Horizontal Violence in Nursing: How to Overcome Incivility in Nursing Practice

by | Jan 24, 2017 | Nurse Life, New Grad Nurse | 7 comments

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A culture of negativity is not something very obvious and apparent. Horizontal violence in nursing – or nurse bullying, can be quite subtle. A comment here, an eye roll there, gossip in the dictation room, or a passive-aggressive sigh.  It can be really hard to navigate this at any point in your career, but it is especially difficult for people who are new to the profession.

I think one of the most important ways to survive working in a negative unit culture and dealing with nurse bullying (aka horizontal violence in nursing), and maybe even potentially shift the culture, is this:

Be outside of the negativity, not within it.

I’ve outlined some practical tips for those of you who find yourselves in the thick this situation:

Horizontal Violence in Nursing

My Secret Antidote to Horizontal Violence in Nursing

Full disclosure, I have somewhat of a 🔥 hot take 🔥 here. A lot of horizontal violence training focuses on the bully and identifying behavior. However, how we’re told to deal with it is very textbook-y … things that sound great on paper or in theory but in the human-to-human conversation don’t translate well.

I can’t change a bully’s behavior. They’re not the one Googling “how to deal with horizontal violence in nursing.” Often, they don’t even realize they’re being very not-cool. I believe the antidote to bullying is assertiveness. This is a skill we all need, but are not formally taught. If you are assertive, that means you’ll tactfully push back to this behavior, which makes it so you’re not an easy target.

My favorite resources for learning assertiveness are here and here. I cannot recommend those books enough to give the appropriate background on the topic. We also talk about assertiveness in my online courses because every nurse needs to know these skills to work with one another, physicians, families, and more.

By learning assertiveness skills, you will be able to deal with horizontal violence in nursing with more confidence and tact. However, there are more tips to help navigate the subtle art of dealing with negative coworkers in a nursing context. Let’s go through my 8 tips to help you through those dreaded situations at the nursing station when someone starts to be unkind, negative, or gossip.

1. Don’t participate in negativity

Simply be silent. It’s a little awkward at first, but people will soon learn that they can’t go to you to talk about people or complain. It’s kind of like getting used to the awkward silence that’s necessary when supporting your patients. I’ve done this. It takes time, but it works.

By choosing not to engage in negativity, you’re setting a clear boundary and fostering a culture of respect and positivity in your workspace. This approach doesn’t mean you’re indifferent; it means you’re committed to constructive and empathetic communication. As you consistently avoid participating in unproductive conversations, you’ll likely notice a shift in your workplace’s dynamics, and more specifically, they just won’t involve you in negativity because they know you won’t participate. Your colleagues might even begin to view you as a proponent of positive change, and you may inspire others to reflect on their actions and contribute to a healthier, more supportive environment for everyone.

2. Provide a positive point for every negative one

When people start talking negatively, provide a positive point for every negative one. So if they’re talking about how stupid an employee is, bring up times when they were smart or did something great. Counteract the negativity… soon, it won’t be fun bringing up the things they think are funny because you’re forcing them to think about the positive things.

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This way, you not only counteract the negativity but you also subtly shift the narrative towards a more balanced and fair perspective. Over time, this approach can change the tone of conversations in your workplace. By consistently highlighting the positive, you consistently diminish the appeal of negative banter, encouraging a more supportive and appreciative work environment.

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3. Spark conversations about the positive

Learn about some things the informal leaders enjoy that is NOT negative, and spark up conversations about it. Be engaged and interested when they start talking about that, and completely disengage when they start to be negative. This approach not only redirects the conversation away from unproductive negativity but also helps you connect with these influencers on a more personal level, combating horizontal violence in nursing. By showing genuine interest in their positive interests, whether it’s a hobby, a recent vacation, or a favorite book, you create common ground and foster positive interactions.

Over time, these leaders may begin to associate interactions with you as uplifting and positive, making them more likely to initiate conversations that aren’t centered around negativity.

4. Be unapologetic about being positive

If you’re doing something the informal leaders think is lame, like pulling a policy they think you should know, or giving you heck for being involved in shared governance, just be you and do what you want. This stand against incivility in nursing not only affirms your values but also demonstrates your courage to stand by your convictions. Talk about it with others positively in front of them; show that you’re not scared to go against the negative grain.

By embracing your positive actions and speaking about them openly, you not only affirm your values but also demonstrate the courage to stand by your convictions. Trust me, this is incredibly impactful in a workplace environment, as it sets a precedent for others. It signals that it’s not only okay to be positive and proactive, but admirable. Your confidence in the face of cynicism can inspire colleagues to rethink their own attitudes and perhaps even embolden them to express their positive viewpoints and ideas.

5. Be kind but direct when it’s about the job

Be all business when it’s black-and-white clinical stuff. If they’re simply not doing their job, in an all-business way, call them out.

  • “Hey Mary, your alarms keep going off for no reason. Can you go adjust them so we don’t keep thinking it’s our patient?”
  • “Hey Joanna I love you but, I’ve answered about 19 of the last 20 of your call lights while you kick it here in the nurse’s station.”
  • “Hey Joe, I’m going to need you to quit calling out last minute! You really left is in a bind!”
  • **Everyone is sitting at the nurse’s station and Sarah’s patient is alarming again and she’s not getting up to address it, hoping someone else will** “Sarah, looks like your patient is going off again!”

But don’t stop there – the most important aspect of this is not shunning them after you say something like this. Call them out respectfully, but don’t treat them differently. “Hey Sarah, your patient’s alarm is going off again.  What did you bring for  lunch?”

