Horizontal Violence In Nursing: Causes, Effects And Strategies To Combat It

What is Horizontal Violence?

Question:

Identify and Critically reflect on a Personal Professional Practice experience of your choice that is different to the issue you covered in your semester topic presentation. The focus is on an issue that you believe may occur again during your transition to practice as a graduate registered nurse. Justify your selection of this topic area and its Importance.

Horizontal violence (HV) is defined as an act of unwanted hostility or abuse occurring within the workplace (Becher&Visovsky, 2012).Horizontal violence is a series of repeated conflicts that makes HV overwhelming, generating symptoms like depression and posttraumatic stress among the victims(Becher&Visovsky, 2012). The phenomenon of HV is at times used interchangeably with the term lateral violence (Taylor,2016). When a nurse or a group of nurses expresses hostile or harmful behaviour toward a particular co-worker, then it is term as horizontal violence in nursing profession(Sheridan-Leos, 2008). The members of nursing profession belongs to oppressed group with the majority of the members are women. According to the theory of oppression, lack of power and lack of control over the work environment lead to the generation of HV within the profession of nursing (Johnston, Phanhtharath& Jackson, 2009). In nursing profession the act of HV is complicated because HV is extensively ingrained in the workplace culture of nursing and thus the victim nurses who are experiencing or witnessing the same do not recognize it (Taylor,2016). HV which results out of cyclic acts of aggression towards the co-workers is also termed as workplace bullying. Here bullying means demeaning the employee, either publicly or privately. Here the main intension of the bully’s is to cause psychological and physical stress to the victims (Vessey, DeMarco&DiFazio, 2011). Other behaviour that contributes horizontal violence include blaming, verbal fighting among the colleagues, criticizing, refusing to provide help, humiliation in a public place and undermining efforts (Dumont, Meisinger, Whitacre& Corbin, 2012). Other threats are gossiping, isolation, threat, ignorance and making observable physical expression like rolling of eyes (Thomas & Burk, 2009).

HV perished dignity of an individual and this in turn is detrimental for the profession. HV has special implications over the students or the newly graduated nursing personnel who have mainly question regarding practical field of work and requires profession guidance in order to achieve their full potential in nursing profession. New graduate nurses who are the victims of HV face difficulties in achieving success due to complex workplace environmental conflict(Laschinger et al., 2010). Not only the team of newly graduates, HV hamper the equilibrium of nursing profession or the health care team. This damage is caused by ever widening rift between the nursing professionals or group of professionals. The effect of HV in turn indirectly affects the health and the quality of life of the patient (Roche et al., 2010). The victims of HV in nursing profession suffer from low self-esteem, anxiety, sleeping disorder and depression. All these side-effects are detrimental for nursing profession and effects the employee retention leading to poor patient : nurse ratio (Wilson et al., 2011; Weaver, 2013). This is due to the fact that the majority of the nurses who have become the victim of HV have considered leaving the profession and which have contributed to the shortage in national nursing. In the name of HV, important information related to patient care is either omitted or kept secret from the new attending graduate nurse. As a result, the victimised nurse falls in a poor position in front of the doctors and the family members of the patients. Not only this, patient, quality treatment and health is also compromised due to such acts. This negligence in patient care arising out of the lack of information may cost negatively to the patients, their family and the health care institute. Such condition may also inflict potential legal action against the guilty nurses and the overall condition can be staggering. Moreover, what more threatening is, HV has also inflicted suicidal behaviour.

Causes of Horizontal Violence in Nursing

In spite to its wide spread detrimental effects, the majority of the incidence of HV remains unreported. Even with zero retaliation policies, victims are not aware of the appropriate steps to report against V. Moreover, the problem in employee retention and lack of quality care arising out of the HV has affected the health care institute financially. Moreover, this financial loss is further increased as a result of absenteeism, therapy for depression and anxiety and poor work performance.

In this essay I will highlight a specific case of HV that I have experienced during my transition to practice as a graduate registered nurse under the 5Rs framework for reflection(Bain et al. 2002).

