Nurses are known to be the devoted caregiver of sick patients. How can the patients get rid of their burden if their own caregivers are in conflict among each other in hospital settings? When there is conflict in such kind of environment, it is called horizontal violence, interpersonal conflict or bullying which is aggressive and destructive behavior of nurses against each other (Woelfle & McCaffrey, 2007). It is an expression of oppressed group behavior evolving from feelings of low self-esteem and lack of respect from others which is supported by the theory of oppression.
According to the theory stated by Woelfle & McCaffrey (2007), in order for the horizontal violence to take place in the nursing setting, oppression exists when a powerful and dominant group controls and exploits a less influential or easy target group. As a consequence the oppressed group displays low self esteem and self hatred as evidenced by anger and frustration (Woelfle & McCaffrey, 2007).
Group of nurses, Base Hospital #45
Nurse log, Quinault Rain Forest Nature Trail
Nurse PractitionerThe theory of oppression helps to explain that the behaviors of horizontal violence aren't directed at the individual but rather is a response to the specific situation where one feels fear of punishment that prevents the nurse from responding to the oppression. When people feel oppressed they feel inferior and powerless. These kinds of nurses who feel powerless behave aggressively towards peers to relieve tension because they can't fight against their oppressor. That results to the display of emotion which victimize the colleague where the colleague or the coworker gets the feeling of vulnerability or prone to be hurt. The emotion or body language often includes rolling of the eyes, folding the arms or storming out of the room, using sarcasm, raised voice and shouting. These people manipulate the work environment while denying doing anything wrong and get satisfied from experiential difficulty and discomfort of others. These negative behaviors have obvious results in human mind leading to anxiety and stress at work. This cycle of denial maintains its own pattern of repeated action against the vulnerable group and allows the power relations to be unchallenged. Rather than fighting back and risking from the superiors/violence creators, the oppressed groups' frustration is manifested as conflict in their own ranks with horizontal violence from coworker to coworker. Hence, people begin to think this kind of behavior as a norm which they displace their feeling of aggression to another highly prone groups such as new grad nurse or student and even less confident coworkers. This cycle of behavior is typically described as horizontal violence (Woelfle & McCaffrey, 2007).
As an example, a coworker in a unit behaves aggressively in a reaction to their own part of stress by acting aggressively and displacing their anger to another same or lower hierarchical level group or coworker. Another coworker as a victim gets devastated with this behavior especially if the superior authority or managers don't acknowledge the behavior. Hence the victim feels angry, frustrated and vulnerable continuing the cycle of horizontal violence. Rather than fighting back against the aggressor, this group accepts this as a behavioral norm which they unconsciously displace to other lower or same hierarchical level coworker such as grad nurse or the nursing students. These nursing students or grad nurses later learn to displace their stress to other with the verbal or nonverbal expression giving the feeling of vulnerability to the prone groups. Hence this cycle of oppression continues as a horizontal violence in the work place area as part of the work stress. Consequently the oppressed group often lack autonomy, accountability and control over their profession (Woelfle & McCaffrey, 2007).
Horizontal violence is a purposeful ongoing collection of often negative behaviors and actions that accumulate over time. Moreover, it includes repeated acts involving an imbalance of strength or power, in which one or more individuals engage in over time with the intention to harm other and create a hostile work environment. They displace their part of frustration to others in the form of negative verbal or nonverbal expression. The cycle of oppression continues which is supported by the theory of oppression. The result of horizontal violence affects nurses, nursing managers, other medical and administrative staff, patient and their family. It is clear that horizontal violence is everywhere in nursing today and can drastically affect the nursing area. When the tension is elevated in the patient care, nurses cannot perform their best which often lead to poor quality patient care (Woelfle & McCaffrey, 2007).
Reference:Woelfle, C. Y. & McCaffrey, R. ( July-September, 2007). Nurse on nurse. Nursing Forum, Vol 42(3), p123-131
British nurse in nurses' station.
Czech nursing students.
Nurse in Australia (undated)