Medicine has always been a revolving door of change and advancement. But regardless of the frequent changing, incivility in the workplace has always been a constant. I’m sure at one point everyone has seen or personally experienced some form of incivility. The nursing world is no exception to this form of unjust treatment (Armstrong, 2018). In order to have a better understanding of incivility, it is important to have a thorough understanding of what incivility is and how it relates to the nursing world. It is also important to know examples of incivility and have the necessary tools to utilize in said situations to resolve the issue or to make the issue better. If you are lucky, you won’t have to deal with a negative work environment but just know that even though you may not be part of the problem, you could be part of the solution.
The Issue of Incivility
Just what is incivility? Incivility is a round about word that can describe various social behaviors that are deemed unacceptable and has the potential to cause some form of harm (Armstrong, 2018). These behaviors can be repetitive with the aim to undermine or intimidate a specific person or group of people. All in all, incivility is a type of bullying (Glasper, 2018).
I believe people can have their own definition of incivility purely based on personal experiences. It is an unfortunate reality to be subjected to, especially when you are in a profession with the intent of helping people. Living in the real world is difficult without having to deal with the negative aspects of work that potentially has the capability to be unsafe. Common courtesy and politeness are something that a work environment should possess.
Individuals that engage in uncivil behaviors promote conflict within the workplace (Blevins, 2015). This incivility includes but is not limited to; complaining, fabricating information, back taking, intimidating, manipulation, belittling, etc. It is a wonder why these individuals act in such ways, but it is most likely because of some form of negative self-imaging (Blevins, 2015) and we all have the potential to be victims.
The Importance of Incivility in Nursing
Nurses are regarded to be one of the highest rated professions with being honest and ethical (Farrell-Burns, 2017). In 1893, Lystera Gretter had written the nursing code “Florence Nightingale Pledge” which had been an informal oath until about 1950. While Gretter’s pledge continues to be a part of many nurses, the American Nurses Association currently engages the “Code for Professional Nurses” (Ferrell-Burns, 2017). The “Florence Nightingale Pledge” and the “Code for Professional Nurses” both hold nurses to high standards. Nowhere does either document state that in the workplace incivility will be a part of nursing. In fact, Gretter’s pledge states that the nurse “will do all in his/her [my] power to elevate the standard of his/her [my] profession” and that includes how we treat others (Ferrell-Burns, 2017). Provision 6 in the “Code for Professional Nurses” provided by the American Nurses Association, basically lays out that we as nurses are personally responsible to continue to improve our work environment as a whole in order to have a safe work environment that reflects in quality health care (Springs, 2015).
Impact varies from person to person and from organization to organization. When individuals are subject to incivility, various issues arise. As a result, a well-educated nurse can become distracted and emotionally unstable to care for a patient safely. What should be a pleasurable place to work, incivility leaves the nurse without the support he or she needs. This can lead to medication errors, hostility, loss of motivation, depression, and in severe cases posttraumatic stress disorder (Armstrong, 2018).
Prolonged individual nursing incivility can overflow organizational wide with time. This happens when situations are not being taken care of appropriately leading to increased incivility. It is almost like when the individual incivility occurs and is not being dealt with, it shows others that it is okay to continue with the act. On an organizational level, incivility can lead to increased spending of care, high employee turnover rate, and poor patient reviews (Meires, 2018). Optimal work environments must include team work for a good working flow. Without that necessary teamwork, the workplace suffers. This is seen especially in high volume and high stress departments where incivility is increased (Meiers, 2018). In order to prevent financial suicide, health care facilities need to deal with incivility directly and right away.
A Personal Experience
Personally, I have been on the receiving end of incivility and embarrassingly, the giving end as well. I am not the type of person to get a thrill by making somebody else’s life horrible on purpose. If I have been a bully it has been unintentional and more than likely it had to do with how I came across as a person. I tend to be critical with how things are done, and I try my best to give constructive criticism without making the person feel bad. Unfortunately, sometimes a person perceives constructive criticism as being put down. I have learned over the years that before I give my constructive criticism, I will do it away from others and I will let them know what was done wrong before teaching the best way to have gone about the task.
