Nursing Peer Review to Reduce Lateral Violence and Incivility

PICO Question and Overview

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

How Incivility Affects Nurses and Patients

The issue of incivility in the workplace affects all stakeholders in nursing—from supervisors to staff nurses to patients. Allen, Holland, and Reynolds (2015) found that when incivility occurs in the nursing environment, nurses can become burned out and may act in a detached manner as a defensive response. When nurses feel that colleagues are being rude to them, they may neglect their duties and disengage from the workplace environment. Incivility can also lead to higher-than-normal turnover. Research indexed in PubMed and studies such as Lim and Bernstein (2014) show that incivility can undermine the culture of care that is essential in the nursing workplace, creating an unstable professional atmosphere.

When nurses are negatively affected by incivility, they stop engaging fully with their work and stop providing quality care to patients. The problem of incivility thus ends up impacting patient care and potentially patient health in a negative manner (Allen et al., 2015). Because patient care is the top priority of the nurse, lateral violence should be seen as a direct impediment to the nurse's ability to implement quality care. Incivility can also cause nurses to call off work or quit altogether (Hamblin et al., 2015). Lateral violence therefore impacts patient care by preventing nurses from being fully engaged in their work (Warrner, Sommers, Zappa, & Thornlow, 2016). Nurses who are not fully engaged cannot provide the highest level of concern and quality care that patients deserve.

Personal Reflection on Incivility

In my own experience, I have seen how incivility can cause dysfunction in the workplace. I have even sometimes caught myself being uncivil to others, as it is sometimes an unconscious behavior that goes unnoticed when one is not in the right state of mind. Stanton (2015) shows that incivility is often a behavior that nurses are not even aware they are exhibiting, which makes it all the more important for nurses to be able to identify and reduce it in the workplace. When I have been uncivil to a co-worker, it has come back to affect me by making the work environment more difficult. Likewise, when I have experienced unkindness from others, it has frustrated me and diminished my desire to be present in the workplace.

The review of literature helped identify several 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 (NPR) process (Bergum et al., 2017). Another potential solution is to focus on organizational culture change (Johnson, 2015) and build a more positive culture by promoting collaborative care, communication, and respect.

The solutions proposed here center on establishing a better culture in the nursing workplace by promoting respect, collaboration, and communication. The most effective way to accomplish this is to institute nursing peer review, which requires nurses to be reviewed by their peers at least once a year. This process teaches nurses to put themselves in others' shoes and to be respectful and open to change so that they can improve professionally. Nursing peer review can help nurses identify areas that need development and work toward addressing them. Making civility, communication, and respect core features of an NPR will help prevent incivility from taking root.

Conclusion

Incivility and lateral violence in the nursing workplace create tension and undermine existing culture, leading to hurt feelings and isolation. Nurses can experience burnout and begin to disengage from their duties. This disengagement ultimately affects the patient, who depends on the nurse being mindful and fully present while on duty. When the quality of patient care begins to decline as a result of workplace incivility, it becomes clear that the problem must be addressed systematically.

There are many ways to reduce the risk of incivility in the workplace. Nurses can be trained to be more civil, receive civility education in nursing school, practice collaboration in the workplace, and foster a culture of caring and respect. The best solution, however, is the nursing peer review, because it brings all of these strategies together into one integrated approach. The nursing peer review requires nurses to be respectful of one another, to collaborate, to communicate openly, and to commit to ongoing self-improvement.

Allen, B. C., Holland, P., & Reynolds, R. (2015). The effect of bullying on burnout in nurses: The moderating role of psychological detachment. Journal of Advanced Nursing, 71(2), 381–390.

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. (2015). Catalysts of worker-to-worker violence and incivility in hospitals. Journal of Clinical Nursing, 2458–2467.

Johnson, S. L. (2015). Workplace bullying prevention: A critical discourse analysis. Journal of Advanced Nursing, 71(10), 2384–2392.

Lim, F., & Bernstein, I. (2014). Civility and workplace bullying: Resonance of Nightingale's persona and current best practices. Nursing Forum, 49(2), 124–129.

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.

Warrner, J., Sommers, K., Zappa, M., & Thornlow, D. (2016). Decreasing workplace incivility. Nursing Management (Springhouse), 22–30.