Sample Assessment 5 Cultivating Healthful Environments
The Issue of Incivility and Strategies for Cultivating Healthful Environments
Incivility occurs in most contemporary workplaces and nursing practice is not an exception. Various healthcare workers often fall victims to incivility at least once in their career. Incivility in nursing practice impacts negatively on the patient’s care and quality of the healthcare outcomes. The consequences of incivility in the nursing workplace include but are not limited to medication errors, absenteeism of healthcare workers, and resignation or transfer of caregivers at critical moments. This paper discusses the issue of incivility and provides strategies for cultivating a healthful environment in nursing practice.
The Issue of Incivility
The dictionary definition of incivility describes a speech or behavior that is impolite or rude, or sometimes offensive. The American Nursing Association (2020) defines incivility as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them.” The nursing practice workplace has a social environment where nurses interact through communication and behavior. Other items of literature have described workplace incivility as rude or disrespectful behaviors through verbal or non-verbal actions (Asghari et al., 2017). The impacts of incivility affect the witnesses, the perpetrators, and the victims (Zhu et al., 2019). In nursing practice, the victims are usually the junior nurse practitioners, the nursing students, and other junior workers, while the perpetrators are the nurse educators, nurse managers, senior experienced nurses, and physicians.
Importance of Civility and the Impacts of Incivility
Workplace civility is important in nursing practice especially to promote nursing education, career development, enhancement of patient safety, and excellent quality healthcare outcomes. Good workplace civility promotes proper communication and boosts the nursing team morale for maximal positive health outcomes. Nurses must therefore, ensure positive collaboration and respect of each other in the most civil ways. Incivility in nursing practice, on the other hand, affects the individuals and the organization often with greater ramifications. At the individual level, the nursing workplace incivility can affect, directly or indirectly, the patients, and the caregivers. According to Shen et al. (2020), nursing caregivers with little experience are the most affected victims of nursing workplace incivility. The impacts at the individual level, according to Shen et al. (2020), include low job performance, stunting career growth, and mental and psychological effects. Verbal incivility impairs the workability of newly recruited nurses that reduces their job performance, hence the need for concerted interventions.
Nursing workplace incivility impacts greatly on the mental wellbeing of inexperienced or just recruited nurses. This can present with anxiety and depression that prevent the affected individual from achieving their career expectations. A well-psyched employee is more likely to achieve their career expectations and meet their practice goals compared to a poorly psyched one. While some employees can bear with the consequences, the majority will quit their jobs or perform their responsibilities with fear due to intimidation (Zhang et al., 2018). In cases where the nurses have low career expectations, workplace incivility can completely discourage their persistence in carrying out the daily duties and their abilities to survive the profession. The overall impacts on the hospital organization are poor quality care outcomes and a negative hospital reputation.
The ultimate results of demotivation of nurses through workplace incivility include but are not limited to poor patient-nurse partnership and compromised patient safety (Schoville & Aebersold, 2020), errors in medications, compromised teamwork and spirit, and absenteeism. In the worst cases, workplace incivility can escalate to aggression and violence. This majorly occurs in settings with nursing staff shortages and stressful work conditions. Incivility in nursing, therefore, impacts the individual, the nursing microsystem environment, and the nursing profession at large (Asghari et al., 2017). The effects in the three levels are cumulative and interrelated and can result in poor individual and organizational performance.
In a hospital setting where the ratio of nurse to patients is 1:16, there are two registered nurses, four nursing assistants, and one nurse manager. The nursing students occasionally assist the nurses in their daily responsibilities during daytime shifts. In the process, the students are expected to learn from these nurses and to master the requisite skills. There have been reports in recent years that the registered nurses during the change shift do not handover and document the care given to their patients and blame it on the nurses during the night shift. Due to poor staffing that often result in increased work pressure for available nurses, nursing students sometimes handle nursing procedures without prior adequate training.
The registered nurses in their defense explain to them that they should learn nursing the hard because they also passed through the same self-driven system of learning. Cases have been reported where nurses working the night shifts often switch off the patient alarm buzzers so that they can care for the patient in order of their room numbers. This has affected learning and resulted in increased admissions to the intensive care units from the wards. In such scenarios, the work environment, the students, the patient, and the nurses have all been the victims of incivility.
