1. Horizontal Violence in the Workplace A Computer Based Learning Module S. Swearingen, PhD, RN March, 2008

2. Behavioral Objectives After completion of this computer based learning module, the learner will be able to: After completion of this computer based learning module, the learner will be able to: –Identify horizontal violence in the workplace –Articulate methods for reducing horizontal violence –Determine the link between bullying and horizontal violence –Incorporate, into their own practice, the Florida Nurses Association’s “Statement of Position” in relation to horizontal violence and bullying in the nursing environments.

3. Trigger Learning Points What is Horizontal Violence What is Horizontal Violence –Be able to name three types of horizontal violence behaviors in the workplace Horizontal Violence is a common characteristic of Horizontal Violence is a common characteristic of –Be able to state two groups that are prone to horizontal violence How to stop Horizontal Violence How to stop Horizontal Violence –Be able to state two ways to stop horizontal violence

4. Nurses Eat Their Young! Not only their young…but also the older, more experienced nurses Not only their young…but also the older, more experienced nurses Novices and nurses are especially vulnerable Novices and nurses are especially vulnerable Staff reject responsibility for new staff member’s successes or failures Staff reject responsibility for new staff member’s successes or failures Progresses to point of the new nurse leaving Progresses to point of the new nurse leaving (Baltimore, 2006; Swearingen, 2004)

5. What is Horizontal Violence? (Baltimore, 2006)

6. Horizontal Violence Dysfunctional behavior Dysfunctional behavior Directed at a peer or team mate Directed at a peer or team mate Self and professional defeating behavior Self and professional defeating behavior Creates significant work place stress Creates significant work place stress Leads to a loss of engagement in the work place Leads to a loss of engagement in the work place (Abu, 2004; Baltimore, 2006; Longo & Sherman, 2007)

7. You Might be Guilty of Practicing Horizontal Violence if :

8. (Baltimore, 2006)

9. Horizontal Violence in the Workplace – A Role Play

10. How Does Bullying Fit into the Equation? Becomes part of the norm of nursing Becomes part of the norm of nursing Nurses are bullied as students and new graduates by other nurses Nurses are bullied as students and new graduates by other nurses Nurses see patients being bullied and coerced to undergo treatments that they may not want Nurses see patients being bullied and coerced to undergo treatments that they may not want Each generation of new nurses is socialized into negative practices Each generation of new nurses is socialized into negative practices (Randle, 2003)

11. How Destructive is Gossip? Healthcare workplaces are ripe for gossip due to their complexity Healthcare workplaces are ripe for gossip due to their complexity Work can be chaotic and unpredictable Work can be chaotic and unpredictable One way to express emotions and vent frustrations One way to express emotions and vent frustrations It is malicious and It is malicious and –increases work-related stress stress (Baltimore, 2006)

12. Horizontal Violence is a Common Characteristic of…. Oppressed groups Oppressed groups Those who lack autonomy Those who lack autonomy Those who lack power Those who lack power Those who lack resources Those who lack resources Those who don’t understand their own reactions to oppression Those who don’t understand their own reactions to oppression (Lee & Sneed, 2001; Leiper, 2005: Thomas & Droppleman, 1997)

13. Why Does Nursing Experience Horizontal Violence? Nurses are ill prepared to confront issues of horizontal violence Nurses are ill prepared to confront issues of horizontal violence Nursing has historically devalued power and views ambitious nurses as unbecoming Nursing has historically devalued power and views ambitious nurses as unbecoming Lack of involvement in policy making Lack of involvement in policy making Nursing is often an oppressed profession Nursing is often an oppressed profession (Fudge, 2006; McKenna, Smith, Poole, & Coverdale, 2003 Thomas & Droppleman, 1997)

14. Understanding the Cycle of Horizontal Violence Culture may drive horizontal violence Culture may drive horizontal violence Must become aware of the dynamics Must become aware of the dynamics Recognize that horizontal violence does exist in the nursing culture Recognize that horizontal violence does exist in the nursing culture Realize that due to powerlessness, nurses may use horizontal violence as the only means they have to gain power over others. Realize that due to powerlessness, nurses may use horizontal violence as the only means they have to gain power over others. (Freire, 1970; Leiper, 2005)

15. Work in devaluing environment Internalization of culture’s view of being worthless Begin behaving like the dominant group Begin to reject persons of their own group Resulting interpersonal conflict causes horizontal violence Society continues to devalue the group People over time begin to believe that the oppressed group is legitimately valueless (Thomas & Droppleman, 1997)

16. Damaging Effects of Horizontal Violence Poor collaboration Poor collaboration Poor work environments Poor work environments Deteriorating quality of care Deteriorating quality of care Increased burn out Increased burn out Perpetuates unacceptable behaviors Perpetuates unacceptable behaviors Suppresses development of nursing as a profession Suppresses development of nursing as a profession (AACN, 2005; McKenna, Smith, Poole, & Cloverdale, 2003; Thomas & Droppleman,1997)

