Horizontal Violence or Beyond the Bully...

Nursing has done a fair job of promoting better relationships in hierarchical relationships (vertical) with policies such as those that address physician behavior and when to escalate a concern, but nursing has not done as well, dealing with the interpersonal conflicts sometimes referred to as Horizontal Harassment or Violence. Sometimes the lines between horizontal and vertical violence get blurred and issues that may seem to be vertical harassment/violence, such as with charge nurses, supervisors, or managers are really the same issues. This includes issues of horizontal harassment/violence  that occur between male and female, generations, job titles, i.e., RNs and LPNs, CNAs, housekeepers, pharmacists, young nurses, new nurses, and seasoned (we refuse to be old nurses!), etc. Bullying is bullying wherever it comes from.

How to place this horizontal violence aside and focus on the team and positive attitudes is a focus of this article. Nurses today have reached a point in their professional careers where retention and job satisfaction is paramount.  They tend to focus on four key qualities: RESPECT, RESPONSIVENESS, RECOGNITION, and RELATIONSHIP, with their managers and their co-workers. Recent studies have shown that a majority of nurses are leaving their jobs due to factors relating to their managers, not particularly to an organization. Many of these ‘factors’ have sprung from horizontal violence or bullies in the workplace. 

So what is Horizontal Harassment anyway?

According to Duffy (1995), Horizontal violence is hostile and aggressive behavior by individual or group members toward another member or group of members of the larger group. Horizontal violence is generally non-physical inter-group conflict that is manifested by overt and covert behaviors of hostility (Freire, 1972, Duffy, 1999). Usually these are psychologically, emotionally, and spiritually damaging behaviors, which can have devastating long-term effects on the recipients (Wilkie, 1996). It is generally non-physical, but may involve shoving, hitting or throwing objects. It is one arm of the submissive/aggressive syndrome that results from an internalized self-hatred and low self-esteem as a result of being part of an oppressed group (Glass, 1997). Horizontal violence is a symptom of the dynamics around oppression and a sense of powerlessness. Horizontal violence is common in nursing because of the historical nursing and medical culture, the predominance of females, the patriarchal attitudes of physicians, management, and administration: and even generational differences, which results in inappropriate means of oppressed people releasing built up tension when they are unable to address and solve issues with the oppressor. Some groups of people within each particular workplace unconsciously adopt inflated feelings and attitudes of superiority. Some groups adopt unconsciously submissive attitudes, learned helplessness, within the workplace. The internal conflict, generated by conforming to structural pressures and, in some, subduing the desire for autonomy, whilst over inflating it in other groups, compounds the self-hatred and low self-esteem of certain groups of people and perpetuates the cycle of horizontal violence. Horizontal violence is a ‘systems’ and cultural issue, a symptom of an emotionally, spiritually and psychologically toxic and oppressive environment. Horizontal violence is not a symptom of individual pathology, although individual pathology flourishes in a climate that supports and condones aggressive behavior.

What Are The Signs of Horizontal Harassment?

Workplace violence and harassment experts identify the following behaviors that constitute horizontal/lateral violence and bullying in the workplace:

• aggressive or mocking body language such as raising eyebrows or making faces
• verbal retorts, abrupt responses, vulgar language, sarcastic comments or retorts

• belittling gestures e.g. deliberate rolling of eyes, folding arms, staring into space when communication being attempted - Body language designed to discomfort the other

• undermining behavior such as constantly ignoring questions, devaluing comments
• criticizing or excluding individuals from discussion (freezing out) or controlling behaviors
• withholding needed information or advice
• sabotage such as setting up a new hire for failure, or turning others against a person
• constantly confronting with negativity
• infighting and bickering
• scapegoating
• blaming and gossiping behind a colleague’s back
• humiliation and confrontations in public
• failure to respect privacy, and broken confidences
• shouting, yelling or other intimidating behavior
• judging others on age, gender, sexual orientation, ethnicity or size

