Horizontal Violence in Nursing

Horizontal violence is cases of violent behavior or disruptions of workplace violence that occur between two peers. It is a dilemma that stretches beyond the nursing profession and can be a serious issue in nearly any field. However, it is especially pertinent in nursing as this is a field where people outside of the profession directly depend on you. This is not to say that horizontal violence does not have extremely adverse effects in other industries. It is always an issue that should be taken seriously. And yet, it is hard to imagine a more imminent scenario than a patient in critical condition who is not receiving the care they need because there is an altercation between two of the nurses. This brief examination will identify catalysts that can often lead to horizontal violence. It is important to note the causes so that peers and employers can spot early warning signs. Then we will address how to prevent horizontal violence from happening.

There are several ways in which horizontal violence can occur. It does not always play out in overt attacks, but can come in the form of “criticism, sabotaging, undermining, infighting, scapegoat, and bickering” (Duffy, 1995). Unfortunately, this occurs far too often in nursing, and mostly involving senior and veteran nurses, as well as nursing instructors, inflicting horizontal violence on nursing students and first year nurses. This, of course, is the opposite of how a new hire should be treated. Especially one in which their profession is caring for those in need. Gerald A. Farrell (1997) remarks about how contradictory it is “that a discipline that has ‘caring’ for others as its main focus employee relationships are so poor” (p. 507). It is not unusual for veteran employees in any industry to treat new hires with some degree of resentment, but the treatment of nursing students and new hires in nursing can be especially harsh and cruel.

Some of this treatment can be attributed to nursing shortage and nursing burnout. There is a shortage of nurses at most hospitals and this leads to nurses becoming overly stressed and burnt out or fatigued. While stress and fatigue often lead to anger and irritability, this kind of behavior only exacerbates the issue, as nurses in training who experience severe horizontal violence are much more likely to abandon the profession. In a 2001 study, 34% of recent nursing student graduates reported that they had contemplated leaving the profession as a direct result of the horizontal violence that they received (King-Jones, 2011). If horizontal violence is allowed to continue, then more prospective nurses get turned away. The burnout continues, the shortage grows, and the cycle goes on.

The process of reducing violence and preventing and deterring horizontal violence in nursing falls mostly on the shoulders of nurse leaders. Nurse leaders need to appoint nursing instructors who are patient and have a knack for teaching. They need to provide an outlet for nursing students and new hires so that they can safely report horizontal violent behavior. Likewise, veteran nurses need an outlet to voice their frustrations with workload, stress, and burn out so that they do not project this energy onto the more vulnerable newly hired nurses. There also simply needs to be more education regarding horizontal violence. Some researchers have recommended implementing educational posters and fliers regarding horizontal violence that can be placed throughout a hospital (Cleary, Hunt, Walter, & Robertson, 2009). This could alert nurses of the warning signs leading to horizontal violence, for themselves and for their peers.

Horizontal violence is a critical issue in the profession of nursing. It leads to high job turnover, high reports of job dissatisfaction, and ultimately, a shortage of nurses. It can get better with time, but it will take immense cooperation by all levels of nursing staff.

References

Cleary, M., Hunt, G. E., Walter, G., & Robertson, M. (2009). Dealing with Bullying in the Workplace. Journal of Psychosocial Nursing and Mental Health Services, 47(12), 34-41. doi:10.3928/02793695-20091103-03

Duffy, E. (1995). Horizontal violence: A conundrum for nursing. Collegian, 2(2), 5-17. doi:10.1016/s1322-7696(08)60093-1

Farrell, G. A. (1997). Aggression in clinical settings: Nurses’views. Journal of Advanced Nursing, 25(3), 501-508. doi:10.1046/j.1365-2648.1997.1997025501.x

King-Jones, M. (2011). Horizontal violence and the socialization of new nurses. Creative Nursing, 17(2), 80-86. doi:10.1891/1078-4535.17.2.80