Examples of Horizontal Violence

burn out · Jun 1, 2006

I don't think they eat just their young, they are just plain cannibals.

DusktilDawn · Jun 1, 2006

Actually I'm really fed up with that saying "nurses eat their young" and the negative stereotype it perpetuates. Horizontal violence can also come from newbies entering the profession, not just exclusively from the experienced nurses.

My experience: bad behavior can come from anybody, not just the experienced.

UnderpaidNurse · Jun 1, 2006

Actually I'm really fed up with that saying "nurses eat their young" and the negative stereotype it perpetuates. Horizontal violence can also come from newbies entering the profession, not just exclusively from the experienced nurses.
My experience: bad behavior can come from anybody, not just the experienced.

Thank you to both of you, for your comments. They are both duly noted. But now, if you could give me an example of each side of the story, it would help me out immensely.

Thank you

DusktilDawn · Jun 2, 2006

Thank you to both of you, for your comments. They are both duly noted. But now, if you could give me an example of each side of the story, it would help me out immensely.
Thank you

OK Eka69, but it's long:

It can be your manager that rolls their eyes when you bring up a concern. I had one manager that no matter what it was would always turn the situation around into what my deficiencies were as a nurse. Apparently I'm inadequate because I complained or an issue with something, according to her, I was the only one with a problem (yeah, like no one else ever brought it up). The same manager freely gossiped about situations involving other employees, thus creating anomosity towards those employees. The same manager, while I was looking for a job as an RN, told another RPN (LPN) that was being laid-off that it was MY fault because I was still in the department.

It can be that NA who conveniently "forgets" to report that abnormal BP or hides during the shift. I work with one NA (rarely thank God) that is the master of passive/agressive behavior. You cannot rely on her to do anything you delegate, she won't tell you "no," she just won't do it. Oh, and what a master at making whatever she does appear like: a) Oh I didn't hear you. b) Oh, I'm sorry, I misunderstood what you wanted. She's created a situation where it is less stressful for you NOT to request her assistance. Hiding out was a famous ploy used by some of our NAs. Your running you butt off doing things you could delegate to them if you could find them. Or it can be that exagerated sigh because you had the gall to ask them to help turn a patient. Or my personal favorite: "That's not my patient," said as their butt is planted in a chair while they are surfing the internet. I'm tired of feeling like I have to be a b**** when I have deal with nonsense like this, it's not who I am. I'm fed up with feeling like I cannot depend on these people to even do their job when it comes to the patient. I'm frustrated because it is my a$$ chewed out because they didn't record a foley OP. I'm also frustrated because if I could do it all myself, I damn well would.

It can be the housekeeper who stands in front of you tapping their foot in annoyance while your on the phone with a physican because it is not in their job description to strip a bed. I worked as a housekeeper in a hospital, and I can assure you that there are some housekeeping and other ancillary staff (dietary, transporters, supplies, etc) that LOVE to brag about how they "told off the b***** nurses" on their breaks. It's almost akin to a badge of honor with some. Interestingly, I got treated better by the nursing staff when I was a housekeeper than I do now by some ancillary staff as a nurse.

It can be that X-ray tech who decides they need to "lecture" you the nurse, because the doctor didn't put the XR requisition in the precise place on the chart that they want it to be, and then threaten not to perform the procedure on the patient. First the XR tech made a big production about not being able to find the requistion, so I went to the chart, turned to where the doctor left the requisition in the chart. The tech than felt the need to lecture me about where the requistion was supposed to be blah, blah, blah. I told this tech to tell it to someone who had a break tonight, or better yet, page the doctor who filled out the requisition and crab at him. The tech than threatened that next time, they won't do the XR if it's not there. I responded that instead of threatening the patient's well-being, they need to inform the MDs where these reqs are to go on the chart since I was not their personal secretary and it IS THEIR responsibilty to fill out the reqs. I was livid, the reason was that they threatened the health and well-being of a patient because a requistion was not where THEY WANTED it to be on the chart.

It can be that memo sent by PT/OT to the nursing staff that they will not see a patient if the requistion is not done and the order is not entered by 7:30 AM. They don't bother to send a memo to the MDs, the one's that actually have to write these orders. Why does everybody think we are supposed to babysit the doctors? Do you think maybe if they informed the physicians that they will not see patient's if orders/reqs are not done by 0730, that maybe THEY would actually have them done on time?

