For many years, nurses in international clinical and academic settings have voiced concern about horizontal violence among nurses and its consequences. However, no known framework exists to guide research on the topic to explain these consequences. This paper presents a conceptual model that was developed from four theories to illustrate how the quality and safety of patient care could be affected by horizontal violence. Research is needed to validate the new model and to gather empirical evidence of the consequences of horizontal violence on which to base recommendations for future research, education, and practice. 1. Introduction For several decades, clinical and academic nurses have written about horizontal violence among nurses in clinical settings and its consequences. Horizontal violence is behavior that is directed by one peer toward another that harms, disrespects, and devalues the worth of the recipient while denying them their basic human rights [1]. Examples include nonverbal behavior, such as ignoring a peer, verbal behavior, such as making sarcastic comments to them or talking behind their back, and/or physical acts like shoving someone or slamming things [1]. Other similar terms used to label negative behavior among nurses at work include nurse-on-nurse aggression [2, 3], bullying [4–8], verbal abuse [9–11], lateral violence [12–14], incivility [15], and lateral or horizontal hostility [16, 17]. The term horizontal violence was used in this paper because, unlike the other terms, horizontal violence is drawn from oppression theory, one of the four theories used to develop the model described herein. Research articles [2, 3, 5–7, 18, 19] and opinion pieces [20–22] from Australia, New Zealand, the United Kingdom, and the United States suggest that nurses share an ongoing and growing concern about horizontal violence and its consequences for nurses, nursing, healthcare organizations, and particularly for patients. Many researchers have described horizontal violence among nurses working in hospitals [2, 3, 5, 6, 10, 11, 14, 18, 23, 24]. Nurses suffer consequences as a result of their experiences such as sadness, anxiety, mistrust, diminished self-esteem and self-confidence [7, 10, 18], job dissatisfaction [10], and negative effects on peer relationships [10]. Some describe their experiences as painful [24] and far more distressing than when similar behaviors are directed toward them by physicians or patients [2, 3]. Some nurses intend to leave their current job to find work elsewhere [5, 6, 8, 11] while others consider leaving nursing
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