This paper reviews the issue of horizontal violence and bullying within the nursing profession, drawing on Egues and Leinung's (2013) work on strategies to address these workplace concerns. The paper examines implications across several dimensions — personnel, financial, patient care, hospital reputation, and legal ramifications — while identifying the three roles involved in bullying: perpetrator, victim, and bystander. It argues that nurses must model exemplary behavior, participate in education and self-reflection, and advocate for zero-tolerance policies. The paper concludes that systemic cultural change within nursing is essential to improving workplace environments, patient outcomes, and nurse retention.
The nursing profession faces pervasive horizontal violence, and there is even a saying that "nurses eat their young." Nurses must take deliberate efforts to bring change to their existing professional culture. They can begin by sharing tips to overcome bullying and by modeling positive behaviors. Nurses can also exchange their experiences with horizontal violence through workshops held across the country. These workshops have examined different approaches, such as discussing contemporary perspectives, employing methods of engagement, promoting debate, and using practical resources to prevent horizontal violence.
Those workshops revealed increased knowledge regarding horizontal violence and its application to the workplace among participating nurses. Evaluations are typically conducted through pre-tests and post-tests or written assessments. Nurses need exposure to practical approaches to deal with horizontal violence (Egues & Leinung, 2013).
Bullying, horizontal violence, and workplace incivility should not be tolerated or accepted by nurses. To address these issues, nurses should participate in education on bullying. They need to self-reflect on these practices by communicating about bullying among their peers in a respectful manner. They should also discuss strategies for dealing with associated conflicts and managing them effectively. For example, nurses who display bullying behavior should be identified as perpetrators and made aware that their actions are harmful.
The three roles in bullying are the bully (or perpetrator), the victim, and the bystander. The bully is a person who consistently displays aggressive behavior, using language that can be described as "spewing venom." The victim is the target of the bullying person, who generally singles someone out and undermines their confidence or self-esteem. These victims have done nothing to incur the bully's aggression. Rather than recognizing the bully's behavior as a reflection of the bully's own insecurities, victims tend to internalize the aggression directed at them.
Most of the time, nurses have witnessed bullying as bystanders and may not know how to respond to aggressive behavior. A nurse who has experienced horizontal violence in any of these three roles can draw on that experience to become a role model for change. Every nurse should conscientiously and consistently model exemplary behavior. It is widely recognized that teamwork brings job satisfaction by fostering a sense of mutual support among coworkers. A sense of unity in the workplace reduces nurse burnout and turnover. Effective teams must balance individual autonomy with shared roles and responsibilities in order to excel professionally.
Nurses must care for themselves in addition to caring for others. This means getting adequate exercise, good nutrition, and sufficient sleep. Relaxation therapies such as massage — some of which are available at lower cost — can also be beneficial. Every nurse needs the support of peers in working to change the bullying culture within nursing. Nurses who are being bullied may leave their jobs because they feel isolated or depressed. However, the termination and turnover of nurses devastates healthcare facilities by depleting the available workforce.
"Nurse shortages and unhealthy work environments"
"Bullying's effect on recruitment and retention"
"Zero-tolerance policies and reporting procedures"
There should be a support system for changes that address and create strategies against horizontal violence. These changes can improve workplace environments, patient outcomes, and nurse retention. Nurses should step up to truly embody care of the body, mind, and spirit of all people in the pursuit of a more peaceful and respectful profession. Rather than being part of the problem of horizontal and lateral violence, nurses should be part of the solution. As Egues and Leinung (2013) emphasize, self-reflection and education are part of a call to action — one that empowers nurses to stop doing harm to themselves in the name of helping others.
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