Did you know that while only 10% of professionals across industries report experiencing disruptive behavior in the workplace, healthcare professionals report rates that are three times higher? In fact, horizontal violence — also known as lateral violence or workplace bullying — is alarmingly prevalent in nurse-to-nurse interactions, with estimates suggesting that between 46% and 100% of nurses experience or witness this behavior at some point in their careers.
Horizontal violence is particularly problematic in nursing because of the high-stress, fast-paced work environments where teamwork and clear communication are crucial for patient care. Horizontal violence undermines these factors, leading to burnout, turnover, and a decline in care quality.
What is horizontal violence?
Horizontal violence refers to non-physical, hostile, aggressive, or harmful behavior directed at colleagues in the workplace. These actions can manifest in various ways, including:
- Snide, belittling, or sarcastic comments
- Public humiliation or bullying
- Gossip or exclusion from social groups
- Patronizing or condescending language
- Passive-aggressive behavior or intimidation
The devastating effects of horizontal violence in healthcare
Horizontal violence doesn’t just affect individual nurses — it erodes teamwork, communication, and the overall quality of care. Victims may experience emotional distress, such as anxiety, depression, and low self-esteem. In severe cases, it can lead to physical symptoms like insomnia, weight changes, or even cardiac problems.
On an organizational level, horizontal violence contributes to:
- Increased medical errors
- Decreased patient satisfaction and safety
- Higher staff turnover (approximately 60% of new graduate nurses leave within six months due to horizontal violence)
- Annual costs estimated at $4 billion, including lost productivity, absenteeism, and lawsuits
To combat these challenges, healthcare organizations must take proactive steps to reduce the occurrence and impact of horizontal violence.
How to reduce horizontal violence in healthcare: 5 proven strategies
The following strategies can help your organization eliminate and prevent horizontal violence.
1. Implement a zero-tolerance policy
A zero-tolerance policy for horizontal violence is critical. Make it clear to all employees that hostile behavior will not be tolerated and provide them with safe avenues to report incidents without fear of retaliation.
Key action items:
- Establish clear policies, procedures, and consequences for disruptive behavior.
- Empower employees to speak up and report issues, ensuring confidentiality and support.
2. Leadership must model healthy behaviors
Cultural change starts from the top. Healthcare leaders and managers must consistently model respectful communication and enforce zero-tolerance policies.
Key action items:
- Train managers on how to handle reports of violence and support affected staff.
- Hold regular team meetings where issues can be openly discussed.
- Ensure incidents are documented and promptly addressed.
3. Conduct behavioral and situational assessments
Assessments can be a powerful tool to diagnose the root causes of horizontal violence and prevent dysfunctional team dynamics.
Key action items:
- Behavioral assessments help identify personality traits and conflicts that may contribute to violence.
- Situational assessments evaluate team communication and help supervisors guide staff in challenging situations.
4. Provide conflict management training
Many nurses feel ill-equipped to manage conflicts with co-workers. Providing education on conflict resolution can empower staff to handle situations effectively and prevent escalation.
Key action items:
- Offer workshops and training sessions on identifying and addressing workplace bullying.
- Teach staff communication techniques that promote collaboration and mutual respect.
5. Encourage reflection and continuous improvement
Encouraging staff to reflect on their own behavior can foster a culture of respect and help prevent future incidents of horizontal violence.
Sample reflection questions:
- How do you communicate with co-workers during stressful situations? Could it be perceived as impatient or rude?
- Do you feel comfortable asking questions or seeking help from more experienced team members?
- Think about how you interact with new employees. Do you respectfully answer their questions?
- How do you respond when you hear gossip or witness troubling interactions? Do you attempt to stop it?
- If a coworker asked for your help handling an issue relating to horizontal violence, what advice would you give them?
- What behaviors do you most need to work on to strengthen a culture of respect at work?
Why reducing horizontal violence is critical for healthcare
Healthcare is a fast-paced, high-pressure environment. Without proactive measures, horizontal violence can lead to an unhealthy workplace culture and impact patient care. Organizations must create a supportive environment where all employees feel safe, respected, and empowered to report hostile behaviors.
By adopting a zero-tolerance policy, training leaders and staff, conducting assessments, and promoting reflection, healthcare leaders can reduce workplace violence and create a culture of collaboration, trust, and high-quality care.
However, reducing horizontal violence in healthcare requires a concerted effort at all levels of the organization. By promoting respectful communication, offering educational resources, and enforcing strict policies, healthcare organizations can create a safer, more supportive environment for staff and patients alike.
How Relias can help
At Relias, we help healthcare organizations build high-performing teams through behavioral and situational assessments. We offer comprehensive training on conflict management, communication, and more to help healthcare teams reduce horizontal violence and improve overall workplace culture.
Relias Assessments can help you hire the best-fitting nurses for your organization and provide insights into staff dynamics to correct dysfunctional teams.
Nurse Salary and Job Satisfaction Report
Download our 2024 Nurse Salary and Job Satisfaction Report for actionable insights on nurse recruitment, retention, and job satisfaction. Based on a survey we conducted of more than 3,600 nurses, the report provides industry insights and current data for healthcare leaders, recruiters, and hiring managers to enhance recruitment and retention methods for developing a highly engaged staff.
Download report →
