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Horizontal Violence


Horizontal violence is described as abusive and hostile behavior in the workplace. This term includes any form of aggressive or harmful behavior that was caused by a nurse or a group of nurses towards coworkers. Horizontal violence is characterized as permanent abusive actions over durable time. The cause of such behavior may be an isolated conflict which was not completely solved. The continuous harassments lead to nervous stress or even nervous breakdown. The victim feels the constant pressure because of the hostility which he/she faces every day. Horizontal violence has many in common with bullying in the workplace.

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Bulling is a situation in which an employee becomes a victim of aggressive behavior on the part of his/her colleagues. This phenomenon can be characterized as a situation in which the abuser causes physical or physiological stress to the victim. Bulling or horizontal violence usually includes such ways of intimidation as criticizing, refusing to assist, fighting among employees, blaming, or public humiliation. The abusive behavior may include also gossiping, isolating, nicknames calling, ignoring, or using silence (Becher, 2012).

Problem Statement

Horizontal violence damages the victim’s dignity since the person feels stressed out and cannot carry out his or her obligations productively. The working atmosphere becomes a field of battle; you endure an army of aggressive enemies while you expected to find friends or at least pleasant coworkers who are ready to support you. Horizontal violence has a negative effect on young nurses or graduate students who require professional advice at the beginning of their careers. When a young and ambitious person gets in the negative atmosphere, where horizontal violence is a common thing, he/she may lose any desire to work in this sphere.

No doubts, horizontal violence brings nothing but negative consequences for its victims. One can say that everything depends on a person; some people are more resistant to stress situations, including cases of horizontal violence, whereas others are less resistant. Nevertheless, victims usually suffer from depression, anxiety, sleeping disorders, and, as a rule, they have low self-esteem. Many nurses who were victims of horizontal violence have left their profession and try to find a job in other spheres. Researchers reported also suicide cases that were caused by repeated acts of bullying (Becher, 2012).

The American Nurses Association Code of Ethics

The American Nurses Association Code of Ethics prescribes how employees should behave in the workplace. Standard 6 states that nurses must create a friendly atmosphere, where everybody is respected and treated fairly. This notion concerns everybody who works in the medical sphere, from the chief nursing officer to an ordinary nurse. The current nursing atmosphere reports increasing cases of horizontal violence. The increased level of patient acuity, poor staffing, and lack of resources combined with constant stress lead to such phenomenon as horizontal violence.

Nurse leaders are those who can reduce the impact of horizontal violence and improve the general situation within the organization. They must provide resources that will give support and education to their nurses. Trustworthy behavior is the key point that demonstrates that leaders are ready to provide support when it is needed. Professional development and opportunities for education are important in preventing horizontal violence. Training must be an integral part of the job; moreover, it is better when educator is one of a well-known and respected person of the same organization. In other words, it must be a person, whom nurses know because they meet him/her every day and they treat him/her as an expert, who has rich experience in this sphere.

Horizontal Violence Phenomenon

Education must also include a detailed plan of action if horizontal violence takes place. When such a phenomenon as horizontal violence occurs, certain measures should be taken to change the environment that encouraged such actions. However, the best way of eliminating horizontal violence is its prevention. One should note that horizontal violence is the consequence of poor leadership. Inappropriate behavior may appear only in the organization where the policy of all-permissiveness takes place. If a leader turns a blind eye on unethical behavior among his/her employees, then it is not surprising that horizontal violence prospers. On the other hand, if a leader is a strong supporter of ethical code and takes all possible measures to prevent and eliminate any footprints of inappropriate behavior and horizontal violence, then the level of horizontal violence will be quite low.

Horizontal violence often appears in the working environment where a leading group of employees establishes its own rules and obligations. One can compare this behavior with bullying at school; in fact, it has many in common with it. Horizontal violence predetermines that there should be a victim. A victim is a person who is not a member of a leading group; it can be both a new employee and a person who has been working for a long time. Thus, horizontal violence may refer to anybody who works within an organization. A victim of such unethical behavior may be a person who has the opposite world view; the impatience may concern race, gender, sex, political views, or simply the presence of this person in the workplace (King-Jones, 2011).

Horizontal violence does not necessarily have some fundamental reasons. Sometimes it is an ordinary intolerance towards other people. This phenomenon refers to psychology and social behavior. People, who cannot establish at least working relations with others, usually have some disorders or they suffer from stress and other factors that influence their behavior in society.

