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A silent killer has made its way into nursing and slowly eaten away at the core of who we are as nurses. This epidemic is becoming so wide spread that everyone from administration to nurse's aides are affected by it. It is the epidemic of horizontal violence.

The term "horizontal violence" (sometimes called "lateral violence") is quite new to many individuals but the behavior it describes is not. The term was developed to describe distasteful behavior nurses sometimes portray toward colleagues.

Horizontal violence takes on many different characteristics. Simply put, it is overt and covert nonphysical hostility, such as criticism, sabotage, undermining, infighting, scape-goating or finger pointing and bickering.

Who is harmed by horizontal violence?

They are individuals who have felt ridiculed, demeaned by a colleague or doctor, and even asked to do something they have not yet even learned how to do only to be left completely humiliated for not knowing how to do it.  It affects new hires, new graduates, and nurses who have worked at a facility for a long time.

New Grads

One of the groups most frequently victimized by this is new nursing graduates. 

It is crucial for experienced staff to embrace the new grads and support and encourage them as a group. The first year of nursing is an opportunity to achieve great confidence in and establish self-esteem on the job.

New graduates are inexperienced, and because they lack the skills and knowledge necessary to stand up for themselves, they often are yelled at, ridiculed and dehumanized. I have witnessed this psychological abuse first hand as a nurse educator.  

Unfortunately, new graduates accept this behavior as a rite of passage and move on, only to mimic it later on, as it is what they have learned from their predecessors. Nurses need to become aware of who it is they are affecting and begin to develop new behaviors that will benefit each other's self-esteem.

Vicious Cycle

In order to make people aware of this issue, someone must begin reporting it. But what if it is never reported and the behavior continues?

This is the determining factor for alleviating horizontal violence in the nursing profession. Individuals need to begin to report it and feel safe in doing so without retaliation.

Horizontal violence is so severely underreported because opinions surrounding horizontal violence are subjective in nature. Each us tolerates the behaviors of others a little bit differently. However, if the behavior is in any way offensive to you, or undermines you and your job in any way, then it probably is horizontal violence and you need to report it to your manager.

Secondly, there also is a greater fear of retaliation from the perpetrator. Speaking up is one thing, but having to face the person everyday at a new job after reporting them may be a task that many are not willing to take on. As a result, more individuals will begin their careers in an unsupportive work environment, and the cycle will continue. 

What Have You Done?

The negative impact of horizontal violence is really quite impressive and obvious.

If you think about the nursing shortage today and wonder why we are losing nurses to other professions, or wonder why the new graduate or new employee that was just hired has left so soon, take a good hard look at yourself and the people around you and begin to imagine what it must have been like to learn something new all over again.

Were you supportive? Did you encourage that person to gain and develop new skills and offer learning experiences to help the person grow as a nurse? Or did you create an environment that was infected with horizontal violence?

Wouldn't it be great to know that when you were asked to orient someone into your work environment, you were able to give them a healthy and positive outlook toward the job and the environment?

Wouldn't it be great to know the new nurses on your unit would enjoy their learning experience so much that they would be more likely to feel like staying in that job because the work environment was so supportive?

These new nurses are going to relieve the pressures experienced nurses feel everyday. They are the future. Because of them, there will be one more person on the unit to help in a crisis, one more person to lend a hand when one is needed, and one more person to call when the census goes up and you need help.


Horizontal Violence

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I'm also a new lpn grad second career first nursing job..... I'm in shock I can't believe that people nurses treat each other with such harmful disrespect I don't blame the facility it's work bully's and the only way to fight back is with silence because then they can't run back and complian about every little thing ..... I love my position ..... And sad they the nurses with so many years have so much knowledge that they could help us new people or new to a type of position with that maybe with there very fake smile we can absorb there seasoned wisdom in the job experience and learn and place the negative distroying actions in the trash because something's in a great package deal was placed to harm us but we can spit them out not allowing situations to become toxic in our atphoshere so al though your along scream with a silent voice by not feeding in to there foolishness☺️🌺🌼🌸

Deborah Ramada ,  Lpn,  Out Patient OROctober 18, 2014
Rochester, NY



I enjoyed the information surrounded around Horizontal Violence. I am very disappointed that any individual has to be subjected to these behaviors as a new employee. It's not just nurses it is physicians who are also engaging in horizontal violence. It's not okay and I will not tolerate it! I am currently meeting with my direct reports regarding this issue. I personally believe that there needs to be education and guidelines incorporated to help the abuser. This is a great article and I will utilize this article as one example of research that support my findings of what I am experiencing. This is a catholic institution and it is not aligned with the mission or philosophy of the organization for anyone to be experiencing horizontal violence in the work place. Especially in a hospital where patients come to get care.

Jameszetta James,  ED Case ManagerOctober 12, 2014
Chicago, IL



I've experienced this type of bullying numerous times and it never stops. This is why people go postal. This field is already stressful enough without manipulative circles of women that try to mame and destroy new nurses, young nurses, old nurses, pretty nurses and even a race outside of the major demographic. What makes it worse is that management knows and agrees that it's wrong when it's brought up but smiles about it and even encourage it to a certain degree. The only way to cope is to know that you do your job to the best of your ability, keep a good rapport with family and patients and know that something inside of those bullying are damaged and see something in you that they want or are just mad that they can't understand. (Rant over :)

Yancey ,  lpn,  unihealth post acute care fairburnMarch 19, 2014
Fairburn, GA



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