“MANAGING
HORIZONTAL VIOLENCE”
TERRY CLIFFORD, MSN, RN, CPAN
PORTLAND, MAINE, USA
ASPAN IMMEDIATE PAST PRESIDENT
Objectives
 Review definition and behaviors
associated with ‘Horizontal Violence’ (HV)
 Review theoretical causes of HV
 Review consequences of HV
 Review strategies for managing HV
What is Horizontal Violence?
 Horizontal violence or
lateral violence can be
described as overt or covert
aggressive and destructive
behavior of nurses against
each other.
 It’s more than ‘Nurses eat
their young’….
Alternative terms
 Mobbing
 Bullying
 Lateral Violence
 Nurse Hazing
 Horizontal Violence
 Verbal Abuse
 Workplace Violence
 Workplace Aggression
Types of Behaviors
Types of Behaviors
Types of Behaviors
 Backstabbing
 Verbal affronts
 Scapegoating
 Belittling remarks
 Infighting
 Persistant criticism
 Disrespectful behaviors
 Humiliation
 Failure to respect
 Intitmidation
privacy
 Broken confidences
 Withholding
information
 False accusations
 Social isolation
 Unreasonable
workloads
Incidence
 Scandinavian Countries – 1 to 5 %
 UK and US – 10 to 38 %
 Austrailia – 50 to 57%
 Turkey – 86.5%
Causes
 Apathy towards ‘bad’ behaviors


Desensitized
“It is what it is.”
 Enabling


“That’s just the way she/he is”
“She/he is just having a bad day”
 Complacency



“I don’t have time to deal with it”
“I don’t want to get involved”
“A silent witness”
 Fear of retaliation

“If I say something, I’ll be the next target”
Causes
 Subservient role to MDs (oppressed-group model =
perceived lack of power)

Nursing, under Florence Nightingale, developed as a very hierarchical
system where submission was ‘expected, encouraged, indeed, demanded’.
 Low self esteem
 Leadership too authoritarian/too ‘laissez-faire’
 Stressful work environment – volatility
Shrinking resources
 Downsizing
 Restructuring
 Demanding work

Consequences at work
 Adverse affects on teamwork
 Adverse effect on patient care/safety

Nurses stressed by the effects of a hostile environment are more likely to
make errors.
 Unreported errors/near misses
 Nurse retention issues

60% of nurses new to practice leave their first positions within six months
because of some form of lateral violence being perpetrated against them
 Excessive sick time
 Lack of trust
 Lack of respect
Consequences to the nurse
 Stress related illnesses:
 PHYSICAL
 Weight
loss
 Weight gain
 Hypertension
 Cardiac palpitations
 Irritable bowel syndrome

EMOTIONAL
 Depression
and/or anxiety
Humiliation
 Feeling alienation

 Job dissatisfaction
Management tips
 Integration of TEAM BUILDING
 Educate all healthcare team members on appropriate
professional behavior/code of conduct
 Train leaders in conflict management – giving
feedback, assessing unit culture
 Reduce fear of intimidation and retribution for those
who report disruptive behaviors (“Just” Culture)
 Develop a “ZERO” Tolerance policy
SAMPLE
Is this happening to you???
 Gain control.
 Realize that the aggressor is at fault, not you.
 Get help from your employer.
 Make a plan for action.
 Talk with family, friends, and co-workers
 Get info from books and Websites
 Seek advice and support from others who’ve had similar experiences
 Talk with a counselor or call an advice line.
 Take action.
 Keep a detailed log of all incidents, with names of witnesses.
 Keep written records so you’ll have substantive and quantifiable evidence.
 If these incidents are affecting your health, see your health care
provider.

If an illness is diagnosed, make sure the cause is recorded; for example,
stress in the workplace.
Is this happening to you???
 Confront the aggressor.
 Make it clear that this behavior is offensive and must stop.
 Make a formal written complaint.
 By taking this step, you transfer the onus of taking action to the
organization.
 Follow the grievance procedures provided by your organization
or union.
 Take legal action.
 As a last resort, consider consulting an experienced lawyer
about your legal options.
Tips to change this pattern…
 Lead by example

For instance, if a colleague lashes out at you regarding your opinion on a
unit issue, you should hear the person out, think about what and why it
was said, then respond to your colleague in a non-judgmental and nonargumentative tone.
 Learn to identify and deal with your own triggers and
emotions at work

Changing the cycle of negative behavior requires personal and professional
self-reflection
 Find BALANCE

Don’t work when you are home – rest, play, eat well….
Culture of Caring
 Initiate and participate in workplace celebrations
 Compliment your colleagues
 Encourage respect for each other’s ideas
 Think before you respond
 Support colleagues who are struggling with personal or
workplace issues
Thank you!
 “Take care of yourself, always take the high
road, assume that a workable relationship
can be established, and reach out to experts
for advice.”
C Kerfoot, 2008
Questions?
tclifford@aspan.org