Workplace bullying and intent to leave: Measuring the impact of horizontal hostility

The concept of "horizontal hostility" (HH) (also referred to in the literature as 'bullying', 'lateral violence,' 'peer incivility', or 'nurses eating their young') has been well described for nearly 2 decades. Behaviors consistent with HH vary and range from overt behavioral manifestations such as infighting among nurses, sabotage (where a nurse intentionally withholds pertinent information), scape-goating, passive-aggressive behaviors, or demeaning verbal remarks to more covert behaviors such as failure to respect confidences. Horizontal hostility is apparent when the 'workplace culture or norm' enables dominant individuals to pressure those who are more vulnerable, such as newly-hired nurses or nurses with less experience. Impaired personal relationships in healthcare lead to errors, accidents, and diminished work performance including nurse 'burnout.' In a 212-bed community hospital in the Southwest U.S., a descriptive study was undertaken to measure the impact of HH on select outcomes, including adverse patient events and nursing intent to leave. All RNs (regardless of area) were surveyed using a 28 item questionnaire modeled after the AACC (2006) and the Lateral Violence in Survey tool (Stanley et al, 2007), including basic nurse demographic information. A return rate of 32% (n = 130) was obtained and indicated that the majority of nurses (nearly 85%) have seen HH in this facility. "A nurse from my unit" (61%) was most commonly listed as someone who has exhibited hostile behaviors, followed by "a physician" (49.5%) and "the charge nurse" (27.1%). When asked whether HH contributes to ill calls, nearly 75% of the staff reported 'yes', although only 20% have personally ever called in ill because of what they perceive to be a hostile environment. Despite a competitive workforce environment, nearly 40% (39.5%) of respondents are considering leaving their current position due to HH. Implications for practice and results obtained will be addressed.