Nursing Incivility in the Workplace

Introduction
Incivility is a problem in many nursing workplaces around the world and it is a problem because people from time to time forget what it is they are there to do. The nurse is there to serve the patient and to support other nurses in their duties to the patient. However, nurses can become unhappy, dissatisfied, angry and unfriendly. They can bully one another, neglect one another, and cause emotional harm in the workplace. Incivility can lead to declines in nursing quality care (Lachman, 2015). This paper will define the issue of incivility, describe its importance to nursing, provide an example of it in a short story, explain how a healthful environment can be created, and, finally, discuss the practice application of this issue on nursing.
Issue of Incivility
What is incivility? The American Nurses Association (2015) has defined it as a complex manifestation of disregard and insensitivity for others. Stanton (2015) explained incivility in a workplace setting as “individuals openly or secretly directing their dissatisfaction with their work settings at co-workers of equal or lower levels within an organization” (p. 7). While dissatisfaction towards a place or people may not seem like a significant issue, the manner in which it is manifested can have a severely negative effect on the workplace culture and the feelings, attitudes, beliefs and morale of others (Manojlovich & Ketefian, 2016). Moreover, the issue is complicated by the fact that there is no one-size-fits-all definition or expression of incivility: “Some harmful actions may be more overt, such as making demeaning comments or using intimidation to undermine a coworker. Other forms of incivility and bullying can be more covert, such as failing to intervene or withholding vital information when actions are clearly indicated and needed for work to be done in a safe manner” (American Nurses Association, 2015, p. 2). Identifying incivility and addressing it effectively in the workplace is both important and difficult to do, but it is something that must be addressed in order to prevent nurses from becoming detached from their work and indifferent to their duties, colleagues and patients.
Importance to Nursing
The issue of incivility is important to nursing because it represents a critical attack on the very essence of nursing itself: nursing is about nurturing and providing quality care to others. Nurses must interact in a positive manner not just with patients but also with each other because they rely upon one another for moral support, guidance, and continuity of care. If nurses write one another off or act abusively or derisively towards one another, they disrupt the very fabric of solidarity that they are meant to represent, and that in turn disrupts the quality of care they show to patients (Lachman, 2015). As Manojlovich and Ketefian (2016) show, organizational culture is very important to the nurse’s ability to perform at a high level and provide quality care to patients. The culture has to be supportive, positive, and encouraging—and incivility undermines that culture and fosters an environment that is negative, hurtful, and destructive. And as Stanton (2015) points out, incivility is an action that oftentimes nurses do not even realize they doing. Therefore, it is important to the individual nurses, to the microsystem work environment and to the profession of nursing to identify the issue and address it.
Storytelling
Becky was covering a shift for Amy and so was pulling double-duty in the nursing workplace. She was already tired from a long weekend and she needed a break. The supervisor knew that Becky had been very helpful and accommodative so far so told her to take an extra fifteen if it would help get her stamina back up. Becky did so, but upon her return, she heard a couple other nurses in the department talking badly about her: “Becky is probably taking another break! God, does that girl do anything around here?” The other nurse laughed. Becky stopped dead in her tracks and felt as though someone had stabbed her in the back. She genuinely cared for all the nurses and really tried to be as supportive as possible. Maybe she took an extra few minutes here or there to recharge but when she got back to work she always gave 110%. She knew her supervisor felt the same way, but it really hurt her to hear her colleagues talk about her like this. She was so demoralized that he she failed to make her rounds—which did not go unnoticed by the other nurses. In fact, it just gave them more ammo for talking badly about her. She noticed one or two of them giving her mean looks. After pulling double-duty this was too much. She broke down into tears to her supervisor, who sent her home and then reprimanded in a very angry and upsetting manner the other nurses for their lack of civility. The nurses were baffled and confused and now were tasked with picking up the slack that Becky had been shouldering. They had not even realized what they were doing and were left angry by the rebuke that they felt was undeserved.
The impact of the incivility was most keenly felt and seen in Becky. She was really emotionally hurt by the unkind words of her co-workers—particularly because she felt them to be unjust. They so demoralized her that she could not even perform: whereas before she had been able to summon the strength to cover the extra shift out of sheer good will, now her spirits were depleted and she no longer had the enthusiasm as she felt all her efforts were unappreciated by the others. She felt burned out, as often happens when incivility hits (Manojlovich & Ketefian, 2016). She finally broke down mentally and emotionally as the incivility continued. The supervisor sent her home and the work she had been covering was now put on the other nurses. They were reprimanded but did not understand the cause, as they were ignorant of the fact that they were being uncivil. Thus, they doubled their resentment towards Becky and now harbored some towards the supervisor. The work environment was thus negatively affected as there was no good communication or understanding and no explanation of how the nurses were being uncivil towards Becky and why they should be more mindful of their actions in the future. The work environment was now a hostile one and the tension needed to be defused.
