Horizontal violence in nursing : policy implications

Abstract

The problem of horizontal violence (HV) in nursing remains a prevalent problem despite recommendations of zero tolerance from national organizations such as the American Nursing Association and the Joint Commission. Horizontal violence is defined as "hostile, aggressive, and harmful behavior by a nurse or group of nurses toward a coworker or group of nurses via attitudes, actions, words and/or behaviors" (Thobaben, 2007, p. 82). A study conducted in 2003 and repeated in 2013 by the Institute of Safe Medication Practices (ISMP) found a persistent culture of HV tolerance and indifference in healthcare settings. Horizontal violence is closely related to retention of both seasoned and new graduate nurses, a serious concern in the current and looming nursing shortage. This project investigated possible policy implications related to horizontal violence in nursing by increasing an understanding of the supportive role of hospital policies. Procedures for this project included (a) a review of current HV literature, (b) a request for policies on HV, workplace violence, harassment, bullying and/or codes of conduct/ethics from 10 hospitals (both critical access and non-critical access) in Montana, and (c) analysis of the policies using an evidence-based grid. Out of the ten hospitals of various sizes contacted, there was a 50% response/participation rate. Of the five hospitals that responded, none had policies specific to horizontal violence. Three hospitals had workplace violence policies and two hospitals had no policies on HV or any related key words. Findings indicate a clear need for further study with a larger hospital sample and an improved policy retrieval process to better understand the presence or absence HV healthcare policies. Use of the evidence-based grid developed for this project could serve as a useful tool for hospitals interested in creating a policy directly related to HV in nursing and a mechanism for consciously developing and enforcing cultures of respect in the workplace.