According to Duffy (1995), Horizontal or lateral violence can be widely defined as the unreceptive and antagonistic behavior remitted towards particular individual or group by another individuals or group perceived or thought to be superior to the later. In essence horizontal violence is described as an inter-group struggle for dominance and authority. Horizontal or lateral violence is prevalent in the workplace society and it is an intolerable, obnoxious, destructive and distasteful phenomenon. All employees, in all organizations are called upon to unite and work together against this social vice of oppression and exterminate its insalubrious behavior from our organizations. The term horizontal violence which is also referred to as lateral violence, is generally a new phrase or terminology, but the character it describes is not new. The term was coined to illustrate repugnant behavior that nurses occasionally portray towards their fellow colleagues. Horizontal violence comes in various different forms and characteristics. Basically put it is a blatant and concealed nonphysical aggression, such as sabotage, finger pointing, bickering, condemnation and blame (Vonfrolio, 2005).
There are various people who have felt embarrassed, ridiculed, scorned and scoffed at by other medical practitioners. One of the most affected work groups that experiences horizontal violence is the new nursing graduates. In any work force it is very essential for the experienced staff to welcome and support the new graduates to encourage them in their new profession. Usually during the first year of nursing practice is when new grandaunts develop and build and establish their confidence and self-esteem. As a new graduate a person lacks experience, knowledge and appropriate skills to defend themselves. As a result they are often dehumanized. Regrettably, all new graduates openly accept this treatment as a ritual of passage, disappointingly they also come back to emulate their predecessors and remit the same abuse to others who join after hem (Duffy, 1995).
Horizontal or lateral violence has been widely and extensively described as any unsolicited abuse or aggression within the work environment (Stanley, Martin, Nemeth, Michel, & Welton, 2007). According to Thobaben (2007), horizontal violence refers to any intimidating, unreceptive, inimical and aggressive behavior exhibited by a nurse or a group of nursing practitioners directed towards an individual or group of fellow workers through arrogance, thoughts, opinions, mindsets, and behavior. Horizontal violence is illustrated by the presence of a sequence of undermining occurrences over a period of time, as compared to single isolated disagreement in the workplace (Jackson, Firtko, & Edenborough, 2007).
This continuous conflict usually makes horizontal violence irresistible, prodigious and devastating eventually leading to signs of dejection, hopelessness, gloominess and might even cause post traumatic in the person affected. Horizontal violence tends to be hidden, hard to conceptualize, realize and ascertain; the affected party subsequently has problems or difficulty in obtaining help within the work environment. Horizontal violence also has been depicted as an intergroup struggle with elements of blatant and hidden aggression (Joint Commission, 2008). The nursing profession has been termed to be an oppressed lot, mainly comprised of female workers. Proponents of the oppression theory argue that lack of independence and control over their working area; hopelessness, defenselessness, and low personal self esteem greatly sponsor the development and expansion of horizontal violence inside the nursing profession (St-Pierre & Holmes, 2008). However this has not been able to explain why horizontal violence is manifested in various professions and includes organizational, social and individual traits (Wilson, Diedrich, Phelps, & Choi, 2011).
Horizontal violence that generates in to repeated incidents of aggression directed at workmates is also referred to as workplace bullying (Longo & Sherman, 2007). According to Vessey, Demarco, and DiFaizo (2010), a bully can be defined as a person who openly or secretly demeans another colleague. They described the bully`s behavior as being intentional, with the purpose of generating body or mental suffering to the victim. Threatening behavior of the persons engaged in bullying are evident throughout the lifespan. Bullies often seek support from other persons as a means of legitimizing their behavior. The support obtained from their peers further goes to provide an audience that strengthens aggression which in turn fosters further segregation of the victim and enable the aggressor to operate and expand their influence (Randle, Stevenson, & Grayling, 2007).
