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

Journal of Clinical Nursing, 2025; 0:1–17 https://doi.org/10.1111/jocn.17834 1 of 17 Journal of Clinical Nursing INTEGRATIVE REVIEW OPEN ACCESS Understanding the Predisposing Factors of NursetoNurse Horizontal Violence in Hospital Settings: An Integrative Review CristinaReguera-Carrasco1 | NiciadelRocíoSantana-Berlanga1,2 | SergioBarrientos-Trigo1 1Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Seville, Spain | 2Saint John of God Aljarafe Hospital, Bormujos (Seville),Spain Correspondence: Nicia del Rocío SantanaBerlanga ([email protected]) Received: 13 August 2024 | Revised: 2 May 2025 | Accepted: 21 May 2025 Funding: The authors received no specific funding for this work. Keywords: horizontal violence| hospital nursing staff| integrative review| work environment ABSTRACT Introduction: Nursetonurse horizontal violence is a highly prevalent issue in healthcare, significantly affecting nurses' wellbeing, 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 nursetonurse 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 nursetonurse 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 nursetonurse 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. Managementrelated 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 wellbeing and care quality. Trial Registration: PROSPERO: CRD42023396684 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2025 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd. 2 of 17 Journal of Clinical Nursing, 2025 1 | Introduction Nursetonurse horizontal violence (HV) refers to disruptive, aggressive or hostile behaviours, whether occasional or recurrent, that occur among nurses of the same hierarchical level within healthcare settings (Lee etal.2022; Noor etal.2022). These behaviours can take various forms, ranging from verbal hostility to physical aggression with the intent to degrade or demean the recipient (Wei etal.2024; VidalAlves etal.2021; Zapf etal.2020; SannerStiehr and WardSmith2017). Most authors classify horizontal violence into physical, psychological and verbal (Travaini etal.2024; Desharnais etal.2023). Also, some studies distinguish between overt and covert violence, where overt violence includes insults, threats and workplace sabotage, whereas covert violence manifests through microaggressions, social exclusion and the deliberate withholding of critical information (Desharnais etal.2023). The prevalence of horizontal violence among nurses is estimated to range from 30% to 85% and is widely documented in countries such as the USA, Canada, Italy, Turkey, Taiwan and Pakistan (Travaini etal.2024; Wei etal.2024; Noor, Rehman, Ahmed etal. 2023; Desharnais etal.2023; Wilson etal. 2020). Although it can occur in various healthcare contexts, it is particularly common in hospital settings, where hierarchical structures, high patient acuity and demanding workloads contribute to its persistence and negative impact on staff (Travaini etal.2024; Desharnais etal.2023). Despite differences across healthcare systems, the underlying causes tend to be similar, often related to hierarchical organisational cultures and insufficient managerial response. In highpressure units such as critical care or surgical wards, this phenomenon is frequently exacerbated (Lambert etal.2025; Becher and Visovsky 2012). Similarly, in Italy, high prevalence has been linked to shift overload and role ambiguity (Bambi etal.2018), whereas in Turkey and Pakistan it is associated with interpersonal rivalry, peer envy and limited mechanisms for conflict resolution (Lambert et al. 2025). Despite its high prevalence, horizontal violence often remains underreported by nurses. Barriers such as fear of retaliation, the normalisation of violent behaviour and the lack of institutional support hinder formal reporting, particularly in highly stressful contexts like the COVID19 pandemic. This invisibility limits recognition of the problem and delays the implementation of preventive measures (Christensen etal.2024; Byon etal.2021; McKenna etal.2003). In this regard, from a theoretical perspective, horizontal violence in nursing is not just an interpersonal issue but is deeply embedded in the organisational structure and power dynamics within healthcare (Arif etal.2024; Noor etal.2022; Noor, Rehman, Ahmed, etal.2023). Freire's theory of oppression describes how subordinated groups internalise their position and reproduce oppression within their group instead of challenging those in power (Freire1972). The historical evolution of nursing exemplifies this pattern, as in the early 20th century, significant social and structural transformations led to the increased subordination of nurses. The professionalisation and bureaucratisation of healthcare systems and the expansion of hospital care under a medical model were the leading causes (Kennedy 2020). Oppressed group behaviour theory extends this idea by explaining how nurses redirect their frustrations laterally within this rigid power dynamic rather than challenging the structures that oppress them. Furthermore, this is supported by Farmer's theory of structural violence, which also highlights how unfavourable environments lead to horizontal violence and establishes this violence as cyclical (Farmer etal.2006). Beyond the structural causes contributing to horizontal