NSE 112 Lecture Notes - Lecture 7: Workplace Violence, Workplace Aggression, Silent Treatment
Week 7: Professional Development
1. Defining Bullying
o Bullying is: signaling out someone to harass or mistreat
o For an action to be labelled as bullying, the following needs to occur;
- Imbalance of power
- Repeat in action
- Victims to be individuals who cannot defend or stand-up for self
- It must be done for the purpose of causing harm
o Bullying also known as:
- Horizontal violence
- Lateral violence
- Nurse-to nurse incivility
- Nurse to nurse hostility
- Hazing
- Workplace violence
- Workplace aggression
o Examples of negative behaviors in
The workplace
- Non-verbal negative behavior
(overt/covert): rolling eyes,
Smirking, raising eyebrows, making faces, ignoring, dirty looks, giving someone ‘the
silent treatment’ and ignoring them, using ‘good’ words accompanied by threatening
non-verbal behavior, e.g. “oh, really good job, Kathy”
- Negative verbal remarks(overt): belittling, teasing, snide, rude or demeaning
comments. Sarcasm or condescension. Abrupt or rude answers to questions,
excessive criticism, interrupting, side conversations in meetings, asking for input and
then ignoring or belittling it, undermining another person’s credibility, public
reprimands.
- Negative actions: hiding equipment, not being available to help, ignoring request for
help from other nurses, being “too busy” to help, neglecting, being denied
opportunities, blocking opportunities for promotion, sending a nasty or demeaning
email, disrupting meetings or always arriving late
- Withholding important information (covert and overt): deliberately not telling
another nurse something that he needs to know to function well in the healthcare
environment (e.g. that equipment is broken, or that the patient doesn’t speak
English), sharing this as humorous with others, ‘forgetting’ to acknowledge other’s
help or contributions.
2. Negative Behaviours
o Not all of these are overt and not all are obvious as examples of horizontal violence
o Many are more accurately examples fo what we call: workplace incivility
o Some of the literature equates workplace incivility with horizontal violence while other
authors claim that they are different
o The pervasive Nature of horizontal Violence
What is horizontal violence?
▪ Negative behavior of nurses toward other nurses
▪ Overt or covert
▪ May be aggressive, hostile or destructive
▪ Possible source: patients and families, other health care
professionals
▪ Nurse-on-nurse incivility is felt to be tolerated at a
much higher level, in nursing, than in other professions
▪ Can take place over the phone, in-person, internet,
social media, or even display of offensive materials
such as pictures or posters.
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- May be difficult for outsiders to see
- May be made up of “innocent enough” remarks which can be taken ambiguously, but
insiders know that the intentions behind the remarks are typically negative
- Cyclical in nature, and can reach a “tipping point” or point of crisis
- If not stopped or addressed, it can lead to a “toxic work environment”
o Causes: possible cause of horizontal violence in the workplace
1. Hierarchy system
2. Seniority
3. Feelings of insecurity
4. Patients’ protection
5. Territorial tendency
6. Differences in education
o Effect of Horizontal violence- patient care
- Higher likelihood of patient safety issues including more frequent errors, more “near
misses” and more unreported errors.
- Problems with recruitment and retention, high turnover.
- Nurses choosing to leave the profession.
- Poor team performance and lack of cohesiveness in teams.
- Complaints from patients and families.
- More sick time and increased absenteeism.
- Lack of trust, lack of respect.
- May be expensive for institutions! (costs from absenteeism to lawsuits)
- Mental and physical health problems
- Increase substance use, dependence or abuse
- Feelings of “burnout”
- Lack of loyalty to the workplace, avoidance of the workplace or certain persons
- Decreased work satisfaction.
3. Oppressed Group Behavior (OGB)
o Has been used to describe certain groups, e.g. women in certain cultures, people who
live in colonized societies
o “dominated people feel devalued in a culture where the powerful promote their own
attributes as the values ones” (Robers, Demarco & Griffin, 2009, P 289)
o Those who are the dominant members feel that they members feel that they must
demonstrate oppressive behavior to demonstrate their value
o OGB IN NURSING
- Identified in nursing literature in the 80s
- Traditional hierarchies of medicine “at the top” with nursing lacking power and
control
- Lack of control and power has been felt to be beneficial to medicine and to the
efficient functioning of hospitals but detrimental for nursing.
- Nurses may feel devalued, viewed as “handmaidens” to physicians, or doubly
devalued as a still-predominant female profession
o What is the relationship between horizontal violence and OGB?
- Horizontal violence is often seen as a result of OGB, but not all the literature connect
these two concepts.
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- Horizontal violence and silencing behavior are felt to be two common consequences
or aspect of OGB (certainly this is what Robersts, demarco &Griffin claim)
4. Silencing the self
▪ Learned patterns of behavior. More common in men than women.
▪ Passive aggressiveness and silencing, arising out of low self-esteem and
devaluing of work.
▪ Silent about contributions, achievements, successes.
▪ Diminishing of one’s accomplishments.
▪ Silence about good work in nursing and contributions to patients’ care.
▪ Silence as strategy: To avoid and compromise.
▪ Silence to maintain the status quo and not cause upset.
▪ Indirect communication or lack of effective communication among nursing
groups or teams.
▪ Nurses in some settings feel silenced and not asked about important decisions or
issues, even when provided with the chance to participate, they remain silent.
5. What about nursing students?
o Horizontal violence occurs everywhere, across contexts, and is not limited simply to
registered nurses.
o It exists in situations and relationships involving nursing students, new graduates, for
faculty members and clinical instructors.
o New graduate nurses are felt to be particular susceptible to horizontal violence.
o This may be one reason often linked to higher-than-expected rates of job turnover and
nurses who are simply leaving the profession within 2 years of graduation.
o There is evidence that those who are involved in horizontal violence may well have
been a victim of it.
o Suggests a cycle of horizontal violence and also suggests that this may begin in nursing
education.
o Clinical placement experiences have a significant impact upon what students choose to
do immediately after graduation.
o Working with mentors/preceptors is not always a positive experience – could be the
first time when nursing students start to experience horizontal violence.
6. Ways to move forward
• Nursing researchers are looking at ways to identify and measure horizontal
violence and negative behaviours.
• The topics are becoming more frequently discussed in nursing education, but more
needs to be done.
• Identify sources of pride and accomplishment.
• Understanding nursing history and the legacies of history.
• Engaging in values clarification, reflective practice and opportunities to provide
mutual support among nurses.
• Some suggest a “zero tolerance” approach for negative behaviours.
• Clear and direct communication.
• Role modeling by faculty, experienced nurses, nurse managers and leaders.
• Anti-bullying laws exist in many jurisdictions and awareness of bullying in other
contexts is increasing.
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