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Horizontal Violence: A critical review of literature

Human beings are social in nature, and where people socialize they are bound to either make friends or enemies. Naturally some persons perceive them selves to be superior to other persons either by virtue of their age, experience, academic qualifications, ethnic affiliation and length of service in an organization. This has lead to rise in conflict in many organizations resulting in massive loses. The nursing industry has not been exempted as it has experienced such challenges over the years. Recently there have been more and more reports of harassment, assault, intimidation and bullying. Bullying has been reported as the worst form of aggression and violence remitted out against nurses. Horizontal violence can be defined as conflict amongst peers in this case nurses.
Nurses have been charged with a very important responsibility of proving care to sick patients; it is ironical how they engage in savage acts of harassment and bullying. The most important purpose of health care is to provide patients with emotional and physical care. Poor personal relationships can lead to poor work performance, errors, sabotage and accidents at work. Horizontal violence contributes to a high human resource turnover due to job dissatisfaction. Violence amongst workmates is totally unacceptable, and has a negative effect toward team building and team work not only in the nursing industry but all work places in general.
Literature review
According to King-Jones he defines horizontal violence as overt and covert nonphysical hostility, such as criticism, sabotaging, undermining, infighting, scapegoat, and bickering. He holds that, horizontal violence refers to the harsh reality experienced by some nurses beginning their careers in nursing; he describes it as eating our young (King-Jones, pp. 80-86).
Horizontal violence has been documented to take place in various forms of psychological torture which include issue of threats, verbal abuses, humiliation, intimidation and discouragement, denial of access to opportunities and withholding of information.it has been reported that exposure to bullying behavior can be psychologically distressing. It has been documented that some nursing personnel have had to leave their profession as a consequence of bullying. Usually these cases go unreported due to fear of retaliation from accused parties (Coverdale et al, p. 91).
Nurses who have the responsibility of provide medical and emotional cares often turn towards each other with hostility and aggression rather known as horizontal violence bullying or interpersonal conflict. The nursing profession has little tolerance for physical or verbal aggression and has developed strict rules and regulations to deter this practice. It is highly expected for nurses to receive hostile treatment from sick patients or their family but it does not compare to horizontal violence. Horizontal violence hurts them more because it comes from their colleagues (Leiper, p. 44).
Leiper argues that the management should embrace transformational leadership skills by taking objective stand on critical issues, continuously inspire and challenge their junior colleagues to uphold good morals, and constantly advice their peers to instill positive thoughts (pp. 44-45). The cycle of horizontal violence can be broken using the following guide lines; gaining control by realizing that the aggressor is at fault and not you, getting help from management on harassment issues, by talking to family, co workers and friends to share experiences and get advice and taking legal action against the aggressor by making a formal complaint (Leiper pp. 44-45).
Lee and Ismat argue that oppression exist throughout the world of nursing a profession most often associated with women (p. 15). They go ahead to argue that nurses belong to oppressed groups. Membership to oppressed groups results reactive rather than rational behavior. Reactive behavior results to more oppression   which intern presents an obstacle to professional development (Lee and Ismat, p. 15).
Embree and White refer to horizontal violence as lateral violence (p. 168). They argue that about 60% of nurses’ desert their posting upon the first six months of appointment due to what they refer to as lateral violence directed towards them. Nurses are most likely to leave their work place if no intervention is made to address this situation. A high staff turnover usually has huge financial implications on an organization, hence the need to avoid it (Embree and White, pp. 166-171).
Woelfle and McCaffrey defined horizontal violence as aggressive and destructive behavior of nurses against each other (p. 123). They argue that nursing has for ages experienced a hierarchical structure where the young and of junior experience, often become targets of discrimination and intimidation by their superior counter parts. The organization and nurses both suffer as a consequence of lateral violence and these may either be physical or psychological. By extension the organization looses staff and gets poor quality out put from their staff. On the other hand nurses suffer from demotivation and lack of self esteem (Woelfle and Mccaffrey, pp.124-125).
