Saint Marys University School of Health Sciences Bayombong, Nueva Vizcaya

JOURNAL REPORT ON HORIZONTAL VIOLENCE

submitted by: Kevin Davidson Adviento

Submitted To: Mam Hazel Valmores Clinical Instructor-Payward

HORIZONTAL VIOLENCE: Staff awareness and education needed to rid the nursing environment of this disastrous infection.
http://nursing.advanceweb.com/Article/Horizontal-Violence.aspx

A silent killer has made its way into nursing and slowly eaten away at the core of who we are as nurses. This epidemic is becoming so wide spread that everyone from administration to nurse's aides are affected by it. It is the epidemic of horizontal violence. The term "horizontal violence" (sometimes called "lateral violence") is quite new to many individuals but the behavior it describes is not. The term was developed to describe distasteful behavior nurses sometimes portray toward colleagues. Horizontal violence takes on many different characteristics. Simply put, it is overt and covert nonphysical hostility, such as criticism, sabotage, undermining, infighting, scape-goating or finger pointing and bickering. Who is harmed by horizontal violence? They are individuals who have felt ridiculed, demeaned by a colleague or doctor, and even asked to do something they have not yet even learned how to do only to be left completely humiliated for not knowing how to do it. It affects new hires, new graduates, and nurses who have worked at a facility for a long time. NewGrads One of the groups most frequently victimized by this is new nursing graduates. It is crucial for experienced staff to embrace the new grads and support and encourage them as a group. The first year of nursing is an opportunity to achieve great confidence in and establish self-esteem on the job. New graduates are inexperienced, and because they lack the skills and knowledge necessary to stand up for themselves, they often are yelled at, ridiculed and dehumanized. I have witnessed this psychological abuse first hand as a nurse educator. Unfortunately, new graduates accept this behavior as a rite of passage and move on, only to mimic it later on, as it is what they have learned from their predecessors. Nurses need to become aware of who it is they are affecting and begin to develop new behaviors that will benefit each other's self-esteem. Vicious Cycle In order to make people aware of this issue, someone must begin reporting it. But what if it is never reported and the behavior continues?

This is the determining factor for alleviating horizontal violence in the nursing profession. Individuals need to begin to report it and feel safe in doing so without retaliation. Horizontal violence is so severely underreported because opinions surrounding horizontal violence are subjective in nature. Each us tolerates the behaviors of others a little bit differently. However, if the behavior is in any way offensive to you, or undermines you and your job in any way, then it probably is horizontal violence and you need to report it to your manager. Secondly, there also is a greater fear of retaliation from the perpetrator. Speaking up is one thing, but having to face the person everyday at a new job after reporting them may be a task that many are not willing to take on. As a result, more individuals will begin their careers in an unsupportive work environment, and the cycle will continue. What Have You Done? The negative impact of horizontal violence is really quite impressive and obvious. If you think about the nursing shortage today and wonder why we are losing nurses to other professions, or wonder why the new graduate or new employee that was just hired has left so soon, take a good hard look at yourself and the people around you and begin to imagine what it must have been like to learn something new all over again. Were you supportive? Did you encourage that person to gain and develop new skills and offer learning experiences to help the person grow as a nurse? Or did you create an environment that was infected with horizontal violence? Wouldn't it be great to know that when you were asked to orient someone into your work environment, you were able to give them a healthy and positive outlook toward the job and the environment? Wouldn't it be great to know the new nurses on your unit would enjoy their learning experience so much that they would be more likely to feel like staying in that job because the work environment was so supportive? These new nurses are going to relieve the pressures experienced nurses feel everyday. They are the future. Because of them, there will be one more person on the unit to help in a crisis, one more person to lend a hand when one is needed, and one more person to call when the census goes up and you need help. Staff Awareness & Education Needed The net effects of horizontal violence are threefold. The literature reveals that, because of it, there are a greater number of reports in absenteeism, a decrease willingness to help and a high number of nurses considering leaving the profession.

