Horizontal Hostility in Nursing
Lateral or horizontal hostility among medical practioners represents in a long line impediments that have hampered efforts aimed at assuring and improving the quality of healthcare services within key healthcare institutions. Specifically, the management of many healthcare organizations has been involved in initiating cases or situations that are more likely to hamper communications and relationships between health care practitioners despite the existence of management policies, strategies, and interventions. Lack of efficient and high quality healthcare service delivery and poor communication among healthcare practitioners can be attributed to the escalating cases of horizontal hostility among health care practitioners. A survey conducted by the American Association of Critical-Care Nurses (AACN) revealed that nursing working environment is marred with a multiplicity of issues that call for immediate attention in order to ameliorate and sustain the milieu that essential for the delivery of quality patient care (McKenna, 2003). Sadly, majority of relate to the involvement of individuals within the management or in leadership positions.
According to Bartholomew (2006), Horizontal hostility refers to the existence of aggressive behavior and antagonistic interactions among individuals in similar hierarchical positions within the organization and such aggressive behavior is aimed at intimidating, bullying, backbiting, sabotaging, or undermining the self-esteem of confidence of the victim. Hostile actions include unnecessary criticisms, faultfinding, shouting, and using covert tactics such as segregation and allocation of assignments that are rather considered unfair. In a healthcare setting, horizontal hostility can be manifested in different levels such as hostility between nurses-to-nurses or hostilities between managers (physicians, administrators, and supervisors) from different departments or healthcare setting. Nursing practitioners are individuals expected to show compassion among each other. It is highly unlikely to expect nursing practitioner to engage in activities characterized by horizontal hostilities, but unfortunately, that is what happens in the health care environment (Grant, 2011).
Overview of the Organization
HealthNorth Hospital is a leading health care institution in New York City that is dedicated to the provision of high quality patient care with inexorable consideration to excellence in nursing, patient care and safety in addition to allocating unmatched commitment and passion to ensure that our clients receive the best healthcare. HealthNorth Hospital’s vision revolves around the fulfillment of the following activities:
Creation of a healthcare institution preferred by patients, employees, and healthcare practitioners due to the preeminent health care and teaching facilities well equipped with leading healthcare technological facilities to improve the delivery of healthcare services become a leading healthcare institution in meeting the healthcare needs of patients and communities within New York through the delivery of unparalleled and incomparable care to patients and other healthcare wellness programs.
Equally, HealthNorth Hospital is operated under high quality values such as cooperation, integrity, trust, heritage, and teamwork. Trust entails the creation of open and honest communication among workers and patients, dignity entails safeguarding and valuing the life of each patient, and cooperation involves the creation harmonious relationships with individuals across different specialties within the institution. Speaking of heritage, health care services are HealthNorth Hospital are inspired by strong religious foundations while integrity entails observing strict measures that involve fairness, and upholding professional ethics. Finally, teamwork is an essential factor in the delivery of health care services because recognizing the contribution of every member in order to motivate nurses and other healthcare practitioners to give their best in the delivery of healthcare.
Horizontal Hostility Case
Kelly is an assistant at HealthNorth Hospital and she aims to gain experience to enable her qualify for a nursing instructors’ course at the Hospital’s teaching program. Sadly, the experience that she is currently being exposed more than what she expected to receive at the hospital. For instance, in one particular morning, she watched as a drama unfolded in front of her. Nurses were engaged in unnecessary arguments a couple of minutes before 7 a.m. A group of four nurses was trading insults at each other. Nurse Teresa was being accused of having being too loyal to rules and ethics in the Hospital. She too accused other fellow nurses of ignoring and delegating certain duties to her that they considered too filthy. The supervisor assured Kelly not to be surprised because that was normal among nurses within the hospital. Interestingly, the supervisor told Kelly that the group in question were involved in a series of arguments that involved hatred, backbiting, and finger pointing. Equally worrying is the fact that the supervisor had engaged them in a series of counseling meetings to help them resolve the enmity that had grown amongst them. As if nothing happened, all the nurses resumed and/or reported to their duties.
Still puzzled and mesmerized, Kelly could not come into terms with what she had seen despite the stringent rules and regulations that have been put in place by management to prevent violation of ethics within the Hospital. Additionally, HIPPAA’s standards and practices require that nursing practitioners caught violating ethical standards should be punished and fines applied where applicable. Kelly recalled a situation that happened the previous day when she got to work with two other nurses who spent the better part of their shifts venting about one another. To her dismay, she seemed to find meaning to a popular phrase within the nursing profession concerning nurses eating each other and their young (Kathleen, 2006).
