Horizontal Violence

by PATTI on MARCH 24, 2007

The stories are all too familiar. CNA’s treating each other poorly. New CNA’s often receive the worst assignments and are blamed when things go awry. Experienced CNA’s participate with this “hazing” of new staff. The overwhelming need to fit in is important. But at what cost? Does anyone consider the consequences of their actions? Increased turnover is the result of Horizontal Violence and job dissatisfaction. This means increased workloads for those left behind and this results in poorer quality care for the residents. Another possible ramification is the image the general public has of CNA’s and of Nursing in general. CNA’s aren’t considered to be professionals. A case for professionalism isn’t made when patients hear CNA’s telling each other off or arguing with nurses. All CNA’s should work together to stop Horizontal Violence. What can the CNA do to help stop this?
It is easy to say: “I refuse to participate in any activities that may undermine another person’s worth”…But some lack the courage to say this. A lot of changes must take place in workplaces to create an environment in which CNA’s need not fear communicating the truth, and where others invite their input and listen to it. In reality, actions speak loader than words. Those who are looked to as role models or have the courage of their convictions should act to create such a workplace. It is acknowledged that where Horizontal Violence occurs management is a part of the problem. Behaviors begin at the top. If their is a perceived lack of support then there is little likelihood for change. Policies need to be in place, and supported, which clearly state the work ethics of the institution. Change is difficult but it is to the advantage of the CNA, the resident and the entire facility.

The average CNA can contribute. Follow the simple Golden Rule: Do onto others what you would want them to do to you. Treat people the way you want to be treated.

Try adopting the following into your everyday work habits:
Use kindness, concern and respect in all dealings with others.
Respectful listening-look peers in the eye when talking
Lead By Example (Make a bed for another CNA who is behind)
Own up to your mistakes, don’t attempt to shift the blame
When making requests, be polite, be tactful.
Use a positive and respectful tone
Don’t participate in gossip
Invite loners and newcomers to breaks and meals
Tell the nurse she did a great job or compliment her for something extra special she did to help.
When others do a kind act, thank them in front of others,
Bring your whole self to work and give it your best shot
Accept your fair share of the work load.
Respect others privacy
Be respectful of shared working conditions
Be willing to help when requested
Work together despite personal dislikes
Don’t denigrate to superiors
Address peers by their first name
Ask for help and advice when needed.
Repay debts promptly
Stand up for peers in their absence, don’t be critical of them.

Some of the effects of the above acts:
Increased job satisfaction
Higher self esteem
Personal power
Faith in Self and in Others
Lower absenteeism rates
Work environment deemed more “family like” than”just another job”

A Note About Vertical Violence (from nurses to CNA’s):
The manner in which nurses treat each other as well as CNA’s needs to be addressed. How do we handle a situation such as being yelled at by a nurse because we didn’t get something done? When a nurse (or CNA) is yelling at us, it is virtually impossible to maintain any sense of control. We get embarrassed, we are humiliated and get red faces. While being yelled at we cannot even begin to defend ourselves or explain what has happened. The best thing to do at this point is to ask the nurse, in a respectful manner, to leave the area and go to a private place. This is where these discussions should take place in the first place, and CNA’s should always insist on this. Ask the nurse to restate her concern without the load body languages and tones. Once you think you understand what the nurse is saying to you, rephrase it back to her. This is called validating. Once she agrees that you understand each other, explain to her what happened. Remember that nurses are also victims of Horizontal and Vertical Violence; they get yelled at by doctors, DON’s, administrators, patients. Collectively we are get yelled at and we are all victims. Together we can work to bring an end to this, and maybe someday we can say with pride that we are professionals.

The CNA can do all these simple things to bring about change within their work units. By refusing to undermine others, and by maintaining a high work ethic, CNA’s are in a good position to help create a positive and enriching environment in which to work. CNA’s should consider meeting with management to discuss “Horizontal Violence” and describe it’s negative impact upon quality care.

Some things to consider when meeting with management:
Look at turnover rates…Ask why so many leave. The usual high ratios and low pay are always there, but look into the way staff treat each other. Honest and open discussion are required in order to truly change. If staff feel a sense of belonging and personal satisfaction they will continue to work under less than perfect conditions.

Ask management to add a lecture about HV in CNA Training Classes
Ask management to form an Employee Mentor Program(for new staff)
Ask management to form Quality Teams (who will tackle all areas of quality within the facility)
Ask management to consider forming a policy about all forms of Workplace Violence- Horizontal,
& Vertical. The benefits will outweigh the costs involved.
Ask management to write a statement of position about workplace violence.

Bring to management’s attention the following early warning signs of impending physical violence:
Weak or non-existent policy against all forms of workplace violence-physical as well as horizontal and downward.
Negligent Human Resource Practices: (weak hiring practices, negligent training, poor supervision)
Ineffective or non-existent reporting procedures for violence and threats
An autocratic or abusive management style (unfortunately, typical in nursing)
An atmosphere of indignity tolerating sexual and non-sexual harassment, disrespect and intolerance.

Many nursing homes have adopted the following list of “Rights of The Employee”:

1) To insist on a reasonable workload and fair expectations
2) To put family obligations first when necessary
3) To refuse to do something that conflicts with your principles
4) To receive fair compensation and increases for the work you perform
5) To be treated with dignity and respect
6) To refuse to be responsible for someone else’s performance
7) To be kept informed about decisions that impact your job
To refuse to participate in office politics without fear of emotional or economic retaliation
9) To stand up and take action against any kind of harrasment, threats, intimidation attempts and discriminatory behavior, verbal abuse, violations of trust and confidentiality.
10) To performance expectations that are clear, consistant, rational,honest, stated up front, and free of unwritten rules.
11) To adequate training
12) To question procedures that seem contradictory, overly complex or excessively bureaucratic.
13) To be treated as an individual, and to refuse to be treated as a unit or a statistic.
14) To insist that stated or implied promises and commitments be kept
15) To move on if your job doesn’t meet your needs


Some links to workplace violence, Horizontal Violence and Nursing:
Ending Nursing Violence

Horizontal Violence: A Male Nurse’s Perspective

Are you being bullied?

The Costs of Workplace Discontent

A Management Toolkit: Ending Nurse-to-Nurse Hostility

And remember that by complaining about the situation at work and not doing anything towards changing it you are contributing to a negative work environment. Each CNA had within them the capacity to help make a difference.

Try it….Today.

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This material can be used freely for educational purposes.