Nurses' Perceptions of Horizontal Violence

Taylor, Rosemary A.

Saturday, 16 November 2013

Rosemary A. Taylor, PhD(c), BSN, RN
School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA

Learning Objective 1: The learner will be able to identify three contextual elements that may affect nurses’ perceptions of negative interactions with colleagues.

Learning Objective 2: The learner will be able to identify three factors that influence reporting of incidents of horizontal violence.

Horizontal violence (HV) contributes to an unsafe work environment and adversely affects patient outcomes. HV affects nurses’ morale, sense of worth, physical and mental health, and has been implicated as a factor in recruitment and retention. Despite increased awareness of the phenomenon, the problem remains unresolved. The majority of nursing studies to date have focused on describing behaviors associated with HV, measuring prevalence, and identifying antecedents and consequences. Most are based on survey data, relying on self-report. Because the phenomenon is poorly defined and studies indicate that nurses minimize and underreport HV, self-report alone may not adequately reveal the complexities of the phenomenon. This study aimed to investigate individual perceptions of horizontal violence within the context of the nursing work environment using an ethnographic approach.

Policies and codes of conduct were analyzed. Observation was used to develop an understanding of the context and culture on two inpatient hospital units within a large urban medical center. In addition, staff were asked about their perceptions of HV, broadly defined as “any physical or emotional, non-caring or non-supportive behavior between nurse colleagues,” factors they believe contribute to the perpetuation of these behaviors, as well as their own experiences of the phenomenon. Data was coded and analyzed thematically.

Results indicate that HV is perpetuated by lack of recognition, as well as causal attributions. Reporting is inhibited by fear of reprisal, isolation, and labeling. The majority of behaviors identified would not meet criteria for workplace violence as defined under existing policies, but would be prohibited under codes of conduct which are not enforced.

Horizontal violence is a complex phenomenon and interventions focused on a single cause may not be effective. Future interventions need to address the complexity of phenomenon. The results of this study may help to illustrate some of that complexity.

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