Violence in Nursing

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Professional team synergy is imperative amongst the workers in any organization that wishes to achieve high standards of service from its workforce. Teamwork in nursing is a critical requirement for satisfactory outcomes in patient care. Team members achieve positive performance outcomes by adapting positive attitude, sharing a common vision and maintaining respect towards each other. The failure to observe these practices creates a negative working relationship. Unfavorable workplace relationships in any organization often lead to increased employee turnover, burnout, and poor performance. Nursing professionalism is not an exceptional sector. The repercussions of the nurse-to-nurse violence affect the team performance of any organization in a similar way.

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An aggressive action of a nurse against a colleague is termed as horizontal violence. In this essay, different occurrences of nurse-to-nurse violence in the workplace will be described and techniques for controlling and preventing its effects will be analyzed. The solutions will be based on the application of the nursing leadership theory to the professional clinical practice.

Background, Scope and Definition

Different scholars have attempted to define horizontal violence. According to Stagg, Sheridan, Jones, & Speroni (2013), it is aggressive, hostile, and harmful conduct or behavior demonstrated by a group of nurses or a single nurse toward a group or single colleague through actions, behavior, words or attitudes. Horizontal violence is associated with continuous undermining occurrences or incidences over time, unlike isolated conflicts that exist in the workplace. The repeated conflict leads to the overwhelming horizontal violence in nursing, which eventually may cause depression and symptoms of post-traumatic stress syndrome of the subjected victim. Horizontal violence is hard to discern, covert or discover. Therefore, the victim faces a hard time when seeking assistance within a job setting.

Nurse-to-nurse violence is depicted as an intergroup conflict with hidden hostility elements in the health sector (Major, Abderrahman, & Sweeney, 2013). The members of the nursing profession, where the greater percentage comprises of the female gender, have been characterized as oppressed. The oppression theory suggests that the lack of control over the working environment, powerlessness, and subsequent low self-esteem have contributed to horizontal violence in this profession (Vessey, DeMarco, Gaffirrey, & Budin, 2009). However, this claim does not support the notion that horizontal violence occurrence is encompassed and experienced across many professions based on the social, personal or organizational characteristics (Major et al., 2013).

According to Betcher & Visovsky (2012), horizontal violence that causes repeated acts of oppression towards colleagues in an organization is termed as bullying. Further, Vessey et al. (2009) describe a bully’s behavior as characterized by private or public actions that demean another employee’s personality. They suggest that bullying is intentional and serves the aim of causing psychological or physical stress to a victim. Bullies may seek support from other workmates to help them endorse their behavior and enable them to reinforce their oppressing influence on the victim.

According to the recent report by the American Nurses Association (ANA) (2011), bullying includes intimidation, fighting, criticizing and blaming among employees. Moreover, it is characterized by public humiliation, undermining the efforts of a targeted individual, withholding behavior, and denial of lending assistance. Other associated behaviors include physical expressions, such as rolling of eyes, gossiping, ignoring, isolating, name-calling, unreasonable assignments, and threatening the victims. In most incidences, these behaviors are ignored and considered as minimal conflicts, which in the end leads to the existence of horizontal violence in organizations (Major et al., 2013).

A study by Betcher & Visovsky (2012) has proven that horizontal violence occurs mostly among peer group employees on a professional level. In the study, 61.1% of sample population reported horizontal violence existence among the members of their job unit. The study also recorded that there was a high possibility of extending horizontal violence from one peer group to another causing rivalry amongst the nurses. This rivalry encourages even more violence among the nurses and causes unfavorable working conditions. Stagg et al. (2013) reported in their study that at least 49% of the surveyed nurses had experienced bullying from their colleagues in their level unit at a workplace.

