title: Hospital staff registered nurses' perception of horizontal violence, peer relationships, and the quality and safety of patient care.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Purpora
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Blegen
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Stotts
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D061214:Patient Safety; D010379:Peer Group; D010465:Perception; D011787:Quality of Health Care; D064450:Workplace Violence
keywords: Peer; negative workplace behavior; peer communication