A new grad nurse.  Janet K. was a new graduate on the nursing unit. She was very excited to have

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A new grad nurse. Janet K. was a new graduate on the nursing unit. She was very excited to have passed her NCLEX exams and was very pleasant and enthusiastic about starting work on her busy unit. The nurses on the unit knew that a particular physician, Dr. M. followed a specific routine for making rounds. Janet K. had several of his patients that day but was unaware of his routine. The nurses on the unit decided not to share that information with her as they know that Dr. M would be arriving soon with certain expectations of the nurse who would be making rounds with him. They decided that this would be a “fun” way to “take her down a notch, and wipe that silly grin off her face.” Dr. M. arrived and Janet had not prepared his patients or his charts for his rounds. He began to berate her loudly in front of everyone at the nurse’s station. The other nurses, retreated to the back in the medicine room and all smirked & chuckled while Janet K. stood red-faced and endured his tongue lashing. Janet K. learned to hide her enthusiasm for nursing and stayed on the unit long enough to be oriented and to complete the required six months before transferring to another unit in the hospital.

1)      What examples of horizontal violence are seen in this case study? Describe them.

2)      What are some of the effects that horizontal violence can have on a nursing unit or healthcare institution?

3)      Based on the article and the recommendations that it provides, how would you advise nurse Janet to handle each of the situations?


A confrontational attitude. Sylvia Stevens has worked at the hospital for four years. In the last few months, several of her coworkers have provided the nurse manager of their unit with negative feedback about her behavior. All have described confrontational and unprofessional interactions with Sylvia. Sylvia is often seen rolling her eyes during the “shift huddle,” when the nurses gather to discuss each patient, and has yelled at coworkers on the unit.

After each incident, the nurse manager asked Sylvia’s coworkers to speak to her about the offensive behavior. In each case, when the coworker told Sylvia she didn’t appreciate her behavior, Sylvia denied it had occurred and ended the conversation. The nurse manager has also spoken with Sylvia three times in the past year about her behavior, and this has led to temporary improvements. A few months after these discussions, however, the negative, abrasive, and aggressive behavior that Sylvia’s peers have described resurfaced.

In the last four weeks, Sylvia’s colleagues have reported several negative interactions.

* A physician’s assistant complained that Sylvia made a comment about a patient’s “disgusting” body odor within earshot of the patient.

* A nurse coworker described how Sylvia yelled at her for asking too many questions during report.

* An ancillary nutritional aide told the nurse manager she doesn’t want to interact with Sylvia after hearing her say on numerous occasions that the hospital’s food is “horrible” and she “wouldn’t feed it to a dog.”

1) Is there a difference between lateral violence, vertical violence, and horizontal violence? Explain.

2) Do you agree with the nurse manager’s handling of the situation? How have her actions hurt or helped the situation?

3) How would you further advise the nurse manager? How would you further advise the nursing peers?


NSG 490


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