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Objective: To test hypotheses from a horizontal violence and quality and safety of patient care model: horizontal violence (negative behavior among peers) is inversely related to peer relations, quality of care and it is positively related to errors and adverse events. Additionally, the association between horizontal violence, peer relations, quality of care, errors and adverse events, and nurse and work characteristics were determined.

Participants: A random sample (n=175) of hospital staff Registered Nurses working in California.

Methods: Nurses participated via survey. Bivariate and multivariate analyses tested the study hypotheses.

Results: Hypotheses were supported. Horizontal violence was inversely related to peer relations and quality of care, and positively related to errors and adverse events. Including peer relations in the analyses altered the relationship between horizontal violence and quality of care but not between horizontal violence, errors and adverse events. Nurse and hospital characteristics were not related to other variables. Clinical area contributed significantly in predicting the quality of care, errors and adverse events but not peer relationships.

Conclusions: Horizontal violence affects peer relationships and the quality and safety of patient care as perceived by participating nurses. Supportive peer relationships are important to mitigate the impact of horizontal violence on quality of care.


Accepted Manuscript. Article is published prepress (Epub Ahead of print) on June 16, 2014 by WORK: A journal of prevention, assessment, and rehabilitation. Print is anticipated to be published in May or June 2015.

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