Introduction
Human beings are social in nature. Notably, when people socialize, they are bound to either make friends or enemies. Naturally, some persons perceive themselves to be superior to other persons. This is done based on various aspects such as age, experience, academic qualifications, ethnic affiliation, and length of service in an organization among others. This has led to the rise in conflict among many organizations resulting in massive losses. The nursing industry has not been exempted as it has experienced such challenges over the years. Recently, there have been an increased number of incidences involving harassment, assault, intimidation, and bullying in the workplace. Bullying has been reported as the worst form of aggression and violence geared towards nurses. Horizontal violence can be defined as conflict amongst peers in the case of nurses.
Nurses have been charged with a very important responsibility of providing care to sick individuals. However, ironical on how they engage in savage acts of harassment and bullying. This goes against the expectations of their career. The most important purpose of healthcare is to provide patients with emotional and physical care. Poor personal relationships can lead to poor work performance, errors, sabotage, and accidents at the workplace. Horizontal violence contributes to a high human resource turnover due to job dissatisfaction. Incidences of violence amongst workmates are totally unacceptable. This is because it has a negative effect on team building and teamwork. This is not only in the nursing industry, butalso in other work places.
Literature review
According to King-Jones (2011), horizontal violence is the expressive and the non-expressive nonphysical hostility. He holds that horizontal violence is the unfriendly incidences experienced by some nurses who are beginning their careers in nursing (King-Jones, 2011).
Horizontal violence takes place in various forms of psychological torture. This includes 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, 2003).
Nurses who have the responsibility of providing medical and emotional support often turn towards each other with hostility and aggression. This is a form of horizontal violence that involves bullying or interpersonal conflict. The nursing profession has little tolerance for physical or verbal aggression. The profession 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 this does not compare to horizontal violence. Horizontal violence hurts them significantly because it comes from colleagues (Leiper, 2005).
Leiper (2005) argues that the management should embrace transformational leadership skills in the work place. These include taking objective positions on critical issues, continuously inspire and challenge their junior colleagues to uphold good morals, and constantly advice their peers to instill positive thoughts (Leiper, 2005). The cycle of horizontal violence can be broken using various guidelines. This includes gaining control by realizing that the aggressor is at fault and not the victim. Also, the victim can get help from management on harassment issues. In addition, this vice can be addressed by talking to family, coworkers, and friends to share experiences and get advice. In extreme cases, taking legal action against the aggressor is encouraged (Leiper, 2005).
Lee and Saeed (2001) argue that oppression exists throughout the world of nursing, a profession most often associated with women. They observe that nurses belong to what they refer to as “the oppressed groups”. Those who belong to the oppressed groups are prone to reactive rather than rational behavior. Reactive behavior results to increased incidences of oppression. In turn, this presents an obstacle to professional development (Lee and Saeed, 2001).
Embree and White (2010) refer to horizontal violence as lateral violence. They argue that about sixty percent of nurses relinquish their posting within the first six months of appointment. This is due to lateral violence directed towards them. Nurses are most likely to leave their workplace 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, 2010).
Woelfle and McCaffrey (2007) defined horizontal violence as aggressive and destructive behavior of nurses against each other. Nursing has experienced a hierarchical structure where the least experienced often become the targets of discrimination and intimidation by their superior counterparts. The organization and nurses suffer as a consequence of lateral violence and these may either be physical or psychological. By extension, the organization loses staff and gets poor quality output from their staff. On the other hand, nurses suffer from demotivation and lack of self-esteem (Woelfle and Mccaffrey, 2007).
Khalil (2009) holds that, amongst all forms of aggression and discrimination, psychological torture is the worst form of violence. This demoralizes a person, and no staff should project such treatment to colleagues. 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 2009).
Longo and Sherman (2007) define horizontal violence as an act of aggression that is directed towards colleagues of the same grade or rank. Also, they state that horizontal violence may be verbal or emotional abuse. It may also involve physical abuse that is subtle or overt. They also include talking behind a colleague’s back and segregation of a colleague from group activities (Longo and Sherman, 2007).
Some of the common behaviors associated with horizontal violence include nonverbal behaviors. This includes moving eyebrows or making gestures in response to comments from the victim; engaging in activities that deter the victim from working at their optimum capacity; deliberate sabotage of colleagues at work; failure to accord peers their privacy especially at their work stations and attributing everything that goes wrong to the victim (Kelly, 2010)
Discussion
Kelly (2010) argues that horizontal violence is an expression by the oppressed groups. This is described as behavior under evolution precipitated by low self-esteem and lack of respect offorhe authority. Nursing is referred to as “an oppressed group” profession because the profession has been associated with the female gender. Historically, nursing has existed under a patriarchal system of governance. In this case, nursing has predominantly been headed by male administrators and doctors (Kelly, 2010).
