Workplace and Horizontal Violence in Nursing

Workplace and Horizontal Violence in Nursing

Definition and Scope of the Issue

The duty of a nurse is to continuously provide unconditional love, patience, and the utmost care for their patients’ health and safety. It is almost impossible for anyone to work in an environment in which they feel their safety is jeopardized. In the present-day, workplace violence has been an ongoing global issue, especially in the healthcare setting. “Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors.” Another term that coincides with workplace violence is horizontal violence, which is any act that can be deemed as aggressive among employees. In relation to nursing, this aggression can be nurse to nurse or from a group to one individual. Some examples of workplace and horizontal violence are belittlement, verbal and physical abuse, sarcasm, unprofessional criticism, humiliation, unfair work tasks, and peer favoritism. There are guidelines that are set in order to help reduce the number of workplace violence cases.

Scope of the Issue Related to the Nursing Profession

According to the National Institute for Occupational Safety, there are three different categories of workplace violence. The three different types of workplace violence are criminal intent, customer/client, worker-on-worker, and personal relationship. Criminal intent violence is when “the perpetrator has no legitimate relationship to the business or its employees, and is usually committing a crime in conjunction with the violence (Ceplenski, 2013).” An example of this category is a physician gets robbed in the parking garage. This type of violence is less commonly seen in healthcare settings.

Customer/client violence, the most common category, happens when “the perpetrator has a legitimate relationship with the business and becomes violent while being served by the business. It is believed that a large portion of customer/client incidents occur in the health care industry in settings such as nursing homes or psychiatric facilities; the victims are often patient caregivers (Ceplenski, 2013).” Healthcare workers are at the greatest for this particular type of violence because of their constant interaction with people on a daily basis.

The third type of workplace violence is worker-on-worker. In this violence “the perpetrator is an employee or past employee, who attacks or threatens another employee(s) (Ceplenski, 2013).” This can stem from people losing their jobs because of something they did wrong, personal situations outside of work, and built up aggression from bullying from peers at work. Managers are most likely to experience this in the nursing field. Worker-on-worker violence is also termed horizontal violence. This occurs in chain of command relationship as doctor to nurse and nurse to unlicensed assistive personnel (UAP).

Lastly, personal relationship is when “the perpetrator usually does not have a relationship with the business but has a relationship with the intended victim (Ceplenski, 2013). Personal relationship violence is directly related to domestic violence. These situations happen because of things that are happening outside of the workplace but boils over into it. Women are at the highest risk for this based on today’s statistics for domestic violence. This specific type of workplace violence can lead to fatalities in the severity of the situation.

In addition to workplace violence, horizontal violence has evolved into being the act of bullying in the workplace. Bullying has been more common because some nurses seem to think that it is okay to bully or mistreat new nurses on their unit. This is where the famous saying “the nurses eat their young” comes from. The effects of workplace and horizontal violence on nurses include depression, low self-esteem, anxiety, and high levels of stress. In the world today, higher authorities tend to let their authoritative power get the best of them and begin to mistreat the ones who do right by them. New nurses who experience workplace violence are more vulnerable to just keep letting it slide until it reaches a point where they can no longer tolerate it. In some extreme cases of workplace violence and bullying, it has led to even some fatalities because every does not have a strong mindset to tolerate things that people say or do to them. Nurses are already stressed enough with all of the responsibilities that they have to uphold on a daily basis and violence would not do anything but make it worse. Bullying in the workplace has been going not anything new, but has actually been going on a long time. It now has progressed into an ongoing epidemic that does not seem to ever cease.

Trends and/or Views on the Issue by Scholarly Experts

The way that the healthcare is set at a high standard it is common that nurses do not report any type of workplace violence because of the feeling of being punished. “A total of 61.6% of the nurses surveyed had been exposed to violence in the past year. Most victims were exposed to psychological (60.1%) and economic violence (28.9%). Victims reported acts of violence in formal written form in a range from 6.5% (psychological violence) to 10.9% (physical violence). The largest share of victims who did not report violence and did not speak to anyone about it were victims of sexual violence (17.9%). The main reason for not reporting the violence was the belief that reporting it would not change anything, followed by the fear of losing one’s job (Kvas & Seljak, 2014).” As seen by these statistics, a numerous number of nurses feel scared to open up about violence in the workplace and cases that go undocumented. It is important that healthcare professionals speak up about violence because it can be one step toward stopping workplace violence as a whole.

