Horizontal Bullying in Nursing: Causes, Effects, and Solutions

This report delves into the pervasive issue of horizontal bullying within the nursing profession. It defines horizontal bullying as hostile or aggressive acts among nurses, impacting both nurses and patient care. The report explores various causes, including nurses' perceived inability to assert themselves, the predominantly female composition of the profession, learned behaviors, and the perception of nurses as an oppressed group. The effects are significant, ranging from mental health disorders and physical injuries to absenteeism and increased workloads leading to medical errors. To address this, the report suggests extensive training on the consequences of bullying, the importance of assertiveness, and the inclusion of nurses in decision-making processes. The report uses evidence from multiple sources to support its claims.

Horizontal Bullying
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Description
• Thobaben in his article “Horizontal workplace violence. Home Health
Care Management & Practice,” defines horizontal bullying as any form
of hostile, aggressive or harmful acts by either a nurse or a group of
nurses towards one of their workers or to group of workers
(Thobaben, 2017).
• The behavior can be through actions, words, physical and other
means. Horizontal bullying can include verbal insults to nurses, sexual
abuse to female nurses and physical harassment. Horizontal bullying
has been going on for quite some time and it affects the nurses and
the quality of care provided to the patient.

Causes
• Evidence has it that there are different factors that lead to horizontal bullying
among nurses. One of the factors contributing to horizontal bullying is the fact
that that nurses are meant to believe that they can’t assert themselves. Granstra
explain that the nurses’ education as well as work experience have made nurses
to believe that they are unable to assert themselves (Thobaben, 2017).
• The author explains that nurses have been made to believe that they should not
support their peers and neither should they come unite in a collective voice with
other nurses for a common good. With this form of behaviour, it is impossible for
nurses to fight horizontal bullying. The second reason for horizontal bullying
according to Wolf, Perhats, Delao, & Clark is the fact that nursing profession is
mostly made up of women (Wolf, Perhats, Delao, & Clark, 2017)

• The authors further describes women as weak vessels who rarely stand up
for their rights and this encourages the act of horizontal bullying. The third
reason why horizontal bullying exist according to Pfeifer & Vessey is all
about what nurses are taught (Pfeifer & Vessey, 2017). In a survey among
nurses from Great Britain, majority of the responses point out that bullying
is a learned behaviour and nurses are encouraged to bully one another.
• Finally, horizontal bullying is as a result of nurses being perceived as an
oppressed group. Skehan describe that nurses are meant to be obedient to
other physicians (Skehan, 2015). Rarely are nurses involved in decision
making process and this makes them vulnerable to horizontal bullying.

Effects of horizontal violence on nurses and
patients
• 45% of nurses subjected to horizontal violence have reported mental
health disorders due to stress. Other nurses have reported injuries
due to physical violence. Horizontal violence also contribute to
absenteeism and this creates shortage of nurses. The remaining
nurses have an increased workload leading to medical errors that
leads to poor healthcare services to patients.

• In order to address horizontal bullying, there should be extensive training of nurses.
Hampton, Tharp Barrie, & Kay Rayens in 2018‐ argue that the nurses should be trained
about the consequences of bullying (Hampton, Tharp Barrie, & Kay Rayens, 2018)‐ .
Bullying in itself has had negative impacts on healthcare and training could be an eye
opener.
• Furthermore, the author states that nurses should be trained on the importance of being
assertive. Since lack of assertion among nurses have made them vulnerable to bullying,
training in this line is likely to address horizontal bullying.
• The nurses should also be involved in decision making processes in hospitals. Granstra
states that nurses are vulnerable to bullying since they are isolated and oppressed
(Granstra, 2015). Coming up with policies that incorporate every nurse or staff in the
decision making process will avert horizontal bullying.
•

References
Granstra, K. (2015). Nurse Against Nurse: Horizontal Bullying in the Nursing Profession. Journal of Healthcare
Management, 60(4), 249-257. doi:10.1097/00115514-201507000-00006
Hampton, D., Tharp Barrie, K., & Kay Rayens, M. (2018). Experience of nursing leaders with workplace‐
bullying and how to best cope. Journal of Nursing Management, 27(3), 517-526. doi:10.1111/jonm.12706
Pfeifer, L. E., & Vessey, J. A. (2017). An Integrative Review of Bullying and Lateral Violence Among Nurses in
Magnet® Organizations. Policy, Politics, & Nursing Practice, 18(3), 113-124. doi:10.1177/1527154418755802
Skehan, J. (2015). Nursing Leaders: Strategies for Eradicating Bullying in the Workforce. Nurse Leader, 13(2),
60-62. doi:10.1016/j.mnl.2014.07.015
Thobaben, M. (2007). Horizontal Workplace Violence. Home Health Care Management & Practice, 20(1), 82-
83. doi:10.1177/1084822307305723
Wolf, L. A., Perhats, C., Delao, A. M., & Clark, P. R. (2017). Workplace aggression as cause and effect:
Emergency nurses’ experiences of working fatigued. International Emergency Nursing, 33, 48-52.
doi:10.1016/j.ienj.2016.10.006
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