Creating a Healthful Environment
A healthful nursing care environment is one that fosters patient safety and ensures nursing teamwork and collaboration free from workplace incivilities. The three strategies for creating a healthful environment include skilled communication, genuine collaboration, and ensuring effective nursing leadership. Skilled communication concerning workplace civility involves providing clear channels, languages, codes, and policies regarding collaboration in the hospital among health workers. The nursing education system should provide the students with adequate communication skills that would enable them to interact well with other nurses in their practice (El Hachi, 2019). Good nursing leadership promotes skilled communication and solves disputes among nurses. True collaboration in nursing entails engaging other workers and fellow nurses in achieving a healthful environment.
My specialty track is nursing education. The majority of nursing workplace incivilities have their origins associated with negative learning and teaching environment (El Hachi, 2019). Therefore, I would use two strategies in my master’s prepared-advanced practice role to cultivate a healthful work environment. The first entails fully communicating the codes of conduct and behavior to the nurses and students as they are outlined in the hospital’s policies. The second entails training experienced nurses and leaders on the need for workplace civility and methods to prevent incivility.
Nurse educators and managers are responsible for stopping the chain of incivility in the nursing practice to discourage future experienced nurses from practicing the vice because of inappropriate education (Shen et al., 2020). To break the chain, nurse educators, leaders, managers, and other experienced nurses should express the best image that would act as an example to the junior nurses and nursing students (Asghari et al., 2017). By training and reminding the nursing leadership on workplace civility and its consequences through evidence-based practice, the junior nurses are likely to have a healthful environment from which to learn.
Described by the American Nurses Association as the intentional or unintentional rude, discourteous, or disrespectful actions by nurse practitioners towards other nurses in the practice, nursing workplace incivility is a serious bloat on the profession. In particular, the issue of incivility leads to negative impacts at the individual and organization levels with manifestations ranging from medication errors and compromised patient safety to high nursing workers’ turnovers.
Good workplace civility promotes productive communication, collaboration, and motivation among caregivers to enhance patient safety and improved healthcare outcomes and quality. With specific intervention strategies such as skilled communication, true collaboration, and effective nursing leadership, it is possible to eliminate instances of nursing workplace incivility. In nursing education, I would ensure workplace civility through promoting proper communication on policies that encourage good conduct and behaviors, in addition to empowering nurse leaders with the skills and knowledge to intervene on workplace incivility.
- American Nurses Association (ANA). (2020). Violence, Incivility, & Bullying. Retrieved from https://www.nursingworld.org/practice-policy/work-environment/violence-incivility-bullying/
- Asghari, E., Abdollahzadeh, F., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal Of Nursing And Midwifery Research, 22(2), 157. https://doi.org/10.4103/1735-9066.205966
- El Hachi, M. (2019). Faculty incivility: Lived experiences of nursing graduates in the United Arab Emirates. International Nursing Review, 67(1), 127-135. https://doi.org/10.1111/inr.12554
- Schoville, R., & Aebersold, M. (2020). How Workplace Bullying and Incivility Impacts Patient Safety: A Qualitative Simulation Study Using BSN Students. Clinical Simulation In Nursing, 45, 16-23. https://doi.org/10.1016/j.ecns.2020.01.003
- Shen, H., Wang, H., Yan, L., Liu, W., Zhang, J., & Zhou, F. et al. (2020). Incivility in nursing practice education in the operating room. Nurse Education Today, 88, 104366. https://doi.org/10.1016/j.nedt.2020.104366
- Zhang, S., Ma, C., Meng, D., Shi, Y., Xie, F., & Wang, J. et al. (2018). Impact of workplace incivility in hospitals on the work ability, career expectations, and job performance of Chinese nurses: A cross-sectional survey. BMJ Open, 8(12), e021874. https://doi.org/10.1136/bmjopen-2018-021874
- Zhu, Z., Xing, W., Lizarondo, L., Guo, M., & Hu, Y. (2019). Nursing students’ experiences with faculty incivility in the clinical education context: A qualitative systematic review and meta-synthesis. BMJ Open, 9(2), e024383. https://doi.org/10.1136/bmjopen-2018-024383