July 2015
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Recommended Courses*

  • #43315 / #32815 Workplace Bullying and Lateral Violence
  • #310216 Conflict: Don’t Eliminate it, Manage it
  • #52316 / #113516 / #314416 Communicating in High Pressure Environments
  • #22215 Communication and Conflict Management

  • * course numbers may vary by facility

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January 2017

Horizontal Violence

Did you know that while about 10% of all professions report disruptive behaviors in the workplace, reports for healthcare professions are three times higher? Hostile behavior is most prevalent in nurse-to-nurse interactions with 65% to 80% of nurses reporting they have either experienced or witnessed it.

Horizontal Violence (HV) is described as non-physical, hostile, aggressive and harmful behavior toward a co-worker or group via attitudes, actions, words and/or behaviors. It is characterized by behaviors such as:

  • Making snide, belittling or sarcastic comments
  • Public humiliation
  • Isolating a colleague from a group
  • Ignoring or avoiding
  • Patronizing or condescending language
  • Undermining personal values and beliefs
  • Mocking

HV can be devastating. Victims can suffer from depression, anxiety, panic attacks, and sometimes even attempt suicide. Physical symptoms are also common and can include weight loss or gain, insomnia and cardiac arrhythmias. Victims of HV also have a higher likelihood of leaving their employment within six months of the first incident.

In the healthcare workplace, HV is estimated to cost more than $4 billion dollars each year due to lost time, productivity and turnover. It also leads to lawsuits, compensation for disability, loss of profits and poor patient satisfaction.

Safe, quality healthcare is dependent on respectful working relationships, teamwork and collaboration. But HV increases the occurrence of adverse events, medical errors and patient mortality.

For positive change, organizations should adopt a zero tolerance policy for incidents of hostility and should empower staff to speak up without fear of retaliation. Managers must be committed to enforcing zero tolerance policies, modeling healthy communication and creating an environment where staff feel comfortable discussing concerns. Document incidents of HV and promptly report it to the proper personnel. All members of the healthcare team must work together to end the cycle of HV.


  • A Hidden Truth: Hostility In healthcare. (2012, January 18). Retrieved from HospitalNews: http://hospitalnews.com
  • Bloom, E. M. (2014). Horizontal Violence Among Nurses: Experiences, Reponses and Job Performance. University of Rhode Island. Open Access Dissertations. Retrieved from http://digitalcommons.uri.edu 
  • Incivility: Beyond the Nurse. Retrieved from allnurses: http://allnurses.com
  • Murray, J. (2009). Workplace Bullying in Nursing: A Problem that Cannot be Ignored. MEDSURG Nursing, 6, pp. 273-6. 
  • Quick Safety: Bullying has no place in health care. (2016, June). Retrieved from Joint Commission: https://www.jointcommission.org 
  • Rainford, W., Wood, S., McMullen, P., & Philipsen, N. (2015). The Disruptive Force of Lateral Violence in the Health Care Setting. Journal for Nurse Praxtitioners, 2, pp. 157-164. Retrieved from http://www.medscape.com
  • Stanley, K., Martin, M., Nemeth, L., Michel, Y., & Welton, J. (2007). Examining Lateral Violence in the Nursing Workforce. Issues in Mental Health Nursing, pp. 1247-1265.

Time to Reflect

Reflection is widely viewed as a valuable part of professional practice. It is a conscious, dynamic process of thinking about, analyzing and learning from an experience to help respond to future situations with a changed perspective. It requires focusing on personal interactions to gain a clearer picture of behavior in order to change or improve it. Use these questions as a guide for reflection on your behavior as it relates to horizontal violence.

  1. When in the midst of a stressful or chaotic situation at work, how do you usually speak to your co-workers? Could it be perceived as impatient, rude or snide?
  2. If you’re a seasoned veteran in your profession, think about how you interact with new employees. Do you respectfully answer their questions?
  3. If you’re new, how do you interact with more seasoned members of your team?
  4. When you hear gossip about a co-worker, how do you usually respond? Do you participate? Do you stay silent or walk away? Do you take a stand to stop the gossip cycle?
  5. What did you do the last time you witnessed horizontal violence between co-workers? Did you do something positive to stop it? Did you attempt to stay out of it? Did you perpetuate the violence by joining in?
  6. If a co-worker asked for your help in handling an issue with horizontal violence, what advice would you give them?
  7. If you have harassed, bullied or ignored a co-worker, how might that have affected them? The team? Patients?
  8. What behaviors could you most need to work on to improve a culture of respect in your workplace?

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Tell the victim that she needs to leave the abuser.

Answer: DON’T – She already knows she needs to leave but she doesn’t feel she can. Instead, discuss a safety plan.


Affirm that domestic violence is wrong and that talking to you is the right thing to do.

Answer: DO – Violent partners often blame the victim for their actions. Reassure him or her that it’s not their fault and that no one deserves to be abused.


Stay quiet if physical and other signs indicate abuse could be occurring, but the victim denies violence as the cause.

Answer: DON’T - Let the victim known you’re concerned and that the type of signs you’re seeing are sometimes associated with abuse. Provide referral information and encourage a return visit if violence occurs in the future. Ensure him or her that confidentiality is a priority. Document your concern in the medical record.


Health professionals should confront an abuser about their behavior if they are present.

Answer: DON’T – An abuser may try to harm a confronter or retaliate against a victim for talking about abuse. Instead, talk to the patient about a safety plan.


Take photographs of injuries caused by domestic violence.

Answer: DO – Photos are valuable evidence should a case be filed against the abuser in the future. Ask the patient for permission and obtain written consent. Let him or her know that photos will become part of the medical record and can only be released to the police or prosecutor with his or her permission or by court order.