Professional Nursing Vertical Violence Paper Proposal ...

Running head: VERTICAL VIOLENCE PAPER PROPOSAL 1

Professional Nursing Vertical Violence Paper Proposal

Nicole Daley

University South Carolina Aiken

VERTICAL VIOLENCE PROPOSAL PAPER 2

Abstract

This is a professional nursing vertical violence paper. The paper begins by introducing

the issue of vertical violence and my experience with the phenomenon. Vertical violence is then

defined in depth. Theories that are associated with the issue of vertical violence, including the

theory of oppression, generational/hierarchical abuse, and low esteem, are then discussed. The

impacts of vertical violence, including negative psychological impact, high turnover, workers

absenteeism, poor patient outcomes, and decreased worker retention, are discussed in depth. It is

then that measures of alleviating the issue of vertical violence are discussed. Measures include

education, transformational leadership, and confronting the bullies. The conclusion n

summarizes the main argument and re-states the proposed ways through which vertical violence

in the workplace can be alleviated.


Professional Nursing Vertical Violence Proposal Paper

Every career takes dedication and hard training to perform at a satisfactory level. Today

vertical violence plays a great role in the hindrance of successfully fulfilling expected tasks in

the workplace. One would think that employers should work together for the good of the facility,

but often this is just not the case. This issue is serious to me due to my experience as a student

nurse. Those feelings of insecurity and low self-esteem are embedded in that individual and, as

such, affect their future professional decisions and actions. Vertical integration is a problem that

is becoming so rampant in the nursing profession. The presence of vertical integration in nursing

has increased turnover rates, subsequently increasing the organization cost and negatively

affecting patient outcomes (Dinmohammadi, Peyrovi & Mehrdad, 2014). This issue needs to be

addressed as it leads to nurses leaving the profession and poor patient care.

The Definition of Vertical Violence

Vertical violence can be defined as any act of violence transcending between two or more

people in different professional levels of the hierarchical system. Vertical violence can include

rude and snide comments, ignoring, yelling, and other humiliating behaviors. Vertical violence

has also been associated with intimidation, sabotage, and bullying behaviors. Violent behaviors

from an upper to a lower staff level have been noted in different professions and mostly in the

field of medicine. The behavior stems from a superior to a subordinate level and has the potential

of limiting performance while at the same decreasing work satisfaction.

Theories Associated with Vertical Violence

It is important first to understand the theories that are associated with vertical violence

before discussing its impact and ways through which the problem can be alleviated. The theory


of oppression has been widely associated with violent behaviors. The nursing profession, for

instance, is dominated by females despite the administrators and those presiding it being male.

Stereotypically, women are regarded as weaker as and more emotional than men (Elemary &

Nagar, 2017). Many female nurses thus tend to be dominated by their male administrators and

often struggle to overcome such oppressive force. In some cases, the oppressed nurse can, in

turn, react to become the oppressor to those working below them, such as the student nurses. The

reactive behavior thus becomes a controlling factor that perpetrates violent behaviors to student

nurses.

Nurse’s observational practices and generational/hierarchical abuse have also been

contributed to vertical violence. Bullying will be more likely to occur on different profession

levels, with those high up at the chain command being the perpetrators. Nurses entering the

profession have to be assigned preceptors that are to show them and orient them with the

working environment routines. Those veteran nurses orienting others may themselves have had

encountered violent behaviors as new nurses or students (Courtney‐ Pratt et al., 2018).

Consequently, they considered vertical violence as a rite of passage and have to conduct the

same to the nursing students and those new at the workplace. Vertical violence is thus

proliferated as a cycle of negative behaviors from a generation of nurses to the next.

Low-esteem in veteran staff nurses has also been reported as a factor that has contributed

to the perpetuating of violent behaviors against nursing students. Research findings continue to

report vertical violence being experienced by many in the nursing profession at some point in

their careers. It will be the same nurses that have experienced vertical violence that can revert

back to oppression as they seek to regain power and self-esteem by subjection those lower on the


hierarchy to violent behavior (Courtney‐ Pratt et al., 2018). Low self-esteem from the staff

nurses can prompt them to exert power to those below them and mostly the nursing students.

The Impact of Vertical Violence

There are many negative outcomes that are associated with vertical violence. As earlier

noted, the perpetrators of vertical violence are considered to have low self-esteem. Practicing

violent behaviors can also mean that an individual is feeling powerless stress at the workplace,

and they will go to lash out those at the lower levels of the hierarchy ladder (Mitchell Ahmed &

Szabo, 2014). This culture spreads and is assumed that it must be practiced to every newcomer

so that the perpetrator feels powerful upon conducting violent acts. The continual process cycle

of vertical violence is thus propagated to new generations and becomes a part of the culture in an

organization.

