Horizontal Violence
Elizabeth Bennoch, MHSA, SPHR
Horizontal Violence is also called
Lateral Violence
Interpersonal abuse
Workplace violence
Interpersonal conflict
Psychological violence
Workplace incivility
Horizontal Violence
…is a phrase coined by Paulo Friere in 1970, to indicate
“the curious behavior of members of oppressed groups
who often lash out at their peers in response to
oppression instead of attacking their oppressors.”
Pedagogy of the Oppressed, 1970
“Columbine happened because the
whole community failed. Students
failed to report what they were
hearing and seeing, teachers &
administrators failed to take the
threats seriously & law enforcement
failed to investigate what should have
been a very clear & present danger.”
Christopher & Pohl, 2012
Horizontal Violence
SHRM says:
It is “persistent, offensive, abusive,
intimidating or insulting behavior or
unfair actions directed at another
individual, causing the recipient to feel
threatened, abused, humiliated, or
Jusko, 2013
The results of a 2012 SHRM survey:
50% of organizations surveyed reported an
incident of bullying in their workplace, and
for larger organizations of >500 employees,
the % grew to 71%!
Jusko, 2013
2011 Civility in America poll: 38% of workers
believe the workplace is becoming more
disrespectful, and 67% believe there is a
strong need for civility training
Inside Training, 2013
HV Facts & Stats
The American Nurses Association reports:
 48% of nurses, pharmacists & others
reported strong verbal abuse
 43% of nurses, pharmacists & others
reported experiencing threatening body
 Student nurses reported that 53% had been
put down by a staff nurse
 40% of clinicians “kept quiet” or “ignored” an
improper medication due to an intimidating
AMA, 2013
Workplace Civility
"Organizational success depends on a climate of
fairness & compassion; supportive working
environments are consistently identified as an
important attribute of an effective learning
organization…in order to learn, employees must
feel safe to disagree, ask questions, & make
mistakes. They must recognize the value of
competing ideas & feel encouraged to take risks.
If your organization’s culture is one of negativity
& aggressiveness, none of this is allowed to
Inside Training, 2013
More Facts
Roughly 60% of new RN’s quit their first job within
6 months of being bullied, and 1 in 3 new graduate
nurses considers quitting nursing altogether
because of abusive or humiliating encounters
Townsend, 2012
Nurses who survive bullying early in their
careers tend to carry their learned behaviors
with them. They accept the bully culture as part
of the job and eventually choose one of two
paths: leave the unhealthy work environment in
search of a healthier one, or participate in the
culture either as a bully or bystander.
American Nurse Today, 207
HV as a role issue
Nurses are educated to process work in teams and most
nursing models are built on the team concept; however,
physicians are educated to believe they are the “captain of
the ship”
This leads to stress between physician and nurses. Nurses
expect to work as colleagues with physicians; however,
physicians don’t always see this as desirable
Such differing cultural expectations breed conditions that are
ripe for horizontal violence
And then nurses “eat their young”
HV as an oppressed group issue
This occurs when one group believes they have been
excluded from the power structure
The oppressed group is abusive to peers & those
individuals with lesser status because they are
unable to or fear addressing the source of the
stress affecting them. They then may strike out at
peers, students, unlicensed assistive personnel, etc.
“Sociological literature shows that oppressed group
members tend to act out against one another
because they lack control over their
situation…powerlessness further lowers their selfesteem and triggers the cycle of oppressed group
behavior undertaken to boost self-esteem – which
in turn causes more frustration, lack of coworker
support & conflict.”
American Nurse Today, 2007
HV as a culture issue
A company’s beliefs & attitudes towards Horizontal Violence
play a large part in the acceptance of Horizontal Violence.
Leadership’s role is vital
A culture of deferred responsibility develops when leadership
looks the other way when this type of behavior happens. “When
we think that we will not get into trouble, we tend to do things
that we know we shouldn’t.” (Christopher & Pohl)
What makes us look the other way when someone’s in distress?
“…environment & social mores are at the crux of it.” (Christopher & Pohl)
“…peer groups are a particularly effective & influential source
of social learning…groups help create social norms - attitudes,
beliefs or behaviors that are commonly accepted as appropriate
by the group.” (Christopher & Pohl) We develop socially acceptable codes
of conduct affecting the workplace based on group norms
Horizontal Violence Includes:
Belittling gestures (eye-rolling,
Withholding information (about
Verbal abuse (name calling,
folding arms, staring into space
when someone’s talking to you)
patients, meetings, new equipment,
threatening, intimidating,
For Example:
Gossiping, talking behind your
coworker’s back
Finding fault (nitpicking)
Telling coworker how to do his/her job
Not respecting personal privacy
Personal insults
Sarcastic comments, jokes &
teasing (used as an insult)
Rude interruptions
Withering e-mail flames
Anonymous letters aimed at hurting
the target
Wait, there’s more!