6. Know when to get a nurse manager

Only bring in a nurse manager when absolutely necessary. Part of professional accountability is holding each other accountable and not having to bring in a third party who wasn’t there. It merely turns into “he said, she said,” and minimal progress is made. We are professional nurses; we should be able to speak to each other when someone isn’t pulling their weight. The manager should be brought in for serious things that can’t be mediated between one another. 

Many people just want the manager to step in and fix something, but the manager isn’t there to see the subtle behavior; you and your colleagues are.  Some people also don’t want to “get involved” but they want to complain. If you’re frustrated enough to complain, be professional and speak to them about it.

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7. Don’t always assume it’s laziness or malicious

Maybe someone seriously doesn’t know what they’re supposed to do, and whenever they ask for someone to explain it, they get brushed off. If someone keeps forgetting to chart something or doesn’t adjust their alarms, take a second to show them how and answer any questions before assuming they’re being lazy.

Taking this approach will not only avoid misunderstandings that can lead to horizontal violence in nursing, but also fosters a culture of support and learning. By taking the time to educate and assist, you’re showing empathy and patience, qualities that are essential in a high-stress environment like nursing. Moreover, this behavior models positive conflict resolution and teamwork, encouraging others to act similarly. Over time, applying this mindset to your interactions can significantly reduce the incidence of horizontal violence, as they promote understanding and cooperation over judgment and exclusion.

8. Be quick to admit when you’re wrong

Set an example of it being okay to be wrong and to not be perfect. Many times, mean and negative coworkers set this unrealistic example of what they expect people to be like. Showing fault or flaw in themselves is unthinkable because they must maintain their tough exterior. Fear is one of the biggest motivators! Take ALL the power from that and make it okay to be wrong and to ask for help.  Model that mentality. Be the change you want to see in others.

This attitude not only humanizes you in the eyes of your colleagues but also cultivates an environment where learning from mistakes is valued over pretending to be infallible. By openly admitting your errors and showing how you choose to learn from them, you encourage a culture of honesty and continuous improvement. It dismantles the fear associated with being wrong (a great example for fellow new nurses in your unit!) and replaces it with a supportive framework for growth. Over time, this can transform the workplace into a more open, trusting, and innovative space where everyone feels empowered to contribute their best, without the shadow of unrealistic expectations.

Final Thoughts on Horizontal Violence in Nursing

I hope these practical steps and talking points will help you the next time you find yourself in a negative situation. Remember, just because other people are negative does not mean you need to be. You can still be a positive, joyful person. Bullies and negative people do not get to dictate who you are.  Be empowered to be you!

We can never change someone else’s behavior, but we can change how we perceive it. We can take away the power they think they have. So what if they think I’m lame because I go to committee meetings? I enjoy them. I enjoy my job. I enjoy my life. That’s what matters, not what some negative person thinks about me.

If someone is being negative or demeaning to you, do not give it any power or make you think less of yourself. Release the power that has on you. You are way too awesome to let a complacent and negative person take that away from you!

More Resources for Horizontal Violence in Nursing

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    Hi, I’m Kati.

    Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

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    1. Nick Angelis

      I almost feel guilty because I would set my alarms to see how many times I could get my OCD coworker to get out of his chair and silence them. I love being goofy at work, but we all have those coworkers so enthralled by their own witty cleverness that they hamper productivity–at my work that’s me, like when I bring cans if soup for the coat drive.

      • FRESHRN

        Ha! But if I know you’re messing with me, that’s one thing… but if you’re being lazy then I’ll lose my mind. Kind of like the time when the night shift was coming in soon and they were all like 5’4″ and shorter, so myself and the other tall day shifters put all of the IV poles super high so they couldn’t reach their bags. BWHAHAHAHAHAHAHAHAHAHAHAHAHA.

    2. esther

      what excellent set of suggestions!! Practical and wise. thank you! i wonder if there are more things we can do about it – make some real changes. i have a pickle/ or a puzzle – however you want to see it – dealing with a group of people at my work – i wonder if there is a forum to discuss that…anyway, thanks for the article, bringing together lot of helpful tips.

      • Kati Kleber, BSN RN CCRN

        Thanks Esther! I’m currently trying to explore technology to get a forum together for my platform, so stay tuned! I think that would be really beneficial.

    3. Kristen

      Problem is some nurses in charge would rather pick and choose who they like. Too many CNAs and new nurses getting bullied out here and we should all be a team

    4. Sisterdisco

      Having difficulty with staff at new job, been nurse for well over 15 years. Feels like unprofessional, disorganized, chaotic and loud unit, unable find supplies. Swearing and lots joking not knowing when serious or not.
      Bullying, don’t know what really needs be done at times as one says this and other says that. One dr group particular hard get situations addressed if at all, they want you do their work.
      Techs not all accountable.
      Many patients very needy and demanding and staff does not have your back even if you are doing everything for Patient.

      • Kati Kleber, MSN RN

        Over the years, I have come to the realization that the best way (in my opinion) to deal with bullying is assertiveness. We’re not going to change others, and pointing it out doesn’t really get us that far. I think being someone who is kind, warm, and assertive is the best way to navigate these situations. It means you’re not going to steamroll others, and you’re also not going to let yourself get walked over. This is my favorite resource for becoming more assertive: https://www.amazon.com/Assertiveness-Guide-Women-Communicate-Relationships/dp/1626253374 While it says it’s for women, it’s really for anyone. There are only a few aspects that are specifically directed at the female experience.


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