Double Blind Peer Reviewed; Editorial Board
Reviewed;
Expert Peer Reviewed; Nursing; Peer Reviewed; USA
Emergency Care; Nursing Education; Occupational Therapy;
Psychiatry/Psychology

1091-3734
NLM UID: 9806525
20140225
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Revision Date:
DOI:
Accession Number:
Database:
20150710
http://dx.doi.org/10.3912/OJIN.Vol19No01PPT01
104034835
CINAHL Plus with Full Text
Lateral Violence in Nursing and the Theory of the Nurse as
Wounded Healer
Lateral violence (LV), a deliberate and harmful behavior
demonstrated in the workplace by one employee to
another, is a significant problem in the nursing profession. The
many harmful effects of LV negatively impact
both the work environment and the nurse's ability to deliver

optimal patient care. In this article, the authors
explain how Conti-O'Hare's Theory of the Nurse as Wounded
Healer can be used in situations of lateral
violence to resolve personal and/or professional pain, build
therapeutic relationships, and promote positive
work environments. A working model of the theory is applied to
the experience of LV in nursing to demonstrate
the nurse's path from being the 'walking wounded' to becoming
a 'wounded healer.' Implications of this theory
for promoting the process of healing and creating an
environment that disenables violence are presented; an
example is provided. The authors conclude that both
practitioners and managers must be aware of the
occurrence of LV and of the need for healing. They note that the
'journey of the walking wounded' is an ideal
pathway to bring about this healing. As nurses promote health
in their patients, they must also promote health
in themselves and one another.
Keywords: Theory of the nurse as wounded healer; walking
wounded; wounded healer; lateral violence;
bullying; workplace violence; horizontal violence
Lateral violence (LV) is a devastating phenomenon in the
nursing workplace. Also known as 'horizontal
violence' or 'workplace bullying,' LV is disruptive and
inappropriate behavior demonstrated in the workplace by
one employee to another who is in either an equal or lesser
position (Coursey, Rodriguez, Dieckmann, &
Austin, 2013). This deliberate behavior can be openly
displayed; however, it is more commonly masked and
subtle as it is repeated, often escalating over time (Hutchinson,
Vickers, Jackson, & Wilkes, 2006). Although
individual acts may appear harmless, the cumulative effect of
these personalized insults and aggressive
behaviors intensify the harm more than would a single violent

act (Einarsen, 2005).
Nursing has been considered the primary occupation at risk for
lateral violence. Nursing has been considered
the primary occupation at risk for lateral violence (Carter,
1999). Studies estimate that 44% to 85% of nurses
are victims of LV; up to 93% of nurses report witnessing lateral
violence in the workplace (Jacobs & Kyzer,
2010; Quine, 2001). Unfortunately, the experienced nurse is
most often the perpetrator while the novice nurse
is the likely victim (Jacobs & Kyzer, 2010). Randle (2003)
found that nursing students and newly licensed
nurses regularly witness LV and personally experience bullying
in their clinical settings (Swenson, Henggeler,
Schoenwald, Kaufman, & Randall, 1998). Some studies suggest
that, because of its prevalence, this behavior
is considered 'normal' and 'accepted' within the nursing culture;
hence it is often overlooked and unreported
(Hockley, 2002; Hutchinson et al., 2006; Jackson, Clare, &
Mannix, 2002).
Nurses who experience LV report less trust in their organization
and significantly lower job satisfaction. The
harmful effects of continued exposure to LV are multiple.
Victims report an overall decreased sense of well-
being, physical health complaints, and depressive symptoms
(Dehue, Bolman, Vollink, & Pouwelse, 2012).
Their negative view of themselves, others, and the world is
increased; and they frequently use ineffective
coping strategies to manage their problems (Dehue et al., 2012;
Mikkelsen & Einarsen, 2002). Other
psychological effects can include sleep disturbances, anxiety,
and even suicidal behaviors and symptoms
consistent with post-traumatic stress disorder (Mikkelsen &
Einarsen, 2002; Quine, 2001; Randle, 2003;
Vessey, Demarco, & DiFazio, 2010). Rates of physical illness,

