Horizontal violence in nursing
Horizontal Violence in Nursing
Quality care depends on an emphasis on teamwork to achieve positive patient outcomes. In essence, teamwork helps nurses to focus on shared vision, positive attitude and developing respect for each other at the workplace. However, where there are negative workplace relationships, team performance is disrupted. Just like any other workplace environment, the nurses are also affected by horizontal violence where a staff, for instance, turns aggressive against a colleague within the workplace. Horizontal violence is often a result of a series of incidents that goes unchecked over a period of time compared to an isolated incident or conflict at the workplace. In most cases, horizontal violence is covert and normally difficult to discern. As a result, it is the victim who repeatedly suffers without any for intervention to address to the problem (Becher &Visovsky, 2012). This paper explores hostile violence in the nursing profession and how it affects health care.
What causes horizontal violence in the nursing profession?
Due to the hectic work involved in the provision of health care, health providers such as nurses tend to experience higher levels of stress and burnout. The work stress adds up to other life stressors that manifest in raising families and personal relationships, for example. Consequently, these stressors may have an impact on a nurse’s psyche. Just like any other profession, nurses also need an avenue where they can release their negative emotions or cognitions. However, such negative emotions or cognitions are often vented on vulnerable co-workers and thus creating an environment where horizontal violence thrive. In any work environment, the vulnerable victims are often new workers who still need mentoring because they are unfamiliar with their roles at the workplace. With time, the victims of horizontal violence also tend to retaliate and this creates a vicious cycle of horizontal violence at the workplace. Horizontal violence at the beginning, often appears passive, but can later escalate to verbal abuses and other forms of violent behaviors (McNamara, 2012).
Since the bullying often goes unnoticed, it becomes a norm thus affecting the work of the victims who become walking wounded themselves. Examples of bullying at the workplace include withholding support, intimidation, denying other workers freedom of speech and making jokes that target gender or sexual orientation. Incivility at the workplace is often caused by a number of reasons that include, for example, opportunistic tendencies by some nursing staff. As a result, they take advantage to intimidate new nurses and other co-workers who appear weak. Jealousy at the workplace is another factor that causes incivility among staff members. Staff members who appear jealous may bully their co-workers out of envy or to seek attention. Others engage in disruptive behavior because they are insecure about their inadequacy at the workplace and tend to bully other staff members who appear to perform their duties more efficiently (Wilson et al., 2011).
The effects of horizontal violence in the nursing profession
Horizontal violence or bullying at workplace causes psychological disturbance for the victims and thus affecting their productivity at the workplace. For example, new graduate nurses who experience horizontal violence tend to have difficulties in performing their duties due to persistent bullying from their co-workers. Horizontal violence also interferes with the work of the entire health care team as a result of creating a rift among team members. The impact of bullying also extends to the patients who may suffer in the hands the walking wounded nurses. As a result of bullying at the workplace, victims often suffer from various psychological disturbances that include, for example, low esteem, anxiety and depression. Most of the nurses who experience bullying at the workplace tend to consider other options such as quitting their jobs and this may have an impact on healthcare due to the shortage created by a high turnover of nurses affected by lateral violence (Wilson et al., 2011).
Further, the formative years in practice is considered to be important for in helping nurses to develop self-confidence in their work. However, subjecting new nurses to bullying behaviors tend to affect confidence and self-esteem. Horizontal violence is also costly for the health care institutions that have to deal with the after effects of lateral violence. Bullying at the workplace also affects communication, the exchange of important healthcare information and an inclusive decision-making process. As such, health care institutions are experiencing numerous medical errors and negative patient outcomes. On the other hand, an abusive workplace environment can also lead health care providers to make mistakes and in most cases, it is the patient who suffers as a result of a disruptive workplace environment (Becher&Visovsky, 2012).
How to prevent horizontal violence in the nursing profession
There are some interventions that have been identified to minimize horizontal violence in the nursing profession. This includes, for instance, cognitive rehearsal as a strategy to contain lateral violence. This strategy involves taking a person through the imagination of difficult situations and helping him or her to deal with such a situation. The person then practices the strategies learned to deal with real life situations such as dealing with horizontal violence. This process is particularly helpful for new nurse graduates who are often bullied by their co-workers. In essence, cognitive rehearsal plays a role in raising awareness regarding horizontal violence in the nursing profession (Dulaney & Zager, 2010).
Also, standards regarding professional work ethics need to be implemented in healthcare institutions to ensure incidents such as horizontal violence is addressed. Such standards need to encompass all levels of nursing practice including the top nursing officers. There are numerous challenges facing health care institutions that can contribute to lateral violence. These include a shortage of nursing staff, increased population of patients seeking health care provision and inadequate resources. As such, the pressure to deliver quality care is strenuous. This in turn, leads to stress and conflicts evident among the nursing staff in different health care institutions. In this regard, effective leadership is necessary to enhance employee involvement (Dulaney & Zager, 2010).
Effective leadership by the chief nursing officer can manifest in terms of providing support to other nursing staff. Such support may involve providing resources necessary to minimize job stress and improve health care provision. Support for other nursing staff may also involve improving communication network to ensure efficient delivery of services. Providing opportunities for training and professional development also play a role in reducing horizontal violence at the workplace. The training should involve nurse educators because they understand how health care systems work. In the nursing profession, accountability by senior staff is necessary for modeling acceptable behaviors. The senior staff needs to ensure that their followers embrace the professional ethical code of conduct at the workplace environment. This ensures that unprofessional behaviors at the workplace environment are dealt with accordingly. The senior nursing staff should also maintain impartiality when dealing with incidents of horizontal violence (Lachman, 2015).
Other approaches that can help in minimizing horizontal violence include facilitating discussions such as focus groups. Such discussions are important in identifying issues affecting the nursing staff and developing action plan geared at improving the workplace environment and quality of care. An active role by the entire nursing staff in combating horizontal violence is important in demystifying incidents of bullying that often goes unnoticed at the workplace. Other strategies to deal with bullying at the workplace involve assertive training, for instance. This help the nursing staff subjected to horizontal violence to speak out regarding their plight at the workplace (Becher&Visovsky, 2012).
In any health care institution, early identification of horizontal violence nurse managers is important in ensuring that the quality of care is not compromised. Further, identifying nursing staff that experience difficulties in dealing with a stressful situation is also important in minimizing lateral violence. Recognizing the walking wounded helps nurse managers to develop coping strategies that assist both the victims and the perpetrators of horizontal violence. Among the coping strategies may involve referring both the victims and perpetrators to employee assistance programs such as counseling, for example. Also, nurse managers should also avail themselves to resolve issues affecting other staff members. This may involve, for example, face to face communication with other nursing staff. In essence, nurse managers play an important role in assisting other nursing staff to become wounded healers (Becher & Visovsky, 2012).
Horizontal violence as a disruptive behavior impacts negatively on health care provision. This behavior causes psychological disturbance to the victim and affects the quality of care and patient outcomes. As such, eradicating the behavior is necessary to avoid the high turnover of new graduate nurses who are discouraged from joining the nursing profession. The first step in eradicating horizontal behavior in the nursing profession involves acknowledging the existence of the vice. This helps to develop intervention strategies to ensure the problem is addressed.
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McNamara, S.A. (2012).Incivility in nursing: unsafe nurse, unsafe patients.AORN Journal,
Wilson, B.L., Diedrich, A., Phelps, C.L., & Choi, M. (2011). Bullies at work: the impact of
horizontal hostility in the hospital setting and intent to leave. Journal of Nursing Administration, 41(11), 453-458.
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HORIZONTAL VIOLENCE IN NURSING
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