Looking back at the literature review, evidences from several studies have shown how nurses over the past several years have continued a trend of horizontal violence that began decades ago. These nurses felt that to prove that before a novice nurse will be ready to enter the profession, there must be a test or rite of passage that they should pass and be able to get through. The said rite of passage was formerly practiced from one generation of nurses and passed it on to the next generation.
This creates an atmosphere of bullying by condoning the practice of such rites or hazing practices that happen to novice nurses in return to prove their ability to perform in the pressure intense environment. Given the above premise, it is the purpose of this study to look into the novice nurse and the type of horizontal violence they may be experiencing in different types of intensive care units (ICU) during the orientation process. Through this study, there can be a validation of whether or not horizontal violence does occur in the ICU during nurse orientation.
If it does, by looking at horizontal violence in various ICU’s, an understanding of such type of violence among new novice nurses may be developed. It is also the purpose of this study to provide the most accurate answers possible to this paper’s research questions. To reiterate, the questions are as follows: (1) While in orientation, do novice nurses experience horizontal violence in the ICU’s in a Midwestern magnet status hospital? ; (2) Is bullying present during the orientation process in the ICU? (3) Do the novice nurses experience sabotage while in orientation? ; and (4) Has the novice nurses experienced feeling like an outcast or have they experienced name-calling during their orientation in the cardiovascular ICU? One theory that stands out when discussions on the theoretical framework with regard to horizontal violence is Paulo Freire’s oppression theory. Theorist Paulo Freire first presented the oppression theory in 1972 when explaining the conflict of the colonized African populations.
This theory discusses the observance of the imbalance of power due to dominate and subordinate groups. The oppression theory discusses how two groups are involved and the dominate group maintains higher power than the subordinate group. The oppression occurs when the subordinate group’s culture is repressed by the dominant group. Due to the subordinate group feeling repressed, the subordinate group begins to act out their self-hatred on each other.
By doing this, the values and beliefs that were held by the subordinate group are soon lost and self-hatred settles in. In 1983, Sandra Roberts, applied the oppression theory to nursing and argued that an “understanding of the dynamics underlying leadership of an oppressed group is an important strategy to develop more effective leaders in nursing to be successful. ” (Bartholomew, 2006). Roberts noted that nursing had displayed the dominate group along with the subordinate group referring to the leadership in the nursing profession.
The dominate group makes various decisions without respecting the values of the subordinate group the nurses working on the floor with the patients. Through this process, the subordinate group loses respect for the dominate groups value system and become oppressed with feelings of low self-esteem, self-hatred, and powerlessness. With the oppression theory there is a sub-subordinate group that feels the results of the oppression theory and this is the novice nurses being hired into the nursing profession.
During the orientation phase the novice nurses fall into a subgroup resulting in oppression trying to bring the novice nurses through the rite of passage to be a nurse in the unit that the orientation is occurring. Organizations fashioned to be hierarchical have not fostered a culture of professional collegiality, nor have they advanced the role of nursing. Too often, nurses have acquiesced to a victim mentality that only facilitates a sense of powerlessness.
Nurses have reported concern about the lack of action taken by supervisors in addressing horizontal violence in the workplace (Farrell, 1997; Stanley et al. , 2007). While not directly addressing bullying or horizontal violence, Kramer (1974) described the “reality shock” occurring for new graduates when they encountered differences in their perception of what nursing could be and the actual reality of the workplace. Kramer suggested that “reality shock” can manifest as hopelessness and dissatisfaction, which is a prelude to conflict in the workplace (p. ).
Today, bullying is an international phenomenon not limited to the healthcare arena, and abuse can also occur between professions. The phrase “nurses eat their young,” has been used to describe the negative behaviors directed toward new nurses (Rowe & Sherlock, 2005). Griffin (2004) described the vulnerability of newly licensed nurses as they are socialized into the nursing workforce; lateral violence affected their perception of whether to remain in their current position.
Sofield and Salmond (2003) found that primarily physicians, then patients, and patients’ families were responsible for most of the verbal abuse towards nurses. One-third of respondents expressed they would consider resignation in response to verbal abuse; it was concluded that nurses lacked the skills to deal with the verbal abuse and perceived themselves as powerless to change organizational response (Sofield & Salmond, 2003). Cox found the most frequent source of verbal abuse was physicians, and in descending order patients, families and peers, supervisors and subordinates (1991).
The turn-over attributed to verbal abuse was 24 percent for staff nurses and 25 percent for nurse managers (Cox, 1991) Cook, Green and Topp (2001) found that perioperative nurses encountered verbal abuse by physicians. However, Rowe and Sherlock (2005) reported that nurses in particular were the most frequent source of verbal abuse towards other nurses. Patients’ families were the second most frequent source, followed by physicians and then patients (Rowe & Sherlock, 2005). In 2004, The Institute for Safe Medication Practices published a survey on workplace intimidation.
