Horizontal violence (HV), or nonphysical intergroup conflict expressed in overt and covert behaviors of hostility, is pervasive in nursing and has been discussed in the literature for more than two decades. It is costly and has potentially devastating effects including high nurse turnover rates, increased illness, decreased productivity, and decreased quality of patient care. Recognizing how these behaviors are established and sustained is necessary if nurses are to overcome these types of behaviors. This mixed methods study used an online survey to examine 76 hospital nurses' experiences and responses to episodes of HV as well as its effects on job performance. Seven of these nurses answered more in-depth questions during a follow-up interview. Nurses in this study recognize HV as a phenomenon that occurred early in their careers as novice nurses. The literature suggests that these behaviors are evident during nursing education. The academic environment is an ideal place to teach the skills necessary to respond appropriately to HV with peer support being essential. Nurses also reported that manager and staff support and workplace education were the most helpful in reducing HV. Increased workload and stress and HV being accepted practice on the unit were factors identified as most important in promoting HV. Further, nurses cited reasons why they continue in their jobs after episodes of HV. Intervention studies are needed to test effective ways of reducing this very difficult behavior among nurses in the workplace.
K E Y W O R D Sabuse/bullying/harassment/incivility, education, professional issues 1 | INTRODUCTION Horizontal violence (HV), or nonphysical intergroup conflict that is expressed in overt and covert behaviors of hostility, is pervasive in nursing and has been discussed in the literature for more than two decades. It is costly and has potentially devastating effects including high nurse turnover rates, increased illness, decreased productivity, and decreased quality of patient care. Recognizing how these behaviors are established and sustained is necessary if nurses are to overcome these types of behaviors.HV has been described in the literature by various authors, and although the definitions vary, there is agreement that HV is violence in the form of action, words, and other behaviors that is directed toward one's peers. 1-6 These behaviors control, humiliate, denigrate, or injure the dignity of another person. HV reflects a lack of respect for the individual.HV directed at nurses in the workplace come from a variety of sources including patients and their families 7,8 ; physicians and other hospital staff 8-10 and between nursing colleagues. 7,8,11,12 These negative behaviors pose a threat to patient safety, [13][14][15][16] and result in increased stress levels, frustration, loss of concentration, and breakdown in communication. 9,