NR 500 Week 7 Discussion: Healthful Environments
NR 500 Week 7 Discussion: Healthful Environments
The workplace incivility I described has been occurring for quite some time. Up until now, strategies I have implemented to improve the situation have been role modeling positive behavior, confronting the incivility face to face with this employee, meeting with our nurse manager in a neutral environment, and sharing the incivility with my spouse and close friends as a means to release my feelings without being met with judgment while also receiving feedback. Green (2018) discusses a strategy to combat civility by practicing a mindfulness approach when communicating and interacting with others in the workplace. This would involve personal reflection in order to deal with frustrations and stressors as related to incivility. I am trying to remember that mere man does not define me and that I answer to a higher calling other than myself and those around me. Other strategies that I will start to implement since the situation has yet to resolve and I am not receiving the leadership support that is needed to reflect zero tolerance of such uncivil behaviors is keeping personal documentation of every event including location, date, and time. This will help me to list this negative behavior factually as opposed to trying to remember every event from memory should it become necessary to escalate the situation further or defend my own actions. I personally despise unhealthy conflicts, especially in the work environment where patient care is my focus. I look forward to a day where incivility in nursing workplaces are frowned upon by all and never tolerated as a way to survive the complex environments we are a part of.
Green, C. (2018). New nursing faculty and incivility: Applying mindfulness-based strategies. Holistic Nursing Practice, 32(1), 4-7. doi: 10.1097/HNP.0000000000000246
Incivility in the workplace is a prevalent concern in nursing and healthcare settings. The knowledge of incivility and lateral violence in nursing is not an uncommon issue. It has been around for decades and remains a strong presence in nursing today. This causes me great sadness for the profession I hold dear. Uncivil workplace behaviors can be characterized as rude and discourteous, with no regard for others (Phillips, Smith, MacKusick, & Whichello, 2018). This repeated act that is essentially bullying, whether verbally or silently, can lead to absenteeism, low job satisfaction and morale, burnout, poor productivity, mental, and physical health problems for the recipient of this poor treatment (Phillips, et al., 2018). The nursing profession must take a continual stand against incivility to assure the safety and well-being of our nurses and ultimately our patients whose care can be affected by work incivility.
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As a nurse of many years, I have been witness to and also the target of workplace incivility. As a novice NICU nurse many years ago, I remember the leadership in my department setting an intimidating tone for new employees. There were cliques and gossiping that ultimately led to low morale and fear. This is truly a sad and dangerous place to be when caring for the precious lives of others. In an ICU setting, nurses need to be able to work as a team to deliver effective care. The ability to discuss care situations with colleagues and receive their input in a supportive, non-judgmental way is how nurses grow in their knowledge and expertise, ultimately fine tuning their trade. When intimidation and condescending attitudes are present, nurses will question their ability to provide good care and may eventually leave the department or the profession.
I am currently serving my fourth year as an assistant nurse manager in the pediatric operating room where I am employed. Upon immediate receipt of this promotion, I felt that the staff who were once my colleagues, but now my direct reports started to treat me differently. Suddenly, I became the enemy in some employee’s perspectives as I became responsible for scheduling, assignments, time and attendance tracking, and evaluations. My determination from the start to was model kindness and compassion towards others despite often times not receiving it in return. At the end of the day, I like to reflect upon the questions: Did I do my best? Was I fair to everyone? Was there anything I could have done better? Unfortunately, even with putting my best efforts forward in communication, organization, and compassion towards others, there are those few in the department that intend on holding grudges and forming untrue opinions about me. We live in a world where very little grace is extended towards others and that is something I intend to provide more of the older I get. Presently, I am dealing with a situation with a particular surgical technologist that refuses to speak to me unless she has too. She talks to everyone around me and is generally well liked by all. She has never taken the time to get to know me personally but became very irritated with me on a few occasions when I assigned her to surgical cases. Instead of immediately coming to me with her frustrations, she would complain to her co-workers. It would be weeks of the silent treatment before I would figure out that she was upset with me. I have tried repeatedly to rectify the situation, exemplify kindness by asking how she and her family were doing, and have unfortunately gotten nowhere. She complained to our manager that I speak to her like a child and give her unfair assignments.
