Last month, I had the pleasure of attending the National Conference of the American Society of Perianaesthesia Nursing in Los Angeles with Manda Dunne, BARNA Chair. This was a fantastic experience of which you will hear more of later. Whilst there, I attended a lecture entitled ‘Horizontal Violence in the Work Place: It Could Happen to You’. This was a new term for me and I imagined I was going to receive some kind of selfdefence course against the aggressive post-anaesthetic patient. Once Sheryl Michelson has started, I realised I couldn't have been more wrong. Horizontal violence is the term that has been given to a very specific kind of bullying within the nursing system. It has been described as the negative behaviour of some nurses towards others who have assumed leadership or teaching roles, or simply shone out in a particular area or situation, and can happen when older more experienced staff demoralise the new graduate staff, through lack of support. I had heard of phrases like ‘cutting down the tall poppies’ and ‘nursing eating it's young’, but hadn't really thought about them properly before.
Horizontal violence can take many forms: criticism, sarcasm, withholding information and deliberately ignoringsomeone. It is mostly passive and is usually unrecognised or treated as gossip. It can even be in the form of sabotage. This behaviour results in the individual feeling humiliated, demoralised and unappreciated in their role.
It shocked me that there was a term for this and so typed it into my Internet search engine. I got over 300.000 hits. We are the only profession that has our own term for it, and sadly it has become ingrained in the culture of nursing. The vast amount of international research on this subject offers devastating statistics. Most studies suggest that 40–60% of nurses leave their first jobs within 6 months, with ‘bullying’ being the number one reason given.
At first I didn't think this applied to the UK, never mind to my own experiences in nursing. However, the more I listened to the studies, combined with Sheryl's experiences and observations, the more I started to realise that this indeed is ingrained in the nursing culture. I remembered times when I had been on the receiving end of what you could class as passive horizontal violence and times where I had maybe contributed to it also. I realise that it is obviously not helped by the fact that the majority of nurses are female, but it is believed that the main influence of this behaviour has come from oppression.
Oppression in the nursing system can be viewed as two separate forces. There is the oppressive force that some nurses experience from a management structure, feeling that they are not listened to and that they have lost control over their own roles. Then there is the oppression that some feel from the medical field. This is the idea that traditional nursing qualities such as sensitivity, caregiving and warmth are not as important as those of the ‘dominant’ medical profession. Nursing is also taking on more of the medical role these days, leaving less time for those traditional nursing roles. All this is said to lead to job insecurity and a continuing circle of general negative feeling.
So, this all seems like a pretty depressing view of the interpersonal behaviour of nurses and the culture as a whole, but all is not lost. We must all strive for the creation of a respectful culture that must start immediately. Let your students and newly qualified nurses know that you are there to support them, as well as be aware of how you treat your colleagues. We must also have courage to confront those we feel are partaking in horizontal violence, with assertiveness training being at the forefront of this. I will leave you with an anecdote I heard whilst in Los Angeles that, for me, describes the goal that we should strive for.
In a field, there is a blind horse. With the horse is a small pony with a bell around its neck. When the night draws in and it begins to get cold, the pony makes its way to the stables with the ringing bell, which allows the horse to follow it into the safety of the stable for the night. Sometimes we are the pony with the bell and other times we are the blind horse.
