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Confronting Horizontal Violence in Nursing

Creating awareness helps curb hostilities on nursing units.

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At a hospital where I once worked I was assigned a preceptor who was very sweet and knowledgeable. But try as I might, I could not do things fast enough for her.

Every day she would finish tasks assigned to me long before I had an opportunity to and was on my heels to increase my speed and competency. I know now that I was doing the best I could and realize that speed and competency come with time and experience.

You can't be taught that in 6 weeks.

On a busy med/surg floor we were like a revolving door where you started the shift with four patients, then sent home two and admitted three more. That was pretty much the routine for much of my orientation.

Originally, I was just socially isolated. Everyone went to lunch at the same time and left me at the desk to answer the phone and lights. Often when this happened I wasn't aware I was alone until they had all left the floor.

If I did happen to get to have my meal break when others were in the break room, they would all sit as far away from me as possible and dare me to join in their conversations. I can think of more than one occasion were I attempted to contribute only to be told quite forcefully, and rudely, "We weren't talking to you". And yes, these are adult women ranging in ages from 28-45.

Whatever the reason, they never appreciated me, my questions, or my concerns and every day I would come to work and wonder what tragedy might befall me next. They would often withhold critical information from me in order to make me look incompetent and often not pass along messages in order to make me appear slow and unresponsive.

On a few occasions they even went so far as calling the doctor for my patients and telling them they were in distress when they had not even stepped into the room to assess the patient!

I asked them many times for help, and they would begrudgingly comply. Often they would refuse me and tell me they didn't have time to do their job and mine. I know it was most likely their intent to make me suffer, but who really suffered were the patients!

A Nursing Reality

When we think of workplace violence, we usually do not think of nurses belittling or threatening each other. Horizontal violence is a reality for nurses employed in all settings. It is hostile and aggressive behaviors by individual or group members towards another member or groups of members of the larger group and is described as inter-group conflict.1

Horizontal violence makes everyone feel uncomfortable, so nurses have a tendency to sweep it under the carpet and for supervisors to look the other way. It becomes corrosive in workplace culture and is an unacceptable and destructive phenomenon.

Senior nurses display of negativity often discourage new graduate nurses by exhibiting the phenomenon of "eating their young" and this behavior can result in new nurses resigning from their positions.

Horizontal violence can also be very costly for the employer as a result of increased absenteeism and burnout, which will often leads to many nurses choosing to retire or leave the profession of nursing altogether.

Educating employees on horizontal violence and developing reporting systems for employees who are victims of horizontal violence will aid in eliminating this type of behavior.

Members of the human resource department play an important role in assisting managers and supervisors as they work towards eliminating horizontal violence. Mathis and Jackson (2008) believed that one aspect of HR policy is to identify how workplace violence can be dealt with in conjunction with disciplinary action and referrals to employee assistance programs.2

Organizational Response

Workplace violence should be addressed as an organizational problem rather than the victim's responsibility. The victim may require support from management, which can result in a leave of absence from the workplace. The victim of workplace violence may be afraid to report the incident to their manager. The manager needs to ensure that there is a process in place for dealing with the issue of workplace violence.

A culture of safety needs to be promoted by the organization and education provided to all staff to promptly report any incidences' of horizontal violence. It is important as a manager to assess staff morale and follow up on any negative influences that workplace violence promotes. It also is important that the manager's style is not viewed as intimidating when dealing with workplace violence as it can lead to staff mistrust and an increased rate of absenteeism.

The Occupational Safety and Health Administration in 2003 recommend all employers' human resources departments establish and maintain a violence-prevention program and there are a variety of ways that this can be accomplished. Initially healthcare institutions must establish, publicize and enforce a written policy on horizontal/workplace violence.3

A clear organizational policy towards workplace/horizontal violence is a necessary first step for a prevention program to be fully effective. A workplace violence preventative policy needs to be comprehensive and should address horizontal violence specifically since it is a significant source of emotional abuse at work.

Also, the presence and publication of a policy specifically addressing horizontal violence lets the employees know that management is committed to reducing violence in the workplace. A healthy work environment is known to be preventive measure and a reduction factor to coworker violence; however, there is a lack of available information on violence that is initiated by coworkers.

Many factors have been identified that affect the work climate and may contribute to bullying and harassment in the workplace. These factors should be included as part of the guidelines and may include: lack of role clarity, low job autonomy, poor communication, competitive work environment, and major changes occurring within the organization.

The policy should include many of the following: a clear statement of unacceptable behaviors, methods for ensuring that employees are aware of the options available to them when confronted with horizontal violence, a statement of support from management, the procedure for reporting incidents, and directions for obtaining post incident counseling.

Zero-tolerance policies have also been adopted by many healthcare institutions, but are difficult to enforce. Human resource departments in organizations must also take on a more active role in organizational change including: staffing, workload, culture, climate, and providing leadership training to managers and supervisors. High priority should be given to organizational intervention in preventing horizontal/workplace violence. Human resource departments play an integral role in helping accomplish this goal.

There are many resources available for both the employee and the employer to cope or deal with horizontal violence. These behaviors will never be eliminated if the actions are swept under the carpet. It is imperative that all employees in the workplace be educated and trained so that we can begin to break the cycle of horizontal violence.

Anna G. Hollister is a registered nurse in Connecticut.


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Thank you for telling your story and providing such valuable insight.

Donna FairbanksAugust 22, 2013
San Diego, CA



Workplace violence is utilized to instigate and exploite a less experienced coworker (me) causing me to become angry and sad. It is extremely unfortunate that HV is used to provoke me and make me ill. I am dealing with a former high level executive of the company and was told It was my problem and I'm allowing outside issues effect me without any concrete evidence to substantiate that fact. It's a still discussed because its still a very commonplace problem and it is very very wrong.

Lori February 23, 2013
FL



Lateral violence is not only common among nurses but many healthcare personnel. I have found it to be at its worst in the OR, the ultimate experience in what happens behind closed doors. Surgeons are often putting patient care at risk by creating toxic work environments with tantrums and explosive anger. I have been both witness and "victim". It seems to me criminal that people should make a place of care and healing such a nightmare for a surgical team. I wonder how many patients would be interested in knowing what kind of environment develops once they are under anesthesia? And would they still want to have surgery at that hospital by that surgeon if they did know?

C H,  CSTNovember 13, 2012
Denver, CO



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