Week 7 Incivility And Healthful Environments

Week 7 Incivility And Healthful Environments

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.

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.

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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.

References

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

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared..

Due Date

The initial posting to the graded collaborative discussions is due by Wednesday, 11:59 p.m. MT. Peer and faculty responses are due by Sunday, 11:59 p.m. MT. All posts for Week 8 are due by the close of class on Saturday, 11:59 p.m. MT. Please note that the late assignment policy does not apply to the collaborative discussions.

Discussion Criteria

I. Application of Course Knowledge: of Course Knowledge: I. The student post contributes unique perspectives or insights gleaned from personal experience or examples from the healthcare field. The student must accurately and fully discuss the topic for the week in addition to providing personal or professional examples. The student must completely answer the entire initial question.

II. Engagement in Meaningful Dialogue: I. The student responds to a student peer and course faculty to further dialogue.

a. Peer Response: The student responds substantively to at least one topic-related post by a student peer. A substantive post adds content or insights or asks a question that will add to the learning experience and/or generate discussion.

A post of “I agree” with a repeat of the other student’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.

The peer response must occur on a separate day from the initial posting.

The peer response must occur before Sunday, 11:59 p.m. MT.

The peer response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.

Faculty Response: The student responds substantively to at least one question by course faculty. The faculty question may be directed to the student, to another student, or to the entire class.

A post of “I agree” with a repeat of the faculty’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.

The faculty response must occur on a separate day from the initial posting.

Responses to the faculty member must occur by Sunday, 11:59 p.m. MT.

This response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.

III. Integration of Evidence: The student post provides support from a minimum of one scholarly in-text citation with a matching reference AND assigned readings OR online lessons, per discussion topic per week.

What is a scholarly resource? A scholarly resource is one that comes from a professional, peer-reviewed publication (e.g., journals and government reports such as those from the FDA or CDC).

Contains references for sources cited

Written by a professional or scholar in the field and indicates credentials of the author(s)

Is no more than 5 years old for clinical or research article

What is not considered a scholarly resource?

Newspaper articles and layperson literature (e.g., Readers Digest, Healthy Life Magazine, Food, and Fitness)

Information from Wikipedia or any wiki

Textbooks

Website homepages

The weekly lesson

Articles in healthcare and nursing-oriented trade magazines, such as Nursing Made Incredibly Easy and RNMagazine (Source: What is a scholarly article.docx; Created 06/09 CK/CL Revised: 02/17/11, 09/02/11 nlh/clm)

Can the lesson for the week be used as a scholarly source?

Information from the weekly lesson can be cited in a posting; however, it is not to be the sole source used in the post.

Are resources provided from CU acceptable sources (e.g., the readings for the week)?

Not as a sole source within the post. The textbook and/or assigned (required) articles for the week can be used, but another outside source must be cited for full credit. Textbooks are not considered scholarly sources for the purpose of discussions.

Are websites acceptable as scholarly resources for discussions?

Yes, if they are documents or data cited from credible websites. Credible websites usually end in .gov or .edu; however, some .org sites that belong to professional associations (e.g., American Heart Association, National League for Nursing, American Diabetes Association) are also considered credible websites. Websites ending with .com are not to be used as scholarly resources

IV. Professionalism in Communication: The post presents information in logical, meaningful, and understandable sequence, and is clearly relevant to the discussion topic. Grammar, spelling, and/or punctuation are accurate.

V. Wednesday Participation Requirement: The student provides a substantive response to the graded discussion question(s) or topic(s), posted by the course faculty (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.

VI. Total Participation Requirement: The student provides at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

Preparing the Assignment

Professionalism in Communication: The post presents information in logical, meaningful, and understandable sequence, and is clearly relevant to the discussion topic. Grammar, spelling, and/or punctuation are accurate.

Wednesday Participation Requirement: The student provides a substantive response to the graded discussion question(s) or topic(s), posted by the course faculty (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.

Total Participation Requirement: The student provides at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

Introduction

This graded discussion will explore the impact of systems theory on a practice problem or issue. Please provide an initial response to the discussion question by Wednesday at 11:59pm MT and two interactive dialogue responses no later than Sunday 11:59 PM MT at the end of WEEK 7. The discussion is worth 75 points. Please refer to the discussion grading rubric for additional criteria.

Assignment

Reflect on an experience in which you were directly involved or witnessed incivility in the workplace. Provide a brief synopsis of the situation. How did this make you feel? How did you respond? What were the consequences of this situation? Provide an example of how this negatively affected the work environment and outcomes. How could the situation have been prevented? Discuss strategies that would support a healthy work environment.

Skilled communication can either be verbal or non-verbal. According to Jones et al. (2019), staff perceives effective healthcare communication as a backbone for a healthy work environment. Therefore, continuous training in interprofessional skilled communication is vital to maintain a healthy work environment. Another strategy is team building and interprofessional simulation activities, which help to increase true collaboration. Effective decision-making, appropriate staffing, and meaningful recognition will help prevent higher turnover rates and staff burnout, thereby making the work environment healthier. Authentic leaders must be cognizant of the perceptions of self and others, model the shared core values, and should be able to inspire others. An authentic leader encourages her subordinates to engage in self-care activities to reach their optimal physical and mental health. When combined with a value-based work environment, staff are effective in reducing stress, burnout, and compassion fatigue, as well as increasing resilience, retention, and coping. These are what make the workplace healthy.