including the onset of cardiovascular disease,
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are also noted to be higher in victims of LV compared to non-
victimized hospital employees (Kivimaki et al.,
2003). Nurses who experience LV report less trust in their
organization and significantly lower job satisfaction.
They are also more likely to leave, thus contributing to
decreased productivity and poor communication on their
units (Johnson & Rea, 2009; Quine, 2001).
Because LV is often perpetrated by nurse managers and
directors, it can be difficult to report (Johnson & Rea,
2009; O'Connell, Young, Brooks, Hutchings, & Lofthouse,
2000). Yet if LV is ignored and permitted to continue,
the healthcare organization can be held liable for the
consequences. Additionally, there can be an increased
cost to the organization, as nurses experiencing LV may leave
the organization. The cost of replacing and
training a medical-surgical nurse is estimated at $92,000 and
the replacement cost of training a specialty
nurses (e.g., a critical care or emergency department (ED)
nurse) can be closer to $145,000 (Kennedy &
Nichols, 2012).
The multiple effects of lateral violence ultimately both decrease
a nurse's ability to deliver optimal patient care
and also compromise patient safety. In this article, we will
describe how the theory of the nurse as wounded

healer (NWH) facilitates nurses' ability to address the stressors
they face throughout their work life and also
explain how the theory can be used in situations of lateral
violence to resolve personal and/or professional
pain, build therapeutic relationships, and promote positive work
environments. Next, we will present
implications of this theory for promoting healing and decreasing
violence and offer an example of LV using the
theory. In conclusion, we will encourage both practitioners and
managers to be cognizant of the occurrence of
LV and aware of the need for healing. As nurses promote health
in their patients, they must also promote
health in themselves and one another.
Theory of the Nurse as Wounded Healer
Nursing is a helping profession in which the needs of people
who are in a vulnerable state are addressed by
individuals who want to aid them in their recovery. Marion
Conti-O'Hare (2002) believed that individuals are
often led to specific professions, such as nursing, by their desire
to relieve the suffering of others after
experiencing or witnessing traumatic events in their own lives.
This section will provide an overview of the
NWH along with the origins and development of this theory.
Overview of the Theory of the Nurse as Wounded Healer
Following exposure to personal trauma, an individual's coping
strategies are either effective or ineffective.
When an individual's coping is ineffective, the impact of the
trauma is unrecognized and the pain remains
unresolved. These individuals then function as a 'walking
wounded,' and experience problems in their social,
intimate, and work relationships. In denying their own conflicts
and vulnerabilities, these individuals project
their woundedness on both patients and colleagues while
considering themselves unharmed, yet being less

able to empathize with others (Zerubavel & Wright, 2012).
If trauma is dealt with effectively, the pain is consciously
recognized, transformed, and transcended into
healing. If trauma is dealt with effectively, the pain is
consciously recognized, transformed, and transcended
into healing (See Table 1). Although injury has occurred, the
wounds will have been sufficiently understood and
processed and will not interfere with providing care (Zerubavel
& Wright, 2012). This processing ultimately
leads to healing, despite the remaining scar. This 'pathway to
healing' leads the nurse to become a 'wounded
healer' and allows for the nurse to draw on his/her woundedness
to provide the service of healing, as
described below. Based on these premises, Conti-O'Hare
developed the theory of the nurse as wounded
healer to explore a nurse's ability to transcend personal pain and
suffering in order to build better therapeutic
relationships with others.
Theory Origins and Development
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The image of the wounded healer was first seen in Greek
mythology� The image of the wounded healer was
first seen in Greek mythology and has continued to be used now
for over 2,500 years (Groesbeck, 1975). The
archetype of the wounded healer suggests that healing power
results from a healer's own injuries, or

