6 Oct 2022


Prevalence of Horizontal Violence in Nursing

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Academic level: Ph.D.

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“Nurses eat their young” is one of the common expressions of the nursing profession in recent years that has continued to grow in prominence. This expression does not refer to nurses being cannibalistic with others in its literal context. Instead, the phrase is used to describe the bullying behaviors experienced by nurses in the workplace that puts patient safety at risk and risks the stability of the nursing profession. The phrase is used about hazing and bullying in nursing, which has become a persistent hazard in the workforce. It has been used by nurses internationally for over 30 years, though little has been done to combat the vice ( Stanley et al., 2007) . The idiom was coined as a call to action for nurses to stop bullying their inexperienced co-workers. However, the bullying seems to be getting worse each passing day with organizations accepting nurse-to-nurse violence as part of the job. In this study, I examine the horizontal violence phenomenon in the nursing field and how it has created a hostile working environment. Despite nurses uniformly accepting the phrase as part of the nursing profession, they are losing out on the essentials of an ideal nursing environment. 

Horizontal violence is a term used to describe workplace bullying in nursing. It comprises behaviors such as intimidating others, spreading rumors or withholding information that can be crucial for some individuals. The practice is mostly directed towards newly licensed nurses, who are often victims of humiliation and belittlement ( Sheridan-Leos, 2008) . The phrase “nurses ear their young” is an unfortunate idiom that refers to the way some qualified nurses treat their junior nurses. Horizontal violence is often described with other words such as relational aggression, workplace bullying, and hazing. It is characterized by aggression and hostility shown towards a co-worker through words, attitudes, or actions. There have been multiple forums where nurses share experiences of being hazed, bullied, or rejected by more experienced nurses ( McKenna et al., 2003). 

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The horizontal violence in nursing has been embedded and an epidemic problem that is ingrained in the culture and how nurses operate within the health facility. The prevailing culture and organizational structure have contributed to horizontal violence and weak employee bonding. The bullying occurs when senior nurses misuse their position by undermining the opinions of their co-workers in junior ranks. Since the newly admitted nurses have less power in the workplace, they are often bullied into working longer hours, more shifts, or doing anything thrown at them. 

This phrase of nurses eating their young is a growing problem that has been embedded in the institution’s culture. For a long time, organizations have allowed this culture of workplace bullying to continue through the organizational culture created in the workplace. Horizontal violence is different from other forms of workplace harassment, such as sexual harassment or discrimination ( Dunn, 2003) . This is the reason why little has been done to deal with the vice in health organizations. While workforce harassment such as sexual insults is condemned in the code of conduct, horizontal violence is often perceived as a part of organizational culture that is normal for employees. 

The prevalence of workplace bullying in the nursing profession is higher than most professionals in the world. Over the years, horizontal violence in nursing has been happening with worrisome frequency, which is a worrying habit within the field of nursing. Reports have revealed that nurses have a higher risk of being bullied in their first years of employment than anyone else ( Sheridan-Leos, 2008) . Slightly over 85 percent of newly registered nurses report having experienced bullying in the first three months of practice. The scope of lateral violence is so enormous that nearly every nurse experiences it in their careers. The recent estimation of bullying in the nursing field is placed at 30 percent, with the rates high among the newly licensed nurses ( McKenna et al., 2003)

These findings indicate the existence of a problem that can be cancerous within the field that is expected to take care of patients. It is an anomaly for a profession like nursing to produce unusually high levels of bullying, with the extent of its use, creating a hostile working environment. The nursing profession should be a caring profession that focuses on helping individuals with their health and wellness. Nurses are professionals who dedicate themselves to improve the health of their clients. They need a conducive working environment to provide the best quality services to patients and ensure their safety. 

Graduates of nursing school go through enough stress getting a license before being admitted to the nursing field. As such, they expect the career to be friendlier to reap the fruits of their hard labor. Most newly licensed nurses entering the workforce have little idea of experiencing bullying in the field. A majority are excited and motivated to begin a career where they extract happiness and satisfaction from helping others ( Stanley et al., 2007) . However, since most students do not expect to experience bullying in the workplace, they are left soul crashed. This is why the nursing profession is no longer considered a luxury for most high school students who are thinking of their future career paths. 

