Bartholomew, K. (2006). Ending nurse-to-nurse hostility: Why nurses eat their young and each other.
Subject: Nurses (Psychological aspects)
Nurses (Practice)
Hostility (Psychology) (Demographic aspects)
Author: Sellers, Craig R.
Pub Date: 03/22/2010
Publication: Name: Journal of the New York State Nurses Association Publisher: New York State Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New York State Nurses Association ISSN: 0028-7644
Issue: Date: Spring-Summer, 2010 Source Volume: 41 Source Issue: 1
Topic: Event Code: 200 Management dynamics
Product: Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Geographic: Geographic Scope: New York Geographic Code: 1U2NY New York
Accession Number: 242591406
Full Text: Bartholomew, K. (2006). Ending nurse-to-nurse hostility: Why nurses eat their young and each other. Marblehead, MA: HCPro.

Although Kathleen Bartholomew's monograph Ending Nurse-to-Nurse Hostility was published a few years ago, sadly, the topic she covers remains relevant.

Bartholomew describes herself as a registered nurse and master's-prepared counselor; she was also the nurse manager for a large surgical unit. For the last several years she has been giving talks nationally, focusing on institutional culture and its relationship to patient safety. The book begins with a discussion of its key concept, horizontal hostility. Bartholomew describes this as "aggressive behavior between individuals on the same power level, such as nurse-to-nurse or manager-to-manager" (p. 4). She goes on to say that anger, aggression, bullying, and verbal abuse behaviors are "all ways in which hostility expresses itself" (p. 4). As examples, she cites: "The smallest thing would trigger retaliation. The charge nurse's refusal to speak was the worst. Once she went 27 days without speaking," and "It was the looks the preceptor gave me, like I was stupid. In my whole three months of orientation, I can't think of a single time anyone ever complimented me" (p. 8). Her argument is generously illustrated with stories and anecdotes such as these.

In the next three chapters, the author discusses oppression theory to explain horizontal hostility, conducts a root cause analysis of horizontal hostility, and then situates the concept within the specific contexts of the organizations, professional relations, and world in which nurses work and live. Her accounts of how nurses develop learned helplessness and powerlessness are painful to read, but nonetheless are imperative to consider as Bartholomew makes her case. The following example is but one of many and provides the reader with specific instances to which I am sure many readers will be able to relate. "Jackie had been mad for weeks, but no one knew quite why. She just kept writing up people and pointing out omissions in charting. Some staff jokingly referred to her as the 'charting Nazi.' It got to the point that nurses evaded her constantly, and then overtime increased as nurses took more time with their charting in order to not be 'punished' by being written up" (p. 49).

After painting a grim picture of workplace misbehavior, I found it something of a relief to reach the latter half of the book in which Bartholomew proposes best practices to eliminate horizontal hostility. She discusses how we can "nurture our young," beginning when they are nursing students, and concluding with how individuals, managers, and organizations can and should respond to horizontal hostility and proactively promote excellent, caring, and safe organizational cultures. I found the discussions, cue cards, sample questionnaires, ideas for innovative programs, and strategies for managers and other organizational leaders to be hopeful and encouraging for our profession. The reader is provided with a number of strategies for addressing hostility: acknowledge the problem of horizontal hostility and bring it to light; create a reflective, narrative community; nurture our young colleagues; intervene with dueling shifts and units; develop a unit philosophy; provide in-services on assertiveness and confrontation skills; role-model excellent behavior; and consider applying for ANCC Magnet Status. The book also contains continuing nursing education quizzes for CEU credits.

In the end, Bartholomew asserts that, although tackling the problem of horizontal hostility surely begins with each of us, "change simply will not happen unless nursing leadership takes on the challenge and the responsibility of making it happen" (p. l81). I strongly encourage all nurses to read this book.

Craig R. Sellers, PhD, RN, ANP-BC
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.