A person that is exposed to vertical violence can experience negative physical and

psychological effects. Student nurses that were treated violently at the workplace have reported

feelings of depression, stress, anger self-doubt, and even inadequacy. More violent behavior

exposure can lead to arising of chronic disease and cardiac problems due to increased stress. A

further manifestation of physical problems arising from vertical violence includes insomnia,

headache, body ache, and fatigue (Elemary & Nagar, 2017). The further perpetuation of violent

behaviors to a victim can lead to weight loss and nausea. Some of the student nurses have

reported increased irritability and tearfulness with violent behavior episodes. Vertical violence


leads to widespread chaos in a healthcare organization with all negative psychological and

negative effects discussed above.

Allowing vertical violence is dangerous for an organization as it leads to decreased

recruitment and retention levels. Research that continues to be conducted shows vertical violence

acts rampant in the healthcare facilities where the turnover rate is high (Mitchell Ahmed &

Szabo, 2014). Student nurses who are exposed to vertical violence have been found to hesitate to

seek employment in agencies where vertical violence is prevalent. Absenteeism cases are more

rampant in healthcare environments, where there is vertical violence. High turnover and

increased numbers of those who are absent decrease the productivity of a healthcare

organization.

There is a likelihood of higher healthcare costs being incurred in facilities where there is

vertical violence. As already noted, low morale for the victim nurses make them be absentees.

Other nurses decide to quit working in environments where they are treated violently. Healthcare

facilities where nurses have resigned have to incur costs to pay for the other nurse's overtime in

order to cover the shift of the ones that are absent. This will result in the spending of too much

orientation costs, with a lot of the staff resigning once they are subjected to vertical violence.


Vertical violence leads to decreased patient care. The physical and psychological effect

of vertical violence directly impacts performance, increasing the likelihood of victim nurses to

commit mistakes. Dissatisfied nurses are less likely to communicate healthily, and it is the

patients that are ultimately affected (Courtney‐ Pratt et al., 2018). Nurses that are treated

violently will be less motivated and will reluctantly perform their duties. This leads to poor

healthcare delivery due to the negative atmosphere caused by vertical violence.

Measures to Alleviate the Vertical Violence Problem

It is true to assert that vertical violence has the potential to cause mass detrimental

effects. It is important to discover some of the strategies that can be used to deal with vertical

violence as the more negative impact could be realized as the phenomenon spreads in the nursing

profession. Educating both the nurses and the students is the first step that can be used to resolve

vertical violence in nursing (Hakojärvi, Salminen & Suhonen, 2014). For student nurses,

professional identity development skills should be aimed early in their undergraduate programs.


Over the past, the development of professional identity in nursing has been prevented by a lack

of instruction in history, and it affects day to day practice. Most of the professional nurses who

practice violent behavior are believed to have no sense of their professional identity (Bowllan,

2015). A true understanding of what it means to be a nurse is therefore very necessary, especially

for the learners that are exposed to the nursing curriculum. Development of professional identity

as a nurse plays a great role in reducing feelings of anxiety, dissatisfaction, and low self-esteem,

and such an individual is less likely to exhibit violent behavior towards others (Hakojärvi,

Salminen & Suhonen, 2014). Education to students should also focus on the communication and

skills of developing healthy relationships with others. Vertical violence can greatly be alleviated

if all those that are enrolling in nursing are being taught how to relate healthily with everybody

(Hakojärvi, Salminen & Suhonen, 2014). Education should also focus on the workplace

environment and what to be expected when a nursing student is in such a situation. Prior

awareness of the potential negative behavior that can be exhibited by those higher in ranks can

play an essential role in preparing the nursing students psychologically so that they will not get

excessively discouraged when faced with negative experiences. Nursing students that have been


exposed to the history of vertical violence and how they can deal with it are less likely to leave

the profession despite encountering negative experiences.

Preceptors play an important role in familiarizing a student nurse in the institution they

are placed in. The practice of vertical violence by some of the preceptors not only negatively the

students negatively, but it also leads to the growth of a culture where violence is considered as a

rite of passage for new nurses and nursing students (Hakojärvi, Salminen & Suhonen, 2014).