However, the reasons of horizontal violence may be caused by poor management, especially oppressive conditions. An employee who is totally satisfied with his work environment hardly would treat somebody unfairly. Negative behavior is a reasonable consequence of job dissatisfaction. This factor includes different aspects, ranging from salary to the general relations between manager and employee. If the manager treats his/her employee in an inappropriate way, then this employee will probably act in the same way towards his colleagues. The main task of managers is to control the work environment within the organization, take measures to improve working conditions, and satisfy employees’ needs and demands (King-Jones, 2011).


Managers have also to control the relations between their employees and gather information about possible cases of horizontal violence. Their responsibility is to avoid such situations and inform the chief managers about these cases. Nevertheless, the best solution to horizontal violence among nurses is to take preventive measures. Prevention has always been better than problem-solving: it is easier to eliminate the problem when it is only at the early stage. Thus, a good leader should take preventive measures to avoid the emerging cases of horizontal violence. Education and training are the best solutions because sometimes employees do not know how to behave themselves in a challenging situation. Education should include such methods:

  1. In the first stage, the manager should demonstrate his/her employees what is horizontal violence, the main reasons for its development, and general information about this phenomenon. In this way, employees receive basic information about horizontal violence and its influence on people and the working process. Employees analyze situations and make conclusions concerning their own actions and behavior towards other employees.
  2. The second stage is a practical part of education. The manager gives real examples of horizontal violence, especially those cases that took place within this organization. This part of education is needed to show employees what consequences and what punishments are predetermined for such unethical behavior.
  3. The third stage is the development of basic good relations among employees. At this stage, employees should realize that they are those people who create their working atmosphere, and their working conditions depend on them.
  4. The fourth stage pays consideration to preventive measures and plans of action if horizontal violence occurs. Employees should know what they must do if they become a victim of horizontal violence. They should not turn a blind eye to it because tolerance to such actions is the reason for proliferating this phenomenon within organization.

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Managers should provide their employees with a copy of the position statement, “Lateral Violence and Bullying in the Workplace”, which is issued by The Center for American Nurses (Brown, 2009). In this circular employees can find information concerning intolerant behavior in the health care sphere. If harassment takes place, the manager should take certain measures to eliminate it immediately. Moreover, the manager should control his/her own behavior and not participate in horizontal violence actions. Managers should establish an environment, in which employees can share their complaints Employees should be provided with necessary tools for crucial conversations that will help to avoid and eliminate horizontal violence within the health care sphere.

The issue of horizontal violence is very controversial. One can say that it is surprising that such a phenomenon is widespread among nurses. Health care workers are those people who dedicate their lives to help others. If they do not show respect towards their colleagues, how can they provide medical help to other people? This fact makes people ponder why horizontal violence prospers in this sphere.

The phenomenon of horizontal violence still exists, despite the fact that the modern world propagandizes respect and tolerance towards all people irrespective of their differences. However, this term means more than a simple disrespect or intolerant behavior within the health care sphere. Horizontal violence predetermines a constant unethical behavior towards a particular person; in some cases without any specific reasons. A person who becomes a victim of horizontal violence suffers from depression, stress, low level of self-esteem, and constant anxiety. The researchers state that there were suicide cases because people could not stay such an attitude anymore (Brown, 2009).


Managers are those people who should control that cases of horizontal violence do not occur within the organization. To avoid this phenomenon and its negative influence on employees and the working process in general, managers should increase the awareness of this issue among employees. Special training should be taken to show employees the consequences of this phenomenon and what may happen if they behave themselves in a similar way. Preventive measures are always better, and that is why education is necessary in this case.

The existence of horizontal violence is the effect of the policy of all-permissiveness and tolerant behavior toward unethical situations. Employees should know that they have the right to be treated fairly, and nobody has the right to abuse them in any way, both physically or verbally. If the particular situation happens there should be a detailed plan of actions which provides a step by step instructions.

The first rule, which the employee should remember, is not to turn a blind eye if something unethical or intolerant happens with him/her or his/her coworker. If everybody treats others fairly and does not allow unethical practices in the workplace then the situation will improve because all changes that take place within the organization must be brought by employees, but not managers.

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