We sat down with our manager to discuss the situation further which led to 30 minutes of her telling me how she has never liked me and does not want me to speak to her and even threatened human resources involvement. During this interaction, I wish that I handled it differently but I did let anger and defensive mechanisms take over, taking the opportunity to call her out on the poor behavior she exhibits towards me on a daily basis. In the end, not much was resolved, my leader advised us to start anew and try to leave negative feelings towards each other in the past. I go to work each day with a desire to provide exemplary care to my patients and support to my team. Unfortunately, not much has changed with my interactions with this surgical technologist as she refuses to speak to me still unless it is a work-related matter, and then she does it begrudgingly. In a recent attempt to improve this situation, I reached out to my manager and fellow leadership group to let them know that despite efforts, this employee continues to display negativity to me in and out of my presence as has been told me to by other employees. My fellow leadership team did not provide the clarification and support I was seeking, but instead responded that I was just one person and this individual is a ray of sunshine to others. One fellow leader responded that she expects staff to talk negatively about us and not agree with everything we do. This response has ultimately left me feeling more isolated and alone in this situation. I am currently at a loss as to how to proceed. I have worked many years to reach my current position. Through hard work and dedication, I have been able to advance my nursing practice and hold my professionalism to a high standard. Phillips, Stalter, Winegardner, Wiggs, & Jauch (2018), describe workplace incivility and its consequences such as nursing resignations, mental anguish, and potential patient safety concerns. Personally, I have felt mental anguish over this situation and have indeed considered other positions. As present, I have decided to stick with it and continue to strive for excellence and maintain dignity despite the discomfort I feel when I am around this individual.
Having known earlier how this employee felt about me and addressing the issue upfront could have potentially led to a different outcome. Over time, tension and frustrations tend to build up in individuals which can lead to grudges and long-lasting opinions. Knowing this, I intend to address concerns and disagreements immediately from now on. I also feel that pursuing my MSN and addressing concepts such as incivility through scholarly review is empowering me to look past personal matters and seek out the root cause of incivility, better equipping me with a deeper knowledge base towards the subject. This in turn will help me develop better leadership skills in my current and future positions as a master’s prepared nurse.
Strategies that support a healthy work environment are education on incivility in the workplace and how to counteract this detrimental behavior. This should be provided upon hire and repeatedly through computer based learning, staff meetings, and educational retreats. If a healthcare system invests in creating a just culture that maintains accountability for behaviors and actions, civil behavior will grow and support a healthy work environment (Phillips, et al., 2018). Leadership should have zero tolerance for incivility and be able to role model appropriate behaviors that promote team cohesiveness and support.
Phillips, G., MacKusick, C., & Whichello, R. (2018). Workplace incivility in nursing: A literature review through the lens of ethics and spirituality. Journal of Christian Nusing, 35(1), 7-12. doi: 10.1097/CNJ.0000000000000467
Phillips, J., Stalter, A., Winegardner, S., Wiggs, C., & Jauch, A. (2018). Systems thinking and incivility in nursing practice: An integrative review. Nursing Forum, 2018, 1-13. doi: 10.111/nur.12250
I recall an experience as a recent graduate nurse in which I was bathing and caring for an eighteen-year-old female patient who had experienced prolonged severe carbon monoxide poisoning. Because of the exposure, she lost her parents and sibling, and she was the sole survivor. She suffered a severe anoxic brain injury that left her mentally devastated. It happened to be my first nursing position straight out of school in the PICU where I had previously worked as a patient care tech. During patient care, the charge nurse came on the overhead speaker in the patient’s room and pretended to talk to the patient. The charge nurse made crude remarks about how the patient was enjoying the bath and needed a boyfriend, would I like to be that man for her? I was in the middle of bathing the patient with another staff nurse when we heard the voice come over the speaker. At the moment that it happened I was not sure how to take the comments. However, I knew enough to know that her actions and comments were inappropriate and far from the standard of care.
As a male nurse, I was still learning how to best care for female patients. Each time I cared for a female patient I was extra intentional in showing respect, dignity, and upholding their privacy whenever possible. This situation caught me off guard and made me feel uncomfortable. My first reaction was to smile, but then the seriousness of the patient’s unfavorable prognosis caught my attention and helped redirect my focus back to the severity of her condition and vulnerability. I was not bothered so much about what the implications of the comment implied towards me as a male nurse but was troubled by the notion that we as health care providers were misbehaving toward the patient and in many ways taking advantage of her mental state and preying on her inability to defend herself. I merely justified the event in my mind and labeled it as the staff just being silly. The charge nurse and other staff members got a real laugh out of the whole thing as the story was retold latter that day.
Regarding the consequences of the situation, most would argue and say nothing happened because none of the patient’s family or relatives and other neighboring families ever found out. As for implications for the patient, one might think it did not matter since she is incapable of understanding what took place. Had a family member heard about the incident or a member of leadership, the situation could have cost the charge nurse her job or at minimum caused for a movement to re-educate the staff on ethical practice standards of best care.
