Tag Archives: horizontal violence

Horizontal Violence Among Direct Care Workers





In my last post, I suggested that there may be something about the Long Term Care work environment that makes conflict among caregivers almost inevitable. Some – or perhaps even most – of the behaviors associated with this conflict could be described as “horizontal violence.”

Horizontal violence is a form of hostile and aggressive behavior exhibited by individuals or groups toward others within the same peer group. It is usually not a physical kind of violence, but relies more on emotional and social pressure. It includes a wide range of negative behaviors, both overt and covert. Examples include such things as direct verbal abuse, belittling gestures, threats, intimidation, gossip, “humorous” put-downs, sarcastic comments, social exclusion, nitpicking, ignoring legitimate concerns, withholding support, and slurs based on race, ethnicity, religion, physical appearance, gender or sexual orientation. In a word: bullying.

The thing that makes horizontal violence “a thing” is not a big list of nasty behaviors. These can happen anywhere and for a lot of different reasons. Horizontal violence is a phenomenon that occurs within oppressed groups. That is, groups of people who do not feel as though they have the means to adequately address the most significant problems and issues associated with their group. Some respond to this sense of powerlessness by becoming submissive and exhibiting learned helplessness. Others respond by adopting feelings and attitudes of superiority over others within their group. In a sense, both are coping mechanisms, characterized by inappropriate and self-defeating behaviors.

If a sense of powerlessness is at the heart of what it means to be an oppressed group, than direct care workers certainly qualify. Overworked, underpaid, and unsupported, LTC caregivers generally do not believe that they have the means to independently create the kind of fundamental change that would address these issues in a meaningful way. You either accept “that’s just the way it is” and learn to do what you can with what you have – or you leave.

At the bottom of the LTC hierarchy, the caregiver brand of horizontal violence plays out in one of two ways. The first way is the classic division of Older Workers vs. Newer Workers. This divide is typical in nursing in general and most of the literature I’ve come across regarding horizontal violence has to do with career RNs, but it applies just as well to nursing assistants.

New workers enter the field with a set of expectations of what caregiving is all about and are soon disillusioned by the reality of what they witness on the units. If they are unable to adapt to “the way things really are,” the more experienced caregivers have ways of putting them in their place. Newer workers are regarded as both naïve and judgmental – and perhaps even threatening – because they base their impressions of experienced workers on unrealistic expectations.  They often become victims of horizontal violence, not fully comprehending why they are being mistreated.

The second situation is created by the absence of adequate and appropriate involvement of management in the typical LTC work environment. The formal rules and standards are enforced inconsistently, sometimes capriciously, depending more on personality and circumstance, such as inspections or any other time the facility is under public scrutiny. Good workers go unnoticed and poor workers go uncorrected.

By default, caregivers are left to fill the vacuum and develop their own norms and standards. These can be very different from facility to facility and even from unit to unit within the same facility. To one degree or another, they are informally enforced by the strongest personalities among the established caregivers.  In the best circumstances these norms and standards are communicated through example and positive leadership, but often they are enforced by various forms of horizontal violence.

Caregivers frustrated by their inability to formally address the larger problems of the Long Term Care workplace find an outlet by dominating their coworkers. Others simply acquiesce, doing their best to keep to themselves as they struggle to find a balance between the official standards, pressure from their workgroup, and their own sense of right and wrong.

In my next post, I will share my take on how we as caregivers should approach the problem of horizontal violence in the LTC workplace.

For more information on horizontal violence:




Caregiver versus Caregiver





For a CNA, working with other caregivers you can trust and depend upon can make a bad shift tolerable and a good shift even better. In an environment where workers often feel like they’re under siege,  maintaining a positive relationship with the people you work with can take the edge off the worst aspects of the job and can provide a sense of security and comradery. It is not unusual for caregivers who work with one another for an extended period of time to develop close personal relationships, sometimes lasting a lifetime.

But it’s not always that way. Right?

You don’t have to work direct care very long to realize that caregivers do not always get along.  A brief survey of caregiver related social media will support this. One of the most common rants in the CNA Facebook groups is about other coworkers. These describe fellow workers as “lazy, whiners, cliquish, back-stabbers, know-it-alls, butt-kissers, bullies, wimps, rude, inconsiderate, uncooperative, mean,” and – of course – “judgmental.”

To be sure, social media rants tend to be motivated by the emotion of the moment and they only tell one side of the story. Also, some of the discord among caregivers can be attributed to the ordinary conflict that occurs in any workplace. There are politics in every organization and at every level. Personalities clash, agendas conflict and sometimes people with good intentions simply don’t agree.

And yet, there just seems to be something about the nature of Long Term Care that makes worker on worker conflict especially prevalent – and harmful. Almost as if it’s woven into the very fabric of the system itself.

I’ve often thought that the LTC brand of coworker friction was a product of the nature of our work. Since we work hands-on with residents, almost everything we – or don’t do – has a direct impact on the well-being of another human being. The moral element is immediate and powerful and when someone implies that you’re not doing your job, it doesn’t just mean they’re calling you a bad worker; they are also saying something about you as a person. Even the slightest hint of criticism can be taken as a personal attack. On the other hand, LTC management is often disconnected from the day to day realities of caregivers and workers in genuine need of correction do not always receive it. The injustice and unresolved resentment grind on people daily and sooner or later, there’s going to be trouble.

However, there may be much more to caregiver vs. caregiver conflict than hyper-defensive workers and disengaged management.  I recently received a request from a reader who asked if we could do a post on “horizontal violence.” Not being entirely certain what that phrase means, I did a little research. What I found was pretty interesting and may provide some additional insight to why caregivers don’t always get along.  In my next post, I’ll give a brief summary of horizontal violence and how I think it applies to the LTC workplace.