Horizontal violence is widespread in nursing with deep influences. Foreign studies on horizontal violence among nurses are rich in content, including epidemic characteristics, influencing factors, impacts, intervention measures, experiences, etc. However, domestic studies are limited to current situation investigation and influencing factors. Research on intervention measures is very lacking. In this paper, horizontal violence relevant literatures at home and abroad were reviewed, and the epidemiological characteristics, effects and strategies adopted abroad were summarized, to provide references for domestic researches.
Nurses play an important role in ensuring patient safety. However, the safety of nurses themselves deserves deep consideration. The American Nurses Association proposed that every nurse has the right to work in a safe environment, which is a prerequisite for providing high-quality patient care [
Horizontal violence is one of the types of violence in the medical workplace violence [
summary, the difference between horizontal violence and bullying is that horizontal violence is an isolated or single negative action event [
Forms of horizontal violence are widely, in Ebrahimi’s study [
Horizontal violence is common in the nursing profession and can occur at all levels of nurses. And it has been proved to be a global problem, however, the prevalence of horizontal violence is different from countries, Bambi’s study [
withholding information | discourage enthusiasm |
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humiliate or ridicule | continuing criticism |
command others to do work that is beyond their abilities | ignore the opinions of others deliberately |
spread malicious gossip | make mischief |
neglect, exclusion or isolation | excessive monitoring of other’s work |
talk or whispers behind one’s back | undermine others’ chances of success or promotion |
public dressing down | blocking access to resources |
release anger on others | joke excessively |
threaten or intimidate | scapegoat |
refusing to help | biased report |
leaking or offensive comments about other’s privacy | ethnic discrimination |
tell someone to quit their job | physical violence (eg: throwing, pushing, spitting) |
experience of horizontal violence of the head nurse and found that the head nurse, like other ordinary nurses, would experience different levels of horizontal violence at work too.
In domestic studies, nurses generally experience horizontal violence. Woo [
Although studies have found a high incidence of lateral violence, The occupational safety and health administration of the United States points out that because the reporting process of organizations is not sound, victims are afraid of retaliation, and horizontal violence is generally underestimated, and low reporting rate is common [
Horizontal violence has negative psychological and physical effects on the health of nurses. It often does not directly attack nurses physically, but indirectly puts victims in a state of high level stress, leading to stress-related disorders and injuries. Physiologically, repeated exposure to stressors depletes the body’s defense system and increases the risk of heart disease, hypertension, sleep disorders and other adverse reactions to stress [
The influences of horizontal violence on patients are of particular concern. Several studies have shown that horizontal violence and other incivility workplace behaviors can affect patient outcomes. Bloom [
According to the US Bureau of labor statistics, currently there are about 3.6 million registered nurses in the US by 2022, it is expected that more than half a million registered nurses will retire, which will create a labor gap for nearly 1 million new registered nurses [
Health care organizations experience a financial burden when employees are impacted by workplace incidences like horizontal violence. Indvik [
There is one research on the intervention of horizontal violence in China at present, coping strategies studied abroad are rich including: Education intervention, Leadership style and behaviors, policies. Basic informations of reviewed articles are listed in
By integrating bullying information and knowledge into the prelicensure nursing curriculum may help change the perception of bullying from an acceptable part of nursing to intolerable and unprofessional behavior. Nikstaitis [
Problem-based learning is an additional educational intervention that has been
research | design | conclusion |
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Nikstaitis 2014 | A quantitative pilot study between 21 nurses | Educational intervention can improve nurses’ awareness of incivility |
Ceravolo 2012 | A quantitative study in inpatient nurses | Educational workshops that enhanced awareness of lateral violence and improved assertive communication |
Clark 2014 | A qualitative study describing how knowledge gained from the Problem based learning (PBL) | A PBL scenario was an effective teaching strategy for preparing new graduates to address nurse-to-nurse incivility in the practice setting. |
Kang 2017 | A randomized controlled trial was performed between 40 nurses | The cognitive rehearsal for workplace bullying improves interpersonal relationships and decreases turnover intention |
Griffin 2014 | A review the use of cognitive rehearsal | Cognitive rehearsal was revisited as a shield for incivility and lateral violence |
Kennedy 2015 | A review to state the role of empowerment in improving the clinical environment | Empowerment can contribute positively to improving the environment in which care is provided |
Wing 2015 | A predictive, non-experimental study in 394 new graduate nurses | Empowering workplaces contribute to lower mental health symptoms in new graduate nurses, empowerment was significantly negatively correlated with supervisor incivility |
Myers 2016 | A qualitative study to explore nurses’ experiences of horizontal violence | Nurse managers need to be the culture champions who hold individuals accountable for HV and foster professionalism through their leadership |
shown to mitigate the effects of horizontal violence. It involves self-learning and group discussion, with the aim not to solve the problem raised but to increase the overall understanding of the problem raised [
Cognitive rehearsal is a technique commonly used in cognitive behavioral therapy, in which individuals rehearse specific situations to practice appropriate interactions or positive coping processes. Cognitive rehearsal consists of four stages: developing scenarios, determining communication standards, role-playing and feedback evaluation [
Leaders play a key role in organizational culture and atmosphere, and transformational leaders can create a more positive interpersonal relationship and work environment. The main feature of transformational leadership is empowerment, which is an important method to improve the work efficiency of employees and achieve individual and collective goals [
In health care settings, solutions to horizontal violence include the direct involvement of nursing leaders. Myers et al. [
The development and implementation of policies on uncivil behaviours in the workplace is a major strategy that organizations should adopt. Although the joint commission advocates for policies on various types of workplace incivility, research on such interventions is lacking in the nursing literature. Rocker [
Horizontal violence has been proven to be widespread in the nursing profession and can occur at all levels of the nursing profession. According to the national nursing development plan (2016-2020) formulated by the National Health and Family Planning Commission, the development of nursing in China is faced with the challenge of the relatively insufficient number of nurses. And tense doctor-patient relationship in our country, when nurses are suffering the external violence from patients and their families, horizontal violence from their colleagues is happening at the same time, this will undoubtedly cause tremendous pressure to nurses, then inevitably lead to the nurse’s staff turnover, therefore, lateral violence among nurses needs to be solved urgently.
Nursing managers in alleviating lateral violence plays a vital role, the manager’s behavior is an example to nurses, the biggest influence of horizontal violence is building team cooperation awareness between nursing administrators and nurses, managers can prevent horizontal violence through participating in unit of daily affairs and work flow, creating a strong sense of teamwork between staff and supervisor; working together to complete tasks or make decisions, empowering staff by asking for input and making decisions based on staff feedback, establishing close relationship with employees, etc. In addition, nurses’ cognition of horizontal violence is insufficient, most nurses think horizontal violence as part of their work mistakenly, even unable to identify these behaviors, thus can’t deal with it correctly [
Horizontal violence is a challenge and threat to nursing, deserving more attention of domestic nurses and managers. In the following studies, the depth and breadth of the research should be increased, large sample surveys and interviews should be conducted, and interventions in line with the condition of nursing in China should be further explored.
The authors declare no conflicts of interest regarding the publication of this paper.
Zhang, X. and Xiong, L.J. (2019) Impact of Nurse Horizontal Violence and Coping Strategies: A Review. Yangtze Medicine, 3, 289-300. https://doi.org/10.4236/ym.2019.34028