The Antecedents of Horizontal Violence Among Nurses: A Qualitative Content Analysis Study
Abstract
Background: Horizontal violence (HV) in healthcare settings refers to any type of violence among healthcare providers and is a serious challenge in nursing. Many different factors may put nurses at risk for HV. This study aimed to explore the antecedents of HV among nurses. Materials and Methods: This qualitative content analysis was conducted in 2022–2023. Participants were 15 nurses purposefully selected from five hospitals affiliated to Hamadan University of Medical Sciences, Hamadan, Iran. In‑depth semistructured interviews were conducted for data collection. The main interview question was, “Have you ever experienced HV in your relationships with your colleagues?” Graneheim and Lundman’s conventional content analysis was used for data analysis. Results: The antecedents of HV among nurses were grouped into two main categories, namely, nurses’ personality traits and the violence‑laden culture of nursing. The subcategories of specific personality traits were bullying personality and oppressed personality, and the subcategories of the violence‑laden culture of nursing were managers’ discriminatory and unjust behaviors and the tense work atmosphere of nursing. Conclusions: Nurses’ personality traits, managers’ discriminatory and unjust behaviors, and the tense work atmosphere of nursing are among the most important antecedents of HV among nurses. These factors can negatively affect nurses’ physical, mental, emotional, and social health, reduce their job motivation, lead to their intention to quit nursing, and undermine care quality.
Keywords
Full Text:
PDFReferences
Maben J, Aunger JA, Abrams R, Wright JM, Pearson M, Westbrook JI, et al. Interventions to address unprofessional behaviours between staff in acute care: What works for whom and why? A realist review. BMC Med 2023;21:403.
Bloom EM. Horizontal violence among nurses: Experiences, responses, and job performance. Nurs Forum 2019;54:77 83.
Travaini GV, Flutti E, Sottocornola M, Tambone V, Blandino A, Di Palma G, et al. Evidence of horizontal violence in healthcare settings: A narrative review. Nurs Rep 2024;14:1647 60.
Zhang X, Xiong L. Impact of nurse horizontal violence and coping strategies: A review. Yangtze Med 2019;3:289 300.
Taylor RA, Taylor SS. Reframing and addressing horizontal violence as a workplace quality improvement concern. Nurs Forum 2018;53:459 65.
Blackstock S, Salami B, Cummings GG. Organisational antecedents, policy and horizontal violence among nurses: An integrative review. J Nurs Manag 2018;26:972 91.
Alshawush K, Hallett N, Bradbury Jones C. Nurse interns’ experiences of workplace violence during internship programme enrolment: A convergent mixed method study. J Nurs Manag 2025;2025:7421931.
Heidari Gorji MA, Jannati Y, Yazdani Cherati J, Jafari K. Horizontal violent behavior in critical care nurses and related factors. J Mazandaran Univ Med Sci 2015;25:78 86.
Krut BA, Laing CM, Moules NJ, Estefan A. The impact of horizontal violence on the individual nurse: A qualitative research study. Nurse Educ Pract 2021;54:103079.
Goh HS, Hosier S, Zhang H. Prevalence, antecedents, and consequences of workplace bullying among nurses—a summary of reviews. Int J Environ Res Public Health 2022;19:8256.
Eblin A. Horizontal violence towards new graduate nurses: When will it stop? Issues Ment Health Nurs 2020;41:850 2.
Fujii C, Iwasa Y. Implications of nursing peer violence on patient safety: An integrative review. Int Nurs Rev 2025;72:e70042.
Varghese A, Joseph J, Vijay VR, Khakha DC, Dhandapani M, Gigini G, et al. Prevalence and determinants of workplace violence among nurses in the South East Asian and Western Pacific Regions: A systematic review and meta analysis. J Clin Nurs 2022;31:798 819.
Bazaid R, Hamilton EM, Parkinson S. Cultivating calm: Applications of biophilic design for reducing ICU nurse burnout and stress. J Inter Des 2025:10717641251381800.