'woundedness' (Zerubavel & Wright, 2012). According to
legend, after Chiron, a centaur known for his
kindness, accidentally received an incurable and painful wound
from Heracles' arrow, he retreated to his cave
to suffer alone. Because he was immortal, he could not die from
the poison that caused his wound. Chiron
moved past his own pain, and in order to heal others, he entered
Hades (Groesbeck, 1975). This self-
sacrificing act signified his ability to transform, transcend, and
ultimately limit his suffering. He emerged as a
wounded healer. Because of his past wounds, he possessed
transformative qualities that are important to
understanding how to assist others with the healing process.
Today the concept of the wounded healer can be found in the
fields of psychiatry, psychotherapy, and religion.
For a long time it has been used to describe doctor/patient
relationships, with the doctor using self as an agent
to assist the patient in regaining health (Groesbeck, 1975).
Carl Jung's philosophical work expanded the concept of the
wounded healer (Jung, 1953). One of Jung's basic
assumptions was that every individual has experienced some
sort of trauma in life. Both conscious and
unconscious factors, derived from personal experiences, drive
human behavior and encompass all individuals.
Instead of perceiving these factors as dichotomous, they must
be recognized as co-existing. The process of
identifying this 'duality' and seeing both parts as a whole is
called 'transcendence.' It creates an extension of
self beyond the limits of ordinary experiences. As mankind
searches for transcendence, he strives to find
interactions, connections, relationships, and integrations with
the world around him to obtain 'wholeness,' in
order to make sense of, define the meaning of, and find the
purpose of 'it' all (Boeree, 2006).

Although some people have believed that healthcare providers
require a problem-free psyche in order to be
effective healers, Jung has suggested that professionals are just
as vulnerable as the rest of mankind, and
strive for wholeness rather than 'clean-hands perfection' when
attempting to facilitate healing (Jung, 1953). He
has developed his 'counter-transference' theory, in which he
describes a wounded healer's complete response,
both conscious and unconscious, to a patient. Jung believed that
the use of countertransference by a
sufficiently recovered wounded healer would be beneficial to
for the patient when it was used to facilitate
empathetic connections and constructively inform the healing
process.
More recently Fordham (1970) has maintained that the wounded
healer can use past experiences to better
assist others who are dealing with the same type of problem.
However, if the damaged parts of the healer
(healthcare provider) are not completely resolved, and the
underlying pain remains, there can be negative
outcomes for both the provider and the patient (Fordham).
� the nurse's suffering is cultivated into the ability to view his
or her pain as part of human growth and
development. Based on Jung's concept of the wounded healer,
Marion Conti-O'Hare inductively reasoned that
nursing was a profession in need of this healing process (Conti-
O'Hare, 2002). She developed the theory of the
nurse as wounded healer as a model of the pathway from being a
'walking wounded' to becoming a 'wounded
healer' (See Figure). Her theory incorporates Jung's assumptions
into nursing, noting that nurses need to
recognize their wounds, whether they be related to personal or
work-related events, in order to process and

transform their pain and obtain transcendence. In this context,
the nurse's suffering is cultivated into the ability
to view his or her pain as part of human growth and
development. The therapeutic use of self is then
dependent on the degree to which the trauma is transcended;
only after this transcendence can personal
experience of healing be used to help others. However, if a
nurse is not able to recognize personal
experiences of pain and fear, emotional distress and self-
destructive behaviors can result.
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Conti-O'Hare clarified fundamental assumptions as she
developed the NWH (See Table 2) (Conti-O'Hare,
2002). She explained that all human beings experience
violence/trauma in their personal or their professional
lives, or both. The process of healing involves moving from
being a walking wounded person to being a
wounded healer. The pain and fear from the experience is
frequently carried throughout one's life; it does not
automatically resolve itself without an intervention. One's
ability to cope with the trauma can profoundly affect
one's ability to care for others. However, if the trauma is
transformed and transcended, the experience of
healing can be used to help others. The process of healing
involves moving from being a walking wounded
person to being a wounded healer. Becoming a wounded healer
allows for the highest level of using self
therapeutically. In professions in which healing is provided, the