It can be abuse/demanding patients or their families.Threats of suing. Threats of violence. Demeaning treatment. Verbal abuse. Sexual abuse. The expectation by the public, management, and yes, even nurses themselves that it is part of the job to tolerate a "certain" amount of abuse, because the patient and their family are under stress. Interesting, it's not the folks that are in the most stressful situations that are perpetuating the abuse. One patient, whom I had already spent basically the first 2 hours of my shift with (a lot of nonsense and drama), loud and nastily DEMANDED to know where I was for the last 45 min. I replied that I had other patients on the other side of the hall that need to be taken care of also and that was where I was. Oh, not good enough, insert nasty tirade from patient, which I interrupted with a reality check that calmed her down. Had that patient remained angry and wrote a letter of complaint, my hide gets called on the carpet, I'm subject to discipline irregardless of how inappropriate the behavior was I received.

It can also be facility issues such as chronic understaffing or "customer service" oriented attitudes that blames the nurse for all complaints. Understaffing is a huge problem, you spend your shift running around like a rat on a wheel, getting nowhere. You won't get a break, despite the fact that breaks are the most needed when it is high stress, and let's not forget, you probably won't be leaving on time either. You leave physically exhausted. Worse is the feeling that despite trying you best, that your patients did not receive the care or attention they should have. You also leave knowing that if anything was missed, it comes back on you. Unless you work in a state with legislated staffing ratios, you can really be screwed as a nurse when it comes to understaffing. SBONs and most state legislatures put the onus on the nurse because they "accepted" the assignment. The reality is that nurses aren't "accepting" this, they are basically being told: "Too bad, we don't have anyone to send you." Unless facilities become responsible for their staffing practices, which nurses have very limited say in, this will not change.

I'm only going to give you a few examples of "customer service" relates to horizontal violence:

1. Scripted responses. Thank you for providing words and little phrases for me, since you obviously think I'm too much of an idiot to effectively communicate on my own. How I got this far in life communicating with others without your supreme guidance is a miracle.

2. Accepting ownership. For any displeasure the customer has, including things you have no control over. For instance, a big complaint regards transporters taking too long to arrive to wheel the patient out (1hr or worse at times). The nurse is supposed to assume responsibility for this by apologizing for the delay, ask if their is anything they can do to make the situation better, and provide a solution. In this instance transportation services has no incentive to improve, in fact, they actually have more incentive NOT TO improve since the end result will be the nurse spending time finding a w/c (would be nice if we actually had a few on the unit) and discharging the patient themselves.

3. Not appearing busy, it makes the patient feel we aren't interested.On a Press Ganey survey a patient wrote: The staff was very nice even though they were very busy. This was recorded as a NEGATIVE, although I highly doubt that was the author's intent. Bonuses are based on our Press Ganey scores. How can this not be harassment? Your facility can understaff you which will greatly hamper your ability to provide care, never mind making sure the "customer" is completely satisfied and than punish YOU.

You see Eka69, horizontal violence is not always "nurse-on-nurse." It is not physical in nature and is usually expressed by overt or covert behaviors. Nurses are really unequal in a facility when it comes to power relations, despite the fact that we have a high accountability for not only what we do, but for what others do. It has to do with oppression and creating powerlessness. In so many situations nurses are between a rock and a hard place, and that is horizontal violence.

Horizontal Violence Defined

Horizontal violence is a harmful behavior, via attitudes, actions, words and other behavior, that is directed toward us by colleagues. It controls, humiliates, denigrates, and injures the dignity of another. It indicates a lack of mutual respect and value for the worth of the individual and denies another’s fundamental human rights. It is a self-serving, nonproductive response that perpetuates an escalating cycle of resentment and retaliation. When practiced by healthcare professionals, horizontal violence can be deleterious to patient care.

Adapted from Matthews-Blanton B, Lybecker C, Spring NM. A horizontal violence position statement. Nurse Advocate website. Available at: http://www.nurseadvocate.org/hvstate.html. Accessed June 1, 2001.

http://nsweb.nursingspectrum.com/cfforms/GuestLecture/HorizontalViolence.cfm

http://www.acegraphics.com.au/articles/hastie02.html

One more scenario for you Eka69:

