Quality patient care requires a combination of the six core competencies approved

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Quality patient care requires a combination of the six core competencies approved by the Quality and Safety Education for Nurses (QSEN) project. If incorporated into nursing care, these competencies ensure that patients and their families are receiving quality and individualized care that is centered around the best outcome for the patient (QSEN Institute, 2019). Unfortunately, there are several barriers that prevent registered nurses from applying these core competencies into their individualized care creating an unhealthy working environment. One of these major barriers is lateral violence. As a registered nurse, it is important to recognize how an unhealthy working environment can negatively impact personal nursing practice and the nursing practice on a Medical Surgical unit. Lateral Violence is a concern within healthcare environments and has become more prevalent over the past decade. Lateral violence is defined as deliberate and aggressive behavior within a workplace setting by one employee to the next. This creates a negative and tense working environment which can affect staff’s energy and passion to work as a team. Studies have shown that nurses report violent encounters daily. Studies also show that 63.8% of nurses have been exposed to verbal abuse, 41.6% to violent threats, 22.3% to physical violence and 19.7% to sexual abuse in a given year. Newly licensed nurses (NLN) become easy targets because of lack of experience and knowledge to stand up for themselves. Some NLN may view it as a rite of passage and some may eventually copy the behaviors observed by their preceptors. According to a study completed by Parker, Giles, Lantry and McMillian (2014), NLN ‘s who experienced negative attitudes from coworkers, received inadequate support, were overloaded at work, and treated unfairly this caused frustrations in the system (Chu & Evans, 2016). The culture of “nurses eating their young” has become more widespread. This impacts the practice of nursing in the following ways: it jeopardizes patient’s safety, decreases morale and communication, and leads to increase turnover rates. Several organizations have implemented zero tolerance policies for lateral violence, but it is the responsibility of the nurse to report these events to administrative leaders. Administrative leaders play a significant role in decreasing the prevalence of lateral violence, but policies are only good on paper if they are not enforced (Chu & Evans, 2016). This competency could also impact one’s personal nursing practice in several ways. The nurse involved often experiences anger as a first response. This can be followed by anxiety, disbelief, decreased job performance and satisfaction, changes in relationships with coworkers, sleep disturbances, headaches, self-blame, helplessness and even Post Traumatic Stress Disorder (PTSD) (Brothers, Condon, Ganske, Cross, & Lewis, 2010).One would utilize Teamwork and Collaboration in combating lateral violence by including these techniques and tools into one’s nursing practice: attending cognitive rehearsal technique classes, attend all continuing education opportunities, encourage your coworkers to attend any preceptor programs available and also attending them when the opportunity has become available for you, become familiar with facility and unit policies about lateral violence and knowing when to report issues to administration. Cognitive rehearsal techniques are evidence-based interventions used when responding to lateral violence. During training nurses are provided with basic rehearsed responses and practice scenarios to act out on one another. After participating in a cognitive rehearsal program, surveyed nurses reported feeling more prepared to deal with bullying and showed improvement in managing bullying. According to Griffin & Cark, Cognitive rehearsal as an intervention against incivility and lateral violence has been discussed by several authors. Dr Griffin first described it as an intervention in 2004 and updated the literature and reviewed the use of cognitive rehearsal as an evidence-based strategy ten years later (Griffin & Clark, 2014). She defined cognitive rehearsal as a behavioral technique consisting of three parts: participating in didactic instruction about incivility and lateral violence, identifying and rehearsing specific phrases to address incivility and lateral violence and practicing the phrases to become adept at using them (Brunt, 2019).Continuing education on lateral violence prevention strategies could enhance the registered nurse’s awareness of this culture and promote teamwork. This will also improve relationships in the workplace and eliminate conflict as well. Research shows that utilization of a support program, like a Preceptor Program, have had positive effects when combating lateral violence as well. Preceptors play a significant role in enhancing mentor’s professional growth and knowledge, making this transition an easier process (Chu & Evans, 2016). In conclusion, along with incorporating the QSEN competencies into one’s nursing practice, creating and sustaining a healthy work environment is pertinent in order to accomplish quality patient care on a Medical Surgical unit. As a result of an unhealthy environment several issue may arise as a result like lateral violence, ineffective communication between staff, poor morale, high turnover rates and jeopardizing patient’s safety. After reviewing multiple studies and articles it is evident that the overall best outcomes for staff and patients depends on the use of teamwork and collaboration.