Antagonistic behaviors such as:
 Gossiping, undue criticism,
 Innuendo, scapegoating,
Weinand, M. R. (2010).
Horizontal violence in
nursing: history, impact,
and solution. JOCEPS: The
Journal Of Chi Eta Phi
Sorority, 54(1), 23-26.
 Undermining, passive aggression,
 Bickering , blaming behaviors
 Sabotage
 Emotional dumping,
indiscriminate venting
Why susceptibility among nurses
• Antagonistic behaviors among oppressed people i.e.:
women
• Nursing predominately women
• Antagonistic behaviors, a form of self-hate
• Demonstrated in the classroom with faculty
dominating student nurses.
• Nurse managers and supervisors cited as frequent
users of bullying culture & top down style
End Product from HV
• Overwhelming sense of negativity cultivated
• Aggression breeds aggression
• Low morale
• High turnover
• Increased absence
• Low productivity
Formal training in teamwork,
positive feedback, conflict
management and
confrontation
skills
Solutions to the problem
Embrace transformational leadership
Inspire and challenge staff;
Utilize active listening,
Advise and coach staff;
Have a positive vision
Reward resolution
vs. identification of problems
King-Jones,
M. (2011).
Horizontal
Violence and
the
Socialization
of New
Nurses.
Creative
Nursing,
17(2), 80-86.
• overt and covert nonphysical hostility,
• criticism, sabotaging, undermining,
infighting, scapegoat, and bickering
• unkindness, discourtesy, divisiveness, and
lack of cohesiveness
• belittling gestures, verbal abuse, gossiping,
sarcastic comments, faultfinding, devaluing
comments,
• disinterest and discouragement, and
controlling behaviors
HV stems from oppression
HV is how oppressed people cope with
powerlessness
HV, a display of powerlessness & negative emotions
Knowledge is power -- a cycle of power and
resistance
To resolve HV, address the dynamics of power and
conflict
Hahn, J.A.
(2011),
Managing
Multiple
Generations:
Scenarios From
the Workplace.
Nursing Forum,
46(3), 119-127.
• Increased numbers of generations
working together creates more
opportunity for misunderstanding
• Veterans, [born before 1945]
• Baby Boomers, [born 1946-1964]
• Generation X, [1965-1976]
• Gen Y/Millennials [1977-1997]
Veterans – before 1945
Grew up in times of
political and economic
uncertainty,
lived experience of the
Great Depression and
World War II
Nursing as a helping
profession and unselfish
Expect rewards for hard
work
Baby Boomers – ‘46 to ‘64
Strong sense of duty, called
workaholics
Lived experience of
prosperity
Look to empower
Arrive early to work
Generation X – ’65 to ‘76
Millennium/Gen Y – ’77 to ‘97
Independent, self-directed,
and techno-savvy
Technology and instant
communication
Latchkey kids
Accepting multiculturalism
Grew-up quicker and stayed
adolescents longer
After-school activities, such as
swimming, soccer, dance
Quality of life important their
parents work long hours and
experienced downsizing
Want work-life balance
Generation
Veterans
<1945
Generational styles
Stable
Reliable
Practical
Loyal
Baby Boomers
1946–1964
Generation X
1965–1976
Millennials
1977–1997
Involvement
Personal growth
Optimism
Mentors
Think globally
Techno-literacy
Pragmatic
Asynchronous communication
Skeptical
Multitasking
Technologically savvy
Outcome driven
Determined
Kupperschmidt, B. (2006). Addressing
multigenerational conflict: mutual
respect and carefronting as strategy.
Online Journal Of Issues In Nursing, 11(2),
• Kupperschmidt argues that
professional nurses must care
enough about their patients,
profession, colleagues, and themselves
to ‘carefront’ disrespectful behavior
Treating each other
with respect is a
nurse's ethical
responsibility
Carefronting, a model of
communication used when
professional nurses care
enough about themselves
and their patients to
confront disrespectful
behavior face-to-face
The goal is the
ability to work
together to
provide safe
patient care in
an environment
based upon
mutual respect
A newly registered nurse Renee is
working alongside Jeanette, a nurse of
twenty five years in a busy trauma
emergency room. Patient Glendale, a
frequent flyer, presents complaining of
chest pain radiating to his right arm,
his history includes hypertension
managed with a beta blocker and drug
seeking behavior.
Jeanette blurts out, “Back so soon.
Ran out of your Percocets in three
days did you?” Renee goes to his
bedside places him on the cardiac
monitor, performs and EKG and tells
the physician the patient may be
experiencing a heart attack.
Jeanette waltzes over, rolls her eyes,
sighs and sarcastically says, “This
rookie needs to go back over there and
complete his history and physical
before jumping to conclusions.
Embarrassed Renee walks away. Later
she seeks out Jeanette and asks to
speak to her in a private area.
Yvonne Bivins MSN RN
Nadia Primus MSN RN
Carefronting Techniques based on Kupperschmidt (2006)
When you called me a rookie and said I jumped to a conclusion (what was
the action). I felt humiliated (your reaction).
Because it portrays me as someone in a rush (what does it look, sound or
feel like).
Was it your intention to embarrass or humiliate me? (repeat what the
action was, STOP! wait for a response)
In the future talk to me in private (what behavior you want to see).
Are you committed to treating me as respected colleague? (What you want
them to do?)
If there isn’t a change, I will arrange a meeting with the supervisor to
discuss your actions (what is the consequence).
16
16
14
12
10
8
6
7
5
4
2
0
Associate
Degree
Bachelor's
Degree
Number of Participants
Graduate
Degree
Pre-test
Post-test
Baby Boomer RNs
7
4
Generation X RNs
17
8
Yvonne Bivins MSN RN
Nadia Primus MSN RN
compared pre and post mean scores of the
participants’ perceived ability to utilize Carefronting
• pre-test M= 40. 75, SD=4.15
• post-test M= 43.08, SD=3.08
• Highest possible score being 50 and the lowest 10
• Alpha set at p<0.05
• There was no significant difference t(11) = -2.17,
The 95%
confidence interval for the mean difference between the two means
was -4.70 to 0.03.
Yvonne Bivins MSN RN
Nadia Primus MSN RN
compared Baby Boomer to
Gen X mean scores on perceived ability to utilize
Carefronting
• No significance difference in the Baby Boomer &
Generation X mean scores
• pre-test t(24) = .992, p = .33
• post-test t(11) = .154, p = .88
Carefronting Techniques based on Kupperschmidt (2006)
 When you called me a rookie and said I jumped to a conclusion
(what was the action). I felt humiliated (your reaction).
 Because it portrays me as someone in a rush (what does it look,
sound or feel like).
 Was it your intention to embarrass or humiliate me? (repeat what
the action was, STOP! wait for a response)
 In the future talk to me in private (what behavior you want to
see).
 Are you committed to treating me as respected colleague? (What
you want them to do?)
 If there isn’t a change, I will arrange a meeting with the supervisor
to discuss your actions (what is the consequence).
Take home
Message
1.
Horizontal Violence
and Generational
Conflict are a problem
within nursing
2.
Both are highly
detrimental to the body
of Black nurses
Caring enough to
confront may help
Carefronting
comes from a place
of love, not
bitterness or hate