walking wounded need to first heal themselves
in order to survive.
Based on these assumptions, the following four key concepts
were integrated into Conti-O'Hare's theoretical
framework:
1. In the search for 'wholeness,' traumatized individuals may
pass from the stage of walking wounded to
wounded healer.
2. Nurses and other health professionals become wounded
healers after recognizing, transforming, and
transcending the pain of trauma in their lives.
3. Wounded healers become able to use themselves
therapeutically to help others.
4. This transformation will have a positive impact on the health
care system, society, and the nursing
profession as a whole (Conti-O'Hare, 2002).
Table 2. Conti-O'Hares' Assumptions
All human beings experience violence/trauma in their lives.
Trauma may be of a personal or professional nature, or a
combination of both.
Pain/fear from traumas experienced can frequently be carried
throughout life.
Trauma does not automatically resolve without intervention.
The ability to cope with trauma has a profound effect on one's
ability to care for others.

Trauma can be transformed and transcended; only then can the
experience of healing be used to help others.
Healing involves moving from being a 'walking wounded' to
being a 'wounded healer.'
Therapeutic use of self is dependent on the degree that trauma
has been transformed and transcended in a
person's life.
The wounded healer represents the highest level of using self
therapeutically.
Professions in which there are many walking wounded need to
heal themselves in order to survive.
* Adapted from: Conti-O'Hare, n.d.
Theory Application to Lateral Violence in Nursing
Nursing is a high stress career, with some studies reporting the
levels of stress and burnout higher among
those in the nursing profession than among members of the
armed forces (Calkin, 2013). Add the stressors of
daily living, personal relationships, and caring for families, and
there can be a tremendous amount of pressure
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on a nurse's psyche. Like others, nurses are in need of an 'outlet'
in which to vent their negative emotions and

cognitions. Unfortunately, vulnerable peers and co-workers
frequently end up being this outlet, thus becoming
victims of lateral violence (Johnson & Rea, 2009). The most
common targets include new graduates in need of
mentoring, new nurses who are unfamiliar with the unit or their
duties, and night shift nurses who are perceived
as not working as hard as those on other shifts (White, 2006).
Unfortunately, these victims then become the
walking wounded, perpetuating the cycle of lateral violence
(LV).
As LV is regularly witnessed or experienced on the unit� the
environment can become inundated with the
walking wounded. Whether the wound is caused by stressors
that are work related or personal, isolated
incidents of LV may begin in the form of passive aggression or
mild bullying directed towards those who are
perceived as lesser or weaker (Hutchinson et al., 2006). The
behavior may be initially appeased with an
apology; however it can also escalate to verbal abuse and other
destructive behaviors, spreading negativity
and creating a volatile work environment. As the attacks
continue, this behavior can become the norm. As LV
is regularly witnessed or experienced on the unit, and the many
effects of LV consume the nursing staff, the
environment can become inundated with the walking wounded.
Under the premises of the theory of the nurse
as wounded healer, each such nurse must first recognize and
transform his or her fear and pain in order to
transcend and continue along the path to become a wounded
healer (Conti-O'Hare, 2002) (See Table 1).
These three steps of recognition, transformation, and
transcendence are delineated below.
'Recognition' of the trauma and its effects allows for a close
examination and dissection of the components