This expression is a warning that is often repeated to nursing students and also used in the nursing field. It has been used to perpetuate bullying behaviors between nurses by mimicking how someone was oriented into a facility. Several assumptions and theories have been made regarding the cause of bullying behavior in the nursing field. The approaches have been established to understand this phenomenon of horizontal violence in the workplace. Some assumptions have argued that people are susceptible to social influence to prevent being isolated from the group. The theories have also associated the abusive and demeaning behavior towards co-workers with an individual's sense of entitlement. This sense of entitlement entails an individual expecting special attention and privileges or not wanting to work overtime due to the presence of a junior co-worker. Other theories have attributed the workplace bullying to issues of workplace stress due to long working hours that creates an environment that breeds bullies. 

Forms of Horizontal Violence 

Lateral violence in healthcare is often a repeated form of emotional, psychological, and physical abuse of nurses intending to demean or humiliate another employee at the same level of responsibility. For decades, nurses have been subject to emotional attacks from their peers in the workplace without having to understand its justification ( Sheridan-Leos, 2008) . Some nurses have reported being undervalued by other nurses or being used to settle personal issues. For example, some nurses at the end of workplace bullying have contemplated suicide due to bullying. Female health workers are at high risk of death due to emotional abuse. 

The horizontal violence in nursing takes several forms in the organization involving nurses and senior individuals in the organization. Bullying in the nursing department can involve continued criticism, career sabotage, and unfair assignment that undermines the professionalism of a nurse ( Dunn, 2003) . This problem is most prevalent among graduates and licensed nurses joining the organization. It involves physical or non-physical acts such as sabotage, undermining nurses, verbal confrontation, and scapegoating, backbiting as well as destructive criticism. For example, a majority of nurses in the workforce complain of verbal abuse from their seniors. The horizontal violence will be evident when a senior nurse yells at a junior employee while performing different practices ( Stanley et al., 2007) . In other cases, nursing instructors berate students for not coming to work even when they have a legitimate excuse such as being sick with a doctor’s note 

Nurses who eat their young have made a habit of turning on others, calling them words such as stupid in front of everyone. The bullying has seen junior nurses waiting for the main bully and his friends to go to lunch first before going to take lunch. The bullies would often alienate other nurses when making lunch, which is one of the hardest things that can happen to a nurse in the workplace ( Dunn, 2003) . In some other cases, nurses are overworked or humiliated in front of patients and other peers, which often affects their self-confidence. 

Effects of Horizontal Bullying in Nursing 

The consequences of uncontrolled bullying and violence in a nursing stretch beyond the wealth and wellness of affected nurses. Its existence contributes to an unsafe work environment for all persons involved. The workplace bullying behaviors often leads to demanding work environments for nurses that often leads to a weak patient outcome that can risk the health of patients. For example, nurses taking part in surgery need all the peace of mind and calmness to operate. However, this can be jeopardized when such professionals are humiliated and intimidated. 

This aspect of nursing eating their young has contributed to the nursing shortage with fewer people willing to take up a course in the field. The bullying has also contributed to nursing shortages by demotivating people from a nursing career in nursing. Several students have retracted from pursuing a career in nursing after reading the experiences of other nurses in the workplace. In the past, some so many people dreamed of pursuing a career in nursing. The incentives and satisfaction that comes with caring for the sick always drove people into going for the nursing degree and getting employment into the nursing field ( Becher & Visovsky, 2012) . In the same light, the current nursing shortage in the nursing department has contributed to making the working environment hostile for nurses, who often struggle meeting the increasing demand. Hostile violence emerges when the demand for health services is high that puts workers in an atmosphere of anxiety. 

The cost of horizontal force is also high, with a significant effect based on field research. The impact of this bullying is experienced in the form of absenteeism, mental health conditions, as well as poor nurse performance ( Stanley et al., 2007) . Feeling undermined and unsupported in the workplace can affect the motivation of any person and their ability to be effective. The bullying experienced in the nursing field affects nurse’s practice and mental health. This is especially crucial when nurses are humiliated in front of patients, such as being ordered to perform specific exercises. The humiliation in front of patients can make them uncomfortable and feel unqualified to treat patients. Some nurses may experience stress or even depression due to belittlement. 

