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How can I tell whether horizontal hostility is a problem on my unit?

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Researchers often use the word "insidious" to describe horizontal hostility because it has existed as an undercurrent of the nursing profession for years. Not only is the behavior hidden, but the costs are hidden as well, as the financial impact lags behind the actual events. And when its destruction becomes obvious, it is usually too late—a high turnover results not only in a mass exodus of staff but also in a crucial break in the unit's knowledge base.

Here are indications that horizontal hostility could be present on your unit:

Poor employee satisfaction scores: Satisfaction surveys differ in content from facility to facility, but there are usually some similarities. The scores you should be most interested in are ‘intent to leave,’ ’sense of belonging,’ ’meaningful work,’ ‘morale of self,’ and ’morale of others.’

High turnover rates: This is an obvious indicator of horizontal hostility. Staff who feel that they belong will clearly want to stay—and vice versa. The key to preventing a mass exodus is to follow up with an employee the moment you get the heads up that he or she may be leaving.

Dueling units, dueling shifts: I was in charge of two floors and for the first six months, I heard numerous complaints as staff whined they didn't want to float to the other floor. Reading between the lines was the message that both floors felt that "our floor is harder than yours." To solve problems like this, try helping each unit understand what it’s like to walk in each other’s shoes. This can be a powerful tool to help staff understand that different floors and different shifts each have their own unique set of challenges.

Incident reports: Be aware if these reports are always filled out by the same person or are about the same person. A nurse consistently writing up her peers may have a witch-hunt mentality.


-- Kathleen Bartholomew, RN, MN

(October 2009)