Running head: HORIZONTAL VIOLENCE AMONG NURSES

HORIZONTAL VIOLENCE AMONG NURSES

HUMBER COLLEGE
MALISSA HARRIS

HORIZONTAL VIOLENCE AMONG NURSES

Horizontal Violence among Nurses

When working in a health care setting, like any job, workers can be faced with a variety
of issues. A common problem witnessed in hospital settings is horizontal violence and bullying
among staff members. Horizontal violence is behaviour of hostile and aggressive acts by group
members towards another member of the group. This type of bullying/ violence occurs in such
ways, including sabotage, backstabbing, and scapegoating, complaining, and other forms of nontherapeutic communication (Dunn, 2003).
There are many studies done researching the occurrences of horizontal violence between
nurses. In an article written by Malena King-Jones, a registered nurse, she focuses on the cycle
of horizontal violence. King-Jones mentions a quantitative study of 270 nurses horizontal
violence does occur in nursing; the most frequent source of horizontal violence identified was
coworkers. Of the total number of respondents, 30% indicated that they dealt with aggression
daily whereas 25% indicated that colleague aggression was a major stressor in the work
environment (King-Jones, 2011). There is a large group of nurses who deal with bullying every
day in the workplace.
Work place violence among nurses have negative psychological effects. In a study
conducted researching nurses self-esteem, concluded that experiences for beginning nurses were
often negative and had repercussions on how they felt about themselves as students and as
individuals. The victim of HV may experience low self-esteem, anxiety, depression, and
sleeping disorders (Becher, 2012). Horizontal violence does not only effect a persons view on
their work life but it impacts their everyday lives. A majority of these student nurses and nurse
had said that the process of becoming a nurse was a very distressing process; out of all the
student nurses interviewed all could recall being bullied by a nurse (King-Jones, 2011) As a

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nursing student, many are subjected to this sort of bullying and as they progress as a nurse they
start to develop these behaviours of aggression and bullying. These behavior begin to develop
because the students have been subjected to these actions and they believe this is the norm for
nurses.
Although these situations are very common in the workplace between nurses, nurse
managers do not see it as very serious events. As described by Joy Longo in her article entitled,
Leveling Horizontal Violence, horizontal violence is thought to be an expression of oppression
which has evolved from low self-esteem or lack of respect (Longo, 2007). Historically nurses
have been an oppressed group, primarily dictated by male physicians. In the recent years of
healthcare nurses and doctors now work on an equal level, and they are to work as partners in the
decision making process. However this is not always the case, and some doctors still like to
dominate the nursing profession., causing nurses to feel oppressed When a group is oppressed
they begins to develop feelings of alienation, and begin to feel a loss of autonomy. These
feelings caused by oppression lead to low self-esteem and feelings of loss of power. When these
feelings occur these oppressed groups tend not to retaliated, but instead resort to manifesting
their anger and frustration to coworkers leading to horizontal bullying and violence. Other
responses characteristic of horizontal violence are manifested as ineffective, nonproductive
forms of conflict resolution. Instead of dealing with a problem directly via rational discussion
between or among members of an oppressed group, one or more of the parties involved exhibits
poor or even harmful communication techniques (Dunn, 2013).
Communication is very important in any work environment, and especially important in
the health care profession. Jennifer Becher talks about how the lack of communication is
believed to be one of the number one causes Horizontal Violence effecting not only the team

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members but also the patient care. When information is being omitted between nurses due to the
acts of horizontal violence this leaves the nurse, who is the victim of the omissions, unable to
provide safe and quality care for their patients (Becher, 2012). This statement, that bullying
between nurses diminishes the quality of care is agreed by the nurses interviewed by Christina
Purpora, Some nurses believe that horizontal violence threatens the safety of patients and
diminishes the quality of their care (Purpora, 2012). It is evident that these acts bullying,
resulting in omissions effect the entire nursing process.
Becher proceeds to discuss how most cases of horizontal violence rarely go unreported. It
the job of health care providers to ensure these incidences of violence between nurses comes to a
stop. It should be in a nurse managers best interest for the workers and the patients to implement
resources to help eliminate horizontal violence in the work place. Educating nurses on the
impacts of horizontal violence can make a difference. These educational sessions should include
defining what horizontal violence is, how to modify certain behaviours that may be witnessed as
horizontal violence and consequences of these violent actions. A nurse manager should also
consider integrating a Zero Tolerance Policy against bullying in the work place. In doing so
they should clearly outline the repercussions of any behaviours going against this policy. Lastly,
nursing leaders should be given training in appropriate conflict management. This will assist
leaders in giving feedback to co-workers and in assessing the cultural employment of the unit.
If I were in the position as a nurse leader, and it was my duty to help prevent these
incidences, I would set up an educational session based on Horizontal Violence. I would make
these session mandatory for all nursing staff to attend, and if they did not attend they would have
to deal with consequences. During these educational sessions, I would clearly outline what
horizontal violence is and provide examples to make these occurrences better understood. During

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the teaching opportunities I would educate the staff on the effects horizontal bullying has both
psychological and physiologically on staff and patients. Another topic that would be necessary to
discuss would be the cause and contributing factors to the prevalence of bullying and violence in
the work place between nursing staff. Lastly I would have the nursing staff brainstorm together
ways to diminish the bullying. I would also want to implement a Zero Tolerance policy that all
nurses must abide.
I would evaluate the success of my actions, by evaluating the effectiveness of the nursing
staff to work in a cooperative manner, demonstrating teamwork skills. Staff turnover rates can
also be assessed, as horizontal violence can be a cause for high turnover rates within a unit. An
effective way to evaluate these implementations would be having retiring and exiting nurses
participate in interviews, asking them about their experiences working on the unit. There should
also be assessments held of monthly violence reports and the severity of them. Patient
satisfaction from nursing care can also be assessed, in order to see if bullying is effecting patient
care.
Horizontal violence is quite prevalent between nurses, and can have lasting physiological
and psychological effects on the victim and patients. Nursing leaders need to develop an order
with in units, so these occurrences will diminish. It is important for nurses and all health care
professionals to understand what horizontal violence is, what causes this bullying, the effects and
what can be done to bring these occurrences to an end. If nurses cannot support one another, how
are they supposed to support their patients?

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Bibliography
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Dunn, H. (2003, December). Horizontal Violence Among Nurses in the Operating Room.
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/200819058?pq-origsite=summon&accountid=11530
King-Jones, M. (2011). Horizontal Violence and the Socialization of New Nurses. Retrieved
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Purpora, C., & Blegen, M. A. (2012, May). Horizontal Violence and the Quality and Safety of
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February 03, 2016, from http://www.nursingcenter.com/cearticle?an=00005217201303000-00009