During my preceptorship in nursing school I was subject to the type of criticism that was anything but constructive. Luckily it was just with one preceptor but the whole situation left me feeling very inadequate and just left out. It had come to my attention that the preceptor and instructor were having a little gossip fest that had nothing to do with my learning. I do not like conflict unless it is necessary but at that time I wanted to quit. After self-reflecting, I decided to e-mail the dean of students about the situation. I kept it simple and to the point. I mentioned what was said between the two parties and how it looked unprofessional on their part and the learning institution. I ended the message with some good experiences I had during my nursing school experience but was saddened that it had ended negatively for me. The overall work environment continued but personally I wasn’t sure I wanted to continue with my nursing career. Today I am happy I pushed that negative aspect out of my life and I continue to try to better myself and stick up for those who have had to deal with the same issues I did.
Creating a Healthful Environment
I believe the first thing a person should do in the event of incivility is going directly to the person causing the issue. Before going from A to B however, it is important to take the necessary time to think about how to approach the situation in order to prevent increasing the problem (Meires, 2018). Sometimes like myself, the person doesn’t realize what he or she has said as something that can hurt feelings. And sometimes the person is having a difficult time and confronting the person in a sensitive way may help with whatever issues they are dealing with. I realize that not everybody is comfortable with talking directly to the person so in such cases it may be wise to have an unbiased person available to sit in with the conversation .
Another thing that can be done is to make sure you understand your facilities policies and procedures when it comes to bullying, harassment, and other terms of incivility. Being familiar with the organization’s policies and procedures will help employees to better understand and identify incivility and the necessary steps to take should it arise. We are accountable for our behavior and if we are victim of incivility and decide to sweep it under the rug, we are in a sense aiding those to victimize.
The last thing a person can do is lead by example. New and younger nurses will follow others in order to “fit in.” Giving them something positive to look up to will hopefully continue with them eventually being leaders. Leading is educating in the sense that you show the way you work by being civil while learning is watching and doing what is being shown
Practice Application
My current goal is to become a family nurse practitioner and specialize in pediatrics and forensic nursing. I know both are full time specialties, but forensic nursing in Central Wisconsin is a small area and therefore can me melded into my love for pediatrics. Today I work my majority time as a private duty nurse and casually as a SANE. I am very fortunate that I don’t have any current issues with incivility and I realize that is mostly because I am independent in both areas. I however realize that in the future once I am working in a facility full time again, I will more than likely come across the negative aspects of incivility. It will then be a matter of how I can work with the organization and peers to provide a civil work environment that shows through patient safety and satisfaction along with happy and healthy workers.
As nurses we have many roles that are not directly involved in direct patient care. Education is the forefront of how we begin and continue to work as nurses. Educating ourselves and our peers about incivility is just the beginning in order to provide a high-quality interdisciplinary team. As mentioned, it is important to lead by example. Having the ability to utilize available research and showing that relative research to others is a way of leading others to do the same. Having that knowledge available and educating that knowledge will be a stepping stone to implementing necessary changes for a civil work environment.
I think that because this is a sensitive subject for many, I would want to get input from those who have been personally victimized. In conjunction with victims, I would like to get insight from other facilities on their policy and procedure on incivility. Sometimes it takes an outside source to find the necessary information that could potentially work for your facility. Overall, I would want to a group to brainstorm ideas that we could try. I wish I could specify a way of doing things to make it better, but I think in this case I would have to get in the role and observe my surroundings before I continue to work with others and decide what we could try. All in all, educating myself and others as well as getting outside information is a great step in the direction of making incivility civil.
Conclusion
No matter where we do for a living or where we work, it is evident that incivility is real and is happening in most work places. We as professionals can educate the effects of incivility and work together to develop strategies that encourage a safe and healthy work environment for everybody. Doing this will show throughout the organization which will improve moral and increase patient safety. It is of utmost importance to hold ourselves and those we work for at high standards. We need to remember why we became nurses and follow the pledge and code and show that we are better than the incivility that is evident.