On another level, Supervisors within the hospital facility seem not cooperate with each other owing to reasons that are not clear. For one, they are jealous of each other’s performance and/or academic and professional qualifications. As such, they tend to ignore issues that affect within their departments thereby ending up affecting entire operations within the Hospital. A clear example is the situation that has persisted among nurses and no official within the management are willing to provide solutions.
Statement of the purpose and objectives of this case analysis
Horizontal hostility is a complex aspect that is deeply rooted in the nursing field and it is characterized with many facets. The situation observed by Kelly is undesirable and can easily distort her dreams of pursuing a career as a nursing instructor. It emphatically crucial that Kelly be made to understand the forces responsible for the creation and maintained situation to persist within healthcare institutions in addition to preventing her from developing negative feelings towards the nursing profession (Grant, 2011). Drawing upon research and research findings, the situation is explainable, analytical, and manageable and hence, measures aimed at upholding the values of the institution and goals of the nursing institution and the HealthNorth Hospital in particular can be put in place. Sadly, research statistics shows that one out of every four nurses leave their jobs because of horizontal hostility (McKenna, 2003).
This paper aims to investigate horizontal hostility in nursing, its causes, effects, and identify measures and remedies that can be applied to solve the situation. This will entail reviewing related literature and analyzing relevant theories in addition to identifying the internal and external factors within HealthNorth Hospital
Review of Literature
An examination of various literature materials in the field of healthcare reveals a myriad of various forms related to horizontal hostility within the workplace. According to Bartholomew (2006), horizontal hostility is manifested in different forms involving verbal abuse, backbiting, aggressive behavior, anger, horizontal violence, sabotage, discrimination, and hatred among others. O’Hare and O’Hare (2004) posit that horizontal hostility is also manifested in the form of relationships that involve nurse-to-nurses, patient-to-patient, and even doctor-to-nurse. The presence of a multiplicity of these factors makes it difficult to categorize hostility into a single picture although the effects of negative emotions among each other can be easily understood.
Additionally, the definitions of horizontal hostility are varied among different scholars depending on the nature of the hostility. For instance, Dunn (2003) argues that horizontal violence amounts to hostility because nurses create sabotage that is directed to workers within the same organizational level. Similarly, Weinberg (2003) believes that the most common form of hostility involves verbal abuse whereby nurses or other healthcare practitioners use condemnatory attacks, harsh words, or undesirable language to cause distress to their targets. A substantial amount of research also reveals that bullying is prevalent in most health care organizations all over the world due to the different ways in which aggression is manifested. For instance, bullying is intended to cause undesirable effects to the target, and the negative effect should be persistent on the victim (Hallberg, 2007). Sadly, bullying is exceedingly common in all organizational levels such as among superiors, peers, and subordinates. In both instances, the victims are demeaned or downgraded using all forms of cruel activities.
Using the oppression theory that argues oppression persists in situations where prestigious and powerful groups use their powers to exploit or control the less privileged or powerless groups (McKenna, 2003). As such, it is evident that horizontal hostility entails a situation characterized by a consistent behavioral pattern aimed at devaluing, diminishing, or causing havoc to the victim thereby creating risk to their wellbeing. It involves both covert and overt behaviors involving all forms of mistreatment, whether spoken or unspoken and often leaves the victim both professionally, emotionally, and/or physically attacked. Overt behavior involves faultfinding, intimidation, gossiping, name-calling, backstabbing, and using put-downs. Covert behaviors include sarcasm, ignoring, unfair assignments, isolation, and sighing.
HealthNorth Internal Analysis (SWOT)
Strengths
Qualified and efficient management
Unparalleled health care delivery services
Well equipped with technological facilities
Committed and compassionate about the needs of the community
Weaknesses
Uncooperative staff especially supervisors
Troublesome nurses
Unresponsive management to hostility cases
Lack of accountability among healthcare practitioners
Opportunities
Available strategies of improving the situation
Dialogue and negotiations
A call for action
Threats
Personal hatred
Group think and intimidation
lack of implementation of the strategies
existence of powerless groups and individuals
Strategic-Analysis Methods
Admittedly, horizontal hostility is an issue that is deeply rooted within HealthNorth Hospital and hence, it emphatically crucial to devise measures and strategies to improve the situation. Interestingly, horizontal hostility is contrary to the organizational goals and objectives that have been put in place at HealthNorth Hospital. The vision of the organization clearly stipulates that the organization is dedicated to the provision of high quality patient care with inexorable consideration to excellence in nursing, patient care and safety in addition to allocating unmatched commitment and passion to ensure that our clients receive the best healthcare. Even at the best of circumstance, horizontal hostility persists within the organization.
