Horizontal Violence in Nursing: Prevalence and Workplace Impact
This paper presents a research proposal investigating horizontal violence in the nursing workplace. The proposal defines horizontal violence — including behaviors such as sabotage, destructive criticism, scapegoating, and verbal confrontation — and argues that its prevalence among nurses contributes to job dissatisfaction, high turnover, and the broader nursing shortage. Using a quantitative survey methodology modeled on prior research into workplace sexual harassment, the study targets 100 nurses across local hospitals. The proposal outlines sampling techniques, data collection instruments, and statistical analysis methods. It situates the study within a limited but growing body of literature and aims to fill critical empirical gaps that currently prevent healthcare administrators from developing evidence-based policies to address horizontal violence effectively.
- Introduction: Context for horizontal violence and nursing shortage
- Problem Statement and Literature Review: Research gaps and prior studies on horizontal violence
- Hypothesis and Research Design: Study hypotheses and quantitative survey framework
- Sampling, Participants, and Data Collection: Random voluntary sampling and survey distribution plan
- Data Analysis and Instruments: Statistical methods and survey instrument design
- Conclusion and Reflections: Research findings, limitations, and future directions
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What makes this paper effective
- The proposal clearly articulates a research gap — noting that while workplace harassment is well-studied, horizontal violence among nurses specifically lacks empirical grounding — which justifies the study's purpose.
- The researcher demonstrates self-awareness by explicitly identifying personal bias and explaining how it will be managed, strengthening the credibility of the proposed methodology.
- The decision to model the survey instrument on a well-known federal study (Erdreich, Slavet, & Amador, 1994) provides a principled rationale for instrument design rather than building from scratch arbitrarily.
Key academic technique demonstrated
The proposal demonstrates effective use of a methodological analogy: the researcher maps the structure of an existing, validated study on sexual harassment in the federal workplace onto the new domain of nursing horizontal violence. This technique — borrowing an established instrument framework and adapting it to a novel context — shows how researchers can build methodological legitimacy when no purpose-built instrument exists for an emerging field.
Structure breakdown
The paper is organized as a formal four-task research proposal. It opens with a problem description and justification for a quantitative approach, then progresses through sampling rationale, data collection methods, and instrument design. The final section consolidates all components into a complete proposal with abstract, literature review, hypothesis, methodology, and a reflective conclusion. An appendix provides the draft survey instrument, grounding the proposal in a concrete, testable tool.
Introduction
In order to provide the best quality care for patients, nurses must be able to focus entirely on their patients' needs. Anything that distracts from that focus has the potential to significantly reduce the quality of care a patient receives. It has long been recognized that a nursing shortage exists and that there are not enough nurses to care for a population with growing healthcare needs. This is particularly true in the areas of long-term nursing and geriatric care. As the Baby Boomer generation ages, its members will require healthcare, and currently there are not enough nurses to meet that demand, let alone the growing needs of the future. It is therefore important to understand what creates job satisfaction and career longevity in the nursing profession.
Horizontal violence in the workplace is a growing problem. It is a particular concern for new graduates and new nurses. It can incorporate physical or nonphysical acts such as sabotage, destructive criticism, backbiting, undermining, scapegoating, and verbal confrontation. Victims feel ridiculed, demeaned, and humiliated. Even tenured nurses are not free from this type of victimization. The harasser tends to be an experienced nurse who feels overburdened by job stress and the long hours that have become a difficult reality of the profession. This research explores the problem of horizontal violence in the workplace as it relates to job satisfaction, retention, and longevity in the nursing profession.
Problem Statement and Literature Review
Currently, research into horizontal harassment in the nursing profession suffers from a lack of direction. Similar types of workplace harassment have been studied extensively — sexual harassment being one prominent example. Horizontal violence differs from sexual harassment, and while victims and perpetrators share some similarities, there are also important differences. Horizontal violence among nurses is a relatively new field of study. As such, no clear definition, established prevalence, typical patterns, or other characteristics that are important to understanding the problem and developing solutions have yet emerged. This study will explore the challenge of defining and understanding horizontal violence in the nursing field and its relationship to job satisfaction, retention, and longevity in the profession.
Literature on horizontal violence among nurses is limited. While it is widely acknowledged that the problem exists, few studies have formally examined the topic. Many hospitals have begun developing policies regarding horizontal violence that resemble their policies on sexual harassment or other forms of workplace harassment. It is encouraging that organizations are being proactive, but these policies cannot safely be assumed effective until valid research has been conducted on horizontal violence specifically. There are significant gaps in the knowledge base regarding horizontal violence in the workplace and its effects on nursing staff.
Thompson and Burk (2009) examined horizontal violence in the workplace against junior nursing students and found that it led to high turnover and lower morale. McKenna, Smith, and Poole et al. (2003) found that new graduates experienced horizontal violence across all clinical settings, and that it had a significant effect on decisions to leave the profession and on interpersonal conflict. That study also found that many respondents had received no training on how to manage such behavior.
