Introduction

The horizontal aggression also referred to as lateral violence is often the cause of stress in the nursing profession which even without the added stress is one of the most stressful professions in the context. Horizontal aggression is defined as “aggressive behaviour that one registered nurse commits against another registered nurse” (Edward, et al., 2014).  American nurses’ association conducted a study where the results showed that the amount of professional stress is higher in the nurses and the rate of leading to the inability to perform the duties is even higher than the armed forces. Therefore, the seriousness of the problem is too high to be discarded casually (Reynolds, Kelly & Singh-Carlson, 2014). There are different theories that explain why some people might gravitate towards a specific profession like nursing and the explanation of the factor often uncover the basic characteristic trait the nurses have in common. These help explain the reasons behind horizontal aggression and the effect of said activity in the quality of health care received by the patients in Canada.
The explanation for the horizontal aggression is based on the theory of the wounded healer. The theory focuses on the facet of the nursing profession where some personal trauma leads some registered nurses to understand the problems of the people needing care and support and thus the people with personal trauma feel the urge to help the people in need. The personal pain of the people can drive them in two ways. If the personal pain is recognised acknowledged and transformed, then it can help the people sympathise with others in need but otherwise it can fester and make them angry or overly emotional. This leads to the bullying of the other members who are vulnerable which has been explained by the term of the walking wounded. The vulnerable are members who are less secure and people with lighter duties like the night shift nurses and new recruits who are unfamiliar with their duties. The effect of this violence is not evident in the shorter period but the overall structure of the workplace is affected and the level of care the patients receive decreases.
Therefore, the effect of the horizontal aggression is to be determined on the performance of the nurses and the quality of care delivery. The patient is the main indicator in the research and the effect that is analysed are based on the overall performance indicator of the nurses is based on the stress level and other factors that are related with the horizontal aggression (Purpora & Blegen, 2015). The level of horizontal aggression differs and the victims are often chosen based on some specific criteria therefore the overall effect of the horizontal bullying can be easily discerned.
 The issue that is to be expounded on in this pare is directed towards determining the relation between the patient care level and the nurse performance and the horizontal aggression.
Impact on health care services and future nursing profession
The stress that is mentioned before is another main culprit in this case also as the stressful and hectic life of the nurse and the stress leads to discontent and emotional instability. These negative emotions need an outlet which is mostly the new recruit or vulnerable ones. This leads to even more discontent and stress in the workplace as essentially the abrasive behaviour passes the stress to the victim who in turn is affected negatively and become a walking wounded who passes on the stress through further violence and thus the cycle can contaminate a workplace corrupting all of the nurses and affecting the health care delivery severely.

Negative work environment

The negative work environment that is created when the stress level is high along with the discontent among the nurses is harmful for the nurse without question but the effect on the patient care quality is astoundingly high. The effect of the overall stress is based on the personal tension, professional high involvement and the of course the stress generated by horizontal aggression. The overall relation between the co-workers who should help one another to gain maximum efficiency in the work is often strained. Therefore, among the resultant harm from the bullying and the overall stressful environment is the negative work environment affects the professional efficiency of the nurse (Egues & Leinung, 2013, July).

Anger and emotional problems

The anger and emotional problems are part and parcel of the horizontal aggression and the effect of the aggression leads to more of the same and the balance of the workplace is disrupted along with the behavioural pattern that needs compassion and the sympathy from the nurses affect the recovery. There is also the factor that the inability to provide proper care is not limited to the time and order of medicine but also the care level and attention of the nurse, therefore the anger and emotional problems also affect the nurses performance and adversely affect the level of care the patient receives (Heckemann,et al., 2015).

Alcohol and drug abuse

Although the nurses are aware of the different harms that come from the drug and alcohol abuse the stress of the workplace when added with lateral violence is often overwhelming for the person to cope with and for relief and oblivion they turn to drugs and alcohol. This also affects the performance as the steady hand and wakefulness is compromised making the nurse vulnerable and the patient suffers from inattention (Myers et al., 2016).

Job satisfaction

As the workload in the nursing profession is very high, the nurses need to be well satisfied to provide best care for the patients. This means that the nurses perform better under the supervisions that allocate specific duties among them according to skill level and experience. The workplace bullying or lateral violence disturbs the balance and reduces job satisfaction (Topa & Moriano, 2013).

Apart from these effects there are many effects that differ from each other on a case to case basis and more often than not the effect of the horizontal aggression is based on the person who is inflicting it on the other and the person upon whom it is being inflicted. Therefore, the analysis is incomplete without the factor of the individuality and uniqueness of reaction being factored in the equation. Nevertheless, the effect of the horizontal aggression is quite profound as many of the factors are applicable in other professions as well bit in the nursing it takes a whole new dimension because of the stressful nature of the job and the compassion and calm judgement required by the profession. The effect of the horizontal aggression on the nurses naturally transfers onto their charges and their health as the performance level of the nurses is directly related to the patient’s wellbeing (Blair, 2013).

Conclusion

It is evident from the above analysis that horizontal aggression and bullying is not just a problem in Canada but all over the world as the level of accountability is high in all the locations. Therefore, it can be surmised from the paper that the effect of the horizontal aggression naturally spills over into the care delivery of the patient and affects their health adversely as the thesis suggests. The different effects are analysed in detail in the analysis and the introduction provides a brief insight into the causes and the definition of horizontal aggression. 

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