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Horizontal Violence Among Hospital Staff Nurses and the Quality and Safety of Patient Care

  • Author(s): Purpora, Christina
  • Advisor(s): Blegen, Mary A
  • et al.

Nursing is among those believed to be oppressed who are at risk for horizontal violence, yet no known evidence of a relationship between these concepts exists. Studies of horizontal violence suggest that some nurses suffer personal consequences, yet almost nothing is known about the consequences for patients. Furthermore, no known framework exists to guide research to explain these potential consequences.

The purpose of the study was to describe staff registered nurses' (RNs) work-related views of themselves, nursing as a group, their interactions and relationships with other RNs, and quality of care. Five hypotheses were tested from the horizontal violence and quality and safety of care model.

A random sample of 173 hospital staff nurses drawn from the California Board of Registered Nursing's mailing list participated online or with a paper survey. The Nurses Workplace Scale measured nurses' work-related beliefs exhibitive of an oppressed self or group. The Negative Acts Questionnaire-Revised measured horizontal violence, also called bullying if it occurs frequently. Peer relations, the quality and safety of patient care and adverse events were also measured.

Horizontal violence was reported by 21.4% of participants. Nurses' who exhibited more internalized sexism (oppressed group beliefs) reported more horizontal violence (r=.463, p=.000). Nurses' who minimized themselves more (oppressed self beliefs) reported more horizontal violence (r=.451, p=.000). Nurses' who experienced more horizontal violence reported less supportive relationships with peers (r= -.638, p=.000), lower quality and safety of patient care (r= - .459; p=.000), and a higher frequency of adverse events (r= .408; p= .000). Findings suggested that peer relationships mediated the effect of horizontal violence on the quality and safety of patient care, but not on adverse events.

Horizontal violence was reported by one fifth of staff nurses in hospitals. Hypotheses tested were supported. Nurses who perceived more oppression of self and nurses as a group reported more horizontal violence. Nurses perceived that horizontal violence negatively impacted peer relationships and the quality and safety of patient care and increased the frequency of adverse events. Education in practice settings is recommended to improve peer relationships in the presence of horizontal violence. Reducing horizontal violence may rely on changing the social structure in hospitals.

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