These research articles are typical of the content available on horizontal violence in nursing. They provide only general information and acknowledge the existence of the problem without offering the specifics needed to develop clear solutions. More detailed research is needed in this area, and the current study aims to fill many of the gaps that exist in the body of literature on the topic.
Hypothesis and Research Design
This research will explore the hypothesis that horizontal violence is prevalent in the nursing profession. It will also explore a secondary hypothesis that horizontal violence among nurses contributes to the nursing shortage by creating a hostile work environment.
The research design for this study involves a quantitative survey methodology that addresses key gaps in the literature regarding horizontal violence in the nursing profession. This design is modeled on study designs used in similar topic areas and will provide definitive answers regarding the scope and defining characteristics of horizontal violence among nurses. The quantitative survey approach is appropriate because it will allow the researcher to statistically analyze the frequency and types of abuse occurring within the research setting. Understanding how and when the abuse is occurring is the first step toward finding solutions.
As researcher, I am already aware that horizontal violence among nurses is a prevalent and important topic. It will be important to ensure that the results of the study are not exaggerated to support personal opinions about the topic. My bias stems from my belief in both the existence and severity of the problem, which may cause me to perceive the issue as more serious or prevalent than the research actually shows. I must remain aware of this bias when writing the final conclusions of the study.
Conclusion and Reflections
This research proposal explores a topic of great importance to the nursing profession. The available literature suggests that horizontal violence is already considered a significant issue and that some organizations are developing policies to address it. However, it is concerning that these policies are not yet grounded in empirical evidence. Empirical research in this area remains limited, and current knowledge is largely confined to a general acknowledgment that the problem exists. Clearly, more research must be conducted before effective policies can be developed.
The process of developing this proposal reinforced the importance of critically evaluating not only individual resources, but also the overall state of research on a given topic. It is essential to understand where a study fits within the broader body of literature and which gaps it addresses. On the topic of horizontal violence in the nursing profession, only limited information currently exists, and many gaps remain before evidence-based policies can be responsibly developed.
In building future research proposals, a more extensive literature review should be conducted before writing begins. Research supported the importance of the topic, but sufficient prior literature was not available to build a fully comprehensive foundation. The most challenging component of the methodology section was ensuring that the chosen research methods genuinely answered the research questions without losing track of the study's purpose.
The literature review was the most engaging part of the process, providing an opportunity to explore a topic of personal interest and to examine how prior researchers have approached related questions. This work generated numerous ideas for future research projects. The ultimate goal is to use this proposal as the basis for a dissertation and to provide information that practitioners can use to develop effective policies to curb horizontal violence in the nursing workplace.
References
Erdreich, B., Slavet, B., & Amador, A. (1994). Sexual harassment in the federal workplace. U.S. Merit Systems Protection Board. Washington, D.C.
McKenna, B., Smith, N., & Poole, S. et al. (2003). Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90–96.
Thompson, S., & Burk, R. (2009). Junior nursing students' experiences of vertical violence during clinical rotations. Nursing Outlook, 57(4), 226–231.
Appendix I: Survey Instrument
1. What is your gender? _______ Male _______ Female
2. What is your age? _______
3. How many years have you been in the nursing profession? _______
4. How many years have you been at this facility? _______
5. Is your position supervisory? _______ Yes _______ No
1. Do you feel you have ever been the victim of horizontal violence in your position at this facility? _______
2. Have you ever said something to someone else and then later thought that perhaps you should not have said it because it might hurt them? _______
3. Which of the following do you consider to be unacceptable behavior from colleagues?
_______ Pressure to perform procedures for which you have not been trained
_______ Demeaning statements about your work or personal life
_______ Threats of termination or punishment for not conforming to something that is not hospital policy
_______ Being blamed for something you did not do
_______ Being excluded from conversation at lunch
_______ Being singled out for something that the entire department has done wrong
4. If you feel you have been the victim of horizontal violence in the workplace, what did you do about it?
_______ Nothing — just put up with it
_______ Told a supervisor
_______ Confronted the person myself
_______ Talked about them behind their back
_______ Got revenge
_______ Would rather not say
5. Do you feel administration would have taken your complaint seriously and acted on it? _______ Yes _______ No _______ Don't Know
6. Does your hospital have a written policy that addresses horizontal violence in the workplace? _______ Yes _______ No _______ Don't Know
7. If it does, do you feel this policy is effective? _______ Yes _______ No _______ Don't Know
8. If you have been the victim of horizontal harassment, was your harasser a group of people? _______ Yes _______ No _______ Don't Know
9. Was your harasser a supervisor or higher in rank? _______ Yes _______ No _______ Don't Know
10. Was your harasser equal to you in position? _______ Yes _______ No _______ Don't Know
11. Was your harasser older than you? _______ Yes _______ No _______ Don't Know
12. Do you feel horizontal violence made you want to leave your job? _______ Yes _______ No _______ Don't Know
13. Have you ever left a job due to harassment from others? _______ Yes _______ No _______ Don't Know
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