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Peer-to-peer aggression threatens patient care and outcomes

between at the same level of authority is jeopardising , research has revealed.

A study of the phenomenon in a perinatal department at a US hospital found that staff on labour and delivery wards experience hostile behaviour more frequently than those working elsewhere in the same service.

A relationship between horizontal violence and ineffective communication, as well as between horizontal violence and poor or near misses, was demonstrated.

Peer-to-peer abuse has been widely documented in fast-paced healthcare environments in other countries.

The study, published in , urges senior nurses and managers to create workplace environments where nurses feel supported to practise their skills without taking out their frustrations or anxieties on colleagues.

The authors recommend developing staffing models that take into account the physically and emotionally demanding aspects of nursing in high-pressured settings, which require advanced critical thinking and specific skillsets.

They conclude that understanding how hostile workplaces can be for some nurses and the effect this can have on and outcomes is critical so that problems can be identified and addressed.


Horizontal hostility and verbal violence between nurses in the perinatal arena of health care, Reynolds G, Kelly S, Singh-Carlson S, Nursing Management (2014) doi.org/10.7748/nm2014.

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