Preceptor nurses also need to be trained on how to nurture the student nurses into the

professional nursing realm. The preceptors need to be trained on how to be supportive to those

lower in the nursing profession hierarchy. Values of respect, healthy communication, and

positive collaboration have to be integrated into the educational programs of the nurses. The

leaders of a health facility can, for instance, organize leadership training programs with the aim

of changing the negative vertical violence culture. A nurturing preceptorship is a key element of

comfortable integration into the nursing world. Nurturing preceptorship will also influence

positive professional development in the long term as the students are not being exposed to

behaviors that makes them think that vertical violence is acceptable.


Implementing transformational leadership can also be used to halt vertical violence. To

begin transforming the nursing workforce, vertical violence should never be tolerated. Health

institutions have the responsibility of creating and implementing policy procedures that can help

to address the issue of vertical violence. Setting a tone to establish a healthy civil workplace

should a strategy to deal with the less obvious forms of workplace bullying. The nurse facilities

leaders should call meetings with other nurse's staffs and communicate dissatisfaction and

disregard for vertical violence behavior (Rudge, 2016). Nurses have to be encouraged to promote

a caring profession by every one of them becoming role models for students to influence the

students to reach a high level of professional behavior. Consideration of the student nurse's

personal temperament, characteristics, strengths, and weaknesses will make them feel accepted

in the nursing profession. Conveyance of consideration for the students and idealized influence

promotes a healthy professional identity development as the students are motivated and

intellectually stimulated.

Apart from education and transformation leadership, one radical way to deal with vertical

violence is speaking up and confronting a bully. Many research findings show victims of vertical

violence to suffer silently and in some cases, becoming very distraught that they leave the


nursing profession. Student nurses that find themselves violently treated need to speak up.

Telling someone about a bully can validate the feelings of the victim, providing support to them.

Nursing students should find a person they relate well with and share their experiences other than

suffering in silence. Other than sharing, the victim themselves can decide to confront their bullies

when they witness a vertically violent act. Nursing students need to be taught how to confront

bullies respectfully. Naming a negative behavior when it occurs can lead to the eventual stopping

of a bully's negative behavior.

Conclusion

Vertical violence has no place in a profession. Vertical violence in the workplace has

evidently hindered the successful fulfillment of the expected tasks. In the nursing profession,

vertical violence is a common phenomenon. Most nursing students and new nurses experience

vertical violence in their workplace on a daily basis. The result is low morale and motivation to

continue working in such environments. Negative patient outcomes are experienced when the

culture of vertical violence continues to spread in a health facility (Dinmohammadi, Peyrovi &

Mehrdad, 2014). We have already seen that vertical violence decreases recruitment and retention

levels. It is important that an organization look into some of the ways that can be used to


alleviate the challenge of vertical violence. I recommend transformational leadership is a strategy

that can help to decrease vertical violence gradually. Confronting the perpetrators of violence is

also another way through which vertical violence can be dealt with. A long-term strategy to

alleviate the problem of vertical violence is educating those undertaking nursing courses on the

development of professional identity and how to enhance a caring profession. Training programs

for already working nurses can also help to raise awareness about the issue of vertical violence.


References

Bowllan, N. M. (2015). Nursing students’ experience of bullying: Prevalence, impact, and

interventions. Nurse educator, 40(4), 194-198.

Courtney‐ Pratt, H., Pich, J., Levett‐ Jones, T., & Moxey, A. (2018). “I was yelled at,

intimidated and treated unfairly”: Nursing students' experiences of being bullied in

clinical and academic settings. Journal of clinical nursing, 27(5-6), e903-e912.

Dinmohammadi, M. R., Peyrovi, H., & Mehrdad, N. (2014). Undergraduate student nurses’

experiences in clinical environment: Vertical violence. Iran Journal of Nursing, 27(90),

83-93.

Elemary, F. M., & Nagar, S. M. A. (2017). Vertical violence among faculty nursing students

experienced in health care settings during their clinical learning. IOSR-JNHS, 6, 86-93.

Hakojärvi, H. R., Salminen, L., & Suhonen, R. (2014). Health care students' personal

experiences and coping with bullying in clinical training. Nurse education today, 34(1),

138-144.


Mitchell, A., Ahmed, A., & Szabo, C. (2014). Workplace violence among nurses, why are we

still discussing this? Literature review. Journal of Nursing Education and Practice, 4(4),

147-150.

Rudge, T. (2016). (Re) thinking violence in health care settings: A critical approach. Routledge.

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