Furthermore, the high rate of turnover has been associated with this culture of horizontal violence. The hazing is sometimes too bad that nurses opt to resign and even find a new career away from nursing. Research has shown that horizontal violence against junior nurses in the workplace has contributed to high turnover rates ( Becher & Visovsky, 2012) . For example, a majority of bullying victims in the nursing field have been reported to contemplate leaving the profession to look for other careers before they retire. The newly registered nurses have a higher risk of resigning from the business within three years of employment by believing they are in the wrong profession. Studies have shown that bullying has been the cause of employee turn-out and nurse shortage in healthcare more than any other reason ( Becher & Visovsky, 2012) . This employee turnout affects the health industry in many ways, including nurse shortages and the costs of replacing the nurses. 

Therefore, there are numerous consequences of horizontal violence in the nursing profession that affects both the worker and the patient. The patient can be severely compromised when nurses have to deal with issues of a hostile working environment, including poor health outcomes and patient experience. Nurses require an appropriate working environment that would allow then to focus on patient’s needs rather than their issues. The nursing profession is hard and stressful, one that requires support and compassion from all staff. However, when the most established nurses involve themselves in the issues of horizontal violence, it leaves many nurses frustrated and demotivated to continue working. The efficiency of their services can be compromised whenever they are distracted from focusing on patient needs. 

Role of Leadership and Management 

One of the major perpetrators of workplace bullying in nursing is the leadership and management style portrayed at the top hierarchy. This leadership has allowed horizontal violence to develop into a culture and made it difficult to combat it. Bullying has continued to grow in the nursing profession because the management has turned a blind eye to it. Most organizations have continued to pretend that nurse-bullying does not occur because victims of this horizontal violence are more loyal and tend to work for longer hours ( Sheridan-Leos, 2008) . They have been providing a silent treatment to the rampant hazing while perpetuating it through their actions. When in the nursing field, this old fashioned bullying is often called “nursing little secret” in playing down its aggressiveness and accept it in the nursing culture. 

At the same time, the horizontal violence has not been addressed due to a corrupt power grip at the helm of the nursing profession that makes it difficult to combat the issue of bullying. For example, nurses who attempt to complain about bullying and unsafe workloads risk losing their jobs. A majority of horizontal violence victims fear speaking out due to a need to protect their jobs. Many nurses have been forced to live with horizontal violence due to the fear of job security and having the whole family support at home. At the same time, bullying behaviors are not always easily describable for victims seeking help. They often fail to see the light due to a lack of sufficient evidence to substantiate the claims. In this regard, it is rare for the bullies to get in trouble for their behavior since they are often favored, employees. 

Often, the perpetrator of horizontal bullying in hospitals is in a position of power that makes them invincible to being ridiculed. Most bullies in the workplace have the power to control different roles and tasks over other employees through a process of ritual indoctrination. This workplace bullying has been associated with aspects such as low staff morale and poor esteem of nurses. The bullying has also been characterized by destroying the confidence and self-image of nurses falling victim to the behavior, which often pushes them out of the nursing field to other professionals. 

At the same time, while a majority of the bullying is from nurses in senior positions, there are cases where bullying involves peer-to-peer as well as patient-to-nurse bullying. Studies have shown that more nurses experience bullying from their peers than from senior hospital staff ( Embree & White, 2010) . They are frequently verbally abused and harassed by their peers that often lead to communication breakdown. 

In essence, this issue of workplace bullying in nursing is more of a cultural problem than a structural issue, which has made it difficult to control. Most nurses who use this term do not perceive incidences of horizontal violence as bullying nor inappropriate behavior. Instead, nurses see bullying and lateral violence as part of offending an individual’s persona and role of the profession. This makes it difficult to minimize the experiences of bullying ( McKenna et al., 2003) . In most cases, nurses who experience incidences of bullying in the workplace rarely report them for appropriate action, which means more nurses continue working in a hostile environment and are forced to adapt. 