Some of the underlying reasons for the persistent hostility can be attributed to long hours of working, poorly managed nursing units, strained nurse-supervisor relationships, increased assignments, jealous workers, and sicker patients. Other possible gaps that exist within the institution include increased vulnerabilities among staff members, prevalence of powerful and powerless groups, and lack of accountability and responsiveness among different groups (Weinberg, 2003). The management structure at HealthNorth Hospital is equally to blame for the persisted intimidation and horizontal hostilities among members within the organization. For instance, the top-down structural management structure leads to the creation of different power groups within the organization. As such, the desire for power and achievement causes supervisors to fail to cooperate with each other thereby leading to persisted problems among subordinates (Kathleen, 2006).
Based on the analysis of the situation at HealthNorth Hospital, horizontal hostilities can be eliminated by understanding the cause and effects of the aggressive behavior. Irrespective of the factors that promote the violence, be it management issues, strained worker relationships, increased workloads, and power groups; the structure of the healthcare system is largely to blame. Majority of resources have been channeled towards the realization of profit objectives, productivity, and technological infrastructures thereby ignoring vital factors that affect the nursing institution (Weinberg, 2003). The truth must be spoken and the nursing image must be rebuilt in order to capture the attention of management personnel. However, it is also necessary to make recognition between genuine criticism and horizontal hostility to avoid cases of confusion. In the absence of adequate reasons, judgment can be suspended until enough evidence is gathered.
According to the formative conceptualization for organizational hostility model, horizontal hostility varies with the kind of organizational structures that allow the vice to develop (Inocencia, and Jose, 2011). The model argues that the management and leadership structures within an organization are responsible for helping the growth of the vice within the organization (Inocencia, and Jose, 2011).
Recommendations
Based on the strategic analysis of the situation, the following action plan can be used to provide strategic recommendations. First, it is necessary to acknowledge the fact that healthcare institution such as hospitals are extremely stressful due to factors such as shortage of nurses, sicker patients, power struggles among patients, and increased cases of oppression. As such, it is essential for HealthNorth to identify the causes and reasons for persisted horizontal hostilities. Second, the hospital management should know that horizontal hostilities are associated with enormous costs and hence, it is critical to develop measures to ameliorate the situation. This will entail identifying ways of improving communication, teamwork, and implementing ways of ensuring job satisfactions. Lastly, it is necessary to listen to the needs of nurses and appropriate action is taken.
The following action plan can be taken:
Utilize three organizational levels to fight horizontal hostility (organizational, personal, and departmental levels).
Encourage nurses to speak up when the issue of hostility becomes prevalent within the organization. This entails organizing discussion with staff and nurses.
Confront the offenders and counsel them on ways of resolving their disputes. This includes teaching and training nurses with the requisite skills.
Members of the management should be responsible for resolving disputes and hence they must ensure that they are not the culprits
Establishing shared values within the organization to ensure the creation of a healthy organizational culture. It will also promote the adoption of standards such as those outlined by the American Association of Critical-Care Nurses (AACN).
Punitive measures should be enacted to those found guilty of horizontal hostilities
Review the plan on a monthly basis to identify any form or forms of progress
All measures and practices will be developed based on the organizational policies and cultures
Evaluation Plan
Since change occurs slowly, the management or the implementing team should be patient and persistent to allow time for strategies to deliver the desired results. Each of the recommended strategy has its own advantage or disadvantage. The following measures apply during evaluation;
Every culprit or offender should be held accountable for his/her actions
Examining the level of power imbalance and communication level and how they manifested during horizontal hostilities
The Leadership management should take responsibility and challenge to implement the above recommendations
Monthly evaluation reports on horizontal hostility should be prepared and supplied to all members within the organization.
Using American Association of Critical-Care Nurses (AACN) Call to Action principles
References
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Dunn, H. 2003. Horizontal violence among nurses in the operating room. AORN
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Research and Strategies (Advances in Health Care Management, Volume 10), Emerald
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Hallberg LR (2007). The origin of workplace bullying: experiences from the perspective of bully
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Inocencia M. M., and Jose A. M., (2011).” The influence of organizational structure on
organizational learning,” International Journal of Manpower, Vol. 32 Iss: 5/6, pp.537 –
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Kathleen (2006). Ending nurse-to-nurse hostility: Why nurses eat their young and each other.
Marblehead, MA: HCPro, Inc.
McKenna, B. G., (2003). Horizontal violence: experiences of registered nurses in their first year
of practice. Journal of Advanced Nursing, 42(1), p. 90-96.
O’Hare, M., and J. O’Hare. 2004. Don’t perpetuate horizontal violence. Nursing Spectrum.
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