* course numbers may vary by facility
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:
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.
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.
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Answer: DON’T – She already knows she needs to leave but she doesn’t feel she can. Instead, discuss a safety plan.×
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.×
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.×
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.×
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.×