Reporting: When I joined as a as a trainee nurse after by completion of graduate degree in nursing, I too became the victim of HV from my senior registered nurses refuse to corporate with me. I was attending a patient in a palliative care and the doctors asked me to replace his nasogastric tube. As a trainee nurse, I was not aware of the actual proceeding are the regulations that are required to be followed during the insertion of fine bore nasogastric tube. For obvious reasons, I was scared but when I approached by fellow colleagues, but they refuse to stretch their helping hands towards me. Since I was novice in this domain, the improper insertion of the tube caused aspiration associated dislodgement(Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017). The patient condition became extremely unstable and got further scared and then my seniors came in and controlled the entire situation. However, in return I got humiliation from the doctors, complains form the patient family and all these dragged my self-esteem to a negative parameter.

Responding: This situation made me feel stupid and incapable. It destroyed my confidence to work as a nurse. I also felt isolated as none of my seniors approached me or helped me out when I was showcased for improper nasogastric tube insertion. I developed a fear of going to work as I was secretly ashamed of being bullied and at the same time confused as to how to fight back. I developed stress-related illness like nausea, headache, weight loss, depression, anxiety, insomnia, irritability and post-traumatic stress syndrome (PTSS)(Elena Losa Iglesias &Becerro de Bengoa Vallejo, 2012). Such conditions gradually became more severe when their act of bullying continued or rather say increased. Whenever I passed through corridor of any ward, I saw certain physical gestures like rolling of eyes or verbal abuse coming against me. This further made me more isolated and affected my self-esteem.

Effects of Horizontal Violence on Nurses and Patient Care

Relating: As time passed and I gradually understood that the problem of HVmight have originated from individual factors, environmental factors and other organisational factors(Rocker, 2008). Here individual factors include mental illness and female gender workers. Workplace environment, lack of safety measures and working with hostile and violent patients and their family membersfall under poor environmental factors (Vessey, DeMarco&DiFazio, 2011). Organisational factors include nurse shortage due to understaffing, lack of adequate resources and poor workgroup(Katrinli et al., 2010).  Moreover, what I felt is bullying behaviour that is prevalent among the nurses is a kind of learned process. For example, the new nursing practitioner may indulgein the act of bullying others, common among the veteran nurses, just to gel with them, contributing towards the continuation of HV among the nursing profession(Rocker, 2008).

Reasoning:When I interacted with the other fellow trainee nursesand friends of mine who are serving as a traineeI discovered that actual incidence and the occurrence of the HV among the nursing profession is underreported and unrecognised(Rocker, 2008). However, according to the report published by Stagg et al., in the year 2011, HV is widespread among the nurses in Australia with an estimated percentage of 65 to 80%. My friends reported that they felt humiliated as they gradually began to assimilate these kinds of demeaning behaviours into the workplace. Moreover, me and my friends in nursing field felt leaving the profession altogether with an increased level of absenteeism in order to avoid uncomfortable situation. I also found that verbal abuse has more significant impacts on self-esteem than the physical abuse in the domain of HV. As a trainee, we do not have a defined and approved social role, neither a fixed salary and nor a dedicated bond with specific nursing work and hence we become an easy prey of verbal abuse that lowersour self-esteem and morale(Magnavita&Heponiemi, 2011).

Reconstructing: What I felt during my transition to registered nurse and subsequent experience of HV is that it is the role of the experienced professional nurse to maintain and attain work environments in consistent with the professional values(Becher&Visovsky, 2012). Here, the nurses or the matrons’ who are serving as the nursing leaders must come forward to prevent these unhealthy activities via providing proper support and education (Becher & Visovsky, 2012). They must also support the trainee nurse or newly graduate nurse via giving periodic feedback about their performance so that they can work on their weak areas while providing opportunities for further professional development. Senior registered nurses must also hold them and their experienced peers accountable for modelling acceptable professional behaviour. When any one of the team displays unprofessional behaviour, a proper corrective plan must be instituted. Moreover, a proper plan must be initiated to revamp the entire nursing culture that preaches and supports the act of HV. I also feel that while approaching complains or allegations regarding HV, the assigned nurse leader must try to maintain a strict objective stance and thereby assess all the related facts. These nurse leaders must also be accustomed or aware about the organisational policies and must take appropriate disciplinary actions when any act of HV is found threatening the overall integrity in the workplace. Health managers in the workplace must also participate in the HV education and must keep their employees alert about the occurrence of the HV and how to report against it. Managers can also generate awareness among the staffs via making them aware about the policies that govern the professional code of conduct of nursing in Australia so that they can feel empowered to take necessary actions against HV (Becher&Visovsky, 2012). According to Huntington et al., 2011, poor staffing along with increased patient acuity and decrease in resources lead to upliftment of stress and conflict and so good ratio to nurse :patient will help in the reduction of the incidence of HV. Manager must also take active steps in proper employee recruitment and employee retention.Another important aspect which can put an end of the HV in nursing profession is proper communication between the employees. These can be done via educational workshops that will enhance awareness in the field of HV and will simultaneously improve positive communication, which will result in better workplace environment with reduction in vacancy rates along with decrease in the incidence of HV (Ceravolo et al., 2012).

