Horizontal Violence/Bullying Among Staff Members

Horizontal violence is a very serious issue confronting members of the nursing

profession. It can be psychologically distressing for nurses that are at the receiving end of such
behaviors. Horizontal violence or bullying is the aggressive behavior towards one nurse or group
of nurses. It includes bullying, withholding of information, gossip, intimidation, and act of
unkindness. It is a behavior that shows lack of respect for another individual (Becher &
Visovsky, 2012). Horizontal violence can create negative working environment, impair
teamwork of the staff members, and compromise the quality of care provided for patients.
This paper will focus on the problems causing horizontal violence at work; the
alternatives and actions that should be taken; how the actions will be implemented; and finally,
how to evaluate if the actions are successful. It is important to know that to provide quality care
for patient, professional teamwork among nursing staff is imperative. Teamwork is a critical
element for achievement of positive patient outcomes (Becher & Visovsky, 2012).
One of the major causes of horizontal violence among staff members in the work place is
the acceptance of oppression as a norm in the work place. As stated by Farrell (2001),
oppression has resulted in nurses resorting to aggressive and destructive behaviors within their
own ranks. This means that there is oppression in the clinical setting, and it has become normal
for some nurses to bully each other. Many nurses are acculturated to turn the other cheek,
believing that negative staff interactions are to be expected and tolerated (Farrell, 2001). This
means that most nurses have gotten used to the idea of nurses bullying each other; to the extent
that most staff members in the clinical setting expect and tolerate horizontal violence.

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Another cause of horizontal violence among staff members is that new nurses serve as
easy targets. According to Leiper (2005), new nurses most times become easy targets for more
aggressive nurses; after some time, the new nurse may get used to the negative behavior and, in
turn, begin bullying others. This is not acceptable in the work place. For example, I have seen
nurses in the clinical setting try to make student nurse feel like they dont know anything. This is
really sad, you will expect older nurses to encourage and teach student nurse; and not oppress or
bully them.
Furthermore, low self-esteem which leads to poor anger management is another cause of
horizontal violence among staff members in the clinical setting. As stated by Leiper (2005), low
self-esteem can lead to poor anger management, which result in acting out against others. This
means that a nurse with a low self-esteem might not be able to deal with the challenges nurses
face at work every day, and the nurse might result into acting out against others. As stated by
Fredriksson & Eriksson (2003), often nurses with low self-esteem react negatively to their coworkers when involved in a highly stressful situation.
There is also horizontal violence among staff members when nurses are unable to
complete assigned tasks in a timely and efficient manner. According to Hurley (1999), nurses
who spend too long on a task or on a patient without facing the consequences are treated poorly
by the other staff members. For example, when some nurses dont do their job effectively and
timely, it affects the job of the other nurses on the unit. After some time the other nurses become
frustrated and they start gossiping, acting unkindly, withholding information and treating the
nurse differently.

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Lastly, another cause of horizontal violence among staff members in clinical setting is the
perceived entitlement of nurse managers or other nurse leaders which allows them to translate
their power into the abuse of others. As stated by Farrell (2001), the prevalent attitude by nurse
managers or other nurse leaders remains: nurses are employees first and individuals with rights
second. This means that some nurse managers and some nurse leaders show lack of respect for
the nurses that work under them. Some of these nurse managers abuse their power just to show
they are the boss or to threaten others to do what they want.
The two alternatives that will help to reduce horizontal violence among staff members
includes: recommending education to raise the consciousness of nurses and assist them in
realizing they have the capability to stop the oppression of horizontal violence; and the nurse
managers committing to being a role model and enforcing a change in unit culture that includes
adequate mentoring and holding fast to the nursing profession vision and values. These two
alternatives can be implemented easily by creating educational programs on horizontal violence
for nurses at the work place, and recommending the College of nurses of Ontario (CNO) to take
a zero tolerance policy for any type of verbal abuse or disrespectful behavior toward a nursing
colleague. When the CNO show a zero tolerance to horizontal violence, nurses will take the issue
more seriously. These two alternatives will go a long way to help stop or reduce horizontal
violence among staff members.
Finally, in evaluating if the actions implemented above are a success, nurses engage in
the activities on their unit that strengthen nursing practice, and advance professional

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development; nurses embrace those new to the profession; and nurses perception and behavior
move from one of oppression to opportunity for all.
In conclusion, the acceptance of oppression as a norm in the work place; seeing new
nurses as easy targets; low self-esteem; treating nurses that are unable to complete assigned tasks
in a timely and efficient manner differently; and nurse managers using their power to abuse
others are the major causes of horizontal violence among staff members in the work place. The
two alternatives that will help to reduce horizontal violence among staff members includes:
recommending education to raise the consciousness of nurses and assist them in realizing they
have the capability to stop the oppression of horizontal violence; and the nurse managers
committing to being a role model and enforcing a change in unit culture.

References

Becher, Jennifer; Visovsky, Constance. (2012), Horizontal violence in nursing.

Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses, 07/2012,
Volume 21, Issue 4.
Farrell, G.A. (2001). Aggression in clinical settings: Nurses views. Journal of Advanced
Nursing, 25, 501-508.
Fredriksson, L., & Eriksson, K. (2003). The ethics of the caring conversation. Nursing Ethics, 10
(2), 138-148.
Hurley, J. (1999). Breaking the spiritual care barrier. Journal of Christian Nursing, 16 (3), 8-13
Leiper, J. (2005). Nurse against nurse: How to stop horizontal violence. Nursing2005, 35(3), 4445.