(Conti-O'Hare, 2002). The recognition process starts with the
nurse asking and answering the following
questions:
* What happened?
* What could be changed?
* How should it have been handled?
After recognition, the nurse can work on the next step, namely
'transformation.' The nurse can transform the
pain into an acceptable and manageable understanding by
asking:
* What can be learned from the incident?
* Has this changed me or the people I care about?
* How can this be used to make things better?
The final step, transcendence, only happens if the previous two
steps have been successfully completed.
Transcending the pain allows for insights and learning from past
experiences that can be used to help others
as they also experience pain and suffering. At this point the
nurse can say:
* I understand your pain.
* How can I make things better for you?
All three steps are necessary to become a wounded healer.
�if subjected to personal trauma or LV again, nurses must
repeat the process� Upon completion of this three-

step process, the walking wounded becomes the wounded healer
with an increased ability to understand
others' suffering and empathize with their pain (Conti-O'Hare,
2002). Professional relationships improve,
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resulting in a more positive work environment, and overall
patient care is optimized. However, if subjected to
personal trauma or LV again, nurses must repeat the process of
recognition, transformation, and
transcendence to regain their wounded healer status.
Implications
In 2006, the Joint Commission established standards for
healthcare providers that include a standard of
leadership for all. Under this leadership standard, agencies are
mandated to recognize and correct behaviors
that are inappropriate and disruptive within the workplace. This
standard calls to action all in leadership
positions (Joint Commission Resources, 2006). Early
identification of inappropriate behaviors by nurse
managers, and all leaders, is key to identifying and resolving
lateral violence. Managers and supervisors need
to be aware of individuals that demonstrate difficulty in
managing stress, either in their personal lives or on the
job, and help them develop appropriate stress-management
strategies. Recognition of these walking wounded
will ultimately assist in preventing the cycle of LV, as these
individuals are not only at risk of being re-

victimized, but, depending on their role on the unit, are also at
risk of becoming a perpetrator.
Managers can be a catalyst to assist the nurse to initiate the first
step along the pathway to becoming a
wounded healer� As soon as LV begins managers should
provide referrals to Employee Assistance Programs
(EAP) or Human Resources (HR) Departments, asking them to
provide resources for employees who need to
resolve personal or professional traumas in their lives.
However, such referrals should not be the end of
managers' interventions. They should also make themselves
available to staff regarding any issues that may
affect ability to work with others or care for patients. Managers
can be a catalyst to assist the nurse to initiate
the first step along the pathway to becoming a wounded healer,
namely the step of recognition.
Additionally, fellow staff members should (at minimum) be
aware if or when a colleague demonstrates
behaviors that are disruptive, maladaptive, or dysfunctional,
especially when safety of a patient is at stake.
Because a colleague may not be the appropriate person to
address the issue, managers should be accessible
and willing to accept reports about peer concerns from staff.
Peers can also provide support and mentorship
for newly licensed or recently hired nurses who may experience
the stress of working in a new atmosphere.
The most successful strategies feature involved administrators,
staff members with positive relationships, and
an obvious commitment to change. When lateral violence does
become apparent in the workplace, it is
imperative for administration and management to become
involved. Many organizations have implemented 'no-
tolerance' policies related to bullying and LV. While there is no