violence, an additional challenge lies in the lack of a universally accepted definition. Despite its recognition by international organisations such as the WHO and ILO since the early 2000s, various approaches contribute to conceptual overlap between horizontal violence and other terms such as mobbing, incivility or bullying (Karaçay and Oflaz2022). Among these, the term bullying is most commonly used interchangeably, particularly in studies from Canada, followed by incivility in the United States and mobbing in countries such as Switzerland (Lambert etal.2025). However, their meanings not being equivalent because mobbing is characterised by systematic and prolonged harassment by a group towards an individual, and bullying involves an apparent power asymmetry where one party dominates another (Peng etal.2022; Tedone2020; Alshehry etal.2019). Consequently, this conceptual ambiguity has hindered the recognition of the phenomenon, complicating early detection (VidalAlves 2023; EscartínSolanelles et al. 2010) and also contributes to its normalisation within workplace culture (Kim et al. 2024; Kennedy2020). In addition, increased horizontal violence has been associated with negative nurse and patient health outcomes (Noor etal.2024; Desharnais etal.2023; Doo and Kim2020). On the one hand, horizontal violence negatively impacts patient safety by disrupting workflow efficiency and fostering a toxic work environment (Jaber et al. 2023; Cayuela Ruiz et al. 2022). It contributes to communication failures and impairs clinical judgement, which has been linked to increased patient mortality, complication rates and readmissions (Desharnais etal.2023; Noor, Rehman, and Gull2023; Doo and Kim2020; Copanitsanou etal.2017). On the other Summary • What does this paper add? ○ Horizontal violence among nurses is driven by managerial, professional and workrelated factors, deeply embedded in workplace culture. This review categorises these predisposing factors, providing a structured framework for recognition and intervention. ○ This review enhances visibility of horizontal violence by clarifying its conceptual boundaries and addressing the lack of consensus in terminology. This contributes to early detection and improved reporting. ○ This study supports organisational decisionmaking and the development of effective preventive strategies against horizontal nurse peertopeer violence. This will have an impact on the work climate, improving relationships between nurses and safeguarding their wellbeing. 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 3 of 17 hand, nurses may suffer from psychological, psychosomatic and social disturbances which can significantly impact their wellbeing and professional performance (AlNawafleh etal.2024; Noor etal.2024; Lee etal.2022; Lever etal.2019). These disturbances often manifest as anxiety, depression and posttraumatic stress disorder (Desharnais et al. 2023; Noor, Faisal, etal.2023; VidalAlves2023; Noor etal.2022; D'Ettorre etal.2018), as well as physical symptoms such as fatigue, insomnia and chronic illnesses (Desharnais etal.2023). Furthermore, horizontal violence has been directly linked to absenteeism, workplace accidents and an increase in the turnover rate (AlNawafleh etal.2024; Noor etal.2024). This trend exacerbates the global shortage of healthcare professionals, affecting approximately 5.9 million workers worldwide (World Health Organization 2020). Consequently, the economic burden of high nurse turnover in the United States alone has been estimated at 1.4–2.1 billion USD annually, placing significant financial strain on healthcare institutions (Kovner etal.2014). In recent years, there has been a notable increase in publications addressing horizontal violence, reflecting a growing recognition of its prevalence in clinical practice and a diversification of methodological approaches. However, the lack of a standardised definition and the interchangeable use of related terms create further ambiguity, making it challenging to distinguish studies specifically addressing horizontal violence from those exploring other forms of workplace aggression. This evolution highlights the need for an integrative literature review that synthesises the current evidence, including qualitative and quantitative studies, to clarify the causes of nursetonurse horizontal violence in hospital settings. Such synthesis not only provides a solid foundation for future research and conceptual model development but also offers actionable insights for hospital administrators to design targeted strategies and preventive interventions aimed at reducing the occurrence and impact of this phenomenon. 2 | Aim The aim was to synthesise the existing evidence on the main predisposing factors of nursetonurse horizontal violence in a hospital setting. 3 | Methods 3.1 | Design An integrative review was conducted using the process posited by Whittemore and Knafl(2005): problem identification, literature search, data evaluation, data analysis and presentation. Given the fragmented nature of the literature on horizontal violence in nursing, resulting from the absence of a standardised definition and the interchangeable use of related terms, this approach provides a framework for synthesising qualitative, quantitative and mixedmethod studies. This methodological choice allows for a comprehensive review of existing evidence, integrating findings from various perspectives to ensure a structured understanding of the factors contributing to horizontal violence (Hopia etal.2016). The findings were reported according to the Synthesis Without Metaanalysis (SWiM) guideline (AppendixS3) (Campbell etal.2020). 