Generally horizontal violence is known to happen within peer groups of the same job grade. In a study conducted by Wilson et al, it was observed that about 61.1% of interviewed nurses confirmed to have witnessed or experienced horizontal violence within their work unit. It is also known to extend to colleagues who work in close relations with nurses such as physicians (49.1%) and supervisors (26.9%). In contrast, horizontal violence has not been restricted to those in lateral positions. Horizontal violence has been evidenced to project from the nursing management to juniors they supervise. In a study carried out by Stagg, Sheridan, Jones, and Speroni (2011) it was observed that 28%of the nurses’ respondents had at one stage been bullied by a representative of the leadership (Wilson, Diedrich, Phelps, & Choi, 2011).
Incidence and prevalence
The extent of incidence and prevalence horizontal violence amongst the nursing profession is generally anonymous, as horizontal violence is often undocumented, unreported and unpredictable. However recent studies have affirmed that horizontal violence is generally far reaching at 65% to 80% of all nurses interviewed (Stagg et al., 2011; Vessey, Demarco,Gaffney, & Budin, 2009; Wilson et al., 2011).
In a study carried out by Johnson and Rea (2009), on horizontal violence amongst 249 nurses who were registered nurses of the Washington State Emergency Nurses Association. It was observed that 27.3% had been subjected to bullying at the workplace, with 18 nurses from the sample population confirming that they encountered at least two demeaning acts on a weekly or daily occurrence, while about 50 nurses reported to encounter three or more demeaning acts on a daily or weekly occurrence. In a separate study conducted on nursing students in Australia, it was observed that an estimated 50% of the undergraduates encountered horizontal violence throughout their clinical rounds (Curtis, Bowen, & Reid, 2007).
Students also confirmed feeling hopeless, humiliated and embarrassed as they begun to digest these actions at the work place. In a study carried out on junior nursing students by Thomas and Burk (2009), it was revealed that horizontal violence generally takes place as early as the first meeting between the students and the professional nurses in the job setting (Thomas & Burk, 2009). It is also reported that most of the new graduates who encounter horizontal violence thought of leaving the nursing profession and also were observed to have high incidence of absenteeism (Curtis et al., 2007).
Effects of horizontal violence
Horizontal violence destroys the self esteem of the individual and is consequently detrimental to the practice, as belligerence and violent behavior increases from fellow workers who ought to be offering guidance and encouragement (Thomas & Burk, 2009). Horizontal violence has profound implications for newly graduated and current students of nursing, who are new in the filed and require constant guidance and advice to enable them achieve their potential. New graduate nurses who encounter horizontal violence may have problems in achieving success due to the nature of constant aggression (Thomas & Burk, 2009).
Horizontal violence has a detrimental effect to the entire health system because of the ever raising rift amongst employees or groups of coworkers. Horizontal violence results in a wide apparel of effects that project from the victim towards the health care group and finally to the patient (Joint Commission, 2008). It is generally noted that victims of bullying mostly suffer from low self-esteem, sleeping disorders, powerlessness, and absenteeism from work amongst many other symptoms (Thobaben, 2007). Supplementary to the psychological consequences of bullying, some of the victims of horizontal violence have been associated with suicidal tendencies (Vessey et al., 2010).
It was reported by the Joint Commission (2008) that inadequate communication was the prime factor in the lookout incidents influencing health care groups and negating patient safety. When critical information about a patient is withheld as a tool of horizontal violence, the victimized nurse will not be in a position to discharge her duties effectively, and this will greatly compromise the safety of the patient. The chain effect is that the patients, patient`s family and the institution are bound to incur tremendous additional financial costs not withstanding the risk of potential legal prosecution. It is estimated that about a half of all horizontal violence incidents are not reported. With strict codes of conduct that deter retaliation, most of the victims are left with no options or avenues to report or defend themselves (Stagg et al., 2011; Vessey et al., 2010).