17. Taking Control Remember what it was like to be the “new kid on the block” Remember what it was like to be the “new kid on the block” Make an effort to socialize with new staff members Make an effort to socialize with new staff members Resist the urge to “test” new nurses Resist the urge to “test” new nurses Abandon the “you have to do it because it was done to me” mentality Abandon the “you have to do it because it was done to me” mentality Check your ego at the door Check your ego at the door (Baltimore, 2006)

18. Set a Culture of Zero Tolerance A culture of zero tolerance for horizontal violence is the most effective way to stop the cycle. A culture of zero tolerance for horizontal violence is the most effective way to stop the cycle. Name the problem Name the problem Educate all staff about horizontal violence Educate all staff about horizontal violence Establish a process for dealing with the issue Establish a process for dealing with the issue (Longo & Sherman, 2007)

19. Good Habits to Adopt to Stop the Violence Kindness, concern and respect Kindness, concern and respect Lead by example Lead by example Own up to your mistakes Own up to your mistakes Don’t participate in gossip Don’t participate in gossip If conflict arises, speak directly to the individual as soon as possible If conflict arises, speak directly to the individual as soon as possible Work together despite personal dislikes Work together despite personal dislikes (Baltimore, 2006; Gasparis, 2005; Leiper, 2005; McKenna, Smith, Poole, & Coverdale, 2003).

20. FL Nurses Association Statement of Position Recognizes impact of horizontal violence Recognizes impact of horizontal violence Provide education Provide education Develop resources to assist nurses in managing horizontal violence Develop resources to assist nurses in managing horizontal violence Establish a goal of elimination of horizontal violence in the workplace Establish a goal of elimination of horizontal violence in the workplace Encourage addition to curriculum of all nursing students Encourage addition to curriculum of all nursing students (FNA, 2007)

21. Conclusion Remember incidences of horizontal violence may not seem like much Remember incidences of horizontal violence may not seem like much –Unless you are the victim of it In order to be seen as a profession, nurses must act as a professional In order to be seen as a profession, nurses must act as a professional –Stop horizontal violence in the workplace

22. Horizontal Violence Blog If you find the topic of horizontal violence has: If you find the topic of horizontal violence has: –Impacted you personally –Or has impacted those around you Please share your stories by visiting Please share your stories by visiting –www.Sandyswear.blogspot.com www.Sandyswear.blogspot.com Through awareness we can stop horizontal violence in nursing Through awareness we can stop horizontal violence in nursing

23. For Comments or Questions Contact Sandy Swearingen @ www.SandySwearingen@hotmail.com Contact Sandy Swearingen @ www.SandySwearingen@hotmail.com www.SandySwearingen@hotmail.com

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25. References Lieper, J. (2005). Nurse against nurse: How to stop horizontal violence. Nursing. 35(3),44-45. Lieper, J. (2005). Nurse against nurse: How to stop horizontal violence. Nursing. 35(3),44-45. Longo, J. & Sherman, R. (2007). Leveling horizontal violence. Nursing Management. Retrieved on line February 28, 2008 at www.nursingmanagemnt.com. Longo, J. & Sherman, R. (2007). Leveling horizontal violence. Nursing Management. Retrieved on line February 28, 2008 at www.nursingmanagemnt.com. www.nursingmanagemnt.com McKenna, B., Smith, N., Poole, S., & Cloverdale, J. (2003). Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96. McKenna, B., Smith, N., Poole, S., & Cloverdale, J. (2003). Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90-96. Radford, P. (2003). Kai Tiaki pages reveal horizontal violence is not new in nursing. Kai Tiaki: Nursing in New Zealand, 9(8), 3. Radford, P. (2003). Kai Tiaki pages reveal horizontal violence is not new in nursing. Kai Tiaki: Nursing in New Zealand, 9(8), 3. Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing. 43(4). 395-401. Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing. 43(4). 395-401. Robersts, S. (2007). Development of a positive professional identity: Liberating oneself form the oppressor within. Advances in Nursing Science. 22(4), 90-96. Robersts, S. (2007). Development of a positive professional identity: Liberating oneself form the oppressor within. Advances in Nursing Science. 22(4), 90-96. Swearingen, S. (2004). Personal observation, August 2004. Swearingen, S. (2004). Personal observation, August 2004. Thomas, S. & Droppleman, P. (1997). Channeling nurses’ anger into positive interventions. Nursing Forum. 32(2), 13-22. Thomas, S. & Droppleman, P. (1997). Channeling nurses’ anger into positive interventions. Nursing Forum. 32(2), 13-22.