3.2 | Search Strategy A threestep search strategy was conducted, following the recommendations of the Johanna Briggs Institute(2017). Firstly, an initial limited search was conducted in PubMed to identify relevant studies and refine search terms, including Medical Subject Headings (MeSH) and freetext keywords. This preliminary search ensured that all relevant terminology was incorporated into the final search strategy. Secondly, a comprehensive search was then performed in four major databases: PubMed, CINAHL, Scopus and Web of Science, using the finalised set of MeSH terms and freetext keywords. The search process took place between 10 September 2022 and 05 February 2023, corresponding to the period during which the systematic data collection for this review was executed. Lastly, additional sources were screened by reviewing the reference lists of selected studies to identify further relevant literature. Additionally, PROSPERO was screened to identify any registered protocols of ongoing systematic or integrative reviews on this topic, ensuring that our study did not duplicate existing efforts. Also, before commencing data analysis, a final search was performed to identify any newly published studies meeting the inclusion criteria. This step ensured that the most uptodate evidence on the causes of horizontal violence was incorporated into the review. The search strategy included MeSH terms sourced from the National Library of Medicine's controlled vocabulary thesaurus, as well as freetext terms related to the research topic (National Library of Medicine2025). Truncation and Boolean operators were applied to refine the results. The search strategy used in each database is given in AppendixS1. 3.3 | Inclusion and Exclusion Criteria Articles were included if they met the following criteria: (1) examined the predisposing factors of peertopeer horizontal violence, (2) focused on hospitalbased nursing professionals, (3) were published in English or Spanish, (4) provided disaggregated data in multiple forms of workplace violence that were analysed (5) between 2013 and 2023. This timeframe was chosen to provide a broader perspective on this phenomenon's evolution and allow for the identification of potential trends and patterns in its causes. The exclusion criteria were as follows: (1) lack of fulltext availability, (2) focus on the predisposing factors of horizontal violence between nurses with different hierarchical roles (e.g., supervisors, nurse managers or clinical educators) or (3) secondary sources without empirical data, such as narrative reviews lacking a systematic methodology or editorials. 3.4 | Screening Two researchers independently managed article selection using RAYYAN systematic review software, a tool specifically 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 4 of 17 Journal of Clinical Nursing, 2025 designed to organise references (Kelly2024). They first screened references by reviewing titles and abstracts to identify potential studies. Then, fulltext reviews were conducted on selected articles that met the initial screening criteria. 3.5 | Quality Appraisal To evaluate the quality of the reviewed articles, the Joanna Briggs Institute's tools were utilised depending on the method used in the study. The quality of all studies in this review was evaluated by two researchers who independently appraised each article and discussed the importance and quality of the articles for consistency. Disagreements were settled by consulting a third researcher. Studies were classified based on the percentage of ‘yes’ responses obtained during the appraisal process. Articles scoring below 50% were categorised as ‘poor quality’, those scoring between 50% and 75% as ‘good quality’, and those exceeding 75% as ‘high quality’ (Johanna Briggs Institute2020; Jordan etal.2019). 3.6 | Data Extraction Two reviewers independently conducted data extraction using a customised data extraction form adapted from the Cochrane Handbook for Systematic Reviews of Interventions (Higgins etal.2019). Both reviewers pilot tested the form with a subset of five studies to ensure relevant data was extracted. The following data were extracted: design, author, year of publication, country, target population, outcome measure and the main results. 3.7 | Analysis and Synthesis Due to the diverse range of measures and outcome assessments in the included studies, a systematic content analysis was conducted. The process involves data reduction, display, comparison and conclusion drawing and verification (Whittemore and Knafl2005). After data reduction and coding of the primary document data, the extracted data were tabulated. This facilitated the comparison of data to identify factors and relationships. An iterative process was undertaken in which authors individually analysed the data and discussed their findings to reach a consensus. This collaborative process reduced subjective bias and premature analytical closure. In addition, it allowed the results to be verified and categorised into three main themes guided by the review's objectives. 