Horizontal Horizontal Violence in the Violence in the WorkplaceWorkplace
A Computer Based A Computer Based Learning ModuleLearning ModuleS. Swearingen, PhD, S. Swearingen, PhD, RNRNMarch, 2008March, 2008
Behavioral ObjectivesBehavioral Objectives
After completion of this computer based After completion of this computer based learning module, the learner will be able learning module, the learner will be able to:to:– Identify horizontal violence in the workplaceIdentify horizontal violence in the workplace– Articulate methods for reducing horizontal Articulate methods for reducing horizontal
violenceviolence– Determine the link between bullying and Determine the link between bullying and
horizontal violencehorizontal violence– Incorporate, into their own practice, the Florida Incorporate, into their own practice, the Florida
Nurses Association’s “Statement of Position” in Nurses Association’s “Statement of Position” in relation to horizontal violence and bullying in relation to horizontal violence and bullying in the nursing environments.the nursing environments.
Trigger Learning Trigger Learning PointsPoints What is Horizontal ViolenceWhat is Horizontal Violence
– Be able to name three types of horizontal Be able to name three types of horizontal violence behaviors in the workplaceviolence behaviors in the workplace
Horizontal Violence is a common Horizontal Violence is a common characteristic ofcharacteristic of– Be able to state two groups that are prone Be able to state two groups that are prone
to horizontal violenceto horizontal violence How to stop Horizontal ViolenceHow to stop Horizontal Violence
– Be able to state two ways to stop Be able to state two ways to stop horizontal violencehorizontal violence
Nurses Eat Their Nurses Eat Their Young!Young! Not only their young…Not only their young…
but also the older, but also the older, more experienced more experienced nursesnurses
Novices and nurses are Novices and nurses are especially vulnerableespecially vulnerable
Staff reject Staff reject responsibility for new responsibility for new staff member’s staff member’s successes or failuressuccesses or failures
Progresses to point of Progresses to point of the new nurse leavingthe new nurse leaving
(Baltimore, 2006; Swearingen, 2004)
What is Horizontal What is Horizontal Violence?Violence?
(Baltimore, 2006)
Horizontal Violence Horizontal Violence
Dysfunctional behaviorDysfunctional behavior Directed at a peer or Directed at a peer or
team mateteam mate Self and professional Self and professional
defeating behaviordefeating behavior Creates significant work Creates significant work
place stressplace stress Leads to a loss of Leads to a loss of
engagement in the engagement in the work placework place
(Abu, 2004; Baltimore, 2006; Longo & Sherman, 2007)
You Might be Guilty of You Might be Guilty of Practicing Horizontal Practicing Horizontal Violence if :Violence if :
(Baltimore, 2006)
Horizontal Violence in Horizontal Violence in the Workplace – A Role the Workplace – A Role PlayPlay
How Does Bullying Fit How Does Bullying Fit into the Equation?into the Equation?
Becomes part of the norm of Becomes part of the norm of nursingnursing
Nurses are bullied as students Nurses are bullied as students and new graduates by other and new graduates by other nursesnurses
Nurses see patients being Nurses see patients being bullied and coerced to undergo bullied and coerced to undergo treatments that they may not treatments that they may not wantwant
Each generation of new nurses Each generation of new nurses is socialized into negative is socialized into negative practicespractices
(Randle, 2003)
How Destructive is How Destructive is Gossip?Gossip? Healthcare workplaces are ripe for Healthcare workplaces are ripe for
gossip due to their complexitygossip due to their complexity Work can be chaotic and unpredictableWork can be chaotic and unpredictable One way to express emotions and vent One way to express emotions and vent
frustrationsfrustrations It is malicious and It is malicious and
– increases work-relatedincreases work-related
stressstress
(Baltimore, 2006)
Horizontal Violence is a Horizontal Violence is a Common Characteristic Common Characteristic of….of…. Oppressed groupsOppressed groups Those who lack autonomyThose who lack autonomy Those who lack powerThose who lack power Those who lack resourcesThose who lack resources Those who don’t Those who don’t
understand their own understand their own reactions to oppressionreactions to oppression
(Lee & Sneed, 2001; Leiper, 2005: Thomas & Droppleman, 1997)
Why Does Nursing Why Does Nursing Experience Horizontal Experience Horizontal Violence?Violence? Nurses are ill prepared to confront Nurses are ill prepared to confront
issues of horizontal violenceissues of horizontal violence Nursing has historically devalued Nursing has historically devalued
power and views ambitious nurses power and views ambitious nurses as unbecomingas unbecoming
Lack of involvement in policy Lack of involvement in policy makingmaking
Nursing is often an oppressed Nursing is often an oppressed professionprofession(Fudge, 2006; McKenna, Smith, Poole, & Coverdale, 2003 Thomas &
Droppleman, 1997)
Understanding the Understanding the Cycle of Horizontal Cycle of Horizontal ViolenceViolence
Culture may drive horizontal violenceCulture may drive horizontal violence Must become aware of the dynamicsMust become aware of the dynamics Recognize that horizontal violence Recognize that horizontal violence
does exist in the nursing culturedoes exist in the nursing culture Realize that due to powerlessness, Realize that due to powerlessness,
nurses may use horizontal violence nurses may use horizontal violence as the only means they have to gain as the only means they have to gain power over others.power over others.
