Implications of Nursing Peer Violence on Patient Safety: An Integrative Review

Abstract

Aim: This integrative review aimed to clarify the nature of horizontal and lateral violence among nurses and assess how such violence affects patient safety.

Background: Bullying and violence among nurses have been examined in numerous reports, yet their impact on patient safety remains unclear. Definitions of horizontal and lateral violence vary, complicating our understanding of their distinctions.

Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We systematically searched Web of Science for articles published between 1991 and 2023 on 27 August 2022 and 4 October 2024. We also searched PubMed and CINAHL to identify papers using the keywords 'patient safety', 'nursing', 'horizontal violence', and 'lateral violence'.

Results: Of the initial 105 studies, 29 were ultimately extracted, with 27 indicating a link between horizontal and/or lateral violence and patient safety. We identified studies showing that nursing, horizontal violence, and lateral violence are related to patient safety. However, distinguishing between horizontal and lateral violence was challenging, and both could be considered peer violence.

Discussion: Horizontal and/or lateral violence encompasses repetitive physical, mental and emotional mistreatment by co-workers, including verbal and nonverbal abuse. These behaviours are characterised by sabotaging, humiliating, excluding and isolating others to alleviate the perpetrator's anxiety and insecurity. They have become systemic issues within healthcare facilities and in the nursing profession. Peer violence also occurs at the expense of the safety of others, including patients.

Conclusion: This review shows links between horizontal and/or lateral violence. It highlights that a culture of incivility, job stress, disruptive peer relationships and organisational silence in healthcare facilities all impact patient safety. Moreover, these problems affect nurses who care for the same patients, creating a vicious cycle of peer violence.

Implications for nursing, health, and social policy: Four solutions for improving patient safety are proposed: showing professional and civil conduct, promoting a safety culture, cultivating constructive peer relationships and creating a healthy organisational environment.

Keywords: burnout; ethics; nursing; patient safety; psychological safety; workplace bullying.

FIGURE 1

Flowchart for selecting eligible studies reporting on horizontal or lateral violence and patient safety.

FIGURE 2

Comparison of peer violence and patient safety.