WFA Professional Development Series
Taking Control: Reversing Horizontal Violence and Bullying in Nursing
Horizontal violence is defined as harmful behavior via attitudes, actions, words
and other behavior that is directed toward us by colleagues (Conti-O’Hare &
O’Hare, 2006). Bullying in the workplace is described as repeated,
health-harming mistreatment of one or more persons by one of more
perpetrators in the form of verbal abuse, threatening, humiliating or offensive
behavior or actions (Coombs, 2007). Horizontal violence and bullying can be
devastating and can negatively affect the work environment for all involved.
On a personal level, horizontal violence and bullying can result in sleep
disorders, poor self-esteem, hypertension, eating disorders, nervous
conditions, low morale, disconnectedness, depression, impaired personal
relationships, removal of self from workplace and suicide.
Horizontal violence can be costly to organizations, leading to job
dissatisfaction, burnout and physical stress. Research indicates that where this
behavior is allowed, many nurses will leave the environment and even the
profession. In some instances, for example, when student clinical groups rotate
through a unit, it may even affect an institution’s ability to recruit new nurses
(Longo & Sherman, 2006).
Horizontal Violence: A Case Study
Janet K. was a new graduate on the nursing unit. She was very excited to have passed her NCLEX exams and was very pleasant and
enthusiastic about starting work on her busy unit. The nurses on the unit knew that a particular physician, Dr. M. followed a specific
routine for making rounds. Janet K. had several of his patients that day but was unaware of his routine. The nurses on the unit
decided not to share that information with her as they know that Dr. M would be arriving soon with certain expectations of the nurse
who would be making rounds with him. They decided that this would be a “fun” way to “take her down a notch, and wipe that silly
grin off her face.” Dr. M. arrived and Janet had not prepared his patients or his charts for his rounds. He began to berate her loudly
in front of everyone at the nurse’s station. The other nurses, retreated to the back in the medicine room and all smirked & chuckled
while Janet K. stood red-faced and endured his tongue lashing. Janet K. learned to hide her enthusiasm for nursing and stayed on the
unit long enough to be oriented and to complete the required six months before transferring to another unit in the hospital.
There is an abundance of literature related to the horizontal violence leveled against new graduates. The
phenomenon of nurses eating their young is widely known and well-documented. This behavior is extremely
detrimental to the future of the profession as well as to the of quality care of our citizens (McKenna et al, 2003).
Both the Center for American Nurses (CAN) and the National Student Nurses Association (NSNA) have adopted policies
in support of a professional workforce culture and have called for the elimination of horizontal violence among
nurses. CAN’s strategies for the reduction and elimination of Lateral Violence include:
• Modeling of professional behavior by nurse leaders, managers and supervisors;
• Utilization of conflict management and conflict resolution strategies to
address this behavior in the workplace;
• Self-reflection and positive communication strategies by individual nurses;
• Collaborative interdisciplinary initiatives within institutions;
• Nurses working collaboratively with employers to ensure that the mission,
vision and values in the Code for Nurses (ANA, 2001) are met.
Why Does Horizontal Violence Occur?
It is believed that horizontal violence arises as an expression of an oppressed group behavior evolving from
feelings of low self-esteem and lack of respect from others. Nursing has been described as an oppressed group
because the profession is primarily female and has existed under a historical patriarchal system headed by male
physicians, administrators and marginalized nurse managers (Longo & Sherman, 2006). Nurses feel a lack of
control over their work environments. Rather than venting their frustrations on the source, they create conflict
within their own group with horizontal violence among colleagues.
It is imperative that horizontal violence and bullying in the workplace be addressed for the health and
welfare of nurses and their patients. Nurses have the power to bring this issue forward to eliminate
this phenomenon. Development of programs that address horizontal violence and bullying are
essential to healthy work environments and a healthy future for nursing.
REFERENCES
Conti-O’Hare, M. & O’Hare, J. (2006) Nursing Spectrum Online. Don’t perpetuate horizontal violence.
http://nsweb.nursingspectrum.com/cfforms/Guest Lecture/Horizontal Violence.cfm
Brought To You By:
Coombs, Andrea (2006) Bully for you: Hair raising bad boss stories and how you can cope.
http://www.bullybusters.org/advocacy/def.html. August 30,2007
Critical Care Nurses as Coworkers: Are Our Interactions Nice or Nasty? Critical Care Nurse. 27(3), 10-14.
Griffin, M. (2004) Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses.
35(6), 257-263.
Longo, O., & Sherman, R. (2007). Leveling horizontal violence. Nursing Management. (38)3, 34-37, 50-51.
McKenna, B., Smith N., Poole, S., & Coverdale, J. (2003) Horizontal Violence: Experiences of registered nurses in their first
year of practice. Journal of Advanced Nursing. 42(1), 90-96.
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provide services and develop policies that positively
impact the work environment.