INTRODUCTION:

“In the societies of the highly industrialized western world, the workplace is the only remaining battlefield where people can ‘kill’ each other without running the risk of being taken to court.”¹

Every nurse in her professional life would have definitely experienced or would have witnessed workplace hostility. The experienced nurses who are supposed to be the mentors for the novice nurses are eating the young ones .

Nurse to nurse hostility exists in many organizations even without the knowledge of nurses. Work place hostility, horizontal or lateral violence, workplace agrees ion, work place bullying, peer to peer hostility all these terms are synonymous with each other. With the nursing shortage and high turnover rates affecting nearly every facility, it is imperative that nurse leaders determine, assess, and eliminate the factors that influence and perpetuate the problems facing the nursing profession today. Researchers report that verbal abuse contributes to up to 24% of staff turnover and 42% of nurse administrator turnover. To make matters worse, studies indicate that approximately 60% of newly registered nurses leave their first position within six months because of some form of horizontal hostility .It's the dirty little secret of nursing, and it needs to be publicly acknowledged, and discussed².

What is horizontal hostility:?

A consistent (hidden) pattern of behavior designed to control, diminish, or devalue another peer (or group) that creates a risk to health and/or safety². Horizontal hostility can be physical or verbal. In nursing, verbal aggression is more prevalent. It can include any form of mistreatment, spoken or unspoken, that leaves a person feeling personally or professionally attacked, devalued, or humiliated .It can be either overt or covert. Since studies show that the majority of our communication is nonverbal, covert behaviors have the biggest impact²

Overt:

Name-calling, bickering, fault-finding, backstabbing, criticism, intimidation, gossip, shouting, blaming, using put-downs, raising eyebrows, etc.

Covert:

Unfair assignments, sarcasm, eye-rolling, ignoring, making faces behind someone’s back, refusing to help, sighing, whining, refusing to work with someone, sabotage, isolation, exclusion, fabrication, etc.

Costs and consequences of peer to peer hostility:

Horizontal hostility drains nurses of vitality and undermines institutional attempts to create a satisfied nursing workforce. The impact of nurse to nurse hostility can be felt in the following areas

· Physical health:

The nurses who are experiencing hostility from their colleagues are likely to suffer from many physical ailments like migraines, hypertension, irritable bowel syndrome, acid peptic disease, fibromyalgia etc. because of the stress they undergo in the workplace.

· Emotional Health:

It also affects the emotional well being of a person. It causes low self esteem, depression, lack of confidence, hopelessness, and feelings of isolation. If it is so severe it can provoke a person to commit suicide as well.

· Patient care:

Intrapersonal conflicts rob us of energy; deflect our interest from patient care. These conflicts affect teamwork, patient safety and quality of care.

· Organizational growth:

Horizontal hostility creates such an environment by producing feelings of inferiority, anger, powerlessness, and frustration, which are counterproductive when working in a group. Emotional issues will incapacitate even the greatest of initiatives. When horizontal hostility enters the picture, it detrimentally affects the environment by producing a host of physical ailments that result in a loss of time from work (absenteeism, time off with worker’s compensation, family medical leave of absences) and reduced productivity while at work. These responses affect not only the organization’s bottom line but also the efficiency of the entire facility.

· Job dissatisfaction and high turnover rate:

Nurses will choose to work on nursing units where they feel valued and supported, so creating a healthy work environment will give facilities a proven competitive advantage. Nurses who experience the highest degree of conflict also report the highest degree of burnout and job dissatisfaction. Moreover they tend to leave the organization at the earliest.

· Tarnishes the image of nursing profession:

Peer to peer hostility will hamper professional development. Nurses in a way act like public relations officer since they deal with the patients (public) directly. When patients witness aggressive behaviors between professional nurses during their interaction with the health care facility, they will have a bad impression about the nurses and in turn develop a prejudice towards the profession.