Hence, it is crucial to provide horizontal violence awareness and education in order to make the necessary changes in the nursing environment to finally rid ourselves of this disastrous infection. Education could be provided in many ways. It could be in your department through staff meetings or hospital wide. Ultimately, nurses need to be the catalyst of change and seek to promote successful new nurses. Of course, many experienced nurses do not adapt well to change, and so going against this culture will take an enormous amount of courage. But if we all work together we can achieve great success in riding the field of this disastrous infection called horizontal violence, which will benefit the nursing profession in the future. If we do not make this change, we risk causing irrevocable harm to the profession and the care we provide patients everyday. So take a look at how you act toward your nursing team, and especially the new grad you might be orienting, and think about how you would like to be treated if it were you on the other end. Remember, a little support and encouragement can go a long way.
Resources Duffy, E. (1995). Horizontal violence: a conundrum for nursing. Collegian, 2(2), 5-17. Farrell, G.A. (2001). From tall poppies to squashed weeds: Why don't nurses pull together more? Journal of Advanced Nursing, 35(1), 26-33. Freshwater, D. (2000). Crosscurrents: Against cultural narration in nursing. Journal of Advanced Nursing,32(2), 481-484. Leiper, J. (2005). Nurse against nurse: How to stop horizontal violence. Nursing 2005, 35(3), 44. McKenna, B.G., et al. (2003). Horizontal violence: experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96. Randle, J. (2003). Bullying in the nursing profession. Journal of advanced nursing, 43(4), 395-401. Tiaki, K. (2004). Prepare students for violence. Australian Nursing Journal, 12(3), 17. Vonfrolio, L.G. (2005). End horizontal violence. RN. 68(2), 60.

SUMMARY: This article talks about the wide spread epidemic infection throughout the nursing profession, horizontal violence or often called parallel violence. Newly graduates are the ones most often target of this epidemic infection. Because they are inexperience, they lack the skills and knowledge necessary to stand up for themselves, they often are yelled at, ridiculed and dehumanized. And the bad thing is that, this cycle continuously revolving from generation to new generation of nurses. Only few have the guts to tell their supervisor or hospital administrator about what had happen between the senior nurse and the newly hired nurse. This article also suggested two ways how to stop this epidemic. These are staff awareness and education. These two come along together.

NURSING INSIGHTS AND REACTION As a student nurse, I often get the feeling of the underdog when I am the ward mingling and working with the staffs there. Yes, we can say I am an underdog because Im still a student, not holding any license not even holding my diploma in nursing. But then, often times, I experience some unpleasant things in the ward when communicating and working with the staffs there. They often do not smile to us. They even give us a weird look because were holding and reading the chart. And the worst I experienced is that when one staff nurse muffled when we arrived at the ward andito nanaman sila. I need not to mention that hospital. Before, I just ignore them. Thinking, I am the underdog and they are the superiors. But now I learned that there is this horizontal violence (parallel violence). This violence is generally not physical but it targets the emotional, social and psychological aspect of us, the novices. It creates gap between nurses. Is

creates an submissive/aggressive relationship in the workplace which can cause havoc later on. It is hard to work in an area where in all your moves is being watched and I mistake can be very detrimental to you. And this horizontal violence is not like a mushroom that just pops out when it rains. This violence became a cycle which runs over and over again. Today you are the abused and the next day you are the abuser. Horizontal violence may come in the form of belittling gestures like rolling eyes, folding arms etc. It can also be verbal abuse like calling names, threatening and the like. It can also be gossiping, sarcastic comments, fault finding, slurs and jokes, disinterest and many other forms. Effects of this violence can be very degrading to ones self esteem and moral. It can also cause anxiety to the person and depression. It can also cause removal of self from the work place and the worst, of horizontal violence is continuous, suicide. But what can we do to eradicate or to stop this? As the article suggests, we need to educate staffs about this type of violence and conduct a self awareness test to let them evaluate their selves if they are doing this violence to their subordinates. For the staffs that are abused, you can name the problem when there is a staff meeting. You need to break your silence and step up. You can be the one to break the chain and stop this violence in your work place. And if you witness such act of violence do not hesitate also to report this to the appropriate person. Be willing to speak up not only for your abused co-worker but also for yourself and for the others. The effects of this horizontal violence can cause break the harmony between workers in a work place. In ours, It can cause ineffective nursing care to our patients because we lack cooperation with other staff specially the seniors. So, as early as possible, we need to take action before it can inflict its deadly infection to all of us.