Elitist attitudes regarding your department, job,
education, experience, etc. (I’m better than you attitude)
“Freezing or icing out” – excluding coworkers from
work-related or social activities and/or conversations
(especially with new staff)
Treating people as if they are invisible
So, concrete examples…
 Hiding (or stealing) someone’s lunch, coffee, etc.
 Derogatory statements: “She’s a know-it-all,”
“Who died and made her boss?” “Where’d she
get her degree, the Cracker Jax box?”
 Laughing or snickering behind someone’s back
(“Take a look at THAT outfit” “Nice hair – not!”)
 Barking orders at people/stomping around
 Not responding when a new (or an old!) coworker
says hello or asks a question
 Withholding paperwork, reports, etc. the
coworker needs to complete own work on time
Dilbert on HV
The 3 Stages
(Hastie, 2002)
Stage 1:
Activation of the fight or flight response within you
You experience:
Sleeping disorders
Free-floating anxiety
Reduced self-esteem
Stage 2:
Your neurotransmitters are depleted from lack of sleep &
fatigue; the brain is over-stimulated and over-sensitive
 You have difficulty with emotional
control – bursting into tears and/or
laughter for little reason
 Irritable or angry when responding
 Difficulty with motivation
 Self-starter seems to be “burnt out”
Stage 3:
Your brain’s circuit breakers are activated
You experience changed response
patterns which superficially resemble a
change of personality
You have a loss of ability to ignore
things that before were manageable
You experience a relative intolerance
of sensory stimulation (slight noise,
voices, lights, etc. bother you)
You feel like throwing up the night before
Your family demands you stop obsessing
about work
You make mistakes
Your health/energy level declines
Your favorite activities are no longer fun
Catalanello, 2009
“Merely showing up for work in an environment
where bullying goes on is enough to make many of
us think about quitting…nurses not bullied directly,
but who worked in an environment where workplace
bullying occurred, felt a stronger urge to quit than
those actually being bullied.”
SAGE, 2012
Is This Your Department?
Costs, Direct & Indirect
“In the United States, the actual cost
[is]…$250 million annually in expenditures
related to health care, litigation, staff
turnover, and retraining from workplace
bullying…this figure may be low given a lot
of these types of costs are not always
attributed to bullying when in fact they
could be.”
BLR, 2012
Incivility, bullying, harassment, & discrimination affect
the bottom line because these behaviors increase anxiety,
depression, absenteeism, presenteeism, & turnover; &
decrease motivation, quality of work, output, job
satisfaction, & ability to meet goals.
Communication ceases, problems can’t be solved, people
can’t learn, gossip takes over, customer service suffers, &
stress prevents effective decision-making. Further, the
consequences of negativity extend far beyond the
perpetrator & target relationship. Anyone witnessing the
aggressive behaviors, even if they don’t necessarily feel
victimized by it, loses loyalty to managers & the
organization, and, thus, their work suffers, too.
Inside Training, 2013
“The real problem is not the young,
inexperienced nurse but the experienced nurses
who are bullies, and those that stand by silently
and allow it to happen. The cost of bullying
behavior is in the loss of bright and talented
nurses who leave the profession, increasing
turnover, destabilizing patient care systems and
putting patient safety at great risk. It is in fact,
almost immeasurable in its cost to society.”
Anonymous, 2013
“Merely showing up for work in an environment
where bullying goes on is enough to make many of
us think about quitting…nurses not bullied
directly, but who worked in an environment
where workplace bullying occurred, felt a
stronger urge to quit than those actually being
Sage, 2012
Effects on the workplace
Increased absenteeism
Increased turnover
Increased costs: EAP programs, recruitment, etc.
Increased risk for accidents/incidents
Decreased productivity & motivation, & morale
Reduced corporate image & customer confidence
Poor customer service
How is HR Neutralized?
HR reports to the wrong level
HR is extremely decentralized
CEO doesn’t get HR’s strategic value
HR is staffed inexperienced, untrained or
unethical people
HR is directly a victim of HV
Suzi Benoit, 2013
To be effective in preventing HV, we must be
effective in preventing neutralization of HR
How Bullies Neutralize Management
Telling only part of the story
Playing the victim
Strategic partnering
Exploiting mistakes
Pre-emptive strikes (complaining about the
victim, safety issues, ethical issues, first)
“Where is the policy on…”
Classic HV!
Preventing HV
Meet w/bully & follow these basic rules:
 This in not an investigative interview – it’s not
about excuses or the bully’s version of things
 Be direct – “People are afraid of you, staff
don’t feel safe” – avoid “Please be nicer!”
 Bully is often in denial and/or disagrees
 Don’t try to understand why bullies bully – this
is not therapy!
 Consequences are an absolute must: bullies won’t
change unless motivated
 Make good on threats – terminate the bully!