Almost half of the 2,095 respondents, which included nurses, pharmacists and other providers, recalled being verbally abused when contacting physicians to question or clarify medication prescriptions; intimidation had played a role in either not questioning a concerning order or seeking ways not to directly confront the prescribers. While physicians and prescribers used intimidating behaviors, however they were not the only intimidating healthcare providers (Institute for Safe Medication Practices, 2004).
In a hostile environment, communication is hindered and this can affect quality of care and patient safety (Joint Commission on Accreditation of Healthcare Organizations, 2002). Healthcare providers report intimidation does alter communication and negatively impacts patient care and safety (Institute for Safe Medication Practices, 2004). Healthcare professionals facing intimidation may sometimes choose to abdicate their advocacy role to avoid intimidating behaviors, impacting patient safety.
The Institute for Safe Medication Practices survey (2004) revealed that more experienced nurses are more likely to encounter intimidating behaviors; differences in intimidating encounters were not appreciably different in terms of gender but females were more likely to ask another colleague to talk with the intimidator for them. The organization’s effectiveness in handling intimidation was viewed less favorably by those nurses and pharmacists with more years of practice in that facility (Institute for Safe Medication Practices, 2004).
To add strength to this study, more literature that points to the ICU being one of the top places in the healthcare setting to be the venue for horizontal violence. Bullying in the medical setting is said to happen most of the time in the top three areas, i. e. , medical or surgical units, intensive care units (ICU) and the emergency department (ER). The occurrences of horizontal violence are lesser in the areas such as child health and maternal health areas, psychiatry and operating rooms.
This is the result of findings such as those made by WHO. The World Health Organization has been showing concern with the horizontal violence happening in healthcare settings and has been aware of the problem becoming an epidemic already and has started to think of solutions by first producing guidelines in dealing with the violence when it happens. WHO touched on the patient to nurse type of violence as well and the effects it has on the emotions of the nurses.
The results of the survey made by WHO also made a significant finding, that the highest rating for workplace violence was in the areas of highest acuity like the intensive care units. This made even stronger the need to find out the prevalence of horizontal violence in the ICU. With all the above literature taken from scholarly journals and books, it is quite apparent that horizontal violence is indeed present in the healthcare industry today. There are even some studies held that have proven its existence in the intensive care unit.
Most of the studies made point to the new or novice nurses as the main victim, with other more superior nurses being their main predators. To get concrete evidence of its existence in the ICU during orientation in a Midwestern magnet status hospital and to get further evidence on horizontal violence in the ICU, a study about it based on a cross sectional non-experimental explanatory research model and the Likert Scale which will further be discussed in the next topics.
Design Novice nurses that have been in orientation in various types of ICU for the past three to six months were asked to participate in the survey. Those that participated were nurses that have attended orientation in any of the intensive care units, i. e. , surgical ICU, cardiovascular ICU, coronary ICU or general ICU. All these novice nurses were given the same survey questions in relation to understanding whether they have experienced horizontal violence while they were in orientation.
With looking at several different ICUs, there are varying variables that are influenced. Firstly, each participating intensive care unit has different formats for their orientation process. There are also different educators for each of the ICUs and varying preceptors orienting each of the novice nurses. A cross sectional non-experimental explanatory research model will be used to conduct the survey of novice nurses in different types of ICU’s. The survey will be given to novice nurses that have been in orientation in the ICU’s for the past three to six months.
Out of the novice, nurses that are surveyed there will be varying educational backgrounds along with different work experience. The common thread among the novice nurses will be that they are novice nurses in the area they are orienting in at the time the survey is administered. Strengths of this study will look at a cross section of the novice nurses in orientation in a Midwestern hospital to investigate the occurrences of horizontal violence during orientation.
Due to the cross section, this study will also give illumination to the working relationship between novice nurses and expert nurses during orientation in the intensive care units. This study will provide a base for educational purposes on how to improve the relationships between the novice nurses and expert nurses during orientation in the intensive care units. Another benefit from the study, there will be a study that has looked at the type of horizontal violence that is occurring during the orientation process in the intensive care units.
This will give the building blocks to educating the expert nurses in how to be more encouraging towards the novice nurses during the orientation process. The reason in using this non-experimental quantitative research model is due to the fact that many of the most vital variables of interest in this study are not manipulable. This is however not indicative of any less methodology employed. Many researchers actually make use of non-experimental research since it is highly descriptive and it allows effective communications in an interdisciplinary research environment.
Non-experimental quantitative research is an essential area of research due to its many vital though non-manipulable independent variables that may need further study. Some known methodologists even say that non-experimental research (Kerlinger, 1986) is more important that experimental research in such as way that educational and social research problems may not lend themselves to experimentation but lend themselves to controlled inquiry that is of the non-experimental type. The mentioned characteristics of this kind of research model make it a good choice for this particular study.
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