Saunders, J., Sridaromont, K., & Gallegos, B. (2021). Steps to Establish a Healthy Work Environment in an Academic Nursing Setting. Nurse Educator, 46(1), 2–4. https://doi.org/10.1097/NNE.0000000000000829

 

Links to an external site.

Jones, L., Cline, G. J., Battick, K., Burger, K. J., & Amankwah, E. K. (2019). Communication Under Pressure: A Quasi-Experimental Study to Assess the Impact of a Structured Curriculum on Skilled Communication to Promote a Healthy Work Environment. Journal for Nurses in Professional Development, 35(5), 248–254. https://doi.org/10.1097/NND.0000000000000573

Good evening Dr.Cox and Classmates,

Incivility and bullying are critical problems in nursing practices. As a newly employed nurse in the intensive care unit, I experienced incivility with my fellow nurses who had just been employed in the department. During that time, some old nurses seemed to feel threatened by new nursing graduates, showing high disrespect towards them. One incident I recall vividly was on the orientation day when one middle-aged nurse passed by a patient I was serving with my supervisor and said, ‘I told you this is a waste; the kids cannot do anything on their own. Make sure you get back and check lest we lose the patients. These statements were harrowing and discouraging. It was difficult to believe I could continue working around such people with insults and disrespect daily. At one point, I lost interest in the job and wished to quit nursing to take a career with little engagement with people’s lives. As the American Nurses Association claims, incivility in nursing practices affects the nurse and the people around them (ANA, 2015). The patient I served at the moment was not in a terrible state since she could see, hear and talk. After hearing the words, she struggled to move, although she could not. The look on her face showed that she had lost faith in my services and would wish to be served by another nurse with more experience.

Incivility has adverse effects on the nursing environment and nurse outcomes. The incidence affected the environment and our results greatly. For instance, the incident created great disharmony in the environment, creating high dissatisfaction in the workplace. Crawford et al. (2019) note that the significant impact of incivility is lowering nurses’ satisfaction in the workplace due to a lack of belonging. Incivility in nursing practices increases turnover among nurses due to a lack of joy in the workplace. The incident also discouraged us from engaging in multiple activities in the department to increase the quality of care. In this case, effective care for patients in ICU requires extensive inter-professional collaborations to improve patient safety. These sentiments discouraged my fellow newly employed nurses and I, so we could not contribute to developing the care plan. Crawford et al. (2019) note that incivility lowers nurse involvement in caring, lowering their productivity.

Such an incidence would be prevented if the healthcare facility had a clearly defined system of punishing the bullying and incivility perpetrators. In this case, we would be sure that the incident would never be repeated if we had raised our complaints and had the assurance that the perpetrator was punished. The healthcare system can develop a healthy environment without violence, bullying, or incivility by adopting several strategies. The nurses should develop a comprehensive approach to handling incivility, violence, or bullying. According to Phillips et al. (2018), healthcare managers should engage different stakeholders to build a comprehensive and systematic approach to handling incivility. In this case, the hospital should develop effective and efficient communication among all stakeholders to ensure that all incidents of incivility are reported for action. A healthy nursing environment can also be prevented by in-service training for nurses to improve their communication skills. The in-service training can effectively eliminate incivility cases, especially when a nurse does not intend to hurt another through their words or did. A conducive caring environment can also be developed by expanding nursing education to prepare nurses more adequately to remain productive in a toxic environment. Phillips et al. (2018) note that the nursing curriculum should include interpersonal relationships to train the nurses to effectively relate with others without showing bullying, violence, or incivility.

In conclusion, incivility in nursing involves using abusive and intimidating language among staff. Incivility affects the nurse’s performance and makes the working environment unconducive. Incivility lower’s the nurse’s performance, lowers job satisfaction, and raises the turnover rate. Healthcare systems can create a conducive environment by developing a comprehensive and systematic approach to incivility and violence. Besides, in-service training can facilitate the development of nurses’ interpersonal relationships to prevent incivility.

Thank you,

Kasia

References

American Nurses Association. (2015). American nurses association’s statement on incivility, bullying, and workplace violence. https://www.nursingworld.org/~49baac/globalassets/practiceandpolicy/nursingexcellence/official-policy-statements/ana-wpv-position-statement-2015.pdfLinks to an external site.

Crawford, C. L., Chu, F., Judson, L. H., Cuenca, E., Jadalla, A. A., Tze-Polo, L., … & Garvida Jr, R. (2019). An integrative review of nurse-to-nurse incivility, hostility, and workplace violence: a GPS for nurse leaders. Nursing administration quarterly, 43(2), 138-156. http://doi/10.1097/NAQ.0000000000000338

Phillips, J. M., Stalter, A. M., Winegardner, S., Wiggs, C., & Jauch, A. (2018, July). Systems thinking and incivility in nursing practice: An integrative review. In Nursing forum (Vol. 53, No. 3, pp. 286-298). https://doi.org/10.1111/nuf.12250Links to an external site.