I was charge nurse one night, full patient assignment (6), 3 newbies (X,Y, and Z) just off orientation, 1 agency nurse (let's call her A). Naturally, A asked me questions simply because she is unfamiliar with the unit and she may have a few questions regarding patient care. X,Y, and Z of course will be looking to me as a resource person, especially since I am the only regular staff member present on this shift. Now Z is doing pretty good on his own, he really seems to have his act together (very organized, appears very comfortable on his own) asked few questions and for help a few times of course. X and Y were both very unsure, constant interruptions and questions, constantly wanting validation about whether they are doing the right thing. Remember I still have a full patient assignment and charge duties. MY patients and MY work is being neglected because of the constant interruptions. After a few hours of this situation, I'm feeling harried and want to pull my hair out. At one point I was very abrupt with Y, saying I was busy (quite true) and it was going to have to wait. She reacted as if I slapped her face. Seemed to have no comprehension of what it MIGHT have been like for me to have to be the resource person for 3 newbies and 1 agency. Naturally she's new and needs a resource person, and no doubt just beginning to be on her own would blind her to my position in this scenario. She needed encouragement and validation, which unfortunately I could not provide. Was I "eating the young" so to speak? Perhaps she felt that way at the time. Sometimes the issue isn't about "nurses eating their young," it can be about not having the proper support system in place to nurture the new.

BTW I did speak to Y later about the situation, and after she did understand that I wasn't trying to be nasty. She also understood that I had really been put in a bad situation that night when we were done talking.