• fault finding (nitpicking) - different to those situations where professional and clinical development is required.
• behaviors which seek to control or dominate (power 'over' rather than power 'with')
• elitist attitudes regarding work area, education, experience etc "better than" attitude

• punishing activities by management, e.g., repeatedly sending someone out of area; bad schedules; chronic under staffing; lack of concern with mental, emotional, spiritual, and physical health of employees
• physical violence

Effects of Horizontal Violence

According to Wilkie (1996, p. 3-5), Horizontal Violence affects people progressively. Most people transition through three specific stages until they are no longer able to deal effectively with their emotions, their environment, or even their job.  These three stages include a multitude of symptoms.

Stage 1 - (activation of the fight or flight response - circulating adrenalin)

• Reduced self esteem
• Sleeping disorders
• Free floating anxiety
• Low Morale
• Eating disorders

Stage 2 - (neurotransmitters depleted with lack of sleep - fatigue - brain over stimulated and oversensitive)

• Difficulty with emotional control - bursting into tears or laughter or irritable and angry in response
• Difficulty with motivation - self-starter seems to be 'burnt out'.
• Hypertension
• Nervous conditions
• Apathy

Stage 3 - (brain's circuit breakers activated)

• A relative intolerance of sensory stimulation
• A loss of the ability to ignore things that before were manageable
• Changed response patterns which superficially resemble a change of personality (brain circuit breakers induce person to actively reduce incoming stimuli)
• Disconnectedness
• Depression
• Impaired personal relationships
• Removal of self from workplace - psychologically, physically (sick leave, stress leave, resignation)
• Suicide (successful or attempted)

What To Do If You Are Subject To Horizontal Violence

Step 1: Decide not to be a victim, or a persecutor.

Step 2: Find the way to do it.

Address the behavior immediately with the perpetrator - most people have no idea they are doing it. Horizontal violence is usually a product of unconscious dysfunctional patterns. These are patterns that fit the 'victim, rescuer, persecutor' triangle model of unhealthy human behavior. Use conflict management strategies; say "I feel ... (whatever you are feeling) when you...(whatever they are doing)..." Use the broken record approach - repeat the process if the other person makes excuses, denies or dismisses incident. Accept their statement and repeat, saying "that may be so and I feel (whatever you feel) when you...(whatever they do or say that is an issue for you). Feel the fear and do it anyway. Respond with a clear intent. Ensure you are willing to engage in uncontaminated communication.

Step 3: Say "No" to bullying, horizontal violence, intimidation or humiliation at work.

It is not easy to say “NO” to a bully but taking a stand will reverse some of the affects of being the victim in a bully’s game.

Step 4: Help others to overcome bullying.

Remember--Those who can, don't. Those who can't, bully! (Leigh, 2003)

If you do not get any positive response, or if the behavior continues:

1. Take comprehensive notes regarding the incidences - this can be in diary form.
2. Name it - refer to it as Horizontal Violence
3. Speak to your supervisor about the incident(s)
4. Speak to your Union steward or Labor Representative (LRS) @ 808-531-1628
5. Call the Compliance Hotline @ 1-800-774-9100
6. Obtain counseling support
7. If your health is adversely affected, you may be able to claim Workmen’s Comp

Strategies for personal action to avoid horizontal violence and create a safe, happy workplace:

You can:

1. Name the problem - use the term 'horizontal violence' to refer to the situation.
2. Raise issue at staff meetings - break the silence about this issue
3. Ask about a process for dealing with this issue in your workplace
4. Engage in reflective practice - keep a journal, raise your self awareness about your own values, beliefs and attitudes and your own behavior; begin or continue a path of personal growth - own your 'shadow' - ensure you are part of the solution, not part of the problem, (and we all are part of the problem at times - the important thing is to note and address it)
5. Ensure self-caring behaviors, massage, counseling, peer support, good nutrition, adequate sleep, time out, meditation, exercise - do the things that help you to be healthy and happy in all aspects of your humanness.
6. Be willing to speak up when you witness it happening and name 'horizontal violence' for what it is.
7. Contact your union representative (LRS) and discuss strategic options

