RUNNING HEAD: Horizontal Violence

Horizontal violence/ Bulling among staff members

Kushanvir Gill
820 420 024
NURS 250 Practical Nursing Leadership
March 14, 2016

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Horizontal violence is defined by Longo and Sherman as an act of aggression thats

perpetrated by one colleague toward another colleague (Hubbard, 2014). It is also referred as
lateral violence, bullying or disruptive behaviors of the staff members. It portrays the aggressive
behavior between two individuals at the same level for example nurse to nurse or it could be
between two individuals who have more experience but are at different levels such as a nurse and
a Health Care Assistant (PSW). Horizontal violence has affected almost half of all the nurses and
the number keeps growing year by year. Some forms of horizontal violence includes raising
eyebrows, making faces, verbal aggression, turning away when one colleague is talking,
sabotage, gossiping, criticizing colleagues in front of others and yelling (Hubbard, 2014).
Horizontal violence impacts nursing in several ways such as decreased patient safety, poor health
of nurses as well as increase in number of staff or new grads quitting their jobs (Hubbard, 2014).
Horizontal violence causes distress in the working environment which affects patients
safety and has a great impact on the quality of care. In 2008, the US Joint Commission gave out
a sentinel event alert to the healthcare facilities in order to combat disruptive behaviors that
affects the patients safety and the quality of the care (Reynolds, Singh-Carlson, & Kelly, 2014).
The commission reported that nearly 70% of the sentinel events were tracked back to a problem
with communication between the staff (Reynolds, Singh-Carlson, & Kelly, 2014). Damage to the
working relationship and communication can put the patients safety at risk. It is the
responsibility of the nurse leaders to become knowledgeable about horizontal violence; its causes
and how it affects the nurses. Factors that contribute to horizontal violence includes the
personality traits of the individual, the authorized position, workplace environment, poor
management and poor leadership skills. All these factors impact a nurses right to dignity, loss of
self-esteem, low morale, stress and eventually resignation or leaving the nursing profession

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( Becher & Visovsky , 2012). Alternatives that can be considered to stop or prevent the cycle of
horizontal violence includes establishing workplace policies and education.
Conflict among colleagues can have an indirect influence on the therapeutic nurse-client
relationship. Poor relationships among members of the health care team negatively affect the
delivery of care. Horizontal violence can erode a nurses self-reliance and compromise her/his
ability to foster therapeutic relationships with clients. During my pre-grad consolidation I have
seen horizontal violence between a charge nurse and health care assistant which escalated
because the one team member (health care assistant) did not support the other member in
achieving work responsibilities or meeting goals. The charge nurse was giving report on what
happened in the meeting with the residents family. The residents family had complaints about
toileting and putting the brief pads instead of disposable mesh panties. They also complained
how resident behavior is different during weekday and on weekends due to different staff
members. The health care assistant started arguing thinking the nurse was talking about her and
walked out of the unit and didnt work on the unit for a week. I think the health care assistant
could have listened calmly and tried to identify the issue whats causing it and how it can be
resolved. The behavior of the health care assistant eventually delayed the care of the client until
arrangements were made of calling another staff member.
All the members of the health care team should be able to work in cooperation with each
other to deliver safe, effective and ethical client centered care. It is important to resolve the
conflicts else they will hinder the communication and collaboration of the team, which will
eventually affect the clients care. To help prevent conflict among the team members from
escalating it is important to adapt some strategies such as promoting a respectful work and

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practice environment. For example: Reporting professional misconduct to the appropriate person
(Colleges of Nurses of Ontario, 2009). Supporting and integrating new staff members into the
practice setting. It is also important for the staff members to reflect on the personal attitudes,
values and beliefs. Identifying the personal areas of improvement and try to change behavior in
situations that have previously ended in conflict (Colleges of Nurses of Ontario, 2009).
Managing stress is crucial as it might affect the relationship with the team members. It can be
done by taking some time off from work, meditating or doing yoga to manage stress levels.
It is the responsibility of the manager to ensure that their institute have zero tolerance of
horizontal violence. The first step towards prevention is to refuse to tolerate violence and
support someone who has been abused by reporting it. The managers can do this by listening the
issues, supporting the staff members, getting input from the staff members and making an
arrangement for in service where staff members will be educated about the zero tolerance policy
of horizontal violence. In order to protect the victim there should be anonymous reporting to
address the conflict rather than avoiding or postponing its resolution. However, it should be the
duty of the managers to enforce the policy in place when notified of the violations. Staff
members can also be made aware of zero tolerance of violence through posters, fact sheets,
memos, e-mails or educative in-services to promote awareness regarding what horizontal
violence is and what can be done to prevent it. The review of Code of Ethics should be done to
provide guidance to nurses regarding their obligations. Overall, it is the joint duty of the
managers and nurses to take responsibility to eliminate bullying from the work environment.
In order to evaluate the actions for success routinely assess the reports of incidence of
conflicts. Create a statistic to inform the staff members regarding the increase or decrease in

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number of incidents since the policy has been established. Ensure follow-up for the nurses who
have been abused during their practice in order to support them. Routine assessment of the
workplace conflict will be an effective way to assess or reevaluate the strategies at place for
corrective actions.
In conclusion, horizontal violence can exist to some extend in some domains of nursing.
It is the duty of the nurses or other staff members to report the existence of horizontal violence,
confront horizontal violence and take actions to eliminate it. Goal is to have a policy of zero
tolerance of horizontal violence.

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References
Becher, J., & Visovsky , C. (2012, July-August). Professional Practice. Horizontal Violence in
Nursing. 21 (4), pp. 210-213.
College of Nurses of Ontario. (2009). Practice Standard: Conflict Prevention and Management.
Retrieved March 14, 2016, from
http://www.cno.org/globalassets/docs/prac/47004_conflict_prev.pdf
Hubbard, P. (2014). WHAT CAN BE DONE ABOUT HORIZONTAL VIOLENCE?. Alberta
RN, 69(4),pp. 16-18.
Reynolds, G., Singh-Carlson, S., & Kelly, S. (2014). Horizontal hostility and verbal violence
between nurses in the perinatal arena of health care. Nursing Management- UK, 20(9),
pp. 24-30.