medsurgnurse, RN · Jun 2, 2006

OK Eka69, but it's long:
It can be your manager that rolls their eyes when you bring up a concern. I had one manager that no matter what it was would always turn the situation around into what my deficiencies were as a nurse. Apparently I'm inadequate because I complained or an issue with something, according to her, I was the only one with a problem (yeah, like no one else ever brought it up). The same manager freely gossiped about situations involving other employees, thus creating anomosity towards those employees. The same manager, while I was looking for a job as an RN, told another RPN (LPN) that was being laid-off that it was MY fault because I was still in the department.
It can be that NA who conveniently "forgets" to report that abnormal BP or hides during the shift. I work with one NA (rarely thank God) that is the master of passive/agressive behavior. You cannot rely on her to do anything you delegate, she won't tell you "no," she just won't do it. Oh, and what a master at making whatever she does appear like: a) Oh I didn't hear you. b) Oh, I'm sorry, I misunderstood what you wanted. She's created a situation where it is less stressful for you NOT to request her assistance. Hiding out was a famous ploy used by some of our NAs. Your running you butt off doing things you could delegate to them if you could find them. Or it can be that exagerated sigh because you had the gall to ask them to help turn a patient. Or my personal favorite: "That's not my patient," said as their butt is planted in a chair while they are surfing the internet. I'm tired of feeling like I have to be a b**** when I have deal with nonsense like this, it's not who I am. I'm fed up with feeling like I cannot depend on these people to even do their job when it comes to the patient. I'm frustrated because it is my a$$ chewed out because they didn't record a foley OP. I'm also frustrated because if I could do it all myself, I damn well would.
It can be the housekeeper who stands in front of you tapping their foot in annoyance while your on the phone with a physican because it is not in their job description to strip a bed. I worked as a housekeeper in a hospital, and I can assure you that there are some housekeeping and other ancillary staff (dietary, transporters, supplies, etc) that LOVE to brag about how they "told off the b***** nurses" on their breaks. It's almost akin to a badge of honor with some. Interestingly, I got treated better by the nursing staff when I was a housekeeper than I do now by some ancillary staff as a nurse.
It can be that X-ray tech who decides they need to "lecture" you the nurse, because the doctor didn't put the XR requisition in the precise place on the chart that they want it to be, and then threaten not to perform the procedure on the patient. First the XR tech made a big production about not being able to find the requistion, so I went to the chart, turned to where the doctor left the requisition in the chart. The tech than felt the need to lecture me about where the requistion was supposed to be blah, blah, blah. I told this tech to tell it to someone who had a break tonight, or better yet, page the doctor who filled out the requisition and crab at him. The tech than threatened that next time, they won't do the XR if it's not there. I responded that instead of threatening the patient's well-being, they need to inform the MDs where these reqs are to go on the chart since I was not their personal secretary and it IS THEIR responsibilty to fill out the reqs. I was livid, the reason was that they threatened the health and well-being of a patient because a requistion was not where THEY WANTED it to be on the chart.
It can be that memo sent by PT/OT to the nursing staff that they will not see a patient if the requistion is not done and the order is not entered by 7:30 AM. They don't bother to send a memo to the MDs, the one's that actually have to write these orders. Why does everybody think we are supposed to babysit the doctors? Do you think maybe if they informed the physicians that they will not see patient's if orders/reqs are not done by 0730, that maybe THEY would actually have them done on time?
It can be abuse/demanding patients or their families.Threats of suing. Threats of violence. Demeaning treatment. Verbal abuse. Sexual abuse. The expectation by the public, management, and yes, even nurses themselves that it is part of the job to tolerate a "certain" amount of abuse, because the patient and their family are under stress. Interesting, it's not the folks that are in the most stressful situations that are perpetuating the abuse. One patient, whom I had already spent basically the first 2 hours of my shift with (a lot of nonsense and drama), loud and nastily DEMANDED to know where I was for the last 45 min. I replied that I had other patients on the other side of the hall that need to be taken care of also and that was where I was. Oh, not good enough, insert nasty tirade from patient, which I interrupted with a reality check that calmed her down. Had that patient remained angry and wrote a letter of complaint, my hide gets called on the carpet, I'm subject to discipline irregardless of how inappropriate the behavior was I received.
It can also be facility issues such as chronic understaffing or "customer service" oriented attitudes that blames the nurse for all complaints. Understaffing is a huge problem, you spend your shift running around like a rat on a wheel, getting nowhere. You won't get a break, despite the fact that breaks are the most needed when it is high stress, and let's not forget, you probably won't be leaving on time either. You leave physically exhausted. Worse is the feeling that despite trying you best, that your patients did not receive the care or attention they should have. You also leave knowing that if anything was missed, it comes back on you. Unless you work in a state with legislated staffing ratios, you can really be screwed as a nurse when it comes to understaffing. SBONs and most state legislatures put the onus on the nurse because they "accepted" the assignment. The reality is that nurses aren't "accepting" this, they are basically being told: "Too bad, we don't have anyone to send you." Unless facilities become responsible for their staffing practices, which nurses have very limited say in, this will not change.
I'm only going to give you a few examples of "customer service" relates to horizontal violence:
1. Scripted responses. Thank you for providing words and little phrases for me, since you obviously think I'm too much of an idiot to effectively communicate on my own. How I got this far in life communicating with others without your supreme guidance is a miracle.
2. Accepting ownership. For any displeasure the customer has, including things you have no control over. For instance, a big complaint regards transporters taking too long to arrive to wheel the patient out (1hr or worse at times). The nurse is supposed to assume responsibility for this by apologizing for the delay, ask if their is anything they can do to make the situation better, and provide a solution. In this instance transportation services has no incentive to improve, in fact, they actually have more incentive NOT TO improve since the end result will be the nurse spending time finding a w/c (would be nice if we actually had a few on the unit) and discharging the patient themselves.
3. Not appearing busy, it makes the patient feel aren't interested.On a Press Ganey survey a patient wrote: The staff was very nice even though they were very busy. This was recorded as a NEGATIVE, although I highly doubt that was the author's intent. Bonuses are based on our Press Ganey scores. How can this not be harassment? Your facility can understaff you which will greatly hamper your ability to provide care, never mind making sure the "customer" is completely satisfied and than punish YOU.
You see Eka69, horizontal violence is not always "nurse-on-nurse." It is not physical in nature and is usually expressed by overt or covert behaviors. Nurses are really unequal in a facility when it comes to power relations, despite the fact that we have a high accountability for not only what we do, but for what others do. It has to do with oppression and creating powerlessness. In so many situations nurses are between a rock and a hard place, and that is horizontal violence.
Horizontal Violence Defined
Horizontal violence is a harmful behavior, via attitudes, actions, words and other behavior, that is directed toward us by colleagues. It controls, humiliates, denigrates, and injures the dignity of another. It indicates a lack of mutual respect and value for the worth of the individual and denies another's fundamental human rights. It is a self-serving, nonproductive response that perpetuates an escalating cycle of resentment and retaliation. When practiced by healthcare professionals, horizontal violence can be deleterious to patient care.
Adapted from Matthews-Blanton B, Lybecker C, Spring NM. A horizontal violence position statement. Nurse Advocate website. Available at: www.nurseadvocate.org/hvstate.html. Accessed June 1, 2001.
http://nsweb.nursingspectrum.com/cfforms/GuestLecture/HorizontalViolence.cfm
http://www.acegraphics.com.au/articles/hastie02.html
One more scenario for you Eka69:
I was charge nurse one night, full patient assignment (6), 3 newbies (X,Y, and Z) just off orientation, 1 agency nurse (let's call her A). Naturally, A asked me questions simply because she is unfamiliar with the unit and she may have a few questions regarding patient care. X,Y, and Z of course will be looking to me as a resource person, especially since I am the only regular staff member present on this shift. Now Z is doing pretty good on his own, he really seems to have his act together (very organized, appears very comfortable on his own) asked few questions and for help a few times of course. X and Y were both very unsure, constant interruptions and questions, constantly wanting validation about whether they are doing the right thing. Remember I still have a full patient assignment and charge duties. MY patients and MY work is being neglected because of the constant interruptions. After a few hours of this situation, I'm feeling harried and want to pull my hair out. At one point I was very abrupt with Y, saying I was busy (quite true) and it was going to have to wait. She reacted as if I slapped her face. Seemed to have no comprehension of what it MIGHT have been like for me to have to be the resource person for 3 newbies and 1 agency. Naturally she's new and needs a resource person, and no doubt just beginning to be on her own would blind her to my position in this scenario. She needed encouragement and validation, which unfortunately I could not provide. Was I "eating the young" so to speak? Perhaps she felt that way at the time. Sometimes the issue isn't about "nurses eating their young," it can be about not having the proper support system in place to nurture the new.
BTW I did speak to Y later about the situation, and after she did understand that I wasn't trying to be nasty. She also understood that I had really been put in a bad situation that night when we were done talking.

