Latest posts by Toni Hoffman (see all)

I’ve wanted to write on this  insidious subject for a long time, I’ve wanted to influence the effect of horizontal violence on my nursing colleagues. I, like most nurses have experienced horizontal violence and it affected me, my colleagues, my ward unit, and most importantly my patients. Horizontal violence can be defined as criticising, intimidation, ignoring, belittling, blaming, withholding behaviours,  and undermining the efforts of others. It also can include bullying and harassment, gossiping, isolating, and lying. It can include playing one staff member up against another. As organisation hospitals undervalue how much horizontal violence affects staff productivity and patient outcomes. Horizontal violence goes to the very core of the dignity of the staff member.

I heard today a story of a Nurse Unit manager whose line manager consistently hung up the telephone on her when she was ringing to obtain approval for overtime. Ringing for approval of overtime is enough to scare the pants off the most experienced NUM. You are faced with such questions as “can the patients be doubled” “Can someone be transferred to the ward” “Can I send you an EN to WATCH THE MONITOR”. Yes, these are all real questions from a line manager to a very experienced and well qualified NUM.

So, before you ring to beg for the overtime so the patients in the ICU can receive the care they need , you have to gather your courage and try to pre-empt any ridiculous questions you may be asked and make the call. Then your line manager hangs up on you, repeatedly. So what do you do ? You need to start calling staff as they are few and far between and there are no agencies in this small town.  Behaviour like this is rife in our hospitals and one of the reasons experienced staff just gives up and leave. Imagine what it would be like to work in an environment where your experience and education was celebrated and you were treated professionally. I can’t, I’ve never worked in such a place. For a short time post Patel, there was a period where in a time of transformation staff felt supported by the leadership team, but this did not last long. One of the contributing factors to horizontal violence is the pressures of performance targets and budgetary measures on staff. The leadership team are faced with unrealistic demands upon them and they in turn pass these unrealistic demands onto those at the coalface.

A “good” NUM will try and prevent the ongoing effect from her staff and patients.  It totally puzzles me that how as nurses we can get some things so right ( such as the care we give our patients and their loved ones ) and we cannot stop these insidious other behaviours that cut to our very soul.  Queensland Health introduced a code of conduct many years ago in an attempt to address the issue of noxious bullying behaviour; they also ran a series of absolutely excellent workshops on organisational culture. But unfortunately, the people who should have been attending either did not attend or did not take home the targeted messages.  Nurse Leaders are in a perfect position to influence positive behaviours in the workplace; it doesn’t take much to treat your staff with respect and to acknowledge their expertise. The issues of inadequate and often dangerous staffing issues, inadequate budgets, sneaky  fiscal  redistribution, denial of statutory rights such as professional development leave and even holidays and  reduced resources all contribute to workplace stress  and can be influenced by Nurse Leaders. Providing these resources enables staff to be in the best possible psychological place to be able to provide care to our patients. Nursing staff must take ownership of our own profession. Becoming resilient and staying resilient are two different things. We owe it to ourselves to do better. It’s too hard on us personally to continually accept poor workplace behaviours. When I look back at over 30 years of experience in Intensive Care, it’s not the daily traumas I faced with patients at their most vulnerable; it’s the horizontal violence and aftermath that leaves me with nightmares.( I’d like to acknowledge the seminal essay on Horizontal Violence by  Jennifer Becher and Constance Visovsky in Med-Surg Nursing. July-August 2012)