4 | Results 4.1 | Identification Studies A total of 2769 articles were identified. After applying filters and removing duplicates, the titles and abstracts of 1722 articles were examined. In total, 1669 articles were removed due to irrelevant titles, wrong populations or different outcomes. The full text of 53 articles was then screened for eligibility. Of these, 38 articles were excluded due to different populations, unrelated to the topic or addressing other types of violence. Additionally, a manual search was conducted among the references of the fulltext articles. Finally, 15 articles were included in the review, and their full texts were analysed. Figure1 shows FIGURE 1 | Flow diagram. Graphic description of the search and selection of data in the different databases. Records identified from databases before applying filters (n = 2769) Pubmed (973) Cinahl (521) Scopus(638) WOS (637) Records removed before screening: Duplicate records removed (n = 444) Records screened (n = 1722) Records excluded (n = 1669) Reports assessed for eligibility (n =53) Reports excluded: Different population (n =16) Not related to topic (n = 13) Type of violence (n = 10) Recordsidentified from: Citation searching(n =447) Duplicate records removed (n =7) Reportsassessed for eligibility (n =17) Reportsexcluded: -Language (n =1). -Different population (n =2). -Not related to topics (n =13) Reports of included studies: -Databases: (n =14) -Citation searching: (n= 1) Total included: (n=15) Identification of studiesvia databases and registersIdentification of studiesvia other methods noitacifitnedI Screening Included Reportssought for retrieval (n =440) Reportsnot retrieved (n =423) 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 5 of 17 a PRISMA flow chart with the results of the literature search strategy. 4.2 | Characteristics of Included Studies The main characteristics of the included studies are summarised in Table1. All studies were in English. Most of the studies were crosssectional (n = 10), while the remainder were qualitative studies (2) and systematic reviews (3). Three studies were conducted in the United States and Korea, two in Turkey and Canada and one in Japan, Portugal, Brazil, Jordan and Australia. The sample size ranged from 16 to 993 individuals, and the research subjects were always nurses. Most studies included horizontal violence among registered nurses, although some included staff nurses, midwives and licensed practical nurses (Yokoyama etal.2016). These professionals were included as they operated in peerlevel roles within hospital units. Seven workplace violence measurement tools were used, and the only specific one to measure horizontal violence was the Lateral Violence in Nursing Survey. The primary tool used was the Negative Acts QuestionnaireRevised (n = 8). In addition, many other validated scales were used, such as Workplace Cyberbullying Measurement, the Workplace Incivility Scale, the Scale of Mobbing Behaviours at the Workplace, the Mobbing Scale Workplace, Lateral Violence in Nursing Survey and the Straightforward Incivility Scale. A nonvalidated questionnaire was also used (n = 2). Horizontal violence (n = 5) and bullying (n = 5) were the main terms used to refer to nursetonurse violence. However, lateral violence, coworker incivility, mobbing and workplace violence were also used. In addition, the included articles analyse many different predisposing factors of horizontal violence, such as organisational culture, workplace environment, perpetrators' and victims' characteristics, working conditions, professional experience, demographic characteristics, professional characteristics and institution/unit type. 4.3 | Quality Assessment The majority (n = 8) of articles were assessed as ‘good quality’, being the most affected domains related to the confounding factor assessed, the influence of the researcher on the research and the likelihood of publication bias assessed. They were identified based on the frequency of ‘no’ or ‘unclear’ responses in the JBI critical appraisal checklists. In addition, six articles were assessed as high quality and, finally, one as poor quality, being unclear in at least four domains related to inclusion and exclusion criteria, measurement criteria and outcome measures (João etal. 2023). The quality appraisal results are shown in AppendixS2. 4.4 | Predisposing Factors of NursetoNurse Horizontal Violence Through a narrative summary, this study integrated the main predisposing factors of horizontal violence among nurses in the hospital setting. These factors have been grouped into three categories: management, nursing professional and workrelated traits. This categorisation is presented in Table2, providing a framework for the detailed analysis that follows. 