Enactors of horizontal violence: The pathological bully, the self-justified bully and the unprofessional co-worker.

AIM: To suggest an alternative approach to improving recognition of horizontal violence using enactor types identified in a study exploring nurses' perceptions of horizontal violence.

BACKGROUND: Horizontal violence is an umbrella term used to describe a range of aggressive behaviours between nurse colleagues. It is suggested that nurses do not recognize the phenomenon when they witness or experience it, contributing to its perpetuation.

DESIGN: This was a qualitative, descriptive study undertaken to inform theory development and the design of future interventions to address horizontal violence.

METHOD: Observation, document review and semi-structured interviews took place in two inpatient hospital units in the Northeastern United States between June - November 2012. Ongoing analysis identified three distinct types of enactors of horizontal violence.

FINDINGS: Nurse participants rarely used terms from hospital policies or nursing literature to describe behaviours associated with horizontal violence but identified behaviours by describing the attributes of the enactor and the situation. Three enactor types were disaggregated from the data: the pathological bully, the self-justified bully and the unprofessional co-worker.

CONCLUSION: Findings support previous research suggesting nurses do not recognize aggressive behaviours when they witness or experience them and do not have a name for those who enact these behaviours. This disaggregation of enactors of horizontal violence into recognizable types introduces an alternative approach to addressing the phenomenon. Development of instruments to identify these enactors, as well as testing of these instruments, is required to establish the utility of this disaggregation in nursing practice and in designing future interventions.