PICO
The PICO question for this study is: Among nurses, how effective is nursing peer review as compared a basic civility tutorial intervention in moderating lateral violence and incivility in the workplace?

Introduction: Key Issues

How Incivility Impacts the Nursing Profession

The issue of incivility in the workplace is one that affects all stakeholders in nursing—from supervisors to nurses on down to patients. Allen, Holland and Reynolds (2015) found, for instance, that when incivility occurs in the nursing environment, nurses can become burned out and can act in a detached manner out of defensiveness. If they feel that other nurses are being rude to them, they will neglect their duties and check out from the workplace environment. It can also lead to higher than normal turnover. Lim and Bernstein (2014) show that it can undermine a culture of care that is needed in the nursing workplace. Incivility can thus create an unstable atmosphere in the nursing profession.

How Incivility Impacts Patient Care

When nurses are negatively impacted by incivility, they stop being engaged, stop showing quality care to patients, and thus the problem of incivility ends up impacting the patient’s care and potentially the patient’s health in a negative manner (Allen et al., 2015). As patient care is the top priority of the nurse, lateral violence should be seen as an impediment to the nurse’s ability to implement quality care. Incivility, however, can causes nurses to call off work or quit altogether (Hamblin et al., 2015). Lateral violence thus impacts patient care by preventing nurses from being fully engaged in their work (Warrner, Sommers, Zappa & Thornlow, 2016) and nurses who are not fully engaged will not be able to show the highest concern and quality care towards patients, which is what patients deserve.

How Incivility Impacts Me as a Nurse

In my own experience, I have seen how incivility can cause dysfunction in the workplace. I myself have even sometimes caught myself being uncivil to others, as it is sometimes an unconscious behavior that goes unnoticed because I am not maintaining the right state of mind. Stanton (2015) shows that incivility is often a behavior that nurses are not even aware they are doing, and this makes it all the more important for nurses to be able to identify and reduce it in the workplace. I know that if I am being uncivil to a co-worker, it comes back to haunt me by making the work environment more difficult, and I know that when I have felt unkindness from others, it has frustrated me and made me not want to be there.

Solutions

The review of literature did help me to identify solutions. Lim and Bernstein (2014) recommended collaboration among nurses to reduce incivility in the workplace. And one way to achieve collaboration is through the nursing peer review process (Bergum et al., 2017). Another potential solution is to focus on organizational culture changes (Johnson, 2015) and increase the positive culture by promoting collaborative care, communication and respect.

The solutions I propose are to establish a better culture in the nursing workplace by promoting respect, collaboration and communication. The best way to do that is to institute nursing peer review, which requires nurses to be reviewed by their peers at least once a year. This teaches the nurses to put themselves in the shoes of others and to be respectful and open to making changes so that they can improve. Nursing peer review can help nurses to identify issues that they are having so that they can work on them to improve. Making civility, communication and respect features of an NPR will help to prevent incivility.

Literature Review

The Effects of Incivility on the Nursing Workplace

Hamblin et al. (2015) conducted qualitative content analysis of incident reports on worker-to-worker violence and incivility and found that over half of the incidents involved nurses and that physical violence was not typical. The violence instead was emotional and best described as incivility. The two themes that Hamblin et...…to focus on particular areas of practice that could be developed and improved upon to better enable the creation of a more professional setting. NPRs are conducted by nurses for nurses: they are typically done once a year and every nurse is obliged to undergo them. They are completely professional and never personal. All recommendations made following an NPR are made with the purpose of setting professional goals for the nurse so that the nurse can work towards achieving these goals over the course of the following year. The aim is to constantly be working towards improving the workplace environment by focusing on the individual behavior, attitude, deportment, communication skills and so on of each and every individual nurse. This would be the best solution for the problem of addressing workplace incivility because it focuses on both training and promoting collaboration and communication among nurses with a view towards improving their overall professional development.

Summation

Incivility and lateral violence in the nursing workplace can create tension and undermine whatever culture exists. This will allow for hurt feelings and isolation to occur. Nurses can experience burnout and begin to disengage from their duties. That ends negatively impacting the patient, as the patient depends up the nurse being mindful and fully engaged while on duty. When the patient’s quality of care begins to decline as a result of workplace incivility, it is clear that it is a real problem that needs to be addressed. There are many ways to reduce the risk of incivility in the workplace. Nurses can be trained to be more civil. They can receive civility education in nursing school. They can practice collaboration in the workplace. A culture of caring and kindness can be implemented. The best solution, however, is the nursing peer review, because it essentially brings all this strategies together into one strategy. The nursing peer review requires nurses to be respectful to one another, to collaborate, to communicate and to educate themselves.