(Freire, 1970; Leiper, 2005)
Work in devaluing environment
Internalization of culture’s view of being worthless
Begin behaving likethe dominant group
Begin to reject persons of their own group
Resulting interpersonal conflict causes horizontal violence
Society continues to devalue the group
People over time begin to believethat the oppressed group is
legitimately valueless
(Thomas & Droppleman, 1997)
Damaging Effects of Damaging Effects of Horizontal ViolenceHorizontal Violence Poor collaborationPoor collaboration Poor work environmentsPoor work environments Deteriorating quality of Deteriorating quality of
carecare Increased burn outIncreased burn out Perpetuates unacceptable Perpetuates unacceptable
behaviorsbehaviors Suppresses development of Suppresses development of
nursing as a professionnursing as a profession(AACN, 2005; McKenna, Smith, Poole, & Cloverdale, 2003; Thomas & Droppleman,1997)
Taking ControlTaking Control Remember what it was like to Remember what it was like to
be the “new kid on the block”be the “new kid on the block” Make an effort to socialize Make an effort to socialize
with new staff memberswith new staff members Resist the urge to “test” new Resist the urge to “test” new
nursesnurses Abandon the “you have to do Abandon the “you have to do
it because it was done to me” it because it was done to me” mentalitymentality
Check your ego at the doorCheck your ego at the door
(Baltimore, 2006)
Set a Culture of Zero Set a Culture of Zero ToleranceTolerance A culture of zero tolerance for A culture of zero tolerance for
horizontal violence is the most horizontal violence is the most effective way to stop the cycle.effective way to stop the cycle.
Name the problem Name the problem Educate all staff about horizontal Educate all staff about horizontal
violenceviolence Establish a process for dealing Establish a process for dealing
with the issuewith the issue
(Longo & Sherman, 2007)
Good Habits to Adopt Good Habits to Adopt to Stop the Violenceto Stop the Violence
Kindness, concern and Kindness, concern and respectrespect
Lead by exampleLead by example Own up to your mistakesOwn up to your mistakes Don’t participate in Don’t participate in
gossipgossip If conflict arises, speak If conflict arises, speak
directly to the individual directly to the individual as soon as possibleas soon as possible
Work together despite Work together despite personal dislikespersonal dislikes
(Baltimore, 2006; Gasparis, 2005; Leiper, 2005; McKenna, Smith, Poole, & Coverdale, 2003).
FL Nurses Association FL Nurses Association Statement of PositionStatement of Position Recognizes impact of horizontal Recognizes impact of horizontal
violenceviolence Provide educationProvide education Develop resources to assist nurses in Develop resources to assist nurses in
managing horizontal violencemanaging horizontal violence Establish a goal of elimination of Establish a goal of elimination of
horizontal violence in the workplacehorizontal violence in the workplace Encourage addition to curriculum of all Encourage addition to curriculum of all
nursing studentsnursing students
(FNA, 2007)
ConclusionConclusion
Remember incidences of Remember incidences of horizontal violence may horizontal violence may not seem like muchnot seem like much– Unless you are the victim Unless you are the victim
of itof it In order to be seen as a In order to be seen as a
profession, nurses must profession, nurses must act as a professionalact as a professional– Stop horizontal violence in Stop horizontal violence in
the workplacethe workplace
Horizontal Violence Horizontal Violence BlogBlog If you find the topic of horizontal If you find the topic of horizontal
violence has:violence has:– Impacted you personallyImpacted you personally– Or has impacted those around youOr has impacted those around you
Please share your stories by Please share your stories by visitingvisiting– www.Sandyswear.blogspot.comwww.Sandyswear.blogspot.com
Through awareness we can stop Through awareness we can stop horizontal violence in nursinghorizontal violence in nursing
For Comments or For Comments or QuestionsQuestions Contact Sandy Swearingen @ Contact Sandy Swearingen @
[email protected]@hotmail.comcom
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