Creating a Healthful Environment
How could the situation be rectified? First, there needs to be training. Second, the organizational culture needs to promote kindness and support among nurses at all times. Third, engaging in more collaboration can help to reduce the risk of incivility in the workplace—and one way to do this is through nursing peer review (Bergum et al., 2017).
No intervention is going to be effective without education of nurses. Nurses need to be trained to understand what incivility looks like and why it is bad for the workplace. They need to be shown how to identify it in themselves and how to root it out. They need to be given logical explanations for why kindness and support should replace it and why quality care depends upon nurses working together for one another so that they all can work for the good of the patient. Training is therefore an essential strategy in addressing the issue of incivility.
Then there is the strategy of focusing on organizational culture. Culture is something that can only be improved through intense focus and routine reinforcement of positive behaviors (Manojlovich & Ketefian, 2016). Nurses have to be rewarded for the good actions they take, for the support they show, and they have to be supported when they come up to obstacles. Leadership is required when instilling a culture and nursing leaders must lead by example—i.e., they must show the type of positive behaviors that need to be reinforced. In this manner, the attitudes, beliefs, feelings, and actions of nurses in the workplace reflect the values and ideals that the culture aims to promote, and thus the culture of kindness is created.
Finally, the institution of collaborative care has to be implemented and this can be accomplished by using techniques like nursing peer review (Bergum et al., 2017), which allows nurses to peer review one another at least once a year. Through this process nurses take ownership of their personal and professional development and they also begin to see how they are accountable to one another as they are all part of a nursing team. The peer review process also allows them to put themselves in the position of both reviewer and reviewed and help each other to identify strengths and weaknesses.
Practice Application
My selected specialty track is education and two ways in which I can implement my master’s prepared advanced practice role to cultivate a healthful work environment would be 1) to prepare a tutorial that the nurses can use to better understand, identify and address incivility in their own behaviors and in the workplace; and 2) to help in the development of a workplace culture that is supportive and positive by designing a nursing peer review process that nurses can use to better themselves, their attitudes and their behaviors in the workplace. By developing a tutorial, I could provide nurses with the knowledge they need to make changes, and with the nursing peer review I could provide nurses with the tool they need to make the change. Knowledge plus tool equals an effective change strategy overall. Finally, through my own example and demonstration as a leader, I could facilitate the process of development.
Conclusion
Incivility can become a problem in the nursing workplace as it undermines the good will and intentions that nurses may have towards one another and creates a hostile environment in which distrust and animosity can fester and corrupt the nursing practice, putting patients and nurses at risk. Incivility can often go unnoticed and unrealized by those who do it. Thus there is a need for nurses to be educated about what it is and why it is dangerous for the nursing workplace. Strategies to create healthful environments include training the nurses to recognize and address incivility; developing an authentic organizational culture that rewards, supports and fosters positive and supportive workplace attitudes and behaviors; and promoting a tool that nurses can use to better themselves personally and professionally, such as the nursing peer review tool. In my specialty track of education, I could assist in this process by developing a tutorial that teaches nurses to identify incivility and address it within themselves and their workplace in a positive manner. I can contribute to cultivating healthful environments in my future professional practice by being mindful of my own example to other nurses. This is something I should especially pay attention to as an APRN.
References
American Nurses Association. (2015). Professional issues panel on incivility, bullying,
and workplace violence. Retrieved from https://www.nursingworld.org/~49baac/globalassets/practiceandpolicy/nursing-excellence/official-policy-statements/ana-wpv-position-statement-2015.pdf
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.
Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying,
and horizontal/lateral violence. Urologic Nursing, 35(1), 39–42.
Manojlovich, M., & Ketefian, S. (2016). The effects of organizational culture on nursing
professionalism: Implications for health resource planning. Canadian Journal of Nursing Research Archive, 33(4), 15-33.
Stanton, C. (2015). Action needed to stop lateral violence in the perioperative
setting. AORN journal, 101(5), P7-P9.