Horizontal Violence in the Workplace

1. Horizontal Violence in the Workplace A Computer Based Learning Module S. Swearingen, PhD, RN March, 2008

2. Behavioral Objectives • After completion of this computer based learning module, the learner will be able to: • Identify horizontal violence in the workplace • Articulate methods for reducing horizontal violence • Determine the link between bullying and horizontal violence • Incorporate, into their own practice, the Florida Nurses Association’s “Statement of Position” in relation to horizontal violence and bullying in the nursing environments.

3. Trigger Learning Points • What is Horizontal Violence • Be able to name three types of horizontal violence behaviors in the workplace • Horizontal Violence is a common characteristic of • Be able to state two groups that are prone to horizontal violence • How to stop Horizontal Violence • Be able to state two ways to stop horizontal violence

4. Nurses Eat Their Young! • Not only their young…but also the older, more experienced nurses • Novices and nurses are especially vulnerable • Staff reject responsibility for new staff member’s successes or failures • Progresses to point of the new nurse leaving (Baltimore, 2006; Swearingen, 2004)

5. Bullying What is Horizontal Violence? Agression Witholding Information Gossiping Undermining Scapegoating Insubordination Innuendo's Criticism Passive-Agressive Behavior Threats Intimidation (Baltimore, 2006)

6. Horizontal Violence • Dysfunctional behavior • Directed at a peer or team mate • Self and professional defeating behavior • Creates significant work place stress • Leads to a loss of engagement in the work place (Abu, 2004; Baltimore, 2006; Longo & Sherman, 2007)

7. You Might be Guilty of Practicing Horizontal Violence if :

8. (Baltimore, 2006)

9. Horizontal Violence in the Workplace – A Role Play

10. How Does Bullying Fit into the Equation? • Becomes part of the norm of nursing • Nurses are bullied as students and new graduates by other nurses • Nurses see patients being bullied and coerced to undergo treatments that they may not want • Each generation of new nurses is socialized into negative practices (Randle, 2003)

11. How Destructive is Gossip? • Healthcare workplaces are ripe for gossip due to their complexity • Work can be chaotic and unpredictable • One way to express emotions and vent frustrations • It is malicious and • increases work-related stress (Baltimore, 2006)

12. Horizontal Violence is a Common Characteristic of…. • Oppressed groups • Those who lack autonomy • Those who lack power • Those who lack resources • Those who don’t understand their own reactions to oppression (Lee & Sneed, 2001; Leiper, 2005: Thomas & Droppleman, 1997)

13. Why Does Nursing Experience Horizontal Violence? • Nurses are ill prepared to confront issues of horizontal violence • Nursing has historically devalued power and views ambitious nurses as unbecoming • Lack of involvement in policy making • Nursing is often an oppressed profession (Fudge, 2006; McKenna, Smith, Poole, & Coverdale, 2003 Thomas & Droppleman, 1997)

14. Understanding the Cycle of Horizontal Violence • Culture may drive horizontal violence • Must become aware of the dynamics • Recognize that horizontal violence does exist in the nursing culture • Realize that due to powerlessness, nurses may use horizontal violence as the only means they have to gain power over others. (Freire, 1970; Leiper, 2005)

15. People over time begin to believe that the oppressed group is legitimately valueless Work in devaluing environment Internalization of culture’s view of being worthless Society continues to devalue the group Begin behaving like the dominant group Resulting interpersonal conflict causes horizontal violence Begin to reject persons of their own group (Thomas & Droppleman, 1997)

16. Damaging Effects of Horizontal Violence • Poor collaboration • Poor work environments • Deteriorating quality of care • Increased burn out • Perpetuates unacceptable behaviors • Suppresses development of nursing as a profession (AACN, 2005; McKenna, Smith, Poole, & Cloverdale, 2003; Thomas & Droppleman,1997)

17. Taking Control • Remember what it was like to be the “new kid on the block” • Make an effort to socialize with new staff members • Resist the urge to “test” new nurses • Abandon the “you have to do it because it was done to me” mentality • Check your ego at the door (Baltimore, 2006)

18. Set a Culture of Zero Tolerance • A culture of zero tolerance for horizontal violence is the most effective way to stop the cycle. • Name the problem • Educate all staff about horizontal violence • Establish a process for dealing with the issue (Longo & Sherman, 2007)

19. Good Habits to Adopt to Stop the Violence • Kindness, concern and respect • Lead by example • Own up to your mistakes • Don’t participate in gossip • If conflict arises, speak directly to the individual as soon as possible • Work together despite personal dislikes (Baltimore, 2006; Gasparis, 2005; Leiper, 2005; McKenna, Smith, Poole, & Coverdale, 2003).

20. FL Nurses Association Statement of Position • Recognizes impact of horizontal violence • Provide education • Develop resources to assist nurses in managing horizontal violence • Establish a goal of elimination of horizontal violence in the workplace • Encourage addition to curriculum of all nursing students (FNA, 2007)

21. Conclusion • Remember incidences of horizontal violence may not seem like much • Unless you are the victim of it • In order to be seen as a profession, nurses must act as a professional • Stop horizontal violence in the workplace

22. Horizontal Violence Blog • If you find the topic of horizontal violence has: • Impacted you personally • Or has impacted those around you • Please share your stories by visiting • www.Sandyswear.blogspot.com • Through awareness we can stop horizontal violence in nursing

23. For Comments or Questions • Contact Sandy Swearingen @ www.SandySwearingen@hotmail.com

24. References • Abu, R. (2004). Job stress, job performance, and social support among hospital nurses. Journal of Nursing Scholarship, 36(1), 73-78. • Baltimore, J. (2006). Nurse collegiality: Fact or fiction? Nursing Management, May 2006. Retrieved on line February 20, 2008 at www.nurisngmangement.com. • Florida Nurses Association (2007). Eradication of horizontal violence and bullying in nursing. The Florida Nurse, 55(4),5. • Freire, P. (1970). Pedagogy of the Oppressed. New York, NY: The Seabury Press. • Fudge, L. (2006). Why when we are deemed to be carers, are we so mean to our colleagues? Canadian Operating Room Nursing Journal. Retrieved on line February 15, 2007 @ http://findarticles.com/p/ariticles/mi_ga4130/is_200612/ar_n17194968. • Gasparis, L. (1970). Horizontal violence is “insidious” in nursing education settings. Kai Tiaki: Nursing New Zealand, 9(8). 3. • Lee, M., & Sneed, I. (2001). Oppression and hospital violence: The case of nurses in Pakistan. Nursing Forum, 36(1). 15-27.

25. References • Lieper, J. (2005). Nurse against nurse: How to stop horizontal violence. Nursing. 35(3),44-45. • Longo, J. & Sherman, R. (2007). Leveling horizontal violence. Nursing Management. Retrieved on line February 28, 2008 at www.nursingmanagemnt.com. • McKenna, B., Smith, N., Poole, S., & Cloverdale, J. (2003). Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96. • Radford, P. (2003). Kai Tiaki pages reveal horizontal violence is not new in nursing. Kai Tiaki: Nursing in New Zealand, 9(8), 3. • Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing. 43(4). 395-401. • Robersts, S. (2007). Development of a positive professional identity: Liberating oneself form the oppressor within. Advances in Nursing Science. 22(4), 90-96. • Swearingen, S. (2004). Personal observation, August 2004. • Thomas, S. & Droppleman, P. (1997). Channeling nurses’ anger into positive interventions. Nursing Forum. 32(2), 13-22.