Teamwork is a critical element if the nursing profession is to achieve high-quality care and professionalism in the nursing profession. A team with a shared vision, respect for each other and respect for each other has better chances of achieving the desired results (Becher & Visonsky, 2012) . However, broken relationships at the workplace disrupt the efficiency of the team’s performance, thus increasing the chances for employee burnout, poor patient care delivery and in some instances, increased staff turnover (Becher & Visonsky, 2012) . Some of the bad relationships grow to aggression between the members of the team. This also applies to the nursing profession. Acts aggression by a nurse towards another is referred to as horizontal aggression or horizontal violence (Edward et.al., 2014).
A broad description of horizontal aggression expresses horizontal aggression in as any form of hostility or unwanted abuse by one or a group of nurses towards the other at the workplace (Russell, 2016) . This could be in the form of actions, attitudes, words or behaviors (Dellasega & Volpe, 2013). It is usually characterized by the presence of a series of repeated incidences of undermining, as isolated single conflicts. Repetitive conflicts often lead to depression, sometimes result in post-traumatic stress syndrome on the victim. Sometimes, it is hard to detect or discover the vice due to its hidden nature, making it difficult for the victim to seek assistance within the workplace environment (Vessey, DeMarco and DiFazio, 2010). In the nursing profession, the vice has been seen to be rampant as most of its members who are women are deemed as an oppressed group. This results from lack of control over the working environment, subsequently leading to low self-esteem which creates a good foundation for the development of horizontal aggression (Edward et.al., 2014).
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Thesis Statement
This paper describes the impacts of horizontal aggression on the efficient delivery of patient care and also teamwork. The nursing profession is critical in ensuring that a patient receives the best medical care required, and of the highest quality. However, encounters such as horizontal aggression hinder the achievement of quality care within the nursing profession. This paper looks at how horizontal aggression affects a nurses’ performance of their duties, how this affects the future of nursing, and how it can be remedied.
Impact of Horizontal Aggression
Horizontal aggression impacts negatively on the victim’s service delivery and professionalism. There are several different ways that this negative impact is manifested as discussed below.
i. Nurses become ostracized. Victims of horizontal aggression usually identify with negative feelings such as feeling unwelcome, unaccepted, undervalued, scrutinized, and unsupported by the other members of the team (Vessey, DeMarco and DiFazio, 2010). Sometimes, they become powerless and feel cheated when other members play dirty (Dellasega, 2011) . This results to the victims opting to leave their current work-place in the hope that they will find another employer where they will feel more welcome (Weaver, 2013) .
ii. Horizontal aggression increases the chances of error in a patient (Holmes, Rudge & Perron, 2011). As a result of excessive bullying, nurses who are victims’ emotional distress which disrupts their efficient delivery of service as well as their attention to the patient needs (Vessey, DeMarco and DiFazio, 2010). Cases have reported where nurses deliver wrong medication to the patient, and upon further investigation, it emerges that the nurse felt isolated and lacked the courage to seek support from his or her other team members (Edward et.al., 2014).
iii. Horizontal aggression results in a breakdown of care delivery within the nurses and the practitioners (Reynolds & Singh, 2014). In nursing, communication is crucial. Decision making usually is distributed within the ranks in the profession. This means that nurses are required to be in good communication terms with their team members both senior and junior to ensure that professionalism and delivery of patient care are met (Edward et.al., 2014). Horizontal aggression breaks communication within the team members, thus negatively affecting the delivery of patient care and decision making (Holmes, Rudge & Perron, 2011).
iv. Horizontal as aggression may result in physical damage in the victims. This also includes suicides by nurses due to increased cases of abuse or abuse. Some of the perpetrators of this vice often cause physical damage on their victims and even psychological and emotional distress which is mostly expressed as post-traumatic stress disorder (Vessey, DeMarco and DiFazio, 2010). There are instances where suicide cases have been reported as a result of increased instances of bullying. This negatively impacts on the level of professionalism exercised by the nurses (Holmes, Rudge & Perron, 2011).
Symptoms and Solutions to Horizontal Aggression
Symptoms
Some of the symptoms of horizontal aggression include;
• Increased usage of nonverbal communication within the team ("Decoding Horizontal Violence in Nursing", 2019).
• Increased rate of rudeness and tardiness within the team (Reynolds & Singh, 2014).
