The High Cost of Horizontal Violence in Nursing

Paisley Rojo

Gen 200

July 21, 2015
Dr. Davidov
The High Cost of Horizontal Violence In nursing, there is a growing concern called, horizontal violence. Horizontal violence is an act of aggression from one nurse to the other. Horizontal violence impedes teamwork, hinders patient care and causes a negative work environment (Becher & visovsky, 2012). Even though workplace politics exists in every profession, the effects of horizontal violence, or bullying, in nursing is a costly behavior. Nurses feel devalued in the workplace and experience psychological effects. Patients are likely to experience less favorable outcomes, and retention is difficult costing facilities large amounts of money to recruit and hire replacements.
Types of violence Horizontal violence is physical and or verbal behavior that is believed by the recipient, to be degrading, threatening and considered inappropriate (Bartholomew, 2014). According to Doyle (2001), there are several ways to undermine one's dignity in the workplace. This list includes: humiliating and intimidating the victim, verbally assaulting, and implying threats. Intruding on co-workers, and stalking the targeted person, is another form of horizontal violence. Moreover, repeatedly imposing deadlines and tasks that are unfavorable or impossible is also considered as a form of workplace bullying. Dellasega (2009), states that the participants, willing or not, of horizontal violence, are divided into three roles. The first role is the perpetrator, the nurse or nurses responsible for the aggressive behavior. The second participant is the victim or victims, being targeted. The final or third group of participants is the bystanders, the ones that witness the attack (Dellasega, 2009). There are certain scenarios that can increase the likelihood of a nurse being targeted. In these situations, the nurse may be a new graduate or new employee. The nurse may be experiencing stresses related to lack of staff. Another reason for workplace bullying is a nurse might be receiving recognition and or special attention from supervisors and physicians for an action that peers felt were not appropriate (Dellasega, 2009). A study done by the Institute of Medicine reported that approximately 2,000 clinicians volunteered for a study about horizontal violence as nurses. Over 90 percent had fallen victim to inappropriate verbal interactions with peers. Of that 90 percent, almost 60 percent had been victims of verbal abuse and about 50 percent experienced threatening body language (Papa &
Venella, 2013).
Causes
Although horizontal violence is more common in the clinical setting, some research states this behavior starts long before and during nursing school. Due to the lack of space in nursing programs, combined with stress associated with being the most desired applicant, the competitive process causes conflict between students (Young, 2011). Once in the nursing program, there is still a high level of competition. The desires include; trying to achieve the best grades, trying to gain favor by nursing instructors to get the best internships, recommendations and honors. This competition causes high levels of stress and sacrifice on behalf of the student and causes them to lose patience, ultimately leading them to attack those closest to them including their peers. Negative behaviors such as mean comments, gossip, and other ill-willed behaviors result from the competition and stress. Such behaviors intensify emotions of those involved which ultimately hinders the student in the learning environment. Performance and negative behaviors carry over into the nurse's professional life creating the belief that peers are adversaries as opposed to allies (Young, 2011).

Effects Rowe and Sherlock (2005), states when a nurse experiences verbal abuse on a regular basis, that nurse is less likely to be satisfied with work. Moreover, the victim may have a higher rate of absenteeism, and lack of patient care standards. If this behavior is a problem for the clinical facility, that facility will likely have a higher turnover rate, which will in turn cost more money in recruitment and education. Moreover, bullying also affects continuity of care with patients and may result in sentinel events as well as legal action against the clinician, and facility from patients and family members. According to Aleccia (2008) an estimated 70 percent of nurses involved in a study of horizontal violence believed there was a relation to inappropriate behavior from peers and negative outcomes for patients. Moreover, 25 percent of the study group believed that horizontal violence contributed to patient mortality. Research has shown that there is an estimated $30,000 to $100,000 per annum paid for each victim of horizontal violence. This cost stems from absenteeism, treatment of the psychological effects, and the high rate of turnover (Gerardi & Connell, 2007). Woelfle and McCaffrey (2007) investigated the damage caused by horizontal violence to work relationships in nursing to find a solution. The result of that investigation stated that horizontal violence in nursing is commonplace and experienced by nursing students, nurses with limited experience, and seasoned nurses equally.
Solutions
According to the American Nurses Association, currently federal standards do not require protection from violence in the workplace. Some states have asked that laws be passed establishing prevention programs for healthcare facilities. In this legislature, penalties would increase if convicted of assault on health care employees (ANA, 2015). Organizations need to develop policies to protect staff and penalize those responsible for the horizontal violence. Quality patient care is impossible when nurses and healthcare professionals work under constant fear and coercion (Woelfle and McCaffrey, 2007). A supportive environment geared towards nurses is important when recruiting and retaining nurses and other healthcare professionals (Trybou, Paeshuyse &Gemmel, 2014). Writing policies of zero tolerance is not enough prevention on the part of the employer. The employer must enforce policies related to workplace violence as well. It is important to understand what horizontal violence is and the reasons behind these behaviors. Employers must also provide support for victims and educate the staff (Papa & Venella, 2013). When dealing with nurses that have been victims of horizontal violence, it is important to educate them on the importance of self. Explore the nurse’s feelings and opinions and express their importance, this will help prevent the nurse from internalizing the attack (Kerfoot, 2007). Encourage the nurse to write in a journal as an outlet to the emotions experienced during the attack. Ask the nurse to document each event, as well as save any electronic communications the victim receives from the perpetrator. Accurate and thorough documentation, along with timely reporting, will help management take appropriate action in a timely manner.
Conclusion
It is distressing in a profession that is nurturing and empathetic by nature, that the nursing community is experiencing such a dilemma. The common thought is that nurses should be more supportive when dealing with peers. Unfortunately, this is not the experience that nurses are reporting. It is important that nurses collaborate to preserve the nursing community. It is time for nurses and nurse managers to observe, document, and educate staff on the effects of horizontal violence, rather than continue exposing nurses to unfavorable conditions in the workplace (King-Jones, 2011).

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