Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Nora Warshawsky

Clinical Mentor

Dr. Lisa Fryman

Committee Member

Dr. Debra Anderson


PURPOSE: Horizontal Violence plagues the health of nursing work environments. In order to diminish this phenomenon and establish healthy work environments as established by the AACN, assessments must be completed to identify strengths and weaknesses and determine the proper interventions to employ. However, there is a lack of evidence in actionable interventions. The purpose of this project was to assess healthy work environments of two nursing units by examining horizontal violence, civility, teamwork, and satisfaction, and identify interventions to strengthen the health of the work environment.

METHODS: This study was a descriptive study using an electronic survey of two nursing units at University of Kentucky Healthcare. The survey was composed from three existing tools: Nursing Teamwork Survey, Horizontal Violence Survey, and VA Civility Scale. The target population consisted of 90 nurses on the Intensive Care unit and 48 nurses on the Acute/Progressive unit.

RESULTS: On average, participants in the acute/progressive unit are neutral with their current role (M 3.5, SD=1.2) and satisfied with the level of teamwork (M 4.0, SD=1.0). ICU participants are dissatisfied with their current role (M 2.0, SD=1.7) and teamwork on the unit (M 2.67, SD 1.2). The frequency of horizontal violence was reported as experienced 25% of the time for both units. The acute/progressive unit reports higher ratings of teamwork (M 3.67) and civility (M 4.21) amongst the team, compared to the ICU unit (Teamwork M 3.2, civility M 3.33).

CONCLUSION: Communication, teamwork, and satisfaction amongst nurses play an important role in the health of a work environment. Although both environments assessed in this project reported a frequency of horizontal violence 25% of the time, the health of the acute/progressive unit is higher considering communication, teamwork, and satisfaction. Evidence-based interventions are lacking, however recommendations to strengthen the work environment were provided from the literature. These interventions include identifying horizontal violence, educating staff on horizontal violence, taking a stance against horizontal violence through organization policies, such as zero tolerance policies, and enhancing communication skills.