BLR, 2013
Preventing HV
At management/system level:
 Ensure that respect is a core value
 Ensure a zero tolerance towards abusive
behavior policy & start at senior level
 Ensure protection from retaliation if
 Encourage utilization of EAP program
 Train staff on Horizontal Violence
 Conduct exit surveys & ask about bullying
 Listen!
AMA, 2013, BLR, 2013
Preventing HV
Help staff:
To understand that they did nothing wrong: the bully
usually chooses a victim for no good reason (or because s/he
feels threatened by him or her for some reason)
To engage in reflective practice: keep a journal, raise self-
awareness about their values, beliefs, attitudes, & behavior – are
they guilty of horizontal violence? (are they supportive,
encouraging – or do they create an environment infected
w/horizontal violence)
To ensure self-caring behaviors: seek counseling, promote
peer support, good nutrition, adequate sleep, take time out to
relax, exercise
Be willing to speak up when they see it happening &
name “horizontal violence” for what it is
What to do
If staff are subjected to horizontal violence, have
Address the problem immediately with the
person – often the person has no idea s/he is
doing it
Use conflict management strategies – Say “I
feel … when you …”
Again, name it, and if not stopped – have them
take comprehensive notes, and refer it to their
supervisor or to HR
Coach staff on these methods
What you permit, you promote
Use positive & respectful tone
Use respectful & active listening – look
coworkers in the eye when they are talking
Lead by example!
Own up to your mistakes, don’t attempt to
shift the blame
When making requests, be polite & tactful –
remember, it’s just that: a request
Be willing to help when requested
Don’t participate in gossip
Invite loners & newcomers to breaks/meals
When others do a kind act, thank them in front of others
Accept your fair share of the workload
Work together (despite personal dislikes)
Address coworkers by their first names
Ask for help & advice when needed
Stand up for peers in their absence, don’t be critical of them
Don’t engage in vertical violence – it just perpetuates
horizontal violence in others
So…be a buddy, not a bully!
“The real problem is not the young,
inexperienced nurse but the experienced nurses
who are bullies, and those that stand by silently
and allow it to happen. The cost of bullying
behavior is in the loss of bright and talented
nurses who leave the profession, increasing
turnover, destabilizing patient care systems and
putting patient safety at great risk. It is in fact,
almost immeasurable in its cost to society.”
Stopbullyingnurses.com, 2013
Pearls of Wisdom
More Pearls
Practice the 3 R’s
Respect for self
Respect for others
Responsibility for all your
Anonymous (n.d.) Horizontal violence: The CNA’s worst enemy & the nursing home’s
number one threat to quality care. Retrieved from the World Wide Web on January 28,
2004: http://www.nursingassistants.net/HV~ns4.html
BLR (2012) Bullying at the workplace: statistics on bullying. Retrieved from
Center for American Nurses (2008) Lateral Violence and Bullying in the Workplace.
Catalanello, R (2009) Bullying at work can make you sick, but remedies are few.
Retrieved from: http://www.tampabay.com/news/humaninterest/article1021546.ece
Funk, C. (2002, September 1). Cutting down the tall poppies: horizontal violence: Sam
Houston State University
Hastie, C. (2002, August 6) Horizontal violence in the workplace. Retrieved from:
NIOSH (2004) Most workplace bullying is worker to worker, early findings from NIOSH
study suggest Retrieved from: http://www.cdc.gov/NIOSH/updates/upd -07-28-04.html
Oppermann, S (2008) Workplace Bullying: Psychological Violence? Retrieved from
the World Wide Web on July 30, 2009:
http://www.workplacebullying.org/2009/05/04/workplace-bullying-psychologicalviolenceOrlando Business Journal, (2002) Workplace bullying’s high cost: $180M in lost time,
productivity. Retrieved from
SAGE Publications (2012, July 2) “The Effects of Bullying and ‘Ambient’ Bullying in
the Workplace” Medical News Today. Retrieved from
Skillings, L. N. (1990) Perceptions and feelings of nurses about horizontal violence as
an expression of oppressed group behavior. USM.
Vanderwahl, T. (2005) Retrieved from the World Wide Web on July 31, 2009:
Jusko, J. (2013) Operations: New Year’s resolution – stop workplace bullies. Retrieved
from the world wide web on January 22, 2013:
American Nurses Association (2013) Lateral violence and bullying in nursing. Retrieved
from the world wide web on January 22, 2013:
Christopher, E. & Pohl, JC (2012) Teen truth. why youth have something to hide.
Horizon Intertainment, LLC.
Inside Training (2013) Civility at work. Retrieved from the world wide web on May 29,
2013: http://trainingmag.com/content/civility-work
Townsend, T (2007) Break the bullying cycle. Retrieved from the world wide web on
May 29, 2013: http://www.americannursetoday.com/article.aspx?id=8648&fid=8612

Horizontal Violence