Application of findings to future nursing practice
According to the American Nurses Association Code of Ethics (ANA, 2001), it stipulates the desired behavior and character of professional nurses. The sixth standard in this code suggests that nurses are accountable for attaining and sustaining work environments coherent with professional values. Currently the modern health care scenario poses a lot of challenges that aid horizontal violence. Inadequate staffing, lack of sufficient resources and increased patient perspicacity tend to generate stress and aggression (Huntington et al., 2011). Nurse leaders are perfectly positioned to avert and eradicate horizontal violence by availing resources in the form of encouragement and advice. Leaders who portray a trusting character allow the staff experience support. Provision of resources to reduce job related stress and anxiety can enable nurses be better empowered to care for their patients appropriately (Longo & Sherman, 2007).
Leaders should hold themselves and their juniors responsible for formulating satisfactory professional behavior. When unacceptable behaviors are observed, a corrective measure must be immediately formulated. Once challenges of horizontal violence have been noted in an organization, a formula should be worked out on how change the nature that facilitates acts of horizontal violence. When tackling complaints or cases of horizontal violence nurse leaders should ensure that they keep an objective stand and evaluate all facts from a neutral perspective. They must be conversant with the organizational policies specifically related to horizontal violence (Vessey et al., 2010).
Most importantly they should be ready to implement policies with applicable disciplinary measures when incidents of horizontal violence jeopardize the integrity of the organization. Managers should also engage in similar horizontal violence seminars as their employees to ensure that they are adequately enlightened about horizontal violence occurrences (Stagg et al., 2011). To encourage the deliberation of prevention and eradication of horizontal violence within the organization, focus groups can be constituted to categorize the major areas that need improvement and commence an action program (Longo & Smith, 2011).
Nursing students and newly graduated nurses are potentially at a high risk to the profession as most of them consider leaving due to horizontal violence. During the process of character transformation and increased responsibility and expectations, young graduates and students encounter increased stress in their work environment (Thomas & Burk, 2009). Preceptors delegated to new graduates should be aware of the negative influence of horizontal violence on recently graduated professionals. Preceptors of new graduates and students must construct professional behavior with the objective of giving guidance and assistance (Curtis et al., 2007). Preceptors should also have sufficient intelligence on how to deal with horizontal violence among coworkers, and always demonstrate professional behavior with a view to build trust and cohesiveness. The option of assigning new graduates to mentors from different units may be applied, as it offers appropriates resources found within the organization capable of dealing with probable cases of horizontal violence. Some of the fundamental mentoring accountabilities may include teaching, coaching, counseling, offering protection and sponsorship (Curtis, Bowen, & Reid, 2007).
Implications for identified specialty
In organizations where horizontal violence issues have not been addressed, measures can be instituted by the nurses who have experienced acts of bullying. First and foremost, they must uphold a healthy view of themselves, so that they do not personify the incidents of horizontal violence. During the occurrence of horizontal violence, sharing the experience with a trusted friend or colleague may be of great help (Randle et al., 2007). Talking or sharing of incidences of horizontal violence assists the person to ascertain whether the acts do constitute incidents of horizontal violence, and may also determine a witness to the proceedings. Counseling may be commenced to encourage and address the emotional needs of the individual, and this should be done hastily to prevent unnecessary emotional turbulence (Cleary et al, 2009).
Exhibiting aggressive behavior during the occurrence of the event may be regarded as an acceptable reaction to horizontal violence. It is recommended that actions or acts that comprise bullying must be steadfastly confronted during or just after they have occurred. The dialogue should remain both emphatic and honest (Randle et al., 2007). The offended party must categorically demand that the bullying should stop, and should make specific reference to the offending act, not revealing their emotions or feelings generated by the incident. Only actual incidents that comprise the horizontal violence should be talked about, with an emphasis on the specific uncouth behaviors and the way back to a professional work environment (Cleary et al, 2009).
Every organization experiences some form of horizontal violence, which has the explosive potential of destroying the institutional integrity within the nursing profession, which finally culminates in poor patient care. Failure to address issues related to horizontal violence can profoundly have a negative effect on new students and grandaunt nurses, and this may eventually push them out of the profession. It is important for nurses and nursing leaders to acknowledge the presence of horizontal violence, and instigate appropriate measures to mitigate the situation.
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