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Horizontal Violence is also calledLateral Violence

Bullying

Interpersonal abuse

Workplace violence

Interpersonal conflict

Psychological violence

Workplace incivility

Horizontal Violence…is a phrase coined by Paulo Friere in 1970, to indicate “the curious behavior of members of oppressed groups who often lash out at their

peers in response to oppression instead of attacking their oppressors.”

Pedagogy of the Oppressed, 1970

“Columbine happened because the whole community failed. Students failed to report what they were hearing and seeing, teachers & administrators failed to take the threats seriously & law enforcement failed to investigate what should have been a very clear & present danger.”

Christopher & Pohl, 2012

SHRM says:

It is “persistent, offensive, abusive, intimidating or insulting behavior or unfair actions directed at another individual, causing the recipient to feel threatened, abused, humiliated, or vulnerable.”

Jusko, 2013

Horizontal Violence

SurveysThe results of a 2012 SHRM survey:

50% of organizations surveyed reported an incident of bullying in their workplace, and for larger organizations

of >500 employees, the % grew to 71%!

Jusko, 20132011 Civility in America poll: 38% of

workers believe the workplace is becoming more disrespectful, and 67%

believe there is a strong need for civility training

Inside Training, 2013

HV Facts & StatsThe American Nurses Association reports:

48% of nurses, pharmacists & others reported strong verbal abuse

43% of nurses, pharmacists & others reported experiencing threatening body language

Student nurses reported that 53% had been put down by a staff nurse

40% of clinicians “kept quiet” or “ignored” an improper medication due to an intimidating colleague

AMA, 2013

Workplace Civility"Organizational success depends on a climate of fairness & compassion; supportive working environments are consistently identified as an

important attribute of an effective learning organization…in order to learn, employees must feel safe to disagree, ask questions, &

make mistakes. They must recognize the value of competing ideas & feel encouraged to take risks. If your organization’s culture is one of negativity & aggressiveness, none of this is

allowed to flourish." Inside Training, 2013

More FactsRoughly 60% of new RN’s quit their first job

within 6 months of being bullied, and 1 in 3 new graduate nurses considers quitting nursing

altogether because of abusive or humiliating encounters

Townsend, 2012

Nurses who survive bullying early in their careers tend to carry their learned behaviors with them. They accept the bully culture as part of the job and eventually choose one of

two paths: leave the unhealthy work environment in search of a healthier one, or participate in the culture either as a bully or

bystander.American Nurse Today, 207

HV as a role issueNurses are educated to process work in teams and most nursing models are built on the team concept; however, physicians are educated to believe they are the “captain of the ship”

This leads to stress between physician and nurses. Nurses expect to work as colleagues with physicians; however, physicians don’t always see this as desirable

Such differing cultural expectations breed conditions that are ripe for horizontal violence

And then nurses “eat their young”

HV as an oppressed group issueThis occurs when one group believes they have been excluded from the power structure

The oppressed group is abusive to peers & those individuals with lesser status because they are unable to or fear addressing the source of the stress affecting them. They then may strike out at peers, students, unlicensed assistive personnel, etc.

“Sociological literature shows that oppressed group members tend to act out against one another because they lack control over their situation…powerlessness further lowers their self-esteem and triggers the cycle of oppressed group behavior undertaken to boost self-esteem – which in turn causes more frustration, lack of coworker support & conflict.”American Nurse Today, 2007

HV as a culture issueA company’s beliefs & attitudes towards Horizontal Violence play a large part in the acceptance of Horizontal Violence. Leadership’s role is vital

A culture of deferred responsibility develops when leadership looks the other way when this type of behavior happens. “When we think that we will not get into trouble, we tend to do things that we know we shouldn’t.” (Christopher & Pohl)

What makes us look the other way when someone’s in distress? “…environment & social mores are at the crux of it.” (Christopher & Pohl)

“…peer groups are a particularly effective & influential source of social learning…groups help create social norms - attitudes, beliefs or behaviors that are commonly accepted as appropriate by the group.” (Christopher & Pohl) We develop socially acceptable codes of conduct affecting the workplace based on group norms

Belittling gestures (eye-rolling, folding arms, staring into space when someone’s talking to you)

Backstabbing/Scapegoating

Withholding information (about patients, meetings, new equipment, etc.)

Verbal abuse (name calling, threatening, intimidating, undermining)

Needling

Horizontal Violence Includes:

For Example:Gossiping, talking behind your

coworker’s back

Finding fault (nitpicking)Telling coworker how to do his/her

jobNot respecting personal

privacy

Also…Personal insults

Criticism

Sarcastic comments, jokes & teasing (used as an insult)

Rude interruptions

Withering e-mail flames

Anonymous letters aimed at hurting the target

Wait, there’s more!

“Freezing or icing out” – excluding coworkers from work-related or social activities and/or

conversations (especially with new staff)

Elitist attitudes regarding your department, job, education, experience, etc. (I’m better than you

attitude)

Treating people as if they are invisible

So, concrete examples… Hiding (or stealing) someone’s lunch, coffee,

etc.

