Nurse Educators' Knowledge, Attitudes, and Practice of Horizontal Violence Measured Through Dimensions of Oppression

A paradox exists within the profession of nursing. Despite the fact that nursing is known as the caring profession, empirical evidence demonstrates that nurses do not care well for their own. In fact, an oft quoted statement has been that nurses eat their young. The phenomenon of horizontal violence (HV) is an international problem within the nursing profession (McKenna, Smith, Poole & Coverdale, 2003; Randle, 2003). HV is described broadly as any unwanted hostility or aggression within the workplace and is empirically demonstrrated to be connected to oppressed group behaviors (Roberts, DeMarco & Griffin, 2009). Oppressed group behaviors are the result of powerful groups determining what is valued. This devaluing leads to marginalization and the less powerful group develops low self-esteem as well as a silent voice.

Described as nurse-to-nurse aggression, characteristic behaviors of HV within the nursing profession can be overt or covert (Vessey, et al. 2010; Bechner & Visovsky, 2012). Overt examples include ignoring or minimizing concerns, or direct sabotage; while overt behaviors include making sarcastic comments or belittling gestures (Conti-O'Hare & O'Hare, 2003; Hastie, 2002; Longo, 2007). In HV a power imbalance may or may not exist. We know empirically that the novice nurse first experiences HV as a student and HV continues to exist at every level of the nursing profession (Longo, 2007; Stanley, Martin, Michel, Welton & Nemeth, 2007; Vessey, DeMarco, Gaffney & Budin 2009). Abusive behaviors associated with HV are psychological as opposed to physical and have a significant impact on the nurse as well as the patient. The Joint Commission issued a Sentinel Event Alert (No. 40) in 2008 describing these characteristic behaviors and states that they “undermine a culture of safety.”

Cyclical behaviors which are characteristic of HV are passed on from the more experienced nurse to the novice nurse (Farrell, 2001). This cycle is believed to perpetuate HV as these characteristic behaviors become culturally embedded within the nursing profession when negative behaviors are passed on from one generation of nurses to the next. The literature suggests that HV proliferates through a culture which exists in nursing whereby there is an acceptance of nurse-to-nurse abuse as a professional norm (Roberts, 1983; Roberts, Demarco & Griffin, 2009; Farrell, 2001; Sofield & Salmond, 2003; Randle, 2003).

This study uses a newly validated instrument (NEKAP-HV©) and a national sample of nurse educators (n=254) and explores their knowledge, attitudes and practice of horizontal violence measured through dimensions of oppression.