Registered Nurses’ Experiences of Vertical Violence in the United States Health Care Workplace: A Qualitative Study

Abstract

Background:

The presence of health care workplace violence (WPV) significantly impacts victims, patients, and the organization. Registered nurses’ experience of vertical WPV is not well understood, in part because the extant literature uses inconsistent and ambiguous terminology or focuses on bullying or incivility, excluding other violent behaviors.

Objective:

This critical ethnography study explored the perceptions and experiences of registered nurses who have been victims of vertical violence in the health care workplace.

Methods:

Eight registered nurses who self-identified as victims of vertical violence were recruited via purposive and snowball sampling. Data analysis used the constant comparative method described by Glaser and Strauss. Beck’s criteria for rigor in qualitative studies was used to enhance the credibility of findings.

Results:

Data analysis revealed 4 categories of the registered nurses’ victim experience of vertical violence: (1) encountering vertical violence, (2) understanding vertical violence, (3) struggling with vertical violence, and (4) reflecting on the experience of vertical violence.

Conclusions:

The use of power, influence, and organizational mechanisms to commit vertical violence has the potential to harm nurses and suppress the nurses’ willingness to advocate for others. Despite widespread attempts to prevent WPV, vertical violence continues and poses a significant threat to health care organizations’ core values, culture, reputation, and patient care outcomes. Health care organizations must prioritize the well-being of nurses, create effective systems that support nurses, and foster a culture of accountability to adequately address vertical violence and reduce the detrimental impacts on nurses, patients, and the organization.