Horizontal violence among nurses: Experiences, responses, and job performance

Abstract

Horizontal violence (HV), or nonphysical intergroup conflict expressed in overt and covert behaviors of hostility, is pervasive in nursing and has been discussed in the literature for more than two decades. It is costly and has potentially devastating effects including high nurse turnover rates, increased illness, decreased productivity, and decreased quality of patient care. Recognizing how these behaviors are established and sustained is necessary if nurses are to overcome these types of behaviors. This mixed methods study used an online survey to examine 76 hospital nurses' experiences and responses to episodes of HV as well as its effects on job performance. Seven of these nurses answered more in-depth questions during a follow-up interview. Nurses in this study recognize HV as a phenomenon that occurred early in their careers as novice nurses. The literature suggests that these behaviors are evident during nursing education. The academic environment is an ideal place to teach the skills necessary to respond appropriately to HV with peer support being essential. Nurses also reported that manager and staff support and workplace education were the most helpful in reducing HV. Increased workload and stress and HV being accepted practice on the unit were factors identified as most important in promoting HV. Further, nurses cited reasons why they continue in their jobs after episodes of HV. Intervention studies are needed to test effective ways of reducing this very difficult behavior among nurses in the workplace. K E Y W O R D Sabuse/bullying/harassment/incivility, education, professional issues 1 | INTRODUCTION Horizontal violence (HV), or nonphysical intergroup conflict that is expressed in overt and covert behaviors of hostility, is pervasive in nursing and has been discussed in the literature for more than two decades. It is costly and has potentially devastating effects including high nurse turnover rates, increased illness, decreased productivity, and decreased quality of patient care. Recognizing how these behaviors are established and sustained is necessary if nurses are to overcome these types of behaviors.HV has been described in the literature by various authors, and although the definitions vary, there is agreement that HV is violence in the form of action, words, and other behaviors that is directed toward one's peers. 1-6 These behaviors control, humiliate, denigrate, or injure the dignity of another person. HV reflects a lack of respect for the individual.HV directed at nurses in the workplace come from a variety of sources including patients and their families 7,8 ; physicians and other hospital staff 8-10 and between nursing colleagues. 7,8,11,12 These negative behaviors pose a threat to patient safety, [13][14][15][16] and result in increased stress levels, frustration, loss of concentration, and breakdown in communication. 9,

Nurses’ perceptions of teamwork and workplace bullying

“…Workplace bullying has been identified in the literature (Agervold, , ; Croft & Cash, ; Demir & Rodwell, ) and that noted in this study reflects the rates reported by the Workplace Bullying Institute, , Agervold, , and Duffin (). Consistent with the literature, nurses were more likely to report observing others being bullied than the direct experience of being bullied (Bloom, ; Ditmer, ). As an alternate explanation to that posited above, nurses might be less comfortable saying they've been bullied than sharing their observations of others.…”

The relationship between intention to leave the hospital and coping methods of emergency nurses after workplace violence

“…For instance, Chinese nurses use a variety of coping methods such as obtaining support from family, relying on their own strength and reporting the incident to a leader (Zhao et al., ). Bloom () found that, after exposure to WPV, nurses in the USA responded by walking away, remaining silent or responding to the perpetrator in an emotional way such as getting angry. Jordanian nurses’ responses to violence were mostly to ignore the event, as they believed that reporting it would make no difference (Al‐Ali et al., ).…”

Organisational antecedents, policy and horizontal violence among nurses: An integrative review

“…Bloom (, p. 4) defined the problem of horizontal violence (HV) among registered nurses (RNs) as “violence in the form of action, words, and other behaviours that is directed towards one's peers. It controls, humiliates, denigrates or injures the dignity of another.…”