Perceptions of Horizontal Violence (Bullying) and Relationships to Nurse Job Satisfaction in an Acute Care Hospital

Purpose:
The aims were to establish reliability and validity for a horizontal violence (HV) measurement tool, obtain baseline data on nurses' perceptions of HV, and explore relationships between HV and job satisfaction. Findings will be used to guide interventions for improvements in the work environment.

Background/Significance:
Leaders in healthcare have identified the importance of a healthy work environment to patient and staff outcomes. Lack of acceptance, bullying, and intimidation by co-workers has been identified as a common problem in healthcare and is often referred to as horizontal violence (HV). Although the concept has been studied by many researchers there are no evidence based reliable and valid tools to measure frequency of HV. There is also a lack of evidence supporting interventions to decrease HV.

Methods:
This descriptive and comparative study used survey methodology via the internet. A convenience sample of 507 nurses employed by a regional referral community hospital responded. The investigator developed survey included a 6-point likert scale with a maximum possible frequency of HV score of 144 and minimum of 24. The subscales overt, covert, and personal effects of HV were determined by a focus group. A content validity index (N = 5, CVI = .90) demonstrated agreement of items measuring HV among the team. A pilot study demonstrated internal reliability (N =28, Cronbach's Alpha, .962). Comparisons of HV scores and the RN Survey with Job Satisfaction Scales (NDNQI) will be analyzed by unit.

Results:
The sample represented 50% of the nurses employed by the organization. The mean overall score for frequency of HV was 65.4 (SD 25.2, min. 24, max. 140). HV was reported to be perpetrated most often by peers (mean 3.51, Sd 1.4), physicians (3.29, 1.4), and supervisors (3.06, 1.5). The most common type of covert HV was belittling others behind their backs (3.97, 1.4). The most common type of overt HV was making negative remarks in front of others (3.92, 1.3). The likert scale represented 1 = never, 2 = once,3 = a few times, 4 = monthly, 5 = weekly, and 6 = daily. These results represent horizontal violence occurring between a few times and monthly in the past 12 months at their current job.

Conclusions and Implications for Practice:
Baseline data were obtained and will be used to develop interventions and measure improvements. The HV survey occurred in July 2009. The NDNQI RN satisfaction survey will be conducted in August 2009. Comparative statistics will be run to determine relationships between HV and nurse satisfaction.