Nursing Syringe

JCNRS Research Spotlight

Horizontal Violence: The Effects of an Interventional Program on the Registered Nurse’s Perception in a Magnet Hospital
By Sherri Stroud, MSN, RN, SRMC


The research question for this study is: Does the implementation of an interventional program on horizontal violence(HV) affect the perceptions of registered nurses in a magnet-designated hospital? 

The assessment and measurement of horizontal violence among nurses is challenging due to differing perceptions about whether this phenomenon exists. One nurse may view an episode of negative workplace behavior as simply “the nurse being stressed out,” while another may define it as horizontal violence (Stanley, 2007).  

Nursing literature defines horizontal violence as “nurses covertly or overtly directing their dissatisfaction inward toward one another, toward themselves, and toward those less powerful than themselves” (Griffin, 2004). 

There are both physical and psychological consequences of horizontal violence for nurses and healthcare organizations. The organization suffers because nurses lack the initiative to perform their job well, they use more sick time, and staff turnover is increased. There are more complaints from patients and relatives in these organizations. Nurses themselves have reported illnesses such as depression, anxiety, and posttraumatic stress disorder. Nurses have also reported experiencing physical symptoms to horizontal violence such as weight loss or weight gain, hypertension, cardiac palpitations, and irritable bowel syndrome (Rowell, 2005). Research has also shown that nurses who report the greatest degree of conflict with other nurses also report the highest rate of job burnout and turnover (Thomas, 2003).

The purpose of this research study is to examine how the implementation of a training program for registered nurses directed toward horizontal violence can impact their perceptions of this behavior. It is hoped that by raising nurses’ awareness of the issues and behaviors of horizontal violence, the destructive cycle of this behavior can be broken. This will allow nurses to feel empowered to bring about significant change in their working relationships and their overall work environment.

The analysis of the results of the scores for participants in this study reveals that the participant’s perceptions of HV in the workplace were increased on 8 of the 11 questions after participating in the HV Interventional Class.  Three questions showed no change in the nurse’s perception, while no questions showed a decrease in perception. This suggests that there was a strong impact on the perceptions of HV among the nurses who participated in the HV education.  Through the use of HV interventional training, nurses can be empowered to bring about significant change in their working relationships and their overall work environment.

Research Impact:  Sherri Stroud, MSN, RN has orchestrated training classes for nursing and allied health personnel at SRHS to raise awareness of the issues and behaviors associated with Lateral Violence among and between health care workers.  This endeavor was started approximately two years ago. Ms. Stroud worked with our Employee Survey developer/author, Dr. Wayne Boss, (Leeds School of Business, Boulder, Colorado) to develop a Lateral Violence questionnaire that was incorporated into our bi-annual employee survey.  Areas shown to have higher Lateral Violence scores were offered training first.  To date, over 3000 SRHS employees have been trained in identifying, surfacing and managing Lateral Violence behavior in the workplace. This heightened awareness of Lateral Violence behaviors in the workplace has resulted in a significant culture change within our organization, as evidenced by the positive shift in the bi-annual employee survey results related to Lateral Violence. This culture change has not only decreased the negative effects of Lateral Violence on retention at SRHS, it has empowered nurses as well as allied personnel, to bring about positive change in their working relationships and their overall work environment. 

Submitted by: Susan Duggar, MSN, RN
Chief Nursing Officer, Vice President of Nursing

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