• Withholding of information, and sometimes cases of nurses setting up their colleagues for failure ("Decoding Horizontal Violence in Nursing", 2019).
• Passive aggression and instances of infighting among the team members (Reynolds & Singh, 2014).
Solutions
• Nursing leadership is required to position itself uniquely to detect any cases of horizontal aggression within the team members ("Decoding Horizontal Violence in Nursing", 2019).
• Hospitals and other health care centers where nurses are undertaking their duties should have elaborate guidelines that deter the vice while encouraging teamwork.
• Nurses should ensure that they hold themselves and their peers accountable for ensuring professionalism is practiced.
• Graduate and new nurses are the most hardly affected by horizontal aggression (Russell, 2016). To rectify this, new and graduate nurses should be oriented appropriately to ensure that they adjust well in the workplace (Weaver, 2013) .
• Establishing proper channels through which cases I horizontal aggression can be reported (Weaver, 2013) .
Impact of Horizontal Aggression on the Future of Nursing Profession
The vice of horizontal aggression highly threatens the future of the nursing profession. As noted earlier in this paper, new and graduate nurses are the most affected by the vice (Russell, 2016). Increased instances of horizontal aggression and failure to address it early in advance affect the future of the profession in the following ways;
• It reduces the number of new nurses enrolling into the profession (Weaver, 2013). As a result of the increased cases of bullying, new students fear to join the profession in fear of undergoing the same kind of treatment (Dellasega, 2011) . This will cause a negative impact on the efficiency of care delivery in the future.
• Having experienced this kind of treatment, there are chances that they will exert the same kind of treatment on the new nurses, which impacts on the quality of care that the profession will have in the future (Dellasega, 2011).
• If not addressed, horizontal aggression will dilute the intended duty of nurses, which is to provide high-quality medical care. Horizontal aggression disorients a nurse’s psychological well being, which affects how he or she performs her duties. This will result in degradation of the quality of care provided by the nurses in the future.
Conclusion
Horizontal aggression is a harmful vice that hinders the delivery of quality patient care. It negatively impacts on how a nurse or a group of nurses exercise their duties (Dellasega & Volpe, 2013). The impact could be as a result of either physical or emotional damage on the victims. There are cases where nurses have been reported to have administered wrong medication as a result of nurse becoming ostracized by the actions of his or her peers (Dellasega & Volpe, 2013). Patient care requires maximum attention and accuracy. The future of nursing is also under threat if the vice is not addressed adequately before it escalates to harmful levels. It is therefore essential that the healthcare workplace encourages teamwork and harmony. This will ensure that the nursing team works collaboratively towards the achievement of quality patient care and professionalism.
References
Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. Medsurg Nursing , 21 (4), 210.
Decoding Horizontal Violence in Nursing. (2019). Retrieved from https://www.crisisprevention.com/Blog/October-2017/Decoding-Horizontal-Violence-in-NursingDecoding Horizontal Violence in Nursing. (2019). Retrieved from https://www.crisisprevention.com/Blog/October-2017/Decoding-Horizontal-Violence-in-Nursing
Dellasega, C. (2011). What to do when nurses hurt nurses. Sigma Theta Tau International.
Dellasega, C., & Volpe, R. (2013). Toxic nursing. Indianapolis, IN: Sigma Theta Tau International.
Edward, K. L., Ousey, K., Warelow, P., & Lui, S. (2014). Nursing and aggression in the workplace: a systematic review. British Journal of Nursing, 23(12), 653-659.
Holmes, D., Rudge, T., & Perron, A. (2011). (Re)thinking Violence in Health Care Settings: A Critical Approach (Rethinking Violence in Health Care Settings). Ashgate Publishing Group.
Reynolds, G., Kelly, S., & Singh-Carlson, S. (2014). Horizontal hostility and verbal violence between nurses in the perinatal arena of health care. Nursing Management (2014+), 20(9), 24.
Russell, M. (2016). Lateral violence among new graduate nurses. Gardner-Webb University.
Vessey, J. A., DeMarco, R., & DiFazio, R. (2010). Bullying, harassment, and horizontal violence in the nursing workforce the state of the Science. Annual review of nursing research, 28(1), 133-157.
Weaver, K. (2013). The Effects of Horizontal Violence and Bullying on New Nurse Retention. Journal For Nurses In Professional Development, 29(3), 138-142. doi: 10.1097/nnd.0b013e318291c453