Strategies for management to avoid horizontal violence and create a safe, happy workplace:

Successful strategies come from the top and require an ongoing commitment to culture change concerning horizontal violence! Stressed staff leads to disconnections. Leaders need to guide staff towards high performance while ensuring that recovery times are adequate. Supporting and ensuring that staff sustains a high level of engagement (fulfilled and excited) for improved work and life balance generates meaningful recognition of their strengths rather than their weaknesses (AACN, 2005). Historically, intimidation has been an accepted style of management. This does not make it right, but it has to be recognized and action taken, so those affected can become part of the solution and not remain part of the problem.

You can as a manager:

1. Gain knowledge about Horizontal Violence and its causes, conduct regular meetings with a designated committee and institute a program to address this issue; supervise its operation and success
2. Undertake a formal thorough analysis of your unit's culture.
3. Ensure there is a process for dealing with this issue in your workplace and follow it
4. Have a policy about harmonious workplace relations, support and encouragement of students, new staff members and staff generally.
5. Foster an environment of open collaboration, exploring and healing of issues, rather than faultfinding and blame.
6. Support workers' autonomy and initiative and promote a learning culture
7. Provide education about processes to promptly report incidences of victimization- support and encourage people to do so.
8. Monitor staff morale and address issues which negatively impact upon morale
9. Ensure that staffing is adequate, that rosters are fair and allocation to areas is fair within your unit/institution; ensure that all staff has equal opportunity for advancement and education.
10. Engage in self-awareness activities and in reflective practice. Ask for feedback from staff about your management practices and not just from close associates
11. Institute open, honest and supportive dialogue through peer review - strategies that are process based, not personality based.
12. Revise and articulate core values of institution and health care, make one core value a topic at each team meeting
13. Engage in self care activities as above

Management must deal with any actual or suspected bullying immediately. If left to escalate, the problem will be much more difficult to control or manage. Indicators of a problem include (but are not limited to:

* a high attrition rate in a unit/department;

* increased sick leave, accident and incident reports;

* general low morale and dissatisfaction, reflected in increased complaints; and

* increased compensation claims

Bullying in the workplace is rife. It comes from both management and peers. Even when it is brought to the notice of others, the outcome for most is to get another job or shift to another unit/department or hospital/facility. While this is unfortunate, particularly if you enjoy your work, do not stay in an unhappy work situation just to prove a point.

With recent changes to health and safety in employment legislation, employers must take bullying/intimidation seriously. Failing to do so could result in lengthy and expensive court action. In addition, staying in a stressful situation will damage your health. It is easier to get another job than to recover from burnout, depression, heart disease or cardiovascular problems, all of which are precipitated by a stressful work environment. No amount of money can compensate for damaged health--you and your health are priceless (Leigh, 2003).
References

American Association of Critical Care Nurses (AACN) (2005). AACN stand for establishing and sustaining healthy work environments.  Retrieved from http://www.aacn.org/aacn/pubpolcy.nsf/vwdoc/workenv

Duffy, E. (1995, April). Horizontal violence: a conundrum for nursing. Collegian Journal of the Royal College of Nursing Australia. 2(2), 5-17.

Freire, P. (1972). Pedagogy of the Oppressed. Penguin Education: England.

Glass, N. (1997). Horizontal violence in nursing. The Australian Journal of Holistic Nursing. 4(1).

Leigh, Kelly (2003, October). How to say no to the bully at work. Kai Tiaki: Nursing New Zealand. Retrieved from http://www.accessmylibrary.com

Pugh, A. (2005-2006, Winter). Bullying in Nursing. 9(2).  Retrieved from http://www.reseaufranco.com/en/best_of_crosscurrents/bullying_in_nursing.html

Wilkie, W. (1996). “Understanding the behavior of victimized people" in McCarthy, P. Sheehan, M. & Wilkie, W. (eds) Bullying, from backyard to boardroom. Millennium Books: Australia.