According to Andersson and Pearson, as cited in (Hunt, & Marini, 2012), the term “incivility” encompasses low-intensity behavior that lacks a clear intent to harm, but violates social norms and can cause harm. According to Lambert, Lambert & Ito, as cited in (Hunt, & Marini, 2012), nurses who have less than satisfactory relationships with their coworkers are more likely to leave their jobs. While I did not have any intentions on leaving my job after the incident, I could have turned this negative situation into a decisive, constructive learning moment in which all staff members could have reflected upon its possible negative implications. I might have gained some resistance from my co-workers, but ultimately an environment conducive to excellence is one worth fighting and advocating for. Unfortunately, I allowed my voice to go unheard, and I failed to support civility. I should have imaged my daughter or loved one laying there in that patient’s bed and treated her with compassion and empathy.
According to Pearson and Porath, as cited in (Hunt, & Marini, 2012), incivility impacts on inter-professional team function through disruption of relationships and poor cooperation, and grievances. This situation negatively affected the work environment because each nursing provider failed to work towards a basis of civility in which we would love thy neighbor and was unable to demonstrate respect for this precious soul. All parties involved missed the opportunity to stop these rude comments, thoughtless acts, or negative gestures which were a form of aggression just in a less intense form: verbal rather than physical, passive rather than active, indirect rather than direct, and subtle rather than overt. The cycle of negativity continued because we chose to stay nonjudgmental. A charge nurse and every nurse ought to withhold a position of leadership and leadership qualities lacked during that incident. Nursing is a field in which caring is the backbone of all we strive to do, and we failed to uphold that promise. ANA’s Code of Ethics for Nurses states that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect.” Similarly, nurses must be afforded the same level of respect and dignity as others (ANA, 2015), all these standards were omitted during this occurrence. Strategies that would support a healthy work environment start with continuous self-reflection and self-awareness on our own actions thoughts and perceptions. Confronting negative behavior or perceptions immediately in a nonjudging way with constructive criticism is crucial. ANA defines a healthy nurse as one who actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional wellbeing (ANA 2016). These are the qualities nurse leaders should exemplify so that such crude situations mentioned earlier have no place for acceptance or tolerance and ultimately are prevented altogether.
America Nurses Association. (2016). Healthy nurse, healthy nation. Retrieved from
American Nurses Association. (2015). Incivility, bullying, and workplace violence [Position
Statement]. Retrieved from file:///C:/Users/User/Downloads/PosStat-Endorsed-ANA-Incivility-Bullying-Violence.pdf
Hunt, C., & Marini, Z. A. (2012). Incivility in the practice environment: A perspective from
clinical nursing teachers. Nurse Education in Practice 12(6) pp. 366-370
Fortunately, I have yet to experience any acts of incivility directly toward myself or any other healthcare team member. According to (Alquwez, 2009), uncivil acts from nurses negatively impact their patient safety competence causing poor work performance and errors in many different nursing fields such as medication errors and other nursing tasks.
The consequences of incivility intervention can include counseling, and coaching followed by progressive discipline for staff members who do not adhere to the zero tolerance for workplace incivility initiatives (Green, 2019).
Thus, the ways of maintaining civility in the healthcare environment can include having weekly staff meetings to address conflicts every other week and educational sessions on conflict resolution for all shifts (Green, 2019). Nevertheless, the ultimate ways of preventing situations from occurring are having effective communication with staff, being supportive of colleagues, enhancing knowledge and skills, improving conflict resolution skills, and being empowered (Abdollahzadeh et al., 2017).
Strategies that promote a healthy work environment are embedded in work ethics such as respectful relationships, values of diversity, open and honest communication, equitable and fair treatment of others, mutual trust, and collaboration as healthy work environments promote relationships, collaboration, compassion, and caring, and they produce positive outcomes (Chamberlain College of Nursing, 2022).
Nurse leaders are professionally obligated to acknowledge and address any acts of incivility in the healthcare workplace and failure to do so may eventually affect the nurse leader’s reputation as an effective manager (Green, 2019). By acknowledging the issues of incivility and the necessary intentional decision to function as a change agent and engage the staff in the change process, nurse leaders can resolve conflicts while promoting transformation as well (Green, 2019).
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. https://doi.org/10.4103/1735-9066.205966Links to an external site.
Alquwez, N. (2020). Examining the influence of workplace incivility on nurses’ patient safety competence. Journal of Nursing Scholarship, 52(3), 292-300. https://doi.org/10.1111/jnu.12553Links to an external site.
Chamberlain College of Nursing (2022). NR500 Foundational Concepts & Advanced Practice Roles. Week 7 lesson. Downers Grove, IL: Online Publication
Green, C. (2019). Workplace incivility: Nurse leaders as change agents. Nursing Management, 50(1), 51-53. https://doi.org/10.1097/01.NUMA.0000550455.99449.6bLinks to an external site.
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NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.
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