Horizontal Violence and Incivility in Nursing

Horizontal Violence and Incivility in Nursing
Nursing has long been known as a caring profession with a high level of public trust and confidence. However new nurses, new graduates and those changing specialties are often met with a type of "sink or swim" or "trial by fire" type of attitude from those who are to orient, mentor and nurture the new nurse. The terms for it are many; nurse on nurse violence, eating our young, incivility in nursing, horizontal violence and lateral violence.

The question becomes why do such caring professionals allow such behaviors to exist? How can we stop horizontal violence and instead welcome and greet those entering our profession with open arms and caring hearts? Let's examine some key ways to address such non-caring and hurtful behaviors.

Many nurses are afraid to speak out when they see incivility in others or they may not know what is and is not acceptable behavior. The golden rule is a wonderful yard stick to measure behaviors by; if we would not want to be spoken to in such a manner, if we would not want to be placed in that position then in all likelihood neither would the nurse in question.

If we recognize such untoward behaviors in ourselves what can we do? The first step is already realized because you recognize that what you have done or are doing is not professional. Recognizing one's challenge is the first step in correcting it. Talk to a trusted colleague if you are unsure of how to change or if you should change. Choose a colleague who exemplifies the very qualities you wish to have. Sharing with a trusted colleague can also increase your accountability to change; choosing someone who can help, advise and support is essential to improving our behaviors (and not just in the case of incivility or horizontal violence). Develop a plan of change and action. This plan may include education, research, role-playing situations or keeping a diary. Keeping a diary may help you identify your challenges and successes.

Challenges may be those times you did not react as positively as you should have or not intervened when another was targeted. Successes may include “holding your tongue” or speaking up for another staff member. Remember small but steady steps will help.

It is essential to act whenever we see or hear incivility towards another. If a staff member such as a new nurse is being berated or targeted some units have a "Code Care". All staff come and stand alongside the targeted staff member in silent support showing the victim that they are not alone and showing the perpetrator that they are in the wrong. Many hospitals have started to adopt such a code and have been successful in improving morale and limiting the dangerous side effects of horizontal violence. Other suggestions include role-playing exercises for new graduates on how to respond, requiring all personnel to attend education regarding horizontal violence and showing intolerance for such behaviors. Managers and administrative personnel may need to institute punitive measures to those who perpetrate such incivility. A caring and nurturing culture must be built from the top down but can be started from the bottom up. All staff members should be empowered to address and report incivility against self or others.

Role-model behaviors you want to see others have. By being a role-model to new and experienced staff you show them how you wish to be treated through how you treat others. While this does not guarantee that everyone will behave as you have role-modeled, it does show that you will not tolerate such behaviors when you are present.

Respond to situations when you see them happening. By showing support for those victims of horizontal violence, the perpetrator is shown that they are in the wrong and the victim is not to be blamed. Many victims of horizontal violence feel ashamed and that they deserved it. Victims of horizontal violence are also more likely to have low self-esteem, develop stress-related diseases and have errors affecting patient safety. Horizontal violence is the most common reason cited by new nurses who leave the profession within one year of graduation. Simply responding to and reporting incidents of horizontal violence we can make a difference to those we never imagined we could.

As nurses we took an oath to care. The majority of people in health care are truly caring, nurturing and kind individuals. By responding, reporting, supporting and role-modeling we can change nursing from a profession known for eating our young to a profession known for nurturing our young. Which legacy do you wish for your career and our profession?

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