Incivility has been a long-standing problem in the work the place and has the potential for significant impacts on employees and those the employees serve. This paper is going to define and discuss incivility that has been seen in the field of Nursing. The author of this paper has seen incivility between a nurse and administrative charge nurse and had personal experience with incivility from the administrative charge nurse to the student. Impacts of incivility will be addressed with focus on nursing, patient outcomes and the impacts on hospitals. Strengths and weaknesses of leadership styles such as laizze-faire, transactional and transformational will be analyzed along with strategies and recommendations for dealing with incivility in the workplace.
Workplace incivility is a recurrent issue for nurses working in a hospital settingand has been defined as “low intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect” . The American Nurses Association (2018) says that incivility can be seen as rude or disrespectful behavior that may or may not have the intent to harm. Behaviors that contribute to an environment of incivility include yelling, eye rolling, taking credit for another person’s work, ignoring and speaking with sarcasm while civil behaviors are those the emulate respect for differences in individuals. There are many negative impacts of workplace incivility that affect nurses, patients, and hospitals as an organization.
Incivility in nursing is not new but is an area seen as needing improvement. The past decade accrediting and nursing professional bodies such as the Joint Commission and the American Nurses Association have been taking a closer look at the occurrence of incivility between coworkers in healthcare . In 2015 the American Nurses Association (ANA) came out with a position statement that addressed incivility within the nursing code of ethics. In this position statement the ANA (2015) proposes that nurses create a culture and environment of civility and kindness treating coworkers, colleagues, students with dignity and respect.
Importance to Leadership
Incivility has significant importance to leaders as there are many things that a leader must face when they are managing incivility in the workplace. Workplace incivility not only impacts those who are targeted but, in a hospital setting, it also impacts patient care as well as hospital costs. According to Mikaelian & Stanley (2016) studies have shown that 98% of nurses reported that incivility affects more than just the victim. It also has impacts on patients, the quality of care they receive, potential patient outcomes, hospital culture and hospital expenses.
Smith, Morin & Lake (2018) reported that incivility costs hospitals over eleven thousand dollars per nurse annually because of lost productivity due to incivility between nurses. Other impacts on hospital expenditure due to incivility include increased absenteeism, lost productivity and high staff turn-over rates which results in more costs in recruitment and training.
Patients are also being affected because nursing care needs collaboration between nurses, staff and other healthcare professionals. When incivility occurs patients are at increased risk of negative health outcomes because incivility among coworkers can lead to dissatisfied, unhappy, preoccupied staff which impacts patient satisfaction and potentiates errors. Roche, Diers, Duffield and Catling-Paull (2010) found incivility in nursing was positively correlated with delayed medication administration, medication errors, patient falls. Each of these things inevitably impacts patients and can lead to patient dissastifaction
Lastly and most obviously nurses themselves are impacted by incivility. Incivility between nurses has a negative reflection on the profession which is supposed to be seen as a caring profession. Behaving in an uncivil manner is not in alignment with the nursing practice standards and the nursing code of ethics. Negative impacts on nurses who are victims of incivility include: stress, burnout, poor mental health, decrease in work performance, decrease in empowerment and impaired relationships (Villers & Cohn, While all nurses are affected by incivility there is a particular impact on the new nurse graduates. As the nursing profession will be facing a shortage of nurses the notion of incivility among nurses is of concern. Mikaelia & Stanley (2016) report that new graduate nurses are more vulnerable to incivility and therefore more likely to leave a job due to a poor workplace environment. This in turn has an impact on the organization as it makes it difficult to cultivate a positive work environment to attract new nurses which then leaves the profession devoid of new nurses and directly impacts the future of nursing.
Discussion of Leadership Styles
Leadership is imperative to recognizing and intervening in situations which incivility is occurring. The better the leadership the more effective it can be on making changes to the environment. Some leadership styles seen in nursing include laizze-faire, transactional and transformational. It is important to identify each style and understanding how the leadership influence incivility. Since “leaders are compelling role models, and their actions communicate messages as to what is considered acceptable behavior” we must look at these styles when thinking about incivility in the workplace.
