Nursing Perceptions of

Horizontal Violence in an Acute

Care SettingNicole R. Malmstrom MBA, MSN, RN

CHI Health St. Francis

Disclosures to Participants

I would like to note that I have no financial or other conflicts to disclose.

Objectives

• Define the difference between overt and covert forms of horizontal violence

• Identify strategies used to decrease horizontal violence at one hospital

Review of Literature

• Little research on nurses’ perception

• Studies conducted have little generalizability outside their areas

• Why bullying happens

• Prevalence

– Reported incidents range from 18-31%

• Ethics involved

– American Nurses Association Code of Ethics

• Damaged dignity

• Loss of self-worth

The Research Question

• How does bullying effect nurse engagement

• PICO

Method

• Two phase design

• Horizontal Violence Workplace Inventory (HVWI)

• NDNQI

Examples of survey questions

• Being verbally threatened by a co-worker (O)

• Criticizing someone without having heard both sides of the story (C)

• I have felt discouraged because of a lack of positive feedback (P)

• I have not spoken up for fear of retaliation (P)

Who Exhibited?

• Aides

• Peers

• Supervisors

• Physicians

Results of Phase 1

• 38% Reported Being Bullied by Peers

• 24% report seeing or experiencing

• Only 16% were able to answer this as “once” or “never”

Top 5 Rated Questions

1) Complaining about someone

2) Negative remarks

3) Belittling

4) Making hurtful remarks

5) Criticizing

Safety Concerns

• 7 Questions

– Address as soon as possible

• Not helping

• Not speaking up

– Not asking questions

– Asking for help

Actions Taken

• Disseminated findings to staff

• Code of conduct

• Enforcement

• Education

Phase 2

• Pre-selected questions

– Job enjoyment

– Job satisfaction

Results of Phase 2

0.775

0.678 0.685

0.873

0.317

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Good place to work Manager backs up Feel they have to forcethemselves to come to

work

Respect MD cooperation

“RNs Pitch In to Work” versus NDNQI Questions

Co

rre

lati

on

48

50

52

54

56

58

60

62

64

66

2011 2012 2013 2014

Job Enjoyment All UnitsEn

joym

en

t (s

cale

0-1

00

)

National Data

Hospital Data

42

44

46

48

50

52

54

56

58

2011 2012 2013 2014

Job Enjoyment 5 Med-Surg

National Data

Hospital Data

Interventions

• Mentor/buddy

• Conflict resolution

• Character agreement

• Code word

• Education

• Personal assessment

• Bully Free buttons

Results Over the Years

0

0.5

1

1.5

2

2.5

3

Overt Covert Personal Who Bullies?

Bullying Through the Years

2014 2015 2016

0

10

20

30

40

50

60

70

80

90

100

Low Observations Medium Observations High Observations

Overt Horizontal Violence

2014 2015 2016

P= 0.011

0

20

40

60

80

100

120

Low Observations Medium Observations High Observations

Personal Horizontal Violence

2014 2015 2016

P= 0.0174

NDNQI

4.1

4.15

4.2

4.25

4.3

4.35

4.4

4.45

4.5

2014 Unit 2014 Mean 2015 Unit 2015 Mean

I have to force myself to come to work much of the time

4.04

4.06

4.08

4.1

4.12

4.14

4.16

4.18

4.2

2014 Unit 2014 Mean 2015 Unit 2015 Mean

In my job, I am treated with dignity and respect by everyone

3.8

4

4.2

4.4

4.6

4.8

5

5.2

2013 Unit 2013 Mean 2014 Unit 2014 Mean 2015 Unit 2015 Mean

Would recommend this hospital/would recommend unit

Limitations

• Linking results to units

• Different NDNQI surveys

• Generalizability

Thank you

• Beth Bartlett, MSN, RN, CENP, Vice President of Patient Care Services, CHI Health St. Francis

• Dr. Brenda Bergman-Evans, PhD, CHI Health, for initial data analysis

• Coordinating Council CHI Health St. Francis

1. Alspach, G. (2007). Critical care nurses as coworkers: Are our interactions nice or nasty? Critical Care Nurse, 27, 10-14

ANA (2014). National database for nursing quality indicators. Retrieved from http://nursingworld.org/Research-Toolkit/NDNQI

2. Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. MEDSURG Nursing, 21(4), 210-213, 232. Retrieved from

http://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/resources/MSNJ-Becher-

Visovsky-21-04.pdf

3. Cohen, S. (2012). From sheep to lion: Confronting workplace bullying. Nursing Management, 45(7), 9-11

4. Katrinli, A., Atabay, G., Gunay, G., & Cangarli, B.G. (2010). Nurses’ perceptions of individual and organizational political

reasons for horizontal peer bullying. Nursing Ethics, 17(5), 614-627

5. Reynolds, G., Kelly, S., & Singh-Carlson, S. (2014). Horizontal hostility and verbal violence between nurses in the

perinatal area of health care. Nursing Management, 20(9), 24-30

6. Riggleman, K., Lein, A., Meisinger, S., Dumont, C. (2010). Horizontal violence (bullying) and relationships to nurse job

satisfaction in acute care. Podium presentation for the NDNQI Conference, New Orleans

7. Thompson, R. (2013). Take action against nurse bullying: strategies for individuals. MEDSURG Nursing, 22(6), 403-404

References