Federizo (2010) supports the development of intervention mechanisms together with related programs that will assist in reducing cases of horizontal violence in both learning and professional institutions. She goes further to state that socialization that occurs after graduation takes root during school. Also, educational institutions need to come up with policy changes that move away from the traditional norm of grading. This tradition encourages rivalry and competition while discouraging group and teamwork (Federizo, 2010).
In daily practice, many nurses have not come across the term horizontal violence. However, many have experienced the consequences of this form of violence in one way or another. This concept has been discussed in nursing literature for decades. There are suggestions that since nurses are in a patriarchal system, which is dominated by male doctors, they result in aggression towards one another to lower the hierarchical power. Horizontal violence has been documented as one of the worst experiences that a nurse could ever experience. It has been estimated that about one nurse in every three nurses abandons his or her job because of bullying. Fresh recruits have been identified as one of the most vulnerable groups. The main reason for this is their lack of experience that leads to strict scrutiny of their work. This causes the recruits a lot of stress and deters them from asking follow-up questions to enhance their understanding (Levett-Jones, Bourgeois and Luke, 2009).
The relationships among nurses 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 among nurses. Nurses have been known to behave ruthlessly towards one another. This is 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 colleagues. Whenever they are aware of these malpractices, nurses should stand firm and take action against the perpetrators (Butts and Rich, 2005).
The effect of horizontal violence can be costly and devastating to the medical sector. This includes both the organization and the patients under the care of the nurses. This is because horizontal violence has a negative influence on productivity, quality of patient care, and cooperation of staff. Investigation reveals that unresolved conflicts and destructive behavior are among the core issues that obstruct organizations from the ability to maintain and achieve a safe environment for patient care. In some cases, horizontal violence has been known to embed itself to the hierarchy structure of an organization, which is not openly visible. However, healthcare organizations that deny its existence tend to reinforce and cultivate the culture. Nonetheless, it was found that newly registered nurses who received education on horizontal violence could cope well with the vice and knew how to handle the offender (Feldman and Alexander, 2012).
Conclusion
Horizontal violence is not a myth, but a reality that is here to stay. Unless urgent steps are 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 measures should be taken to punish those who bully fellow colleagues.
References
Butts, J. B, and Rich, K. (2005). Nursing Ethics: Across the Curriculum and into Practice. Sudbury, Mass.; Toronto: Jones and Bartlett.
Coverdale, J. H. et al. (2003). Horizontal Violence: Experiences of Registered Nurses in Their First Year of Practice. Journal of Advanced Nursing, 42(1): 90-96. Print.
Embree, J. L. and White, A.H. (2010). Concept Analysis: Nurse-To-Nurse Lateral Violence. Nursing Forum, 45(3): 166-173.
Federizo, A. (2010). Nursing Students’ Perceptions of Horizontal Violence: Are the Seeds of Departure Planted Prior to Licensure? Reno, Nevada: ProQuest,
Feldman, H. R, and Alexander, G.R. (2012). Nursing Leadership: A Concise Encyclopedia. New York: Springer.
Kelly, P. (2010). Essentials of Nursing Leadership & Management. Clifton Park, NY: Delmar Cengage Learning.
Khalil, D. (2009). Levels of Violence among Nurses in Cape Town Public Hospitals. Nursing Forum 44(3): 207-217.
King-Jones, M. (2011). Horizontal Violence and the Socialization of New Nurses. Creative Nursing, 17(2): 80-86.
Lee, M. B. and Saeed, I. (2001). Oppression and Horizontal Violence: The Case of Nurses in Pakistan. Nursing Forum, 36(1): 15.
Leiper, J. (2005). Nurse Against Nurse: How To Stop Horizontal Violence. Nursing, 35(3): 44-45.
Levett-Jones, T., Bourgeois, S. and Luke, L. (2009). The Clinical Placement: A Nursing Survival Guide. Edinburgh: Baillière Tindall.
Longo, J. and Sherman, R.O. (2007). Leveling Horizontal Violence. Nursing Management, 38(3): 34-51.
Woelfle, C.Y. and McCaffrey, R. (2007). Nurse on Nurse. Nursing Forum, 42(3): 123-131.