Laizze-faire leadership tends to be exactly what it means. Hands off. According to Kaiser (2017) studies have shown that this type of leadership contributes to incivility by the lack of interests and ineffective management style. This type of management leaves employees with the perception that not addressing to actions of incivility normalize these behaviors which allows them to continually happen. Laizze-fair leadership seems to cause more damage than the incivility itself because management fails to act. A major weakness to this type of management is that the perpetrator is not held accountable and seemingly can get away with this type of behavior with no ramification.
Transactional leadership tends to focus more on the day to day transactions of the unit and making sure works gets completed while displaying a lack of interest in individuals. This type of leadership lends itself to a culture that is tolerant of incivility and concerns that are not related to work performance. A strength of this leadership style is that day to day work tasks and expectations are completed but a major short coming is the lack of interest in the employees themselves.
Finally, transformational leadership is visional leadership which focuses on empowerment. Empowerment is the key element in this leadership style because it focuses on empowering all members of the team. Empowerment is when members are provided resources needed to promote and develop effective skills to reach individual and team goals. It has been shown that when nurses feel empowered they report increased job satisfaction and an improved work environment. Transformational leaders have a vision and see a need for change. They encourage and support their group members and provide them the means to excel. There is a focus on the interpersonal relationship between the leader and team member and team members often feel engaged, motivated and empowered. A study conducted by Kaiser (2017) revealed that incivility was greatly reduced when the leadership style was transformational.
Analysis of Strengths and Weaknesses
Analyzing the types of leadership previously discussed it is fair to conclude that laizze-faire leadership style is the most ineffective due to it’s hands off philosophy. Laizze-fair leaders have little vested interest in their team members which appears to promote an environment which allows for and cultivates incivility. This type of leadership overall is an ineffective management strategy that leaves employees feeling vulnerable and unsupported. It is presumable that this style is costly to a hospital organization as acts of incivility are “associated with decreased job satisfaction and organizational commitment”. A strength to this leadership is individual autonomy but has a significant deficeit in cultivating an environment safe from incivility.
Transactional leadership may be a bit better than laizze-faire as the management is concerned about day to day activities and getting those tasks completed. However, while focusing on tasks, management neglects the individual and can create an environment of tolerance as there is little interest in the well-being of the individual. This type of leadership can foster tolerance because there is the leader is too task oriented and fails to recognize behavior that create an environment of incivility. Strengths to this leadership style is that tasks are managed and completed in a timely manner however; lack of interest in team members and inability to recognize certain behaviors can contribute to an uncivil environment.
Transformational leadership seems to be the most progressive leadership style that has a vested interest in the team members and has a vision for a better future. This style provides team members with resources needed to grow professionally as an individual and as a member of a team. A great strength to this type of leadership is that it has “the strongest impact on attenuating nurse-to-nurse incivility”. According to Kaiser (2017) transformational leadership has been reported by nurses as a management style less frequently encountered. Lack of adoption of this management style can have negative impacts on nurses, patients and hospitals as an organization. Identifying individuals with a vision and a genuine interest in team members can be difficult and might be one of the biggest barriers to finding a leader who will adopt this model.
Conclusion
In conclusion incivility in nursing has a long-standing history and will take time and vision to change these behaviors among nurses. With professional organizations such as the American Nurses Association and the Joint Commission it is promising that incivility will no longer be tolerated as more is being done to cultivate working environments that are consistent with nursing ethics and standards of practice.
Recommendations for decreasing incivility include providing policies and procedures that outline expected behaviors and consequences for violations. These policies and procedures need to be consistent with the mission and values of the organization. Organizations must recognize and take action when bad behavior happens to foster a safe environment for employees.
“The problem of incivility needs to be addressed systematically through the very process that currently support its propagation and as such the approach to change needs to be filtered through every level of the organization” . When this occurs everyone will benefit. Nurse turn-over rates will decrease, patient outcomes will improve and hospital expenditure related to an unhealthy work environment will decrease.