Strategies to Combat Horizontal Violence in Nursing

References

Bain, J. D., Ballantyne, R., Mills, C., & Lester, N. C. (2002). Reflecting on practice: Student teachers’ perspectives. Post Pressed.

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

Ceravolo, D. J., Schwartz, D. G., FOLTZ?RAMOS, K. M., &Castner, J. (2012). Strengthening communication to overcome lateral violence. Journal of Nursing Management, 20(5), 599-606.

Dumont, C., Meisinger, S., Whitacre, M. J., & Corbin, G. (2012).Nursing2012 horizontal violence survey report. Nursing2016, 42(1), 44-49.

Elena Losa Iglesias, M., &Becerro de Bengoa Vallejo, R. (2012). Prevalence of bullying at work and its association with self-esteem scores in a Spanish nurse sample. Contemporary nurse, 42(1), 2-10.

Fine Bore Nasogastric Feeding Tubes for Adult Policy. (2017) (pp. 1 to 8). Australia. Retrieved from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments

Huntington, A., Gilmour, J., Tuckett, A., Neville, S., Wilson, D., & Turner, C. (2011). Is anybody listening? A qualitative study of nurses’ reflections on practice. Journal of Clinical Nursing, 20(9-10), 1413-1422

Johnston, M., Phanhtharath, P., & Jackson, B. S. (2009).The bullying aspect of workplace violence in nursing. Critical Care Nursing Quarterly, 32(4), 287-295.

Katrinli, A., Atabay, G., Gunay, G., &Cangarli, B. G. (2010).Nurses’ perceptions of individual and organizational political reasons for horizontal peer bullying. Nursing Ethics, 17(5), 614-627.

Laschinger, H. K. S., Grau, A. L., Finegan, J., &Wilk, P. (2010). New graduate nurses’ experiences of bullying and burnout in hospital settings. Journal of advanced nursing, 66(12), 2732-2742.

Magnavita, N., &Heponiemi, T. (2011).Workplace violence against nursing students and nurses: an Italian experience. Journal of Nursing Scholarship, 43(2), 203-210.

Roche, M., Diers, D., Duffield, C., &Catling?Paull, C. (2010).Violence toward nurses, the work environment, and patient outcomes. Journal of Nursing Scholarship, 42(1), 13-22.

Rocker, C. F. (2008).Addressing nurse-to-nurse bullying to promote nurse retention. Online Journal of Issues in Nursing, 13(3).

Sheridan-Leos, N. (2008). Understanding lateral violence in nursing. Clinical Journal of Oncology Nursing, 12(3), 399.

Stagg, S.J., Sheridan, D., Jones, R.A., &Speroni, K.G. (2011).Evaluation of a workplace bullying cognitive rehearsal program in a hospital setting. Journal of Continuing Education in Nursing, 42(9), 395-401. doi:10.3928/00220124-20110823-45

Taylor, R. (2016). Nurses’ Perceptions of Horizontal Violence. Global qualitative nursing research, 3, 2333393616641002.

Thomas, S. P., & Burk, R. (2009).Junior nursing students’ experiences of vertical violence during clinical rotations. Nursing outlook, 57(4), 226-231.

Vessey, J. A., DeMarco, R., &DiFazio, R. (2011).Bullying, harassment and horizontal violence in the nursing workforce. Annual review of nursing research, 28(1), 133-157.

Weaver, K. B. (2013). The effects of horizontal violence and bullying on new nurse retention. Journal for nurses in professional development, 29(3), 138-142.

Wilson, B. L., Diedrich, A., Phelps, C. L., & Choi, M. (2011).Bullies at work: the impact of horizontal hostility in the hospital setting and intent to leave. Journal of Nursing Administration, 41(11), 453-458.