1. Incivility & Horizontal Hostility in the Nursing Profession
Keith Rischer, RN, MA, CEN, CCRN

2. 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

3. 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

4. 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

5. New Graduate Experiences
Feeling neglected or isolated
Too much responsibility without support
96% of new nurses experienced after 1 year-

6. 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

7. 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

8. 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

9. 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?”
In this study of 26 brand new nurses who used these strategies
96% encountered HH in first year
100% confronted it directly though it was difficult
Most common that these new nurses faced was setting up to fail with unreasonable assignment, sabotage, undermining and not being available

10. 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

11. 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