Nursing and Horizontal Violence

Horizontal violence (HV) in the nursing profession also referred to as Lateral/Horizontal violence and bullying, is found to be disruptive because of its nurse-to-nurse nature. The damage is far reaching because it undermines the profession of nursing. Nursing is seen as a profession that is nurturing and caring. Therefore, to reveal that in-fighting and overall disrespect for one another has been ingrained in the professional as normal and acceptable is disconcerting. This devaluing of one another sets the stage to thwart concise and clear communication, and is of significant concern since HV, though not directed at patient care, will ultimately affect the care of its patients.

When Does Horizontal Violence Begin?

Horizontal violence is so much a part of the nursing profession that the pattern of abuse begins very early on, surprising at nursing school. Once of the reasons is that there is such a shortage of proficient nursing educators, and over half of nursing applicants are not accepted; the nurse student immediately adopts a competitive stance or nature with other nursing students. All are vying to be the top nursing student (Young, 2011). Instead of peers becoming allies, they are set-up at the onset by the instructor to be competitors with statements such as, “look around, one in 10 won’t make it to graduation” (Young, 2011, p. 3). This, though it may sound trivial it contributes to the culture of peer aggression.

HV can be obvious such as student nurses being snubbed, ostracized, put-down, and intimidated or not as obvious such as being made to feel stupid and unappreciated. Becher and Visovky (2012), notes that the pattern of HV is learned at the student nursing level. In a study which interviewed student nurses, 50% experienced HV in their clinical rotations. Student nurses feel victimized and some are unable to deal with the pressure. New nurse graduates experiencing HV react by taking days off from work, or may decide to leave the profession altogether (Becher & Visovsky, 2012).

HV can be detrimental when directed at recent nurse graduates. The learning process can be cut short or important procedures and processes may be missed or incorrectly interpreted. As with anyone who has a new position, there are questions which need to be answered, and unforeseeable conditions which may arise. A new employee should feel free to have all questions addressed and should not be made to feel uncomfortable or awkward for asking. These types of working conditions are not conducive to learning or to career advancement (Becher & Visovsky, 2012).

The Problem and Remedies

The Rittenmeyer study notes that HV and the implications it yields have been reported in nursing literature for nearly 20 years (Rittenmeyer et al., 2012). To support the claims of the seriousness of this problem in nursing, several articles have been written in various publications. Some of the articles refer to HV as “nurse-to-nurse” bullying (Bartholomew, 2013). Bullying tactics are both overt, such as “name calling, bickering, fault finding, criticism, intimidation, gossip, shouting, blaming, put-downs, raised eye brows;” and covert such as. “unfair assignments, refusing to help someone, ignoring, making faces behind someone’s back, refusing to only work with certain people – or not work with others, whining, sabotage, exclusion, fabrication” (Bartholomew, 2013).

One of the known perpetrators of HV is nurse leaders. This is unfortunate since these are the people in the position to help the most. However, they are still the best line of defense in the workplace. Becher and Visovsky refer to the head nurse or the lead nurse as being a critical part of helping to resolve the problem of HV (Becher & Visovsky, 2012). They are in a position to be a model of the behavior they expect staff to emulate. Education at the student level about HV and understanding what it constitutes will help students recognize it and understand how to report it. Focus groups are also recommended, which can facilitate how best to support nurses who have been victimized. One of the most significant remedies suggested is cognitive rehearsal. This is a phycological therapy, which ask the person to visualize a response to a difficult situation (Becher & Visovsky, 2012).

Conclusion

The first line of defense to resolve an issue is understand it. Now that HV has been identified as a detriment to the nursing profession this is the first step to rectifing the situation. Not to address it is to continue to tolerate the abuse and the negative effect it has on how nurses perform their responsibilities. Moreover, the top priority, which is exceptional care for those patients who put their trust in this profession, can be handled with care.

References

Bartholomew, K. (2013, 02 7). Break the spell and end lateral violence in nursing. Nurses Together. Retrieved from http://www.nursetogether.com/break-the-spell-and-end-lateral-violence-in-nursing

Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. MEDSURG Nursing, 21(4), 210-214.

Rittenmeyer, L., Huffman, D., Block, M., Mathaler, M., Misner, S., Moore, E., Wegner, G., & Kleefisch, K. (2012). A comprehensive systematic review on lateral/horizontal violence in the profession of nursing. JBI Database of Systematic Reviews and Implementation Reports, 10 42. Retrieved from http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/172/159

Young, S. (2011). Does nursing school facilitate lateral and horizontal violence? Tennessee Nurse, 74, 3.