Horizontal Horizontal Violence in the Violence in the WorkplaceWorkplace

A Computer Based A Computer Based Learning ModuleLearning ModuleS. Swearingen, PhD, S. Swearingen, PhD, RNRNMarch, 2008March, 2008

Behavioral ObjectivesBehavioral Objectives

After completion of this computer based After completion of this computer based learning module, the learner will be able learning module, the learner will be able to:to:– Identify horizontal violence in the workplaceIdentify horizontal violence in the workplace– Articulate methods for reducing horizontal Articulate methods for reducing horizontal

violenceviolence– Determine the link between bullying and Determine the link between bullying and

horizontal violencehorizontal violence– Incorporate, into their own practice, the Florida Incorporate, into their own practice, the Florida

Nurses Association’s “Statement of Position” in Nurses Association’s “Statement of Position” in relation to horizontal violence and bullying in relation to horizontal violence and bullying in the nursing environments.the nursing environments.

Trigger Learning Trigger Learning PointsPoints What is Horizontal ViolenceWhat is Horizontal Violence

– Be able to name three types of horizontal Be able to name three types of horizontal violence behaviors in the workplaceviolence behaviors in the workplace

Horizontal Violence is a common Horizontal Violence is a common characteristic ofcharacteristic of– Be able to state two groups that are prone Be able to state two groups that are prone

to horizontal violenceto horizontal violence How to stop Horizontal ViolenceHow to stop Horizontal Violence

– Be able to state two ways to stop Be able to state two ways to stop horizontal violencehorizontal violence

Nurses Eat Their Nurses Eat Their Young!Young! Not only their young…Not only their young…

but also the older, but also the older, more experienced more experienced nursesnurses

Novices and nurses are Novices and nurses are especially vulnerableespecially vulnerable

Staff reject Staff reject responsibility for new responsibility for new staff member’s staff member’s successes or failuressuccesses or failures

Progresses to point of Progresses to point of the new nurse leavingthe new nurse leaving

(Baltimore, 2006; Swearingen, 2004)

What is Horizontal What is Horizontal Violence?Violence?

(Baltimore, 2006)

Horizontal Violence Horizontal Violence

Dysfunctional behaviorDysfunctional behavior Directed at a peer or Directed at a peer or

team mateteam mate Self and professional Self and professional

defeating behaviordefeating behavior Creates significant work Creates significant work

place stressplace stress Leads to a loss of Leads to a loss of

engagement in the engagement in the work placework place

(Abu, 2004; Baltimore, 2006; Longo & Sherman, 2007)

You Might be Guilty of You Might be Guilty of Practicing Horizontal Practicing Horizontal Violence if :Violence if :

(Baltimore, 2006)

Horizontal Violence in Horizontal Violence in the Workplace – A Role the Workplace – A Role PlayPlay

How Does Bullying Fit How Does Bullying Fit into the Equation?into the Equation?

Becomes part of the norm of Becomes part of the norm of nursingnursing

Nurses are bullied as students Nurses are bullied as students and new graduates by other and new graduates by other nursesnurses

Nurses see patients being Nurses see patients being bullied and coerced to undergo bullied and coerced to undergo treatments that they may not treatments that they may not wantwant

Each generation of new nurses Each generation of new nurses is socialized into negative is socialized into negative practicespractices

(Randle, 2003)

How Destructive is How Destructive is Gossip?Gossip? Healthcare workplaces are ripe for Healthcare workplaces are ripe for

gossip due to their complexitygossip due to their complexity Work can be chaotic and unpredictableWork can be chaotic and unpredictable One way to express emotions and vent One way to express emotions and vent

frustrationsfrustrations It is malicious and It is malicious and

– increases work-relatedincreases work-related

stressstress

(Baltimore, 2006)

Horizontal Violence is a Horizontal Violence is a Common Characteristic Common Characteristic of….of…. Oppressed groupsOppressed groups Those who lack autonomyThose who lack autonomy Those who lack powerThose who lack power Those who lack resourcesThose who lack resources Those who don’t Those who don’t

understand their own understand their own reactions to oppressionreactions to oppression

(Lee & Sneed, 2001; Leiper, 2005: Thomas & Droppleman, 1997)

Why Does Nursing Why Does Nursing Experience Horizontal Experience Horizontal Violence?Violence? Nurses are ill prepared to confront Nurses are ill prepared to confront

issues of horizontal violenceissues of horizontal violence Nursing has historically devalued Nursing has historically devalued

power and views ambitious nurses power and views ambitious nurses as unbecomingas unbecoming

Lack of involvement in policy Lack of involvement in policy makingmaking

Nursing is often an oppressed Nursing is often an oppressed professionprofession(Fudge, 2006; McKenna, Smith, Poole, & Coverdale, 2003 Thomas &

Droppleman, 1997)

Understanding the Understanding the Cycle of Horizontal Cycle of Horizontal ViolenceViolence

Culture may drive horizontal violenceCulture may drive horizontal violence Must become aware of the dynamicsMust become aware of the dynamics Recognize that horizontal violence Recognize that horizontal violence

does exist in the nursing culturedoes exist in the nursing culture Realize that due to powerlessness, Realize that due to powerlessness,

nurses may use horizontal violence nurses may use horizontal violence as the only means they have to gain as the only means they have to gain power over others.power over others.