DusktilDawn take a bow. The OP wanted SPECIFIC examples and boy did you give some. The sorry part is as I sat there reading I'm nodding my head knowing I've been in similair situctions way too often. (I'm out of the hospital enviroment now.)

DusktilDawn · Jun 2, 2006

DusktilDawn take a bow. The OP wanted SPECIFIC examples and boy did you give some. The sorry part is as I sat there reading I'm nodding my head knowing I've been in similair situctions way too often. (I'm out of the hospital enviroment now.)

You know, in all honesty, I've experienced very little abuse from other RNs. In fact my first job as an RPN/LPN, I worked with the most supportive people you could find. I know that this is not always the case.

I used to pick up extra hours at one facility I worked at. There was one unit I agreed to pick up a shift for and the entire time I was on the unit, not one of the regular staff spoke to me the entire day, seemed like all the bad apples gravitated towards this unit. Ya know, next time they called to see if I wanted to pick up an extra shift the answer was NO! There was plenty of areas in that facility that would call and treated me well when I went there, I didn't need to pick up shifts on a chilly unit. The manager of the chilly floor must have had numerous complaints, rumor had it she got after her staff to treat those that come to the unit from elsewhere in a better fashion. A year later I accepted a shift on that unit and it was an entirely different place to work on (for the better) definately warmer. :lol2:

OH, I forgot to mention the horizontal abuse from doctors. Anyone want to tackle this one? :D

Selke · Jun 2, 2006

hi,
i am preparing a presentation on horizontal violence, a.k.a. how nurses eat their young .
i have all sorts of statistics but what i am lacking are anecdotal stories. if you could relay some of what you have seen, or have happen to you, i would appreciate it.
thank you soooo much,
erika

search the forums for nurse bullying, horizontal violence, nurses eating their young, &c. there are several out there. there are also websites like http://www.bullyonline.org/ which deal with this issue. i'd also suggest you get permission of the folks whose stories you use in your presentation, if you haven't thought of this already.

spaniel · Jun 2, 2006

Just a quick post -I hope. Seems to me the concept of Horizontal Violence is most appoicable when the following occurs: When the RN is unable to address a need, make a needed change, or to effect power in asuitable way,he/she reacts by creating a noxious response directed at her equals. Simple scenario: The unit is severely short staffed. As the RN faces the shift, she is unable to address the issue with her superior. She then "reports" (in writing) numerous omissions of other RNs to prove her point.

ilvnsg · Jun 2, 2006

So there is a name for the kind of abuse that I experience at work everyday. I thought I wasn't fit to be a nurse because I could not take the criticism, sarcasm and fault-finding of my DON. Several times I was reduced to tears (in the privacy of the bathroom) after being yelled at and humiliated in front of other nurses, staff and family members while our administrator looks on and turns a blind eye. Several nurses and CNAs (those that she does not favor) goes through this experience almost on a daily basis. I thought I was being sensitive and just need to toughen up. I am not a bad nurse. I am conscientious about my work and my residents love me but I am given a new position in which I was not formally trained for, not given directions, no mentor to ask for help. Plus I inherited the problems of the previous staff who held this job. I actually had to learn to perform my job on my own. So far I have done my job well and in a short period of time i have gained the respect and trust of my CNAs. But despite this I get yelled at, made feel incompetent and totally treated without respect.

spaniel · Jun 2, 2006

What also comes to mind is the phrase "oppressed group behavior" in which "horizontal violence" comes to mind. I've been in the health field as early as 1969-yea I was REALLY young. I see it as only getting worse,despite advanced training. I must say I saw it the least in the more critical care settings... the most in the LTC settings, by a long shot.

UnderpaidNurse · Jun 2, 2006

THANK YOU!!!!!! You all have opened up my eyes to the whole scope of what this topic entails. One of the saddest things I have to report is that it seems to start in nursing school as well. Once again, thank you to everyone!