Khalil holds that amongst all forms of aggression and discrimination, psychological torture is the worst form violence that demoralizes a person and that no staff should project these to the other (p. 208).psychological torture includes such behavior as gossip, public humiliation and marginalization. A study by the international labor organization revealed that close to two million workers suffer from psychological violence. It is argued that the hierarchical organization of the nursing industry or the health sector encourages horizontal violence (Khalil pp. 209-211).
Longo and Sherman define horizontal violence as an act of aggression that is directed towards colleague from another of the same grade or rank. They continue to state that horizontal violence may be verbal or emotional abuse; it may also involve physical abuse which is subtle or overt. They also include talking behind a colleague’s back and segregation of a colleague from group activities (Longo and Sherman, pp.34-38).
Some of the common behaviors associated with horizontal violence include; non verbal behaviors such as raising of eyebrows or making of gestures in response to comments from the victim, activities that deter the victim from working in their optimum capacity, deliberate sabotage of another colleagues work, failure to accord peers their privacy especially at their work stations and attributing everything that goes wrong to particular colleagues (Kelly p.141)
Kelly argues that horizontal violence is an expression of oppressed groups, a behavior under evolution precipitated by low self esteem and lack of respect of authority. Nursing is generally referred to as an oppressed group because it is generally composed of the female gender. Historically nursing has existed under a patriarchal system of governance predominantly headed or lead by male administrators, doctors and segregated nurses (Kelly p. 141).
Federizo supports the development of intervention mechanisms together with related programs that will assist reduce cases of horizontal violence in both learning and professional institutions. She goes further to state that socialization which occurs after graduation takes root in during school. She further states that educational institutions need to come up with policy changes that move away from the traditional norm of grading, which encourage rivalry and competition, while discouraging group and team work. Competition lowers self esteem, motivation, encourages cheating in exams and hinders learning (Federizo, pp45-49).
In daily practice many nurses have not come across the term horizontal violence but many have experienced the consequences one way or another. This concept has been discussed in nursing literature for decades. Suggestions have been made that because nurses are in a patriarchal system dominated by male doctors, sisters –in-charge and doctors, they result in aggression towards one another to lower the hierarchy power. Horizontal violence has been documented as one of the worst experiences that a nurse could ever go through. According to international polls in has been estimated that about one in three nurses leave their jobs because of bullying. Undergraduate students have been identified as one of the most vulnerable groups. The main reason for this is their lack of experience which leads to strict scrutiny of their work. This causes the students a lot of stress and deters them from asking follow up questions to enhance their understanding (Levett-Jones, Bourgeois and Luke, pp. 62- 64).
Nurse relationships can be viewed as relationships within a community. Communities are brought together by friendship and use of the same language. Unfortunately this has not been evident in nurses. Nurses have been known to behave very ruthlessly towards one another. However there may arise occasions when colleagues may act harshly towards another especially where it concerns the health of a patient. Nurses become advocates when they endeavor to protect patients from incompetent, impaired or unethical treatment from fellow colleagues. When ever they are aware of these malpractices they should stand firm and take action against the perpetrators (Butts and Rich, pp43).
It is argued that the effect of horizontal violence can be costly and devastating to the medical sector i.e. to both the organization and the patients being cared for. This is because horizontal violence has negative influence on productivity, quality of patient care and corporation of staff. Investigation revealed that unresolved conflicts and destructive behavior are among the core issues which obstruct the organizations ability to maintain and achieve a safe environment for patient care. In some cases horizontal violence has been known to embed its self to the hierarchy structure of an organization that it is not openly visible. However health care organizations that deny it existence tend to reinforce and cultivate the culture. However it was found that newly registered nurses who received education on horizontal violence, they were able to cope well with the vice and also knew how to handle the offender (Feldman and Alexander pp. 189-190).
Horizontal violence is not a myth but e reality here to stay. Unless urgent steps have been taken to combat this vice it may lead to the collapse of the entire medical system. Nurses play a very pivotal role in the administration of health care, in this profession any small mistake could lead to a fatality. Organizational heads should come up with ways of ensuring that such practices are not evidenced in their organizations. Strict and stringent measures should be taken to punish those who bully fellow colleagues.

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