2.50
Hdl Handle:
http://hdl.handle.net/10755/211669
Type:
Research Study
Title:
THE INFLUENCE OF HORIZONTAL HOSTILITY AND PATIENT SAFETY in ACUTE CARE
Abstract:
Background / Rationale: The concept of horizontal hostility (HH) (also referred to as bullying, lateral violence, and peer incivility among others) has been well described for over 20 years. Behaviors consistent with HH vary and range from overt behavioral manifestations (such as infighting among nurses, scapegoating, or passive-aggressive behaviors) to more covert actions such as failing to respect confidences. HH 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. Although there are varying opinions about the origins of such behavior (power vs. powerlessness; oppression by nurses toward other nurses as a characteristic of oppressed group behavior), it is imperative to understand the consequences of horizontal hostility in the workplace and how they might affect patient safety. Purpose: The purpose of this study was to determine perceived HH in the workplace at a community hospital in the Southwest; and then to examine potentially adverse behaviors that the nurses have exhibited as a result of that hostility. Methods: After obtaining IRB approval, a 28-item survey was used, modeled after previously-validated peer incivility tools including the AACN (2005) and Stanley et al. (2007). Surveys were distributed and collected in locked survey boxes located throughout the hospital over a two month period (December 1, 2010 through January 31, 2011). The completion rate was 26% (n=130). Data were analyzed using Predictive Analytic SoftWare (PASW) version 18; and descriptive statistics included frequencies of gender, age, years of clinical experience, and educational attainment. Results: Among other questions, nurses were asked: “If you have personally experienced HH by a co-worker or physician, circle all of the statements that reflect your behavior as a result of that experience.” Of those that had personally experienced HH, nurses reported such adverse behaviors as; (a) trying to interpret an unreadable order rather than calling for clarification (28.3%); (b) lifting or ambulating heavy or extremely debilitated patients alone rather than ask for assistance (25.6%); (c) carrying out an order that they did not believe was in the best interest of their patient without challenging it (11.6%); and, (d) using a piece of medical equipment that they were not unfamiliar with rather than seek help (11.6%). Implications:  Joint commission has implemented a standard beginning January 2009 that requires hospitals to define all forms of disruptive behavior and have a process in place for dealing with it.  Results from our study in a single community hospital in the Southwest suggest that the influence of HH or peer incivility in the acute care environment can have a significant impact on nurses’ behaviors with potentially catastrophic outcomes for patients under their care. 
Keywords:
Anger/hostility; Bullying in the workplace; Nurses
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
4774
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleTHE INFLUENCE OF HORIZONTAL HOSTILITY AND PATIENT SAFETY in ACUTE CAREen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211669-
dc.description.abstractBackground / Rationale: The concept of horizontal hostility (HH) (also referred to as bullying, lateral violence, and peer incivility among others) has been well described for over 20 years. Behaviors consistent with HH vary and range from overt behavioral manifestations (such as infighting among nurses, scapegoating, or passive-aggressive behaviors) to more covert actions such as failing to respect confidences. HH 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. Although there are varying opinions about the origins of such behavior (power vs. powerlessness; oppression by nurses toward other nurses as a characteristic of oppressed group behavior), it is imperative to understand the consequences of horizontal hostility in the workplace and how they might affect patient safety. Purpose: The purpose of this study was to determine perceived HH in the workplace at a community hospital in the Southwest; and then to examine potentially adverse behaviors that the nurses have exhibited as a result of that hostility. Methods: After obtaining IRB approval, a 28-item survey was used, modeled after previously-validated peer incivility tools including the AACN (2005) and Stanley et al. (2007). Surveys were distributed and collected in locked survey boxes located throughout the hospital over a two month period (December 1, 2010 through January 31, 2011). The completion rate was 26% (n=130). Data were analyzed using Predictive Analytic SoftWare (PASW) version 18; and descriptive statistics included frequencies of gender, age, years of clinical experience, and educational attainment. Results: Among other questions, nurses were asked: “If you have personally experienced HH by a co-worker or physician, circle all of the statements that reflect your behavior as a result of that experience.” Of those that had personally experienced HH, nurses reported such adverse behaviors as; (a) trying to interpret an unreadable order rather than calling for clarification (28.3%); (b) lifting or ambulating heavy or extremely debilitated patients alone rather than ask for assistance (25.6%); (c) carrying out an order that they did not believe was in the best interest of their patient without challenging it (11.6%); and, (d) using a piece of medical equipment that they were not unfamiliar with rather than seek help (11.6%). Implications:  Joint commission has implemented a standard beginning January 2009 that requires hospitals to define all forms of disruptive behavior and have a process in place for dealing with it.  Results from our study in a single community hospital in the Southwest suggest that the influence of HH or peer incivility in the acute care environment can have a significant impact on nurses’ behaviors with potentially catastrophic outcomes for patients under their care. en_GB
dc.subjectAnger/hostilityen_GB
dc.subjectBullying in the workplaceen_GB
dc.subjectNursesen_GB
dc.date.available2012-02-20T12:07:26Z-
dc.date.issued2012-02-20T12:07:26Z-
dc.date.accessioned2012-02-20T12:07:26Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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