Have you heard of it?
Maybe not, but I'm sure most of us have experienced it at least once. It may have been subtle: outward snubbing when you walk into the nurse practitioner's office or a quick halt of conversation as you round the corner. It may have been overt, such as open criticism of your plan of care when the attending asks, “And why did they do that?” Horizontal hostility, lateral violence, and horizontal violence are terms used to describe the physical, verbal, or emotional abuse of a colleague.1 In a nutshell, horizontal hostility is bullying ... adult style.
Within nursing, horizontal hostility has been defined as nurse-to-nurse aggression. Contrary to what may be assumed with the term horizontal, this may include our peers, those above us (supervisory roles), and those below us (subordinate roles). The violence can be manifested in verbal or nonverbal behaviors. The 10 most common forms of hostility are nonverbal innuendo, verbal affront, undermining activities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy, and broken confidences.2
National organizations such as The Joint Commission, the Association for American Nurses, the Occupational Safety and Health Administration, and the Agency for Healthcare Research and Quality have developed standards against horizontal hostility and other disruptive behaviors that undermine a culture of safety, and healthcare facilities in all types of settings are required to meet them.3–5 As nurses, America's most trusted professionals, we like to think that we are never the issue, but that is not supported by the data. “But we are nurses,” you may argue, “kind and compassionate and caring.” And, although that may be true in reference to our patients, it is not reflective of how we treat each other. We can no longer lay the “bully” label only at the feet of our physician colleagues. We must look at ourselves both as individuals and collectively as the profession of nursing.
Here are some thoughts to consider:
- Have you ever found yourself making excuses for a colleague or friend or heard others making them for you? It might sound like this: “Don't mind her, that's just Jane. She is a really good clinician.” Some would question the title “good clinician” if her interpersonal conduct makes her colleagues hesitant to approach her. Are you or others afraid to speak up in a meeting because of her verbal railroading of anyone who does not agree? The literature would contend that no matter how technically competent this person is, the most important skill set is lacking. Jane's lack of self-awareness and her inability to acknowledge the negative impact of her behaviors on those around her impacts patient safety as well as patient and staff satisfaction. In many instances, because of lack of courage in leadership, this behavior goes unchecked.
- How resilient are you to change? In the transition zone (see the spring 2013 issue of NANN Central for more on this), are you angry or hostile toward those attempting to implement change? Do you covertly try to sabotage the change? This may be as simple as complaining to others about the change or as complex as filing unfounded complaints to administration or human resources.
- How do you treat new members to your team? Do you criticize their performance to others but fail to address concerns to them directly? What part do you play in mentoring them and helping them to succeed (or fail)?
As we look introspectively, we must critically appraise our practice individually and as a community of neonatal nurse practitioners (NNPs). Then, take action. If you have identified behaviors that are unprofessional, seek guidance from a trusted peer or colleague. Just as caring for the most vulnerable patients in a critical care environment is stressful and but rewarding, so, too, is confronting bullying and working to improve our work environment so that it is better for us and for those to come.
1. Carter R. High risk of violence against nurses. Nurs Manage. 1999;6(8):5.
2. Griffin M. Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. J Contin Educ Nurs. 2004;35(6):257–263.
Occupational Safety and Health Administration. Guidelines for preventing workplace violence for health care and social workers (OSHA 3148-01R 2004). http://www.osha.gov/Publications/OSHA3148/osha3148.html. Published 2004. Accessed June 12, 2013.
The Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert. 2008;40:1–3. Retrieved from http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm
5. Rosenstein AH, O'Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Safety. 2008;34(8):464–471.
LAST CHANCE TO SUBMIT YOUR ABSTRACTS FOR 2014
9th Annual NANN Research Summit
Abstract Submission Deadline: October 15
Are you doing research in your neonatal intensive care unit (NICU)? Are you making a practice change in your NICU and evaluating the results? Consider submitting an abstract for the 9th Annual NANN Research Summit, April 1 to 3, 2014, in Scottsdale, Arizona.
Since 2006, NANN's Research Summit has provided a platform for individuals to present findings from their research and evidence-based practice projects. Supported by Mead Johnson Nutrition, the objective of the summit is to emphasize the fostering research effort of NANN's newest neonatal investigators as a means to grow and sustain the body of knowledge that helps guide nursing care for neonates and their families.
For the first time, abstracts will be submitted online. All submissions will undergo a blind review for quality, relevance, and merit by the NANN Research Committee. All submitters will be notified of the status of their submission in November.
For more information or to submit your abstract, visit http://www.nann.org/research.
NANN's 30th Annual Educational Conference
Abstract Submission Deadline: November 4, 2013
The NANN Program Planning Committee invites you to submit an abstract to present at NANN's 30th Annual Educational Conference, September 10 to 13, 2014, in Phoenix, Arizona. The Program Planning Committee encourages submissions that span general areas of neonatal care such as hot topics, developmental care, patient safety and quality care, healthcare reform, general staff nursing issues, and advances in research. Abstracts that are considered evidence-based and challenging for nurses and other healthcare professionals are highly encouraged.
For more information, visit http://www.nannconference.org.
REPORT OF THE 2011 NEONATAL NURSE PRACTITIONER WORKFORCE SURVEY
Perfect for hospital administrators, the Report of the 2011 Neonatal Nurse Practitioner Workforce Survey provides detailed information on workforce characteristics of NNPs in a downloadable format for quick access.
More than 600 neonatal nurse practitioners (NNPs) were surveyed in the areas of demographics, practice environment, scope of responsibilities, benefits and reimbursement, and job satisfaction; those findings are compiled in 48 detailed tables. The report also includes a comprehensive review of literature, description of methods, and in-depth analysis and recommendations regarding NNP education and the healthcare environment.
The Report of the 2011 Neonatal Nurse Practitioner Workforce Survey is now available at a reduced price. Visit http://www.nannstore.org to purchase.
Member price: $99
Nonmember price: $149