4.4.1 | ManagementRelated Predisposing Factors Several management factors were identified as contributing to the occurrence of horizontal violence. Specifically, this type of violence was observed to be prevalent in settings with a hierarchical organisational culture by centralised decisionmaking, rigid role definition and topdown communication (Choi and Park2019; Blackstock etal.2018; An and Kang2016). Specifically, An and Kang (2016) report a prevalence of horizontal violence of 45.5% in these settings. In this study, participants who perceived their organisational culture as hierarchy oriented (characterised by formality, strict role separation and authoritybased relationships) were significantly more likely to report experiences of horizontal violence compared to those in relationoriented environments, which emphasise interpersonal harmony and collaboration (OR = 2.58; p < 0.026) (An and Kang2016). Similarly, Choi and Park(2019) found that a hierarchyoriented culture significantly increased the risk of horizontal violence (β = 0.178; p = 0.002). On the other hand, units with a more positive, teamoriented organisational culture reported lower levels of horizontal violence (r = −0.398; p < 0.05), especially concerning communication (r = −0.396) and staff participation (r = −0.356), thus reducing the risk of hostile behaviours among nurses (Terzioglu etal.2016). Similarly, Choi and Park(2019) found that a relationoriented culture significantly reduced it (β = −0.184; p = 0.002), supporting the idea that collaborative and flexible organisational environments are protective factors. Another predisposing factor identified in the literature was the influence of the nurse unit manager and their leadership style. The nurse unit manager was depicted as an influential figure with considerable influence over the attitude of staff within a clinical area (Hawkins et al. 2019; Yokoyama et al. 2016) showed their results that bullying was significantly associated with lower scores on the nurse manager ability, leadership and support of nurses (OR = 0.59; CI: 0.39–0.90; p < 0.01). This finding suggests that leadership may act as a protective factor, as stronger managerial support is associated with a lower likelihood of horizontal violence. In addition, nurses who have experienced horizontal violence perceive their hospital as having a more permissive workplace violence culture (Myers etal.2016). However, Bloom(2019) indicated that managerial support was lacking, and 49.3% recommended that nurse managers become more involved. In fact, 77.3% of the surveyed nurses identified managerial support as the most effective strategy to reduce horizontal violence. This is supported by the integrative review by Blackstock etal. (2018), which found that a common finding across several reviewed studies was that nurse leaders lacked authority or autonomy in key areas such as scheduling, organisational priorities, workload distribution and nursing roles. This lack of leadership autonomy was associated with an increased risk of horizontal violence due to weakened oversight, limited intervention capacity and reduced role clarity (Blackstock etal.2018). Finally, Choi and Park(2019) reported that a portion of nurses had received training in workplace violence prevention (1.42 ± 0.70) and workplace cyberbullying prevention 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 6 of 17 Journal of Clinical Nursing, 2025 TABLE 1 | Main results of the predisposing factors of horizontal violence. Author (year), country Study design Sample size Horizontal violence measure Main results Outcomes Myers etal.(2016), EEUU Qualitative 126 RN Nonvalidated questionnaire The predisposing factor of HV most commented by respondents was the permissive organisational culture in terms of violence. It is observed that nurses who have experienced HV, feel that they are in a hospital that maintains a more permissive culture with violence, where their supervisors do not contemplate solutions. HV outcome measured: – Horizontal violence Main variables: – Organisational culture Choi and Park(2019), Korea Crosssectional 226 SN NAQR WCM Bullying and cyberbullying are related with the nursing organisational culture which explains the 6.3% of bullying and the 4.3% of the cyberbullying. In addition, hierarchyoriented culture was significantly positively correlated with facetoface bullying (r = 0.196, p = 0.003). Also, facetoface bullying is related to a shorter length of career (F = 2.85, p = 0.025) and the educational experience to prevent violence (F = 2.85, p = 0.025). Related to cyberbullying, male nurses (1.29 ± 0.66), nurses who received education for workplace violence prevention (1.42 ± 0.70) and workplace cyberbullying prevention (1.62 ± 0.98) had higher scores. HV outcome measured – Bullying – Cyberbullying Main variables: – Organisational culture – Demographic factors – Educational experience (Continues) 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 7 of 17 Author (year), country Study design Sample size Horizontal violence measure Main results Outcomes Taylor(2016), United Kingdom Qualitative 80 RN Nonvalidated questionnaire The nurses verbalised three types of predisposing profiles of horizontal violence: ‘the pathological bully’, ‘the selfjustified bully’ and ‘the unprofessional coworker’. In the case of the pathological bully, he or she inflicts harm consciously and with malice. This was the least prevalent. On the other hand, the selfjustified bully is usually found in referring nurses or supervisors and is the one who masks the violence behind work objectives and/or patient needs. Finally, the unprofessional coworker usually occurs sporadically and without being aware of the harm caused, being a consequence of a normalisation of disruptive behaviour within the nursing profession. HV outcome measured: – Horizontal violence Main variables: – Enactors Oh etal.