Jelinčić I, Dujmić Ž, Barać I, Farčić N, Jovanović T, Mamić M, et al. Predictors of conflict among nurses and their relationship with personality traits. Nurs Rep 2025;15:378.
Crawford CL, Chu F, Judson LH, Cuenca E, Jadalla AA, Tze Polo L, et al. An integrative review of nurse to nurse incivility, hostility, and workplace violence: A GPS for nurse leaders. Nurs Adm Q 2019;43:138 56.
Kim K, Choi SSW, Im C. Exploring bystander behavior types as a determinant of workplace violence in nursing organizations focusing on nurse to nurse bullying: A qualitative focus Group Study. J Nurs Manag 2024;2024:4653042.
Chang YC, Huang ST, Wang CC, Yang CC. Resilience as a moderator of the effects of types of workplace bullying and job performance. BMC Nurs 2025;24:254.
Halm MA. The impact of the work environment on patients, families, and care delivery in critical care. Crit Care Nurs Clin North Am 2025;37:543 65.
Schmidt NA, Brown JM. Evidence Based Practice for Nurses: Appraisal and Application of Research. Jones and Bartlett Learning; 2024. p. 604.
Purpora C, Blegen MA, Stotts NA. Hospital staff registered nurses’ perception of horizontal violence, peer relationships, and the quality and safety of patient care. Work 2015;51:29 37.
Grove SK, Burns N, Gray JR. The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. 7th ed. St. Louis: Elsevier Saunders.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105 12.
Fakhr Movahedi A, Salsali M, Negharandeh R, Rahnavard Z. A qualitative content analysis of nurse patient communication in Iranian nursing. Int Nurs Rev 2011;58:171 80.
Lincoln Y, Guba E. Naturalistic Inquiry. Thousand Oaks: Sage; 1985. p. 102 4.
Al Muharraq EH, Baker OG, Alallah SM. The prevalence and the relationship of workplace bullying and nurses turnover intentions: A cross sectional study. SAGE Open Nurs 2022;8:23779608221074655.
Karatuna I, Jönsson S, Muhonen T. Workplace bullying in the nursing profession: A cross cultural scoping review. Int J Nurs Stud 2020;111:103628.
Vessey JA, Demarco R, DiFazio R. Bullying, harassment, and horizontal violence in the nursing workforce: The state of the science. Annu Rev Nurs Res 2010;28:133 57.
Corthésy Blondin L, Negrini A, Vila Masse S, Genest C. Improving the psychosocial work environment to prevent sickness absence and turnover in nurses: A systematic review. J Nurs Manag 2025;2025:7860752.
Farley S, Niven K, Hughes DJ, Booth T. Workplace bullying and personality change: Evidence from a 4 year Swiss panel study. Work Stress 2026;40:54 77.
Peng X, Gan Y, Zeng Q, Xiong L, Zhang F, Xiong H, et al. Nurse to nurse horizontal violence in Chinese hospitals and the protective role of head nurse’s caring and nurses’ group behaviour on it: A cross sectional study. J Nurs Manag 2022;30:1590 9.
Hamblin LE, Essenmacher L, Upfal MJ, Russell J, Luborsky M, Ager J, et al. Catalysts of worker to worker violence and incivility in hospitals. J Clin Nurs 2015;24:2458 67.
Tong Y, Wang X, Lei C, Jian X, Xu X, Zheng Z, et al. Workplace bullying and professional identity among male nurses: The mediating role of work engagement and the moderating effect of fear of negative evaluation. BMC Nurs 2025;24:1294.
Kostich K, Lasiter S, Gorrell R. Staff nurses’ perceptions of nurse manager caring behaviors: A scoping study. J Nurs Adm 2020;50:293 9.
Erum H, Abid G, Contreras F, Islam T. Role of family motivation, workplace civility and self efficacy in developing affective commitment and organizational citizenship behavior. Eur J Investig Health Psychol Educ 2020;10:358 74.
Refbacks
- There are currently no refbacks.