SNIPPET............Paradigm Bytes

This was sent in by Laregis (Laura), Ckppk (Cherie), and BAcello (Barbara)...This is an important issue.
A silent killer has made its way into nursing and slowly eaten away at the core of who we are as nurses. This epidemic is becoming so wide spread that everyone from administration to nurse’s aides are affected by it. It is the epidemic of horizontal violence.

The term “horizontal violence” (sometimes called “lateral violence”) is quite new to many individuals but the behavior it describes is not. The term was developed to describe distasteful behavior nurses sometimes portray toward colleagues.

Horizontal violence takes on many different characteristics. Simply put, it is overt and covert nonphysical hostility, such as criticism, sabotage, undermining, infighting, scape-goating or finger pointing and bickering.

Who is harmed by horizontal violence?

They are individuals who have felt ridiculed, demeaned by a colleague or doctor, and even asked to do something they have not yet even learned how to do only to be left completely humiliated for not knowing how to do it. It affects new hires, new graduates, and nurses who have worked at a facility for a long time.

New Grads

One of the groups most frequently victimized by this is new nursing graduates.


It is crucial for experienced staff to embrace the new grads and support and encourage them as a group. The first year of nursing is an opportunity to achieve great confidence in and establish self-esteem on the job.

New graduates are inexperienced, and because they lack the skills and knowledge necessary to stand up for themselves, they often are yelled at, ridiculed and dehumanized. I have witnessed this psychological abuse first hand as a nurse educator.

Unfortunately, new graduates accept this behavior as a rite of passage and move on, only to mimic it later on, as it is what they have learned from their predecessors. Nurses need to become aware of who it is they are affecting and begin to develop new behaviors that will benefit each other’s self-esteem.

Vicious Cycle

In order to make people aware of this issue, someone must begin reporting it. But what if it is never reported and the behavior continues?

This is the determining factor for alleviating horizontal violence in the nursing profession. Individuals need to begin to report it and feel safe in doing so without retaliation.

Horizontal violence is so severely underreported because opinions surrounding horizontal violence are subjective in nature. Each us tolerates the behaviors of others a little bit differently. However, if the behavior is in any way offensive to you, or undermines you and your job in any way, then it probably is horizontal violence and you need to report it to your manager.

Secondly, there also is a greater fear of retaliation from the perpetrator. Speaking up is one thing, but having to face the person everyday at a new job after reporting them may be a task that many are not willing to take on. As a result, more individuals will begin their careers in an unsupportive work environment, and the cycle will continue.

What Have You Done?

The negative impact of horizontal violence is really quite impressive and obvious.

If you think about the nursing shortage today and wonder why we are losing nurses to other professions, or wonder why the new graduate or new employee that was just hired has left so soon, take a good hard look at yourself and the people around you and begin to imagine what it must have been like to learn something new all over again.

Were you supportive? Did you encourage that person to gain and develop new skills and offer learning experiences to help the person grow as a nurse? Or did you create an environment that was infected with horizontal violence?

Wouldn’t it be great to know that when you were asked to orient someone into your work environment, you were able to give them a healthy and positive outlook toward the job and the environment?

Wouldn’t it be great to know the new nurses on your unit would enjoy their learning experience so much that they would be more likely to feel like staying in that job because the work environment was so supportive?

These new nurses are going to relieve the pressures experienced nurses feel everyday. They are the future. Because of them, there will be one more person on the unit to help in a crisis, one more person to lend a hand when one is needed, and one more person to call when the census goes up and you need help.

Staff Awareness & Education Needed

The net effects of horizontal violence are threefold. The literature reveals that, because of it, there are a greater number of reports in absenteeism, a decrease willingness to help and a high number of nurses considering leaving the profession.

Hence, it is crucial to provide horizontal violence awareness and education in order to make the necessary changes in the nursing environment to finally rid ourselves of this disastrous infection. Education could be provided in many ways. It could be in your department through staff meetings or hospital wide.

Ultimately, nurses need to be the catalyst of change and seek to promote successful new nurses.

Of course, many experienced nurses do not adapt well to change, and so going against this culture will take an enormous amount of courage. But if we all work together we can achieve great success in riding the field of this disastrous infection called horizontal violence, which will benefit the nursing profession in the future.

If we do not make this change, we risk causing irrevocable harm to the profession and the care we provide patients everyday.

So take a look at how you act toward your nursing team, and especially the new grad you might be orienting, and think about how you would like to be treated if it were you on the other end.

Remember, a little support and encouragement can go a long way.

Resources
Duffy, E. (1995). Horizontal violence: a conundrum for nursing. Collegian, 2(2), 5-17.
Farrell, G.A. (2001). From tall poppies to squashed weeds: Why don’t nurses pull together more? Journal of Advanced Nursing, 35(1), 26-33.
Freshwater, D. (2000). Crosscurrents: Against cultural narration in nursing. Journal of Advanced Nursing, 32(2), 481-484.
Leiper, J. (2005). Nurse against nurse: How to stop horizontal violence. Nursing 2005, 35(3), 44.
McKenna, B.G., et al. (2003). Horizontal violence: experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96.
Randle, J. (2003). Bullying in the nursing profession. Journal of advanced nursing, 43(4), 395-401.
Tiaki, K. (2004). Prepare students for violence. Australian Nursing Journal, 12(3), 17.
Vonfrolio, L.G. (2005). End horizontal violence. RN. 68(2), 60.

Josie Roy is a staff nurse in the NICU at The Hospital of Central Connecticut, New Britain, CT, and nursing educator, Capital Community College, Hartford, CT.



Read more about horizontal violence in these articles from the ADVANCE for Nurses archive:
Lateral Violence: Where Are You on the Continuum?
Learning the System