(2016), Korea Crosssectional 255 RN NAQR LVNS Lateral violence is specified in three subcategories (verbal abuse, physical threat and physical assault). The verbal abuse predictor was related positively with individual characteristics of the professionals, like the negative affect and personal individualism (β = 0.27; β = 0.45, p < 0.001). In addition, it was also positively related to working more than 41 h per week (β = 0.28; p < 0.05) and more than 51 h per week (β = 0.33; p < 0.001). Another predictor of workrelated bullying was specialised units (β = 0.13; p < 0.05). HV outcome measured: – Lateral violence Main variables: – Unit type – Working conditions – Professional characteristics (Continues) TABLE 1 | (Continued) 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 8 of 17 Journal of Clinical Nursing, 2025 Author (year), country Study design Sample size Horizontal violence measure Main results Outcomes Bloom(2019), EEUU Qualitative 78 RN LVNS modified Factors that increased HV were related to three areas: workplace environment, organisational support and professional experience. The factors were workload/ stress (72%), accepted practice on the unit (62.8%) and the manager attitude (49.3%). HV outcome measured: – Horizontal violence Main variables: – Workplace environment – Organisational culture – Professional experience An and Kang(2016), South Korea Crosssectional 298 RN Korean version of NAQR The prevalence of workplace bullying in this study significantly differed by monthly salary, type of hospital and working unit. The prevalence of workplace bullying victim also differed according to organisational culture type (χ2 = 9.89, p < 0.019). Specifically, the prevalence was highest among participants who considered their organisation as hierarchy oriented, at 22.2%. According to the likelihood ratio, the odds of being a workplace bullying victim were 2.58 times as high among participants who reported a hierarchical orientation as among those who reported a relation orientation (95% CI: 1.12–5.94; p < 0.026). HV outcome measured: – Bullying Main variables: – Organisational culture type – Unit type – Working conditions Yokoyama etal.(2016), Japón Crosssectional 825 CNM and LPN NAQR Thirteen demographic and workrelated characteristics were associated with being bullied in the bivariate analyses (p < 010). A logistic regression analysis indicated that ‘bullied’ were associated with low scores on two work environment domains: nurse manager ability (OR: 0.93; CI: 0.87–0.99), leadership and support of nurses and staffing (OR: 0 59; CI: 0.39–0.90) and resource adequacy (OR: 0.55; CI: 0.34–0.90). HV outcome measured: – Bullying Main variables: – Organisational culture – Demographic characteristics – Working conditions (Continues) TABLE 1 | (Continued) 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 9 of 17 Author (year), country Study design Sample size Horizontal violence measure Main results Outcomes AlGhabeesh and Qattom(2019), Jordán Crosssectional 120 RN NAQR The length of experience in the Emergency Department (ED) was positively and significantly correlated with bullying at workplace (r = 0.20, p < 0.01); Therefore, the fewer the years of experience working in the ED the more likely a nurse will experience, or be exposed to, bullying. None of the other examined variables, for example, height, weight, age and years of experience in nursing, type of hospital, working shift or education level was significantly correlated with bullying at workplace. HV outcome measured: – Bullying Main variables: – Professional experience Laschinger and Read(2016), Canadá Crosssectional 993 NG SIS Burnout and coworker incivility were positively related (r = 0.34; p < 0.05). Also, the awareness of civility norms were significant predictors of lower coworker incivility (β = −0.62). HV outcome measured: – Coworker incivility Main variables: – Workplace environment Hawkins etal.(2019), Australia Integrative review 16 articles NAQR WIS The precipitating factors included factors such as the new graduates' perceived lack of capability and magnifying power and hierarchy. The established hierarchical culture has made those nurses who are perceived as incapable easy targets for HV, usually perpetrated by more experienced nurses. HV outcome measured: – Horizontal violence Main variables: – Organisational culture – Professional characteristics Blackstock etal.(2018), Canadá Integrative review 22 articles — The main predictors found were the influence of working conditions, relational aspects of teams and leadership, organisational culture, climate and role of structural processes, leadership role and decisionmaking authority and the relationship of organisational structures to antihorizontal violence policy. HV outcome measured: – Horizontal violence Main variables: – Organisational culture – Workplace environment (Continues) TABLE 1 | (Continued) 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. 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Supporting Information Additional supporting information can be found online in the Supporting Information section. 13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17834 by Readcube (Labtiva Inc.), Wiley Online Library on [04/06/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License