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For our Nursing Ethics course. University of North Florida

Brandy Greensmith

on 13 April 2015

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Research: Common
In The Media
Horizontal Violence in HealthCare
Horizontal Violence
Lateral Violence
in HealthCare

Ineffective, inhibited or
lack of communication

& hierarchy

Units with increased
have a greater prevalence of horizontal violence

Existing correlation between horizontal violence and
negative patient outcomes
or near misses
Monday, April 20th, 2015
Lisa Aflleje, Brandy Greensmith, Caroline Myers, Adam Sullivan
Horizontal Violence...
Nurses Eat Their Young
Lateral Violence
in HealthCare

Can be described as actions taking place between co-workers involving bullying usually committed by someone of equal stature or authority and possibly occurring over a prolonged period of time.
May be verbal or non-verbal means of aggression, characterized by psychological abuse.
May include gossiping, secrecy, and banishment or isolation.
May continue outside the workplace, and can occur in direct contact or in cyberspace.
Includes managers and supervisors.
Can take many forms outside the workplace, ranging from verbal threats to homicide.
Horizontal violence / horizontal hostility
- terms used to identify aggressive language and behavior between peers of the same power level. nurse - nurse

- is used to identify conflict where the perpetrator as a higher authority. Existence of a power disparity. {physician - nurse}

- verbal abuse / offensive conduct or behaviors / work interference

Horizontal violence occurs more frequently within the first year of employment - Lack of knowledge/experience & dependence upon an authoritative figure

Psychological is more common than physical violence - of the 60%, 50% will quit the nursing profession

Feelings of powerlessness from authoritative figures can lead to a sense of oppression - leading to aggression in the work place


Horizontal Violence
Factors that
horizontal violence
Nursing Ethical Decision Making
Lateral Violence in HealthCare

Nursing Ethical Decision Making
Lateral Violence in HealthCare

Nursing Ethical Decision Making
Lateral Violence in HealthCare

It's NCLEX time!
Horizontal Violence in HealthCare
Case Study
Lateral Violence in HealthCare
Nurse A asks her mentor, Nurse B, a question. Nurse B puts her hand near Nurse A’s face, gesturing for her to "Stop," and says in a loud voice, "I already answered that question this morning. Why are you bothering me again?”

Case Study 2
Lateral Violence in HealthCare
Nurse A is late giving report to Nurse B. Nurse A apologizes to Nurse B and says "It has been a rough night. I had a patient fall and a code so I was still trying to catch up.” Nurse B then tells Nurse A “I really don’t want to hear your excuses. Every shift is hard. You are late because you are incompetent and now I am starting behind.”

Adam Sullivan
"You think you're a nurse and you don't even know how to ____? Whats the matter with you?!"
Adam Sullivan
Adam Sullivan
Mentoring programs
a proven success
Increases the longevity, proficiency, skill and knowledge as a new nurse transitions in the clinical setting.
million in savings
Key components
- advocate questioning, thinking aloud, debriefing, act as a role model

Policy and educated management
Zero tolerance & anonymous reporting
Floor manager educated in conflict resolution

Responsibility of the nurse
Don't sit by and watch

Adam Sullivan
1. All of the following are terms associated with aggression and conflict between peers with the same power level except:_________.
Horizontal violence
Lateral Violence
Horizontal hostility
2. How is a nurse exhibiting horizontal violence if he/she with holds vital information from another nurse? By_______________.
Causing psychological harm
Causing humiliation
Using verbal abuse
Work interference
Adam Sullivan

It's NCLEX time!
3. Many new nurses are victim's of horizontal violence. Research indicates that horizontal violence is likely caused by:_________.
A very bad day
A nurses discontent for the new nurse
The current economy & workload issues in healthcare
The media's portrayal of what makes a good nurse
4. Which of these options does research suggest as a step in the road to healing for victim's of horizontal violence?
Confronting the nurse who afflicts harm
Professional counseling
Alerting the police
Do nothing
Brandy Greensmith

It's NCLEX time!
5. Which of the following are examples of Horizontal violence (select all that apply)
• Telling the other staff that a nurse is stupid.
• Refusing to double check an insulin dosage because you do not like a nurse.
• Rolling your eyes or making faces at a nurse.
• Reporting a nurse to the supervisor for an unsafe, or impaired patient care.

