Consequences of nurse-to-nurse horizontal violence in hospital settings: A systematic review

Background Nurse-to-nurse horizontal violence (NNHV) is a systemic issue characterized by hostile behaviors between nurses at equivalent hierarchical levels within healthcare settings. NNHV affects not only nurses, but also patient care and the healthcare system overall. Despite growing recognition of its prevalence, a comprehensive synthesis examining the full spectrum of consequences across personal and organizational domains is lacking from the literature. Purpose To synthesize the current evidence on horizontal violence and to define the consequences of NNHV on nurses, patients, and healthcare systems. Methods A systematic review of literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from PubMed, CINAHL, Scopus, and Web of Science. Studies that evaluated the consequences of NNHV were included. The quality of included studies was assessed using Joanna Briggs Institute critical appraisal tools. Data were synthesized thematically into personal and work-related consequences. Results Of 2769 identified articles, 131 were assessed for eligibility, and 33 studies were ultimately included. Of these 33 studies, 28 used cross-sectional designs, four were qualitative studies, and one was a cohort study. Personal consequences included significant psychological distress (anxiety, depression, posttraumatic stress disorder, suicidal ideation), physical health deterioration (stress-related symptoms, chronic fatigue, insomnia), and impaired workplace relationships (emotional exhaustion, reduced trust, isolation). Work-related consequences encompassed decreased productivity, diminished job satisfaction, heightened turnover intention, increased medical errors, compromised patient safety, and adverse patient outcomes. Conclusion This review provides comprehensive evidence that NNHV constitutes a significant organizational risk requiring systematic intervention. Findings support the implementation of multilevel strategies that integrate zero-tolerance policies, transformational leadership approaches, and psychosocial support mechanisms.