(Freire, 1970; Leiper, 2005)

Work in devaluing environment

Internalization of culture’s view of being worthless

Begin behaving likethe dominant group

Begin to reject persons of their own group

Resulting interpersonal conflict causes horizontal violence

Society continues to devalue the group

People over time begin to believethat the oppressed group is

legitimately valueless

(Thomas & Droppleman, 1997)

Damaging Effects of Damaging Effects of Horizontal ViolenceHorizontal Violence Poor collaborationPoor collaboration Poor work environmentsPoor work environments Deteriorating quality of Deteriorating quality of

carecare Increased burn outIncreased burn out Perpetuates unacceptable Perpetuates unacceptable

behaviorsbehaviors Suppresses development of Suppresses development of

nursing as a professionnursing as a profession(AACN, 2005; McKenna, Smith, Poole, & Cloverdale, 2003; Thomas & Droppleman,1997)

Taking ControlTaking Control Remember what it was like to Remember what it was like to

be the “new kid on the block”be the “new kid on the block” Make an effort to socialize Make an effort to socialize

with new staff memberswith new staff members Resist the urge to “test” new Resist the urge to “test” new

nursesnurses Abandon the “you have to do Abandon the “you have to do

it because it was done to me” it because it was done to me” mentalitymentality

Check your ego at the doorCheck your ego at the door

(Baltimore, 2006)

Set a Culture of Zero Set a Culture of Zero ToleranceTolerance A culture of zero tolerance for A culture of zero tolerance for

horizontal violence is the most horizontal violence is the most effective way to stop the cycle.effective way to stop the cycle.

Name the problem Name the problem Educate all staff about horizontal Educate all staff about horizontal

violenceviolence Establish a process for dealing Establish a process for dealing

with the issuewith the issue

(Longo & Sherman, 2007)

Good Habits to Adopt Good Habits to Adopt to Stop the Violenceto Stop the Violence

Kindness, concern and Kindness, concern and respectrespect

Lead by exampleLead by example Own up to your mistakesOwn up to your mistakes Don’t participate in Don’t participate in

gossipgossip If conflict arises, speak If conflict arises, speak

directly to the individual directly to the individual as soon as possibleas soon as possible

Work together despite Work together despite personal dislikespersonal dislikes

(Baltimore, 2006; Gasparis, 2005; Leiper, 2005; McKenna, Smith, Poole, & Coverdale, 2003).

FL Nurses Association FL Nurses Association Statement of PositionStatement of Position Recognizes impact of horizontal Recognizes impact of horizontal

violenceviolence Provide educationProvide education Develop resources to assist nurses in Develop resources to assist nurses in

managing horizontal violencemanaging horizontal violence Establish a goal of elimination of Establish a goal of elimination of

horizontal violence in the workplacehorizontal violence in the workplace Encourage addition to curriculum of all Encourage addition to curriculum of all

nursing studentsnursing students

(FNA, 2007)

ConclusionConclusion

Remember incidences of Remember incidences of horizontal violence may horizontal violence may not seem like muchnot seem like much– Unless you are the victim Unless you are the victim

of itof it In order to be seen as a In order to be seen as a

profession, nurses must profession, nurses must act as a professionalact as a professional– Stop horizontal violence in Stop horizontal violence in

the workplacethe workplace

Horizontal Violence Horizontal Violence BlogBlog If you find the topic of horizontal If you find the topic of horizontal

violence has:violence has:– Impacted you personallyImpacted you personally– Or has impacted those around youOr has impacted those around you

Please share your stories by Please share your stories by visitingvisiting– www.Sandyswear.blogspot.comwww.Sandyswear.blogspot.com

Through awareness we can stop Through awareness we can stop horizontal violence in nursinghorizontal violence in nursing

For Comments or For Comments or QuestionsQuestions Contact Sandy Swearingen @ Contact Sandy Swearingen @

www.SandySwearingen@hotmail.www.SandySwearingen@hotmail.comcom

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