consistent evidence regarding the most effective
implementation of these policies, it is evident that strategies
implemented need to be collaboratively prepared
by administration, management, nurses, and other staff, and
initiated as soon as an incident occurs (Coursey
et al., 2013; White, 2006). The most successful strategies
feature involved administrators, staff members with
positive relationships, and an obvious commitment to change
(Coursey et al., 2013) However, in an
environment in which LV has become the norm, relationships
may already be too strained, and motivation may
be too depleted to spark the need for change.
Because the effects of LV can be significantly traumatic,
managers can use the theory of the wounded healer,
and the steps associated with this theory, to develop the above-
mentioned strategies. Following the model,
those in leadership positions should initially encourage the staff
to recognize that LV is occurring, that it is
traumatic, and that it has impacted the workplace negatively.
This can be done both one-on-one, as well as
together in a group. It is important for staff to not only evaluate
the personal effects of LV, but also the effects
on others and the group as a whole. Once recognition has
occurred, staff can begin to explore what was
learned from the experiences, again individually as well as
collectively. Transforming the pain from their
experiences into knowledge and understanding will assist staff
to transcend it and become a wounded healer.
An Example: Mary's Story
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Below is a story that has been adapted from Beth Boynton's
book, The Nurses' Guide to Improving
Communication & Creating Positive Workplaces (Boynton,
2009). This example demonstrates the experiences
of LV, an application of the Theory of the Nurse as Wounded
Healer, and opportunities where interventions
could be implemented. Listen as Mary tells her story:
Being a new nurse on any job can be hard, but being a new
nurse in the Emergency Department (ED) is brutal!
During my two month orientation period, I was often ignored
and misinformed. My 30 years of experience didn't
matter. I was a new face in the ED and was subject to criticism
and disdain as if it were my very first day as a
nurse. I would say hello to staff members and they wouldn't
answer. One other ED nurse, Leah, seemed to
have it in for me. One day in particular, Leah was talking and
laughing with another nurse. I walked up to them,
and they suddenly became silent. When I asked them what they
were laughing about, Leah rolled her eyes
and muttered something to the other nurse as they turned their
backs to me and walked away.
Early on it is clear that LV is occurring. Mary is obviously the
victim, daily being wounded as she works. Leah
may be the perpetrator, but she may also be a walking wounded
nurse, projecting her woundedness on others,
and in need of her own healing. Other nurses seem to accept
Leah's negativity as well. Have they been
exposed to the same LV and are now walking wounded, too?
One day, I didn't want to go to lunch because I thought a patient

might have an internal bleed and the doctor
didn't seem concerned. I had suggested lab work and was
awaiting the results to make sure the doctor was
made aware of any abnormal values. Leah encouraged to me to
go to lunch and promised to watch for the
results. While off the floor, I heard a code called in ED. When I
got back, my patient was being rushed to the
operating room. The doctor reamed me out for not reporting the
critical lab values immediately. "The lab just
called a minute ago," Leah said, but I saw her half smile and
shoulder shrug to the unit coordinator. I definitely
wondered if she was being honest. When I said something to
another staff RN, she replied: "I guess everybody
has to earn their stripes."
This situation demonstrates a definite escalation of disruptive
behaviors that, unfortunately, also affected the
care of a patient. Further, it appears that other staff
demonstrated no support and the unit coordinator was
unable to recognize the seriousness of the issue. This illustrates
how LV can become the norm in a work
environment, despite the risk of harm to patients.
I decided to talk to my manager about this and similar incidents.
I ended up crying in her office. She told me
she knew that Leah could be "hard on new people" and that "her
bark was worse than her bite." She said Leah
was a crackerjack nurse with a heart of gold and for me to give
it some more time. She told me that I was
"showing some great potential, but should try not to be so
sensitive." I felt awful leaving her office.
Here was a key opportunity for management to intervene, not
only on an individual basis, but also collectively.
The nurse manager should first meet one-on-one with Mary,
Leah, and the other staff and provide them with

referrals to EAP or HR as needed. Individual issues can be
resolved based on the wounded healer model, and
this should be done first. It may be difficult for nurses who feel
vulnerable in front of their peers, especially the
'bullies,' to address the issues. The manager should then
convene a group meeting to recognize the
occurrence of LV and its effects. It is necessary for all staff,
including administration and managers, to
collaborate and develop a 'no-tolerance' policy with strategies
that are feasible for all. Surveys and focus
groups could facilitate this process
Over the next few weeks, I dreaded going to work and started to
feel very depressed and lonely. I had no
mentor, and no one even offered to help me adjust. A nurse who
had started two weeks after I did ended up
quitting within one month. I can only wonder why? I am not
happy in my job, but my family needs the income. I
am not sure where I'll be a year or two from now. Maybe here,
maybe not (adapted from Boynton, 2009).
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Many consequences of LV are demonstrated in Mary's story.
Due to LV, Mary has quickly lost interest in a job
that she once loved and feels depressed and lonely. The ED
maintained an air of negativity and quickly lost
other new nurses that were hired. Management appears to be
aware of the LV behaviors; in good conscience
they can no longer remain blind to its effects. Staff turnover

