How Nurses Can Help End Horizontal Hostility
Nurses are supposed to be compassionate caregivers. So why are so many scarred emotionally from the demoralizing or hostile acts nurses inflict on one another? If you've had enough of the fighting, read on. Veteran nurses explain why such horizontal hostility occurs, revealing the true price it exacts, and share tips for creating a more collegial workplace.
What Is Horizontal Hostility?
Horizontal hostility is hostility that occurs between members of a group of people that outsiders expect would have strong bonds. In this instance, we're talking about nurses who turn on each other when they should be having each other's backs. Horizontal hostility examples include gossip and backstabbing.
Step 1: Know Why It Happens
Hospitals make stressful workplaces. Patients are sicker than ever, nurses are in short supply, and many nurses are getting older. Plus, many groups and individuals often care for one patient, setting up power struggles and an "us-versus-them" mentality, says Melissa Fitzpatrick, RN, MSN, FAAN, former chief healthcare strategist with business intelligence software provider SAS Institute and former chief nurse executive at Duke University Medical Center.
Horizontal hostility among nurses resembles that of other oppressed groups, says Kathleen Bartholomew, RN, MN, whose pre-nursing background was in sociology. After doctors yell at them, nurses may take it out on coworkers. And when people work harder and faster without time to debrief, they act out, says Bartholomew, author of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other.
Generational differences can also create strife when values, communication styles and skill sets clash. In addition, conflict can arise when nurses and institutional practices mishandle the integration of new nurses—an unfortunately common occurrence given the nursing shortage.
Step 2: Realize the Cost
"Nurses who are doing the negative talking, putting others down, don't realize the damage they are doing," Bartholomew says. Negativity leads to a sense of isolation and torpedoes teamwork. "You end up with a life-preserver attitude instead of a lifeboat mentality," she says. "It becomes ‘every man for himself' rather than ‘we're all in this together.'"
Poor teamwork and communication can also spell trouble for patients, Bartholomew says. She almost lost a patient herself when a coworker, upset by a colleague's comments, programmed the pain machine incorrectly, dispensing the wrong dose.
Low satisfaction and morale lead to turnover, which triggers other negative outcomes: The remaining nurses become bitter and resentful, and facilities bear additional costs for orienting new nurses. A survey by the Association of Perioperative Registered Nurses estimated it costs $30,000 to $50,000 to orient a novice perioperative nurse. Other studies place the cost far higher—as much as twice a nurse's annual salary.
Step 3: Take Action
Nurses can help defeat the culture of hostility on three levels: personal, unit and organizational. Here's how:
- Speak Up: When hostility becomes an issue in your work environment, make yourself known. Talk to your manager, supervisor, or an administrator.
- Confront the Offender: Don't engage in the passive-aggressive behavior of complaining to or involving a third party who can't resolve the situation. Ask your peer to step away from patients and talk about what's going on. Acknowledge the behavior and note differences in skills, but agree that you're working toward the same goals. Share strengths as a way to help each other gain missing skills.
- Make Sure It's Not You: Check your behavior to make sure you're not party to the hostility in any way—either as victim, bystander, or aggressor.
- Arm Yourself: Learn to handle confrontation by reading books like Crucial Conversations: Tools for Talking When Stakes are High and others suggested by the American Association of Critical-Care Nurses' (AACN) Healthy Work Environment Initiative.
- Create Shared Values: Work with colleagues to create a unit philosophy that states shared values and defines acceptable and unacceptable behavior, suggests Bartholomew. Articulate consequences, and hold people accountable for their actions.
- Enlist Management's Support: A healthy organizational culture must be a priority that comes from the top. If your hospital hasn't done so already, encourage it to adopt the standards outlined in the AACN's Healthy Work Environment Initiative and achieve the American Nursing Association's Magnet hospital status, which recognizes excellence in nursing services.
Finally, be patient but persistent. Culture change can occur, but it happens slowly.
Find a Healthier Workplace
Horizontal hostility is not something you need to put up with. Ready to find a new employer but not sure how to begin? Start by creating a free profile on Monster. We can connect you with healthcare recruiters, send you custom job alerts, and deliver career advice right to your inbox. Let us help you on the way to finding a brighter, more supportive workplace.