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Causes and Prevalence of Horizontal Violence

The precise cause of horizontal violence in nursing is indefinite. However, it is reported that approximately 65-80% of the nurses surveyed by Stagg et al. (2013) and Betcher & Visovsky (2012) have experienced horizontal violence. Earlier research had recorded the same results. One study surveyed 249 nurses and concluded that 27.4% of them had been exposed to bullying in their workplaces. 18 members of this sample population reported experience in negative incidences on a daily or weekly basis, while 50 nurses reported more than three occurrences during the same timeline (Johnson & Rea, 2009). In another study by nursing students in America, 50% of students experienced bullying during their clinical duty rotations (Major et al., 2013). These acts of aggression left students feeling humiliated and powerless, as they indulged in their profession. The study showed that bullying of the junior students starts with their first interactions in a clinical setting. The repercussions of these experiences are high absenteeism of the new graduate nurses and at times even professional turnover.

Effects of Horizontal Violence in Nursing

Horizontal violence defects the dignity of the victim as it is directly detrimental to the nursing profession. This effect is based on the growing aggression of coworkers who should instead be supporting, guiding, and motivating the new professionals (Stagg et al., 2013). Bullying has wrong implications for the working students, which hinders them from reaching their full potential. New graduates experiencing violence have difficult times attaining success in the unfavorable environment. Indeed, the damage of bullying is experienced by the entire health care personnel through the widening rift between the members of the clinical workforce. Horizontal violence causes a series of effects that stream from the victim to the rest of the personnel and are ultimately extended to the patients (Vessey et al. 2009). The victims of bullying experience depression, low self-esteem, anxiety, and sleep disorders. Other victims are unable to withstand the pressure and quit the profession contributing to the national shortage of nurses (Betcher & Visovsky, 2012).

Repeated acts of horizontal violence have contributed to anger, powerlessness, and absenteeism in the sphere. In addition to these effects, the psychological torture caused by bullying has triggered suicidal behaviors of the targeted victims (Vessel et al., 2010). The American Nurses Association (2011) has reported that poor communication among health teams is the primary factor contributing to horizontal violence and posing a threat to the patients’ safety. When sensitive information is disregarded in the process of horizontal violence, the affected nurses are unable to meet their expected performance levels and ultimately the patients’ safety is compromised. Unfortunately, barely half of these incidences are reported. The financial costs related to bullying are estimated to be $40,000-$100,000 per annum for each victim (Vessey et al., 2009). This cost is accrued from absenteeism, depression and anxiety therapy and treatments, increased employee turnover, and decreased work performance.

Workplace Interventions

The American Nurses Association’s Code of Ethics (2011) defines expected behavior of nurses. Standard 6 of ANA’s code states that nurses are responsible for maintaining and attaining professional working environment (2011). The code further issues a position statement on policies of a healthy working environment, which is applicable to all personnel in the nursing sector. Despite the fact that the current health environment poses many challenges that lead to horizontal violence, the ANA’s code has provided cover strategies against the oppression of any individual. The current challenges of increased patient acuity, reduced resources, and inadequate staffing should be addressed by the leaders to prevent burnouts, conflicts, and depression. The nursing leaders should provide sufficient resources, education, and support for their teams to attain better work performance.

Formal training sessions that cover horizontal violence should be conducted from time to time to help eliminate the violence. The staff should be trained on the repercussion of horizontal violence and be highly discouraged against it. Nursing leaders should correct any unprofessional behavior displayed in the institutions. Preceptors should be acknowledged with strategies of deterring horizontal violence among employees and exhibiting excellent professional actions and behaviors that build trust and teamwork. Essential mentoring activities such as counseling, coaching, teaching, sponsorship, and protecting will help new graduates and the rest of nursing employees prosper in their profession. The conducive environment will contribute to reduced dropouts and cut down absenteeism levels. Ultimately, this initiative will translate into increased safety of the patients.


Horizontal violence can exist in any organization and it will interrupt the job performance of the victims. In nursing, a policy of non-tolerance for any bullying in the workplace is the goal. Responsible leaders should acknowledge the existence of bullying, confront it and take actions to mitigate it.

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