· Hostility among the nurse educators:

Nurse educators have a huge responsibility of preparing dynamic professional nurses to meet the needs of the ever changing healthcare environment. Hostility among the nurse educators has adverse effects on the academic performance and morale of the nursing students. In the long run, the young budding nurses tend to imbibe a wrong attitude towards nursing. Nurse educators need to be cautious about this issue and be good role model for the futuristic nurses.

Ending nurse to nurse hostility: what works??

How we solve intrapersonal conflicts depends entirely on three things:

•Awareness: Our ability to see the problem

•Our communication network and

•Our response

The BEE Algorithm (Appropriate Responses to stinging situations)³Try to use BEE communication model when you happen to witness or experience hostility at your workplace.

B = Behavior:

What the person is doing or not doing that is disruptive, inappropriate, or unacceptable.

E = Effect:

Why/how the behavior is disruptive, inappropriate, or unacceptable…how it affects me, hurts my productivity, destabilizes the team or affects customer service.

E = Expectation:

What do you expect the person to do or not do to meet your expectations?

Example 1:

Your coach snaps her fingers at you to hurry up…

B: Sue, when you snap your fingers at me to hurry up…

E: …it feels demeaning and disrespectful.

E: …I need you to give me the same respect you want from me. Can we structure something like this?

Example 2:

Your coach remarks, “I thought you were smart!”...Give her a B.E.E. to provide correcting feedback

B: Jane, when you make remarks like that…

E: …it offends me and makes me not want to work with you.

E: …I need you to stop making such remarks so we can continue to work together. Can we agree on this?

What you should do about this?³

· Be aware of the signs and symptoms of Horizontal hostility

· Understand the many forces affecting nurses today

· Speak your truth – hold crucial conversations

· Adopt a zero tolerance philosophy

· Never be a ‘silent witness’

· Evaluate your belief system

· Take the time to reflect on your practice

· Educate yourself on

- Assertiveness training,

- Confrontation skills

- Crucial Conversation skills

· Complement each other – often!

· Provide opportunities for socialization

· Embrace, Protect and Nourish new nurses

What the organizations should do?:

· Understand horizontal hostility and why it occurs (includes a sample employee questionnaire to assess whether horizontal hostility is an issue in your facility)

· Recognize the ramifications of allowing horizontal hostility to occur and persist (e.g., nurses quit, patient care suffers, facility loses nursing designation)

· Identify methods to prevent horizontal hostility

· Implement best-practice strategies to deter horizontal hostility from re-occurring (includes steps staff and managers can take to remedy the situation)

· Improve the nursing culture at your facility³

CONCLUSION:

Of all the aggressive behaviors nurses’ experience, peer to peer hostility is the most hurtful. Let us not be sabotage savvy. Instead we should work in a coordinated and concerted manner to address the interpersonal conflicts that arise in the work place. It is better to prevent conflicts rather than trying to mend the broken relationships. Learn the art of confrontation. It does help!!

CONFLICT OF INTEREST:

Nil

REFERENCE:

1. Namie, G., and R. Namie. 2000. The Bully at Work: What You Can Do to Stop the Hurt and Reclaim Your Dignity on the Job. Naperville, IL: Sourcebooks, Inc.

2. Kearns (2010).Nurse on nurse hostility remains an issue. Available from http://healthleadersmedia.com/content/NRS-246664/Nurseon Nurse-Hostility-Remains-an-Issue##,

3. Farrell, G. 2005. “Issues in Nursing: Violence in the Workplace” conference. Tualatin, Oregon. Sponsored by the Oregon Chapter of the American Psychiatric Nurses Association.

4. Bartholomew. K (2006).Ending nurse to nurse hostility. Why nurses eat their young and each other. Available from http://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=8F41539ECB1D0536836BC5C88871DAF3?doi=10.1.1.503.2070 and rep=rep1 and type=pdf

Received on 26.08.2015 Modified on 05.09.2015

Int. J. Nur. Edu. and Research 4(1): Jan.-Mar., 2016; Page 24-26

DOI: 10.5958/2454-2660.2016.00004.1