Horizontal hostility: a threat to patient safety

The objective of this study was to determine the perceived level of horizontal hostility (HH) in a 220-bed acute care community hospital and whether the threat of or experience with HH influenced nurse behaviors directly related to patient safety.

While the acknowledgement and presence of HH in nursing are gaining prominence, little is known about how a nurse's experience with HH directly influences his/her actions with patients under their care, even when the nurse realizes these actions may not be in the patient's best interest.

We used a 28-item survey tool aimed at determining the level of perceived HH in an acute care Magnet-aspiring hospital in the Southwest and then asked about nurses' actions as a result of that experience. Almost 500 nurses were surveyed over a 2-month period in 2011.

Of the nurses who had personally experienced HH, a high number reported performing interventions or actions that could compromise patient care and/or safety, including (a) failing to clarify an unreadable order, (b) lifting or ambulating heavy or debilitated patients without assistance rather than asking for help, (c) using an unfamiliar piece of equipment without asking for clarification, and (d) carrying out an order that the nurse did not believe was in the best interest of the patient, among other behaviors.

The presence of HH has clear implications for patient safety. Recommendations for addressing and managing HH are provided and geared to the hospital leadership level.