Background <p>Horizontal violence is a destructive form of workplace violence that can result in inappropriate behaviors and ineffective care in nursing. Negative behaviors associated with peer violence reduce nurse retention. Evidence remains limited in Tigray. This study examined prevalence of horizontal violence, its associated factors, and its relationship with nurses’ intention to leave in general hospitals in Tigray, Ethiopia.</p> Methods <p>A cross-sectional study was conducted among 634 nurses working in general hospitals in the Tigray Region from March 2018 to June 2019. Nurses were selected using cluster random sampling and completed self-administered questionnaires. Descriptive, logistic regression, and correlation analyses were done in SPSS version 20.</p> Results <p>Out of 608, the 15.6% reported experiencing horizontal violence. The likelihood of horizontal violence was lower among nurses working in emergency units (Adjusted OR = 0.441; 95% CI 0.205–0.945) and in hospitals with disciplinary committees (AOR = 0.592; 95% CI 0.370–0.947), but more among nurses 5–9 years of work experience than 1–4 (AOR = 1.99; 95% CI 1.132–3.499). Horizontal violence was positively associated with intention to leave job (mean = 3.44; SD = 1.945; <i>r</i> = 0.107; <i>P</i> &lt; 0.05; <i>N</i> = 608).</p> Conclusions <p>Horizontal violence affected a notable proportion of nurses and was associated with increased intention to leave the job. Working in emergency units and the presence of disciplinary committees were protective factors. Strengthening internal disciplinary mechanisms, implementing regular staff rotations, enhancing communication and decision-making training, and reinforcing external professional regulatory measures are recommended to reduce violence.</p>