Derogatory statements: “She’s a know-it-all,” “Who died and made her boss?” “Where’d she get her degree, the Cracker Jax box?”

Laughing or snickering behind someone’s back (“Take a look at THAT outfit” “Nice hair – not!”)

Barking orders at people/stomping around

Not responding when a new (or an old!) coworker says hello or asks a question

Withholding paperwork, reports, etc. the coworker needs to complete own work on time

Dilbert on HV

Effects

The 3 Stages

(Hastie, 2002)

Sleeping disorders Free-floating anxiety Reduced self-esteem

Stage 1:

You experience:

Activation of the fight or flight response within you

You have difficulty with emotional control – bursting into tears and/or laughter for little reason

Irritable or angry when responding

Difficulty with motivation

Self-starter seems to be “burnt out”

Stage 2:Your neurotransmitters are depleted from lack of sleep & fatigue; the brain is over-stimulated and

over-sensitive

You experience changed response patterns which superficially resemble a change of personality

You have a loss of ability to ignore things that before were manageable

You experience a relative intolerance of sensory stimulation (slight noise, voices, lights, etc. bother you)

Stage 3:Your brain’s circuit breakers are

activated

Results… You feel like throwing up the night

before work Your family demands you stop

obsessing about work You make mistakes Your health/energy level declines Your favorite activities are no longer

fun

Catalanello, 2009

Turnover“Merely showing up for work in an environment

where bullying goes on is enough to make many of us think about quitting…nurses not

bullied directly, but who worked in an environment where workplace bullying

occurred, felt a stronger urge to quit than those actually being bullied.”

SAGE, 2012

Is This Your Department?

Costs, Direct & Indirect“In the United States, the actual cost [is]…$250 million annually in expenditures related to health care, litigation, staff

turnover, and retraining from workplace bullying…this figure may be low given a lot of these types of costs are not always attributed to bullying when in fact they

could be.”BLR, 2012

Incivility, bullying, harassment, & discrimination affect the bottom line because these behaviors increase

anxiety, depression, absenteeism, presenteeism, & turnover; & decrease motivation, quality of work, output, job satisfaction, & ability to meet goals.

Communication ceases, problems can’t be solved, people can’t learn, gossip takes over, customer

service suffers, & stress prevents effective decision-making. Further, the consequences of negativity

extend far beyond the perpetrator & target relationship. Anyone witnessing the aggressive behaviors, even if they don’t necessarily feel

victimized by it, loses loyalty to managers & the organization, and, thus, their work suffers, too.

Inside Training, 2013

Costs

Costs...“The real problem is not the young,

inexperienced nurse but the experienced nurses who are bullies, and those that stand by silently and allow it to happen. The cost of bullying behavior is in the loss of bright and talented nurses who leave the profession,

increasing turnover, destabilizing patient care systems and putting patient safety at great risk. It is in fact, almost immeasurable in its

cost to society.”Anonymous, 2013

Costs...“Merely showing up for work in an

environment where bullying goes on is enough to make many of us think about

quitting…nurses not bullied directly, but who worked in an environment where workplace bullying occurred, felt a stronger urge to quit

than those actually being bulliedSage, 2012

Effects on the workplace Increased absenteeism

Increased turnover

Increased costs: EAP programs, recruitment, etc.

Increased risk for accidents/incidents

Decreased productivity & motivation, & morale

Reduced corporate image & customer confidence

Poor customer service

How is HR Neutralized?HR reports to the wrong level

HR is extremely decentralized

CEO doesn’t get HR’s strategic value

HR is staffed inexperienced, untrained or unethical people

HR is directly a victim of HVSuzi Benoit, 2013

To be effective in preventing HV, we must be effective in preventing neutralization of HR

How Bullies Neutralize ManagementTelling only part of the storyDeflectionPlaying the victimStrategic partneringExploiting mistakesPre-emptive strikes (complaining about the victim, safety issues, ethical issues, first)“Where is the policy on…”

Classic HV!

Preventing HVMeet w/bully & follow these basic rules:

This in not an investigative interview – it’s not about excuses or the bully’s version of things

Be direct – “People are afraid of you, staff don’t feel safe” – avoid “Please be nicer!”

Bully is often in denial and/or disagrees w/findings

Don’t try to understand why bullies bully – this is not therapy!

Consequences are an absolute must: bullies won’t change unless motivated

Make good on threats – terminate the bully!BLR, 2013

Preventing HV

Ensure that respect is a core value Ensure a zero tolerance towards

abusive behavior policy & start at senior level

Ensure protection from retaliation if reported

Encourage utilization of EAP program Train staff on Horizontal Violence Conduct exit surveys & ask about

bullying Listen!

