In the last two decades, many educational scholars have written about nursing being an oppressed profession. Many nurses faced a lot of frustrations due to inadequate autonomy and power. Due to these frustrations, they tend to be aggressive among themselves. Horizontal aggression in nursing has been present from the onset of the nursing profession, thus becoming a prominent problem within the field. Nurses have argued that they developed the phenomena during the early stages of their careers making them question what job they had selected. Since then, more research has been done to ascertain the aspects and understanding of horizontal aggression.
Horizontal aggression is abuse or violence occurring among workers. Horizontal hostility comprises many types of inappropriate or disruptive behaviour such as intimidation, constant criticism, gossips, insults, bullying and many more. Other examples of horizontal hostility that seem passive include unfair job assignments, favouritism, instants of undermining a colleague, discrimination regarding job evaluation, sarcastic comments, holding a grudge for a long a time among others. Mainly, horizontal aggression is covertly making it difficult for a victim to seek help in the working environment. The actual figure of prevalence and incidences of horizontal aggression in nursing are difficult to know because many cases go unreported or unrecognized. However, research shows that it is widespread with about 60%-80% of the nurses said to have either witnessed or experienced it. Due to the extensiveness of the behaviour, it is essential to look at the impact it has on nurses and the future of nursing professional practice for the sake of creating awareness.
First, repeated cases of horizontal aggression to a victim cause depression, decreased self-esteem, and reduction in self-confidence. The victim may also develop symptoms of anxiety and sleeping problems. Many scholars have reported that nurses suffering from the above issues lose morale to work, and levels of empathy and connectedness become minimal. Also, physical signs may occur such as a drastic loss of weight, weight gain, or a sudden change in eating habits, and an opposing end may cause hypertension. According to Mendez, the constant exposure of horizontal aggression may cause the nurse to lose enthusiasm on the profession due to the most significant incidents of burnout. The burnout causes high levels of stress, and the above conditions will make a victim perform poorly at work. In the end, the patients will receive health care services that are below the optimal level.
Another impact of horizontal aggression is a nurse quitting the job because of stress and other non-motivational workers. Nurses who are verbally or physically abused develop a high rate of vulnerability mounting a desire to stop working. More than 60% of Canadian nurses have left their jobs within six months in their first workplace environment due to horizontal violence. The remaining 40% stay in their current job environment despite the disruptive behaviour. The question revolving in people’s minds is why a victim continues to work after experiencing such unkind acts. Many of horizontal violence victims tend to break institutional guidelines due to fear and trauma. According to Goff, the aggression also adds up to chances of insecurity at the workplace. It is reported that more than half of the nurses working in various hospitals across Canada have serious vulnerabilities. Among many factors, such as low salary, incompatible working conditions, and other minimal factors, horizontal aggression is the leading cause of nurses leaving their jobs. A clear comprehension of this phenomenon may result in interventional studies that could bring a significant impact on enhancing nurse retention and improved workplace environment.
Many Canadian scholars have identified bullying and physical behaviours as a primary concern regarding retention issues. The main reason why there is a high shortage of nurses across the country is due to the low rate of retention. From a survey conducted, it shows that nurses employed in five different hospitals across the country experienced burnout and later dropped out of work. The authors argued that the primary reason for low turnover in the nursing profession is related to low satisfaction at workplace due to the high rise of incivility. The nurses failed to report any cases of horizontal violence due to inadequate empowerment, cynicism, and hostile supervisors. All these negative factors are correlated to work satisfaction, low turnover retentions and lack of organizational commitment.
Further, horizontal violence has adverse implications for students as well as fresh graduates. The students and newly graduated nurses tend to have high aggression to attain their potential fully. Because horizontal hostility occurs in co-workers who should be offering guidance and support to patients and juniors, students and fresh graduates will have a challenge in achieving their ambitions due to constant conflicts in the workplace. Besides nurses, these disruptive behaviours also have a negative impact on the whole healthcare system. Horizontal violence means constant hostile communication that widens the rift between nurses. Due to their continuous behaviours and changes of unexpected events such as irritation, high aggression, and development of other diseases, there will be less control of tasks among nurses that will have adverse effects on deliverance of quality work. Employers will eventually carry the burden of both direct and indirect cost of production loss, below average productivity, decreased efficiency, overall destruction of the facility’s image and the number of patients in the facility will drastically drop.
Lastly, every nurse has a distinct character and experience concerning horizontal violence in a specific way due to family background, cultural environment among others. Each nurse handles an incidence differently, and others may eventually develop resilience. Becoming a victim of workplace abuse may have a severe impact on the employees. The truth is that nurses who suffer from aggression have had their health and lives affected. It also changes the relationship between the healthcare facilities and work, extending to the entire society. According to Vessey, DeMarco, & DiFazio, workplace aggression will develop into a public health problem which will later jeopardize the future of the nursing profession. The general public will undermine the nursing career and the services they provide.
In conclusion, nursing professionals are an outstanding shareholder in the provision of healthcare services. Therefore, current situations like horizontal aggression should change not only in Canada but globally. Participation of all healthcare providers is essential in the search for proper working conditions and ensuring that the safety of all nurses is well guarded. Development of adequate strategies should be put in place to reduce or eradicate such incidences and prevalence of horizontal aggression. The best plans are to provide a safe academic environment where students can be taught how to respond to horizontal violence at work. Additionally, within the hospital setting, the primary approach to reduce this behaviour is to continuously offer educational programs to nurses such as excellent relationships among themselves and interpersonal skills at work. Education and support are vital tools that healthcare institutions should utilize to eliminate horizontal aggression.