Horizontal Violence in Nursing: Personal Experience and Analysis

This essay delves into the pervasive issue of horizontal violence (HV) within the nursing profession, defining it as unwanted hostility and abuse in the workplace. It highlights the detrimental effects of HV, including depression, post-traumatic stress, and the undermining of new graduates. The essay presents a personal case study where the author, a newly graduated registered nurse, experienced HV through the 5Rs framework: Reporting, Responding, Relating, Reasoning, and Reconstructing. The author reflects on the impact of senior nurses' uncooperative behavior, leading to feelings of inadequacy and stress-related illnesses. The essay analyzes the individual, environmental, and organizational factors contributing to HV, and it emphasizes the underreporting of such incidents. The author proposes solutions, including the need for experienced nurses and nursing leaders to foster supportive work environments, provide feedback, and address unprofessional conduct. The essay concludes by emphasizing the importance of improved communication, education, and proper staffing to reduce the incidence of HV and improve patient care and employee retention. The provided references support the arguments presented in the essay.

Running head: HORIZONTAL VIOLENCE
Horizontal Violence
Name of the Student
Name of the University
Author Note

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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

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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.
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.

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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

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verbal abuse coming against me. This further made me more isolated and affected my self-
esteem.
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

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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

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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).

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