Incivility in Nursing

Within the nursing settings, incivility is a part of a larger complex problem, which includes a constellation of harmful actions taken or not taken. In this case, the destructive actions provide an overarching framework that consists of an explicit display of actions such as rudeness, intimidation, disruptive and undesirable behavior directed towards another individual (Warrner, Sommers, & Zappa, 2016). Emerging evidence indicates that incivility in the workplace has numerous implications for the nurses, patients, and the healthcare organizations. In some cases, the full range of these actions have been accepted and culturally condoned. As a result, for over a century incivility has touched far too many members of the nursing profession, in virtually every practice, and even within the academic setting. However, to eliminate incivility within the workplace, it is important to acknowledge first its existence. Nursing professionals, who witness workplace incivility and fail to report, recognize, or even ignore it, are in fact perpetuating it. Healthcare organizations that fail to address the vice through formal systems are indirectly promoting it. By refusing to engage in solving incivility in the workplace, because it has become the accepted norm is no longer an option because not all norms are moral norms or values. In light of this, the entire nursing profession has an active role to drive a cultural change to end incivility in the workplace.

Importance of Incivility to Nursing

Incivility within the nursing setting takes the form of rude and discourteous behavior, gossiping, spreading rumors, or blatant refusal to help a coworker. The actions or behaviors are an affront to the dignity of a coworker and a violation of the professional code of conduct among nursing professionals. The negative impact of incivility can be significant, far-reaching, and can extend to affect not only the targets but also the patients and the entire organization. Ideally, research shows that incivility has the potential to turn into damaged work relationships. As Smokler & Malecha (2011) notes, collaborative relationships between nurses and their managers, and peer relationships are critical for a healthy work environment. Lack of collaboration among nurses has the latent to affect healthcare costs and productivity. Along with that, studies suggest that incivility has the potential to turn into bullying at the workplace (Luparell, 2011). Negative impacts on the individual and the organization include decreased job satisfaction, minimal commitment to the organization, and neglect of personal health. Victims of nurse incivility are more likely to have increased intentions to quit their jobs or even leave the profession altogether. Mounting evidence also indicates that incivility among nursing professionals is likely to have a direct impact on individual performance. For instance, incivility harming a person’s intrinsic sense of self-worth and confidence may result in heightened levels of psychological stress, irritability, and depressive symptoms (Abdollahzadeh, Asghari, & Ebrahimi, 2017). Such effects are likely to impair clinical judgment to the extent of affecting the nurse performance. Intimidation of nurses also has the potential to lead to an increased medication error, errors related to patient safety, and delayed medication administration among other issues. When confidence and competence decrease within the nursing setting, this can affect the quality of patient care and care outcomes. Once the nursing practice is affected, it has the potential to impact the future of the nursing profession, the ability to dishonor nursing contract with the society and discourage new nurses who may want to join the profession.

Scenario of Incivility in a Practice Setting

Normally, within the clinic, we are used to having new graduate nurse practicing on the medical unit. On this particular night, after Leticia and her colleagues we were through with the ward rounds, she overhead a colleague who has been working with the facility for more than five years grumbles that she needed to pick up her pace and pull up her weight. Unfortunately, as a new graduate with no years of experience, Leticia would constantly seek approval of the senior nurse by working extra hard and even sometimes extending over time. With time, Leticia started to develop work burnout, as she was constantly fatigued. This also affected her performance in the clinical setting. Eventually, Leticia had to leave the organization, when she failed to administer medication to the patient at the right time.

Strategies for Creating a Healthful Environment

As conceptualized above, a workplace marred by incivility can contribute to an unhealthy environment that ultimately affects the quality and safety of care delivered to patients. Several studies support the need to develop a culture of civility with the workplace to curb the impact of the vice on the nursing profession. McNamara (2012) recommends three important strategies that can help to eliminate incivility and nurture a healthful environment. The first one is the use of organization’s resources to create a healthful environment. As McNamara elaborates, individual nurses have a responsibility to prevent and abolish incivility, by being aware of the organization’s code of conduct. Ideally, healthcare organizations have a zero tolerance for abusive behavior. Becoming familiar with this information helps the nurse to be able to identify unacceptable practice and the right action to take. Healthcare administrators and nurse managers also have a role in modeling civility by addressing complaints and incidents promptly and correct disruptive behavior. The second strategy is to educate nurses to make them understand that they are accountable for their behavior and that of others. The training should focus on various skills on how to handle lateral violence, conflict resolution, and behavioral techniques to handle nurses with unacceptable behaviors. The third strategy is nurturing a culture of appropriate behavior. Nurses should treat others with respect, and strive to uphold each other’s dignity. Other ways to model proper behavior is by creating an environment where colleagues are open to each other’s ideas, be free to question others and develop a positive attitude towards colleagues. Nurses should also never allow the disruptive behavior to go unchecked; rather they should always address it immediately if possible.

Specialty Track and Addressing Incivility

Ideally, my specialty track is Nurse Executive later to become Chief Nursing Officer. As one of the highest positions in nursing management, I will be responsible for overseeing and coordinating the daily operations of the nursing department. I will also be responsible for ensuring that clinical, patient care and staffing standards within the healthcare organization are met. My role will also involve advising senior management on best practices in nursing, recruitment, training, retention, managing nursing budgets, among other functions of a CNO. Moreover, I have even a bigger responsibility to ensure a healthful workplace environment. In this context, it will be my responsibility to educate nurses and ensure that they understand they are accountable for their behavior. This will be achieved through in-service programs to train nurses on the right way to handle disruptive behavior.  Another thing is to model a culture of appropriate behavior by first being a role model and ensuring nurses follow my example.

Conclusion

At the center of the nursing profession is the desire to care for other people. In fact, a majority of the nursing professionals who enter this discipline do it for altruistic reasons. Sadly, though, the same caring nature does not necessarily pertain to the relationship between nursing colleagues. Nursing incivility is a disruptive or undesirable behavior that one individual is likely to display towards another in a healthcare organization.  Unfortunately, incivility adversely affects workplace environments, impedes patient safety and nursing collaboration, negatively affects the nursing profession, and individuals. With the knowledge of the looming impacts of incivility, every effort should be exerted to create a healthful workplace environment. Given that I know about the implications of incivility to the workplace, and with an executive nursing officer specialty track, it is imperative that I should be able to address this issue to foster a healthful workplace environment. 

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to Prevent Workplace Incivility?: Nurses’ Perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163.

Luparell, S. (2011). Incivility in nursing: the connection between academia and clinical settings. Critical Care Nurse, 31(2), 92-5.

McNamara, S. A. (2012). Incivility in Nursing: Unsafe Nurse, Unsafe Patients. Aorn Journal, 95(4), 535-540.

Smokler, L. P., & Malecha, A. (2011). The impact of workplace incivility on the work environment, manager skill, and productivity. The Journal of Nursing Administration, 41(1), 41-47.

Warrner, J., Sommers, K., Zappa, M., & Thornlow, D. K. (2016). Decreasing workplace incivility. Nursing Management (springhouse), 47(1), 22-30.