Understanding the Predisposing Factors of Nurse‐to‐Nurse Horizontal Violence in Hospital Settings: An Integrative Review

ABSTRACT

Introduction

Nurse-to-nurse horizontal violence is a highly prevalent issue in healthcare, significantly affecting nurses' well-being, job satisfaction and professional performance. Despite its widespread occurrence, it remains largely invisible due to organisational culture, normalisation and underreporting. Recognising and addressing this phenomenon is a priority to improve workplace environments and safeguard both nurses and patient care.

Aim

The aim was to synthesise the existing evidence on the main predisposing factors of nurse-to-nurse horizontal violence in a hospital setting.

Design

An integrative review.

Data Source

Four databases: PubMed, CINAHL, Scopus and Web of Science.

Methods

This integrative review followed Whittemore and Knafl's approach and was reported according to SWiM checklist. Database searches occurred from September 2022 to February 2023, including studies published between 2013 and 2023. Articles were screened by title, abstract and full text based on set criteria. Additional articles were identified through backward citation searching. Quality was appraised using Joanna Briggs instruments, and a narrative synthesis summarised the findings.

Results

Fifteen articles were reviewed, focusing on nurse-to-nurse horizontal violence. Most studies used the Revised Negative Acts Questionnaire and were rated as ‘good quality’. The predisposing factors identified were grouped into three categories: organisational, professional and work related.

Conclusion

The findings highlight that the predisposing factors of nurse-to-nurse horizontal violence are multidimensional and interrelated. Addressing this issue requires a comprehensive and coordinated approach that strengthens leadership and implements standardised early detection and measurement tools to develop effective preventive strategies.

Implications for the Professional Practice and Patient Care

Horizontal violence promotes disruptive work environments. Management-related issues, professional hierarchies and unhealthy working conditions contribute to its occurrence. Therefore, strengthening leadership, promoting peer support and improving work environments are key to mitigating its impact and enhancing nurse well-being and care quality.

Trial Registration

PROSPERO: CRD42023396684