There are numerous ways to prevent these types of occurrences from happening in the workplace. “The major prevention strategy for any organization is the education of all employees. Every employee should be able to recognize the signs of workplace violence and know the proper steps to report potential problems. This demands that hospitals have clear policies and procedures for employees to follow. Hospital administrators must make a deliberate commitment to the safety and security of all employees. Annual training must be mandatory. (Keely, 2002).” Education of all employees plays the biggest role in prevention or progression of workplace violence because this can give nurses and other personnel a better sense of feeling for opening up. Other ways of prevention are improvement of employee identification, implementation of policies, drug screening program, and an advocate program. These implementations can help reduce the cases by a larger number because healthcare workers feel safer with these in effect. The best program to put in effect for nurses is the implementation of policies because with guidelines set in order it gives a sense of authority and direction if something were to happen. There are also courses that nurses take that teaches them about the importance of knowing the signs of workplace violence, speaking out about it, and ways to prevent the situations from even happening.

Another way of prevention is to promote an open line of communication amongst all workers. Sometimes workplace violence happens just because there is not an open establishment of communication among employees. Some may feel intimidated by not being able to communicate with their fellow peers. Within opening a community of communication, pushing the employees to accept one another as individuals can also help prevent this from happening. All manager or people with head positions should closely monitor the peer relationships within their environment because a situation can be caught on early if detected.

The Occupational Health & Safety Administration promoted a way to start a prevention program by management commitment and employee participation, worksite analysis, azard prevention and control, safety and health training, and record-keeping and program evaluation “The best prevention strategy is to maintain an environment which minimizes negative feelings, such as isolation, resentment, and hostility among employees. Although no workplace can be perceived as perfect by every employee, there are several steps that management can take to help create a professional, healthy, and caring work environment. These include, but are not necessarily limited to: promoting sincere, open, and timely communication among managers, employees, and union representatives, offering opportunities for professional development, and fostering a family-friendly work environment. (U.S. Department of Labor).

Exploration of the Future for the Issue Related Nursing Practice

In reference to the exploration of the future of workplace violence in nursing, there is currently a bill that has just been introduced called the Workplace Violence Prevention for Health Care and Social Service Workers Act. “Recently released data from the Bureau of Labor Statistics found a sharp increase in serious injuries as a result of workplace violence among health care workers last year. The

Workplace Violence Prevention in Health Care and Social Services Act

would ensure that health care and social service workplaces adopt proven prevention techniques and are prepared to respond in the tragic event of a violent incident (Baldwin, 2019).” This bill is currently awaiting votes from the House and was introduced on February 19, 2019. If this act passes through all of the branches that it has to go through, then this will most definitely decrease the occurrences of workplace violence.

In the upcoming years, workplace violence will be seen less and less every year after the implementation of some bills put into effect to address the situation. With acts, bills, or laws in place it sets a standard in which some people are intimidated by which is a good thing in this case. This will make people not want to commit crimes of workplace violence as much as they do now because there is nothing that is really going to give them a sense of scaredness. As soon as these laws come into effect, there will be more cases that are going to show up because nurses or others will no longer be afraid to speak their mind.


In conclusion, workplace and horizontal violence is being more commonly seen in the healthcare setting every year. There are bills and prevention programs that are being introduced to help reduce this until it is completely gone. No one should every fear that they can not complete their daily task at work because of the risk of violence from peers, patients, or outsiders. If intervention is done when the subject is first brought about, then the likelihood of the situation progressing will be little to if any at all. It cannot just take the actions of the government or higher authority to prevent situations from happening, but it starts with the nurses, doctors, and all other personnel as well. In today’s society people are not willing to speak up for the things that they experience or the things that they see happening within the workplace. A speak up or speak out program could be put in place for people that want to remain anonymous. When it comes down to prevention programs all categories of people must be kept in mind because everyone is not the same in about the way they want to discuss things.

Everyone has a part in making sure that they are keeping their eyes focused on signs of these things that happen way too often. Statistics show that if more people get on the movement about stopping workplace abuse it can all end in just a matter of time. There are multiple associations that have started campaigns to end workplace violence and bullying in its entirety. It takes everyone to get on board and help promote and advocate for those who have already been victims of workplace violence and bullying. Programs also need to be set up to help get them through whatever their situation was or may have been. No one should be left behind because as nurses we all are one family and should act according to that manner. Nurses have a very huge duty in ensuring that they protect, serve, and care for all of those surrounding them.

Works Cited Page

  • Ceplenski, C. (2013, December 27). 4 Types of Workplace Violence.
  • Seljak, J., & Kvas, A. (2014, May 22). Unreported workplace violence in nursing.
  • Keely, B. R. (2002). Recognition and Prevention of Hospital Violence: Dimensions of Critical Care Nursing.
  • Baldwin, T. (2019, March 14). U.S. Senator Tammy Baldwin Introduces Reform to Protect Health Care and Social Services Workers from Workplace Violence


  • U.S. Department of Labor. (n.d.). DOL Workplace Violence Program.

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