AMA, 2013, BLR, 2013

At management/system level:

Help staff:

To understand that they did nothing wrong: the bully usually chooses a victim for no good reason (or because s/he feels threatened by him or her for some reason)

To engage in reflective practice: keep a journal, raise self-awareness about their values, beliefs, attitudes, & behavior – are they guilty of horizontal violence? (are they supportive, encouraging – or do they create an environment infected w/horizontal violence)

To ensure self-caring behaviors: seek counseling, promote peer support, good nutrition, adequate sleep, take time out to relax, exercise

Be willing to speak up when they see it happening & name “horizontal violence” for

what it is

Preventing HV

If staff are subjected to horizontal violence, have them:Address the problem immediately with the person – often the person has no idea s/he is doing it

Use conflict management strategies – Say “I feel … when you …”

Again, name it, and if not stopped – have them take comprehensive notes, and refer it to their supervisor or to HR

What to do

Use positive & respectful tone

Use respectful & active listening – look coworkers in the eye when they are talking

Lead by example!

Own up to your mistakes, don’t attempt to shift the blame

When making requests, be polite & tactful –remember, it’s just that: a request

Be willing to help when requested

Don’t participate in gossip

Coach staff on these methodsWhat you permit, you

promote

Invite loners & newcomers to breaks/meals

When others do a kind act, thank them in front of others

Accept your fair share of the workloadWork together (despite personal dislikes)

Address coworkers by their first names

Ask for help & advice when needed

Stand up for peers in their absence, don’t be critical of them

Don’t engage in vertical violence – it just perpetuates horizontal violence in others

Smile!

And…

So…be a buddy, not a bully!

Because…“The real problem is not the young,

inexperienced nurse but the experienced nurses who are bullies, and those that stand by silently and allow it to happen. The cost of bullying behavior is in the loss of bright and talented nurses who leave the profession,

increasing turnover, destabilizing patient care systems and putting patient safety at great risk. It is in fact, almost immeasurable in its

cost to society.”Stopbullyingnurses.com, 2013

Pearls of Wisdom

More Pearls

Practice the 3 R’sRespect for self

Respect for others

Responsibility for all your actions

Anonymous (n.d.) Horizontal violence: The CNA’s worst enemy & the nursing home’s number one threat to quality care. Retrieved from the World Wide Web on January 28, 2004: http://www.nursingassistants.net/HV~ns4.html

BLR (2012) Bullying at the workplace: statistics on bullying. Retrieved from http://hr.blr.com/HR-news/Health-Safety/Violence-in-the-Workplace/zn-Bullying-workplace-Statistics-on-Bullying/

Center for American Nurses (2008) Lateral Violence and Bullying in the Workplace.

Catalanello, R (2009) Bullying at work can make you sick, but remedies are few. Retrieved from: http://www.tampabay.com/news/humaninterest/article1021546.ece

Funk, C. (2002, September 1). Cutting down the tall poppies: horizontal violence: Sam Houston State University

Hastie, C. (2002, August 6) Horizontal violence in the workplace. Retrieved from: http://preparingforbirth.com/articles/hastie02.html

NIOSH (2004) Most workplace bullying is worker to worker, early findings from NIOSH study suggest Retrieved from: http://www.cdc.gov/NIOSH/updates/upd -07-28-04.html

Bibliography

BibliographyOppermann, S (2008) Workplace Bullying: Psychological Violence? Retrieved from the World Wide Web on July 30, 2009: http://www.workplacebullying.org/2009/05/04/workplace-bullying-psychological-violence-

Orlando Business Journal, (2002) Workplace bullying’s high cost: $180M in lost time, productivity. Retrieved from http://orlando.bizjournals.com/orlando/stories/2002/03/18/focus1.html

SAGE Publications (2012, July 2) “The Effects of Bullying and ‘Ambient’ Bullying in the Workplace” Medical News Today. Retrieved from www.medicalnewstoday.com/releases/247299.php

Skillings, L. N. (1990) Perceptions and feelings of nurses about horizontal violence as an expression of oppressed group behavior. USM.

Vanderwahl, T. (2005) Retrieved from the World Wide Web on July 31, 2009: Http://www.itstimes.com/jul2005.htm

BibliographyJusko, J. (2013) Operations: New Year’s resolution – stop workplace bullies. Retrieved from the world wide web on January 22, 2013: http://www.industryweek.com/safety/operations-new-years-resolution-stop-workplace-bullies

American Nurses Association (2013) Lateral violence and bullying in nursing. Retrieved from the world wide web on January 22, 2013: http://www.nursingworld.org/Mobile/Nursing-Factsheets/lateral-violence-and-bullying-in-nursing.html

Christopher, E. & Pohl, JC (2012) Teen truth. why youth have something to hide. Horizon Intertainment, LLC.

Inside Training (2013) Civility at work. Retrieved from the world wide web on May 29, 2013: http://trainingmag.com/content/civility-work

Townsend, T (2007) Break the bullying cycle. Retrieved from the world wide web on May 29, 2013: http://www.americannursetoday.com/article.aspx?id=8648&fid=8612