may be one loss, but patient care that is
compromised is an even greater loss. In such cases, specific
interventions need to occur.
Conclusion
When the safety of patients is at risk, all avenues of resolution
of LV need to be taken. The Theory of the Nurse
as Wounded Healer delineates how nurses can be affected by
witnessing or experiencing lateral violence. The
experience of LV can be as significant and painful as that of
any other personal experiences of trauma;
therefore, the same pathway can bring about healing. The
journey of the walking wounded, through
recognition, transformation, and transcendence, to become the
wounded healer is an ideal pathway for the
nurse to travel. Practitioners and managers must be cognizant of
the occurrence of LV in order to recognize its
potential effects and the need for healing. When the safety of
patients is at risk, all avenues of resolution of LV
need to be taken. As nurses promote health in their patients,
they must also promote health in themselves and
one another.
Table 1. Conceptual Terms and Definitions
Terms Operational Definitions Recognition Awareness that
something is affecting a person in a negative
manner, either through his/her own thought processes and self-
evaluation, or with the assistance of other
people in his/her life. Transformation Seeking affirmation and
control over feelings of pain and/or fear through
counseling and/or sharing; using energy from the past to
increase understanding of the present and future.
Transcendence A higher level of understanding (can be spiritual
and/or higher thinking) that allows the person
to use the understanding achieved to increase their therapeutic
relationship with others. Walking Wounded

Those who have experienced either physical or verbal trauma in
their lives that they have not dealt with,
allowing alterations in their ability to cope with current
stressors, leading to negative results. Wounded Healer
Those who, through self-reflection and spiritual growth, achieve
expanded consciousness, through which the
trauma is processed, converted, and healed. The scar remains,
giving the person a greater ability to
understand others' pain.
Adapted from: Conti-O'Hare, 2002, pages 145-150.
Figure. Theory of the Nurse as Wounded Healer
References
Boeree, G. C. (2006). Carl Jung (1875-1961): Personality
theories. Retrieved from
www.ship.edu/%7Ecgboeree/persscontents.html
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practice/clinical-zones/management/ nurses-more-stressed-than-
combat-troops/5053522.article
Carter, R. (1999). High risk of violence against nurses. Nursing
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Sudbury, MA: Jones and Bartlett Publishers.
Conti-O'Hare, M. (n.d.). The theory of the nurse as wounded

healer: Finding the essence of therapeutic self.
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bullying. Norwood: Peacock Publications.
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Lofthouse, J. (2000). Nurses' perceptions of the nature
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~~~~~~~~
By Wanda Christie, MNSc, RN and Sara Jones, PhD, PMHNP-
BC, RN
Ms. Christie currently teaches nursing at Arkansas Tech
University in Russellville, AR. She obtained her MNSc
degree in Nursing Administration from the University of
Arkansas for Medical Sciences (UAMS) in Little Rock,
AR, where she is now completing her doctoral dissertation. Her
research focuses on the exploration of coping
mechanisms used by nurses after experiencing violence in the
workplace. Ms. Christie first became interested
in this topic when she read an article asking: Do nurses eat their
young? Her 25 years as a staff nurse have
convinced her of the need to address workplace violence with
appropriate interventions. Email:
[email protected]
Dr. Jones is an Assistant Professor and Psychiatric/ Mental
Health Specialty Coordinator at the University of
Arkansas for Medical Sciences (UAMS) College of Nursing in

Little Rock, AR. She received her BSN, PhD,
and post-master's certificate in psychiatric/mental health at
UAMS. She is currently pursuing her research
interests in the psychological, social, and neurobiological
effects on individuals who experience trauma and on
those who perpetrate violence. Email: [email protected]
This article is copyrighted. All rights reserved.
Source: Online Journal of Issues in Nursing
Training Plan for New System Implementation Grading Guide
HRM/552 Version 2
2Individual Assignment: Training Plan for New System
ImplementationPurpose of Assignment
Students will apply their knowledge of the needs analysis
process and various options available to organizations. In Week
2, students will consider organizational constraints related to
training design. In addition, student will address social learning
opportunities in the context of training design.Grading Guide
Content
Met
Partially Met
Not Met
Comments:
The student summarizes a suggested needs analysis process and
the steps involved.
The student recommends how to address organizational
constraints related to time and performance.

