Nursing Communication Plan to Reduce Horizontal Violence

Introduction

Horizontal violence, defined as "aggressive behavior, harassment (usually verbal but sometimes even physical), or attempts to sabotage advancement among coworkers on roughly the same organizational level," has been identified as a "common problem in many professions, but in nursing it seems to be especially marked" (CNAs and Horizontal Violence in the Workplace, 2011, CNA Board). Addressing horizontal violence in nursing is critical — not simply as an issue of social justice, but also because of the dangers it poses to the organization. It risks increasing attrition among new nurses, making the hospital more likely to be the subject of discrimination-related lawsuits, and directs the anger of nurses into unproductive channels. Creating a facilitated support group for nurses is one way to encourage nurses to engage in more effective self-care and to foster a more productive culture among diverse nursing staff members.

Horizontal Violence in Nursing

The reasons for horizontal (lateral) violence and other types of aggressive behavior against colleagues have been much-speculated upon within nursing literature. Some cite the fact that physicians and other higher-level officials "devalue or undervalue the contributions of nurses... [nurses] express their need for power or autonomy by victimizing or impeding the professional advancement of others at the same or lower levels... they realize that an expression of anger to higher levels of the hierarchy will probably be unsuccessful or could even cost them their job" (CNAs and Horizontal Violence in the Workplace, 2011, CNA Board). The stressors placed upon nurses — such as long hours, back-to-back shifts, and other occupational challenges — are also frequently cited as contributing factors to this behavior.

Watson's Caring Theory and Nurse Self-Care

Nursing is identified as a caring profession. However, this designation can result in unrealistic expectations being placed upon nurses in terms of their willingness to sacrifice their own needs for those of others. Nurses often neglect basic self-care practices necessary for sustained mental stability. The tendency to overlook nurses' personal needs, coupled with chronic understaffing, can create toxic work environments in many healthcare settings. Some hospitals have instituted support groups and counseling for nurses, which can facilitate communication and dialogue as well as provide psychological support. When nurses fail to engage in effective self-care, they may consciously or unconsciously lash out at others as a result of burnout. Support is particularly essential for new nurses, in order to prevent attrition in an already-understaffed profession. Ironically, by engaging in lateral violence, nurses reinforce the very negative aspects of the workplace that may drive new nurses away from the profession.

The need for the caregiver to care for him- or herself is a critical aspect of Jean Watson's caring theory, which "not only allows the nurse to practice the art of caring, to provide compassion to ease patients' and families' suffering, and to promote their healing and dignity, but it can also contribute to expanding the nurse's own actualization. In fact, Watson is one of the few nursing theorists who considers not only the cared-for but also the caregiver" (Cara, 2010).