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5 Ways to Reduce Horizontal Violence in Healthcare

Did you know that while about 10 percent of all professions report disruptive behaviors in the workplace, reports for healthcare professions are three times higher? Hostile behavior is most prevalent in nurse-to-nurse interactions with 65 to 80 percent of nurses reporting they have either experienced or witnessed it.

Horizontal violence, or also known as lateral violence or workplace bullying, is described as non-physical, hostile, aggressive and harmful behavior toward a co-worker or group via attitudes, actions, words and/or behaviors. It is characterized by behaviors such as:

  • Making snide, belittling or sarcastic comments
  • Public humiliation
  • Gossip
  • Isolating a colleague from a group
  • Ignoring or avoiding
  • Patronizing or condescending language
  • Undermining personal values and beliefs
  • Mocking
  • Passive aggressive behavior
  • Harassment
  • Intimidation

Effects of Horizontal Violence

Horizontal violence can be devastating. Victims can suffer from reduced self-esteem depression, anxiety, panic attacks, and sometimes even attempt suicide. Physical symptoms are also common and can include weight loss or gain, musculoskeletal problems, intestinal issues, insomnia and cardiac arrhythmias. These negative impacts increase the incidence of sick leave and unplanned absences.

Horizontal violence also impacts teamwork and communication. Safe, quality healthcare is dependent on respectful working relationships, teamwork and collaboration. But horizontal violence increases the occurrence of adverse events, medical errors and patient mortality.

Research has also linked nurse hostility with turnover, by associating three retention outcomes: job satisfaction, organizational commitment and turnover intentions. Victims of horizontal violence have a higher likelihood of leaving their employment within six months of the first incident. Per a publication in nursing forum, approximately 60 percent of new graduate nurses leave their first places of employment within the first few months due to horizontal violence. Also, among clinical leaders, abusive conduct has led to decreased quality of care and increased motivation to quit among nurses.

In the healthcare workplace, horizontal violence is estimated to cost more than $4 billion dollars each year due to lost time, productivity and turnover. It also leads to lawsuits, compensation for disability, loss of profits and poor patient satisfaction.

What Can Organizations Do About Horizontal Violence?

1. Clear Zero-Tolerance Policy

For positive change, organizations should adopt a zero-tolerance policy for incidents of hostility and should empower staff to speak up without fear of retaliation. Establish clear policies, procedure, expectations and consequences to enforce and reduce horizontal violence.

2. Behavior Starts from the Top

All members of the healthcare team must work together to end the cycle of horizontal violence. Managers must be committed to enforcing zero-tolerance policies, modeling healthy communication and creating an environment and culture where staff feel comfortable discussing concerns. Documenting incidents of horizontal violence and promptly reporting it to the proper personnel is important to tackling the issue and making continuous improvements.

3. Assessing Root Cause to Violence

Behavioral and situational assessments can also be part your organization’s strategy to reduce horizontal violence. Behavioral assessments can be used as a root-cause analysis conducted when teams become dysfunctional, which can then be addressed through coaching, simulation, and classroom learning. Situational assessments assist with determining baseline communication skills and be used to help supervisors and charge nurses to be proactive in providing guidance to nurses who may be uncomfortable or unfamiliar with specific circumstances.

4. Education on Conflict Management

Most nurses are not able to face conflict or the individual, because they felt they did not have the necessary skills to confront or manage the situation. Therefore, nurses need education and workshops on how to identify, assess, and manage horizontal violence.

5. Time to Reflect for All

Reflection is widely viewed as a valuable part of professional practice. It is a conscious, dynamic process of thinking about, analyzing and learning from an experience to help respond to future situations with a changed perspective. It requires focusing on personal interactions to gain a clearer picture of behavior to change or improve it.

Here are eight questions for you and your team to use as a guide for reflection on behavior as it relates to horizontal violence.

  1. During a stressful or chaotic situation at work, how do you usually speak to your co-workers? Could it be perceived as impatient, rude or snide?
  2. If you’re a seasoned veteran in your profession, think about how you interact with new employees. Do you respectfully answer their questions?
  3. If you’re new, how do you interact with more seasoned members of your team?
  4. When you hear gossip about a co-worker, how do you usually respond? Do you participate? Do you stay silent or walk away? Do you take a stand to stop the gossip cycle?
  5. What did you do the last time you witnessed horizontal violence between co-workers? Did you do something positive to stop it? Did you attempt to stay out of it? Did you perpetuate the violence by joining in?
  6. If a co-worker asked for your help in handling an issue with horizontal violence, what advice would you give them?
  7. If you have harassed, bullied or ignored a co-worker, how might that have affected them? The team? Patients?
  8. What behaviors could you most need to work on to improve a culture of respect in your workplace?

Final Thoughts

The healthcare landscape is fast-paced and challenging with high levels of stress. This kind of environment increases the likelihood of horizontal violence between nurses, with new graduate nurses at a higher risk. The effects of horizontal violence not only include the victim, but also the organization. Due to the physical, emotional and psychological toll individuals endure, this influences behavior, including communication and trust within the team, medical errors, and turnover. To see positive change in regards to horizontal violence, organizations must be prepared with clear policies and procedures, empower nurses to manage conflicts with education, and implement proactive measures. Together, we can reduce and prevent horizontal violence to protect hospital staff members and the patients they care for.

How Relias Can Help

Relias helps hospitals and post-acute organizations build the best patient care teams, through behavioral and situational assessments that give hospitals insight into nurse candidates’ personality traits and interpersonal skills. Relias Assessments can be used both proactively to hire the best-fitting nurses from the start, as well as in response to dysfunctional team dynamics to figure out the behavioral breakdown. Relias also provides education on conflict management, communication, and many other useful skills to respond to horizontal violence as a victim, peer or manager.

How to Assess Behavioral Characteristics to Hire the Best Nurses

This webinar demonstrates the use of three strategic leadership techniques that can be used to assess the behavioral characteristics of nurse applicants, whether you are hiring for a front-line nurse or nurse leader. The use of these strategies will help to provide a robust and holistic hiring environment, as well as contribute to nursing job satisfaction and future job performance.

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