The student analyzes linkages between performance, training,
and needs analysis.
The student assesses options for the needs analysis.
The student recommends the best option for the needs analysis
and included rationale for selecting this option.
The student provides a recommendation for training design.
The paper is between 1,050 and 1,400 words in length.
Total Available
Total Earned

10.5
#10.5
Writing Guidelines
Met
Partially Met
Not Met
Comments:
The paper—including tables and graphs, headings, title page,
and reference page—is consistent with APA formatting
guidelines and meets course-level requirements.
Intellectual property is recognized with in-text citations and a
reference page.
Paragraph and sentence transitions are present, logical, and
maintain the flow throughout the paper.
Sentences are complete, clear, and concise.
Rules of grammar and usage are followed including spelling and
punctuation.

Total Available
Total Earned
4.5
#4.5
Assignment Total
#
15
#/15
Additional comments:
Discussion Grading Rubric: Nursing in a Culture of Violence
Criteria Levels of
Achievement
Grammar
0 points
5 points
10 points
More than 9 errors in spelling/grammar or use of text/email
messaging abbreviations
6-9 errors in spelling/grammar or use of text/email messaging
abbreviations

0-5 errors in spelling/grammar or use of text/email messaging
abbreviations
Content
20 points
40 points
50 points
Response did not address all questions from PowerPoint and/or
no feedback given to classmates
Response addresses all questions from PowerPoint; feedback
given to classmates
Response addresses all questions from PowerPoint and includes
an appropriate referenced scholarly citation; feedback given to
classmates
Participation
10 points
30 points
40 points
First post (response to PowerPoint) more than 72 hours after
discussion open and/or 3 or fewer responses given to classmates
First post (response to PowerPoint) within 72 hours of
discussion open and 4 responses given to classmates
First post (response to PowerPoint) within 72 hours of
discussion open and over 4 responses given to classmates

1/2016 MBG
What is Lateral Violence?
Bullying
Incivility
“Eating Our Young”
Intimidation
Is there an atmosphere of LV in my workplace?Am I or others
offensive, intimidating, and/or irrational?Am I or others
behaving differently toward a staff member?Am I or others
behaving professionally and in the interest of the team?Are any
staff members vulnerable to LV by me or others?Am I or others
participating in gossip, rumors, or breaking confidences?

Is there an atmosphere of LV in my workplace?Am I or others
excluding or ignoring members of the team? Or, withholding
information?Is staff becoming negative with abnormal
monitoring of others?Is the allocated workload appropriate to
level of expertise and reasonable?Am I and others welcoming to
new staff?Do I stand up for myself and others?
Most Frequent Forms of LV in Nursing PracticeNonverbal
innuendoVerbal affrontUndermining activitiesWithholding
informationSabotagingInfightingScapegoatingBackstabbingFail
ure to respect privacyBroken confidences
What to do about LVEvaluate the situationMake notesDon’t
engage in the behaviorStand up for yourself – practice!Use your
chain of command, if no results…Go to human resources, if no
results…Go to the Employee Advocate (EAP), if no
results…Consider your options: contact attorney or consider
resigning. Ask yourself – Is this the kind of environment I want
to work in as a nurse?
Exercise for DiscussionSelect one of the “Most Frequent Forms
of Lateral Violence” and discuss in how you have witnessed or
experienced this behavior.
Next discuss how you have seen a situation with this behavior
handled or how you have handled it yourself.
And finally, consider and share what you would do differently
to handle this behavior if you witness or experience it in the

future.
Additional Resources
www.bullyonline.org
http://bullyinginstitute.org

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