6. Which ethical principal involves protecting and defending the rights of others?
• Autonomy
• Justice
• Beneficence
• Non-maleficence

Lisa Aflleje

It's NCLEX time!
7. What percentage of nurses have reported experiencing horizontal violence?
8. Which of the following is most prevalent reason that a nurse does not report being a victim of horizontal violence?
They do not want to get the offender in trouble
They do not know it can be reported
They believe it is part of the job
Management told them not to report it
Caroline Myers

American Nurses Association. (2011). Lateral Violence and Bullying in Nursing. Retrieved March 29, 2015, from http://www.nursingworld.org/

Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing.
Medsurg Nursing, 21
(4), 210-214.

Croft, R. K., & Cash, P. A. (2012). Deconstructing contributing factors to bullying and lateral violence in nursing using a postcolonial feminist lens.
Contemporary Nurse: A Journal For The Australian Nursing Profession, 42
(2), 226-242. doi:10.5172/conu.2012.42.2.226

Ditmer, D. (2010). A safe environment for nurses and patients: halting horizontal violence.
Journal of Nursing Regulation, 1
(3), 9-14.

Frederick, D. (2014). Bullying, mentoring and patient care.
AORN Journal
(5), 587-593.

Hubbard, P. (2014). What can be done about horizontal violence?
Alberta RN
(4), 16-18.

King-Jones, M. (2011). Horizontal violence and the socialization of new nurses.
Creative Nursing, 17
(2), 80-86.

Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence.
Urologic Nursing, 35

Park, M., Cho, S., & Hong, H. (2015). Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence
and the perceived work environment.
Journal of Nursing Scholarship
(1), 87-95. doi:10.1111/jnu.12112

Reynolds, G., Kelly, S., & Singh-Carlson, S. (2014). Horizontal hostility and verbal violence between nurses in the perinatal arena of health care.
Nursing Management - UK
(9), 24-30.

Warren, D. (2015). Workplace Violence. Retrieved March 29, 2015, from http://nursing.advanceweb.com/Continuing-Education/CE-Articles/

Brandy Greensmith
Brandy Greensmith
Brandy Greensmith
of interpersonal skills
Economy and
of Management Skill
(Croft & Kash, 2012)
Act only to benefit others
(Becher & Visovsky, 2012)
Disruptive Behaviors
(Lachman, 2014)
Do no harm
Lisa Aflleje
Lisa Aflleje
What could be the underlying causes of Nurse B’s responses?
What are the possible implications in Nurse A’s delivery of care that could arise because of the treatment that she is experiencing?
What would be an ethical response by Nurse A? Does she have an ethical responsibility to act?
What would have been a more ethical response by Nurse B?

Lisa Aflleje
Caroline Myers
Caroline Myers
Horizontal violence is a documented serious issue:
48% nurses, pharmacists and others reported strong verbal abuse.
43% nurses, pharmacists and others reported experienced threatening body language.
A study of student nurses reported that 53% had been put down by a staff nurse.
65-80% of nurses reported they had been victims of horizontal violence.
Nurses may not report all incidents of horizontal violence because they believe it is "part of the job."
Caroline Myers
Need to stand up for and support each other in the workplace.
Should not only be advocates for their patients, but also for each other.
Should learn to view each other as equals in the workplace and work as a team.
Need to be welcoming to new nurses, and offer praise and encouragement instead of condemnation.
(Frederick, 2014; Hubbard, 2014)
(Frederick, 2014)
(Park, Cho, & Hong, 2015; Reynolds, Kelly, & Sing-Carlson, 2014)
(Park, Cho, & Hong, 2014; Reynolds, Kelly, & Singh-Carlson, 2014)
(Ditmer, 2010; Lachmen, 2015; King-Jones, 2011)
(American Nurses Association, 2011)
(Warren, 2015)
(Lachman, 2015; Warren, 2015)
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