Incivility & Horizontal Hostility in the Nursing Profession

Keith Rischer, RN, MA, CEN, CCRN

Confronting Horizontal Hostility

• HH Defined– Nurses covertly or overtly directing their

dissatisfaction inward toward each other and those around them• Unkind, aggressive, antagonistic behaviors• Emotionally abusive

– “Professional” behavior that is…• Demeaning• Devaluing• Disrespectful

Most Frequent Forms in Nursing

• Nonverbal innuendo– Raising eyebrows-face making

• Verbal affront– Snide remarks

• Undermining activities– Not available to help

• Sabotoge– Deliberately set up neg. situation

• Infighting• Scapegoating• Backstabbing

Who is at Highest Risk?

• New RN or nurse from another area• Nurses who are different than the dominant

group-Men in nursing or minorities• HH is used to break new nurses into the

“group” or acculturate them into the profession

• HH teaches the “unspoken rules” or status quo that must not be rocked

New Graduate Experiences

• Feeling neglected or isolated• Too much responsibility without support

Consequences of HH cont.

Psychological• Depression• PTSD-50% suffer stress 5 years afterwards• Burnout• Lack of control• Maladaptive responses: substance abuse,

overeating

Physical• Decreased immune response• Cardiac arrythmias/MI secondary to

continuous circulating catecholamines

How does HH Survive & Thrive?• Denial– By both the perpetrator of HH and nurses who remain silent

• Normative– Nobody questions it. Similar to dysfunctional co-dependant

relationships• Ineffective Supervisor Intervention• Lack of Confrontation Skills– Passive/aggressive communication style common with

women and within nursing• Aggression of HH Breeds Aggression in Victim– Vicious cycle is perpetrated

Empowering Strategies:Carefronting

• Recognize what it is• Carefronting uses biblical concepts of respect,

forgiveness and courage to confront• Caring enough to confront the “bully” in a

responsible, respectful manner

Empowering Strategies

• Non-verbal innuendo– “I sense from your facial expression that there may be

something you wanted to say to me. It’s OK to speak directly to me…”

• Backstabbing– “I don’t feel right talking about him/her situation when I

wasn’t there or don’t know the facts. Have you spoken to them?”

• Verbal affront– “Those I learn the most from are direct and clear in their

feedback. What could you share with me to better understand this situation?”

Principles to Transform the Profession

• Form meaningful relationships w/colleagues• Recapture the dignity and value of the nursing

profession• Empowerment– Embrace ability to change the situations that

encourage oppression in health care• Respect and value self and others• Don’t engage in negative conversation about another

co-worker• Stand up for the “absent member

Closing Thoughts

• Need to respect our uniqueness and differences as a strength

• Nursing is a caring profession• We have a professional responsibility to “care”

for each other in addition to our patients