Lateral Violence Workplace Incivility

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 al. (2015) found to be most important in the study were the theme of workplace behavior and the theme of workplace organization. In other words, the majority of cases were either the result of poor professional and respectful behavior from one nurse to another, or the result of poor following of organizational protocol. The overall effect of suffering from incivility was a decline in satisfaction among nurses.
Lim and Bernstein (2014) found in their study that incivility and lateral violence tend to “foster medical errors, increase the cost of care, and contribute to poor patient satisfaction and preventable adverse outcome” (p. 124). They also noted that civility should be part of a nurse’s education and that student nurses should be taught the importance of collaboration and communication. If more emphasis is placed on learning respect for one’s co-workers, Lim and Bernstein (2014) argued that incidents of incivility would decline.
Warner et al. (2016) conducted a training exercise to see if they could reduce incidents of workplace incivility through the use of cognitive rehearsal cue cards. They found that while there was no statistically significant increase of awareness about incivility following the training session, there was on average an increase in general awareness even if it was not statistically significant. This suggested for the researchers that training could be an effective way of dealing with workplace incivility among professional nurses.
Prevention Possibilities
Johnson (2015) found that “the effective prevention of workplace bullying will require departmental and organizational initiatives” (p. 2384). In other words, collaboration is required among department and organizational levels to ensure that the type of behavior desired among nursing professionals is promoted while negative behavior, like bullying, incivility, harassment and other types of actions are reduced if not completely eliminated.
One way to ensure that a truly collaborative nursing environment is created is to work on developing a positive workplace culture, as Manojlovich and Ketefian (2016) showed in their study. Manojlovich and Ketefian (2016) found that “the ability of nurses to practice in a professional manner may be influenced by the organizational culture of their work environment” (p. 15). This is an important consideration to make because culture is such a very large and significant part of the way a workplace operates. For leaders or supervisors to ignore the effect of culture while trying to understand and manage relationships in the workplace is often a big mistake. Culture is what sets the tone of the environment (Manojlovich & Ketefian, 2016). It helps to mold behaviors by placing expectations of behavior out in the open. It allows managers to reward positive behavior with intrinsic or extrinsic motivators while punishing negative behaviors that do not fit in with the organizational culture.
To help create this culture certain steps should be taken. Bergum et al. (2017) call for the institution of the nursing peer review in facilities to help with the development of a more positive and supportive workplace environment. Nursing peer review (NPR) allows nurses to focus on particular areas of practice that could be developed and improved upon to better enable the creation of a more professional setting. The nursing peer review is a way for nurses to communicate effectively, take ownership of their personal and professional development, and engage in collaborative care over the long run.
Johnson (2015) addresses the problem of preventing incivility in the nursing workplace and suggests that an initiative that promotes positive behavior is a good way of normalizing the types of behaviors and relationships that managers want to see in the nursing environment. Johnson (2015) states that depending on a monitoring system or system of surveillance is inadequate to address this issue as her study revealed that “managers acknowledged that one of the drawbacks with using presence as a deterrent is the possibility that individuals will develop strategies for avoiding surveillance. Staff could hide bullying behaviors by engaging in covert behaviors to bully others” (p. 2387). Surveillance is also too passive. A proactive strategy is needed—and that is why the NPR initiative is a good one.
Modeling the right kind of appropriate behavior can reinforce values that can create a positive culture. As one hospital in the study by Johnson (2015) showed, “annual performance review rewarded employees and managers who are a role model for behaviors and values” (p. 2389). Reviews should, therefore, be considered an essential part of creating the right culture for the nursing workplace. This falls right in line with what Manojlovich and Ketefian (2016) found about the relationship between workplace culture and nursing professionalism: if you want nurses to act professionally, you have to create a positive culture in which professionalism is respected, rewarded, appreciated and modeled.
To reduce the risk of burnout or turnover—or even detachment, as Allen et al. (2015) showed—nurse leaders have to address the issue of relationships and how nurses react to one another other. A culture of professionalism has to be promoted and established so that every nurse understands the right way to interact with colleagues. Nurses themselves should bear responsibility for helping one another to develop professionally by participating in a nurse review process that identifies areas that need improvement and allows nurses to set goals for themselves that they can work on over the year.
Best Solution
Bergum et al. (2017) call for the institution of the nursing peer review in facilities to help with the development of a more positive and supportive workplace environment. Nursing peer review (NPR) allows nurses 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.


References
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Bergum, S. K., Canaan, T., Delemos, C., Gall, E. F., McCracken, B., Rowen, D., ... &
Wiens, K. (2017). Implementation and evaluation of a peer review process for advanced practice nurses in a university hospital setting. Journal of the American Association of Nurse Practitioners, 29(7), 369-374.
Hamblin, L., Essenmacher, L., Upfal, M., Russell, J., Luborsky, M., Ager, J., & Arnetz, J.
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Johnson, S. L. (2015). Workplace bullying prevention: a critical discourse analysis. 
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Lim, F., & Bernstein, I. (2014). Civility and workplace bullying: Resonance of
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Manojlovich, M., & Ketefian, S. (2016). The effects of organizational culture on nursing
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Stanton, C. (2015). Action needed to stop lateral violence in the perioperative
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