Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN, Chairperson; Jane M. Georges, PhD, RN; Kathleen M. Stacy, PhD, RN, CNS, CCRN, PCCN, CCNS


falls, horizontal violence, nursing, patient care, registered nurses, work environment


Background: Horizontal violence is a manifestation of oppressed group behavior leading to low self-esteem and feelings of worthlessness among nurses. Horizontal violence leads to the creation of a hostile, unsafe work environment preventing nurses from performing at their highest potentials. A hostile work environment leads to a culture of unsafe patient care which may result in increased harm to patients. An understanding of why horizontal violence occurs and the implications of this phenomenon are the first steps in addressing this destructive behavior as well as protecting patients from harm. Health care environments must support nurses to perform at their best in order to provide safe high quality patient care. Methodology: This was a correlation descriptive study of the relationship between nurses' responses to an online questionnaire regarding prevalence of horizontal violence and NDNQI data submission of the number of unit falls, with and without injury. Data was analyzed and correlated at the individual and group levels but was not simultaneously correlated to demonstrate individual responses as predictors of group outcomes. Simultaneous analysis of hierarchical subjects would require more complex analytical methods outside the scope of this study. Results: A majority of the responses to the survey on prevalence of horizontal violence among registered nurses indicated exposure to at least one of these behaviors. Only 42 out of 168 respondents (25%) gave the response "never" to all four items. At least one horizontal violence behavior was experienced by 126 out of 168 respondents (75%) over a six-month period. Individual response (n=168) to the prevalence of horizontal did not positively correlate to the number of unit falls with and without injury. The mean of individual responses per unit (n=6) did not positively correlate to the number of falls with and without injury. No statistical significance was obtained regarding the relationship between prevalence of horizontal violence among registered nurses and falls. Conclusions: While this study did not demonstrate a positive relationship between the prevalence of horizontal violence and falls, undesirable patient outcomes have been shown in the literature to result from care provided in an environment of poor communication and lack of team work. In the presence of increased numbers of poor patient outcomes, including falls, it is strongly recommended that the work environment be assessed for the presence of horizontal violence.

Document Type

Dissertation: Open Access



Included in

Nursing Commons