Addressing the Problem 

It is about time for health organizations to recognize that nurse-bullying is a significant factor in the workplace and should stop blaming victims. No nurse puts themselves in a position to be bullied, but are victims of circumstances that are growing into a significant problem. A lack of intervention programs toward bullying has significantly affected the nursing profession as a whole ( Egues & Leinung, 2013) . Addressing his issue has been a problem due to a lack of regulatory precedent to reference when looking to deal with the problem. As a result, individual organizations are forced to develop and enforce codes of conduct that can address the issue. 

In this regard, health organizations need to develop policies regarding this prevalent issue of horizontal judgment. The strategies for combating horizontal violence in the nursing field should be similar to those implemented for other discriminatory behaviors such as sexual harassment in the organization ( Egues & Leinung, 2013) . This is because dealing with an inherent bullying problem is akin to changing the organizational culture. Culture change in the nursing profession requires more than a code of conduct as they rarely address cultural issues. Therefore, instead of holding each other up, the managers and senior nurses in work must implement policies that reduce the culture through workplace training. 

Nursing schools should teach students how to identify and stop nurse bullies because the problem needs urgent intervention. For example, workplace training can provide the required layer for dealing with this cultural issue in the field of nursing. Training can focus on reinforcing the impacts of this behavior while triggering anxiety among those involved in the vice ( Egues & Leinung, 2013) . Currently, no class in nursing school teaches students and nurses on how they can deal with the problem of the workplace and addresses the ever-present phenomena of nurses eating their young. No one talks about workforce bullying in the nursing school despite being a common phenomenon, which means most students are unprepared for the vice once they enter the workforce. The nursing curriculum should introduce this topic to teach how to combat lateral violence, address the phenomena, and explain how to identify and stop nurse bullies ( Egues & Leinung, 2013)


The issue of workplace bullying in nursing is becoming increasingly common and pertinent in the nursing profession. The phrase “nurses eat their young” has been used to refer to workplace bullying and how nurses treat junior nurses. However, bullying is an unfortunate culture that has continued to taint the good name associated with a career in nursing. Due to its continued increase over the years, it necessitates a need to develop interventions that would address it. This is a real problem in the nursing field, continually tainting the name of the profession that was once a revered profession in the whole world. Bullying is also contagion in the sense that it spreads from one generation to another over the years when not controlled. 

Reports have shown that the power and marginalization of nurses at the workplace have contributed to this problem of bullying ( Stanley et al., 2007) . The victims of this lateral violence experiences feelings of humiliation, being demeaned and ridiculed, which may grow into stress and depression ( McKenna et al., 2003) . The harassment that victims of horizontal violence experience have a significant effect on their career as well as personal life, with the right proportion of nurses leaving the profession or retiring early. The consequences of this lateral violence in nursing include poor performance from nurses that could affect the safety of patients. In essence, bullying should not be a factor in the nursing department that is associated with caring for other people. 


Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing.  Medsurg Nursing 21 (4), 210. 

Dunn, H. (2003). Horizontal violence among nurses in the operating room.  AORN Journal 78 (6), 977-988. 

Egues, A. L., & Leinung, E. Z. (2013, July). The bully within and without Strategies to address horizontal violence in nursing. In Nursing forum  (Vol. 48, No. 3, pp. 185-190). 

Embree, J. L., & White, A. H. (2010, July). Concept analysis: nurse‐to‐nurse lateral violence. In  Nursing forum  (Vol. 45, No. 3, pp. 166-173). Malden, USA: Blackwell Publishing Inc. 

McKenna, B. G., Smith, N. A., Poole, S. J., & Coverdale, J. H. (2003). Horizontal violence: Experiences of registered nurses in their first year of practice.  Journal of advanced nursing 42 (1), 90-96. 

Sheridan-Leos, N. (2008). Understanding lateral violence in nursing.  Clinical Journal of Oncology Nursing 12 (3), 399. 

Stanley, K. M., Martin, M. M., Michel, Y., Welton, J. M., & Nemeth, L. S. (2007). Examining lateral violence in the nursing workforce.  Issues in Mental Health Nursing 28 (11), 1247-1265. 

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