Civility refers to the respectful behaviors at the workplace towards one another and which makes a person to feel valued. Civility contributes to the mutual respect, team collaboration and effective communication among health workers. Incivility will conversely be defined as the behavior that is minimally intense and that displays ambiguity with intent to harm the other party or violate the mutual respect. They are therefore the behaviors that are uncivil, disdain, rudeness and discourteous and which displayed by others who are colleagues in a work environment. The uncivil behaviors are quite common at the work place. Workplace incivility has for the past several years hampered the nursing profession, patient care and generally the health of the nurses at the workplace.
It is commonly referred to as There is so much literature that looks into the problem of incivility at the workplace and the influence on the possible outcome, however, a few of them have assessed ho the issue can be minimized or prevented. Incivility can also be portrayed through rumors being spread or through gossip and even declining to offer helping hand among co-workers. It may also be presented through public criticism, use of condescending tone and name-calling among others. Generally, incivility is aimed at demeaning the dignity of a fellow worker and in so doing one violates the professional ethics or standards of respect. Study indicated that 98% of more than 14,000 people who had been surveyed in the various healthcare facilities for the past 14 years indicated that they experienced incivility at the workplace, with more than half of them having reported of bad treatment at least once a week.
Many researchers have dealt with negative effects that arise from the acts of incivility of the work place leaving gaps on the solution on how to minimize such acts. This paper, therefore, seeks to analyse the minimization of Horizontal and Vertical Violence in Nursing (Incivility) as a nursing professional problem. It will look into the causes, correlation, associations, effects and the significance of incivility. The implications of incivility at the nursing workplace This emerging incivility at the workplace has fatal implications to not only the nurses but also the patients and the health care organizations generally. The uncivil and disrespectful behaviors tend to drain the productivity of the workers and it negatively impacts the satisfaction of the staff and resultant effect on the patients’ outcome.
Lee & Bernstein (2014) in their article argue that bullying in the nursing workplace can result in serious health-related outcomes for both nurses and patients who are under their care as well as the health care organizations. This is further supported by McNamara (2014) in the article where she heavily emphasized on the safety of the nurse and the patient. She argues that an unhappy nurse may potentially lead to an incident of unhappy patient. The disruptive behaviors nurses may impact a hospitalized patient.
Horizontal and vertical violence at the workplace portrayed by effects of one group being oppresses has been a major factor that has resulted incivility at the workplace. The complex nature of the nursing profession structure promotes hostility at the workplace in some way (Lee & Bernstein, 2014). This is such that the top official leaders are the dominant group while the rest of the members are the oppressed group who use their power being too rigid, coercive and controlling.
It is this behavior that portrays horizontal violence from the leaders to the oppressed group as a way of emitting aggression by the oppressor. Many nurses have opted to leave their jobs due to the horizontal violence. They do so in order to evade the discourteous behaviors that they encounter from these oppressors. As such, it is evident that incivility greatly impacts nursing negatively and causes a reduction in the number through the intention of many opting to evade oppression and leave the profession. Another impact as a result of incivility is seen through the unprofessional relationship and poor communication hat is seen among the health workers which resultantly has an impact on the outcome and safety of the patient. Additionally, incivility has an effect on causing a burnout to the nurses which eventually decreases the chances of being retained for the job.
These disrespectful and behaviors that are causatives of incivility tend to drain or result to the loss of the productivity of the healthcare providers. It also negatively influences the satisfaction and patient outcomes. It negatively affects the safety of the patience care since the nurses are in some way distracted or experience stress at work and do not focus on providing sufficient care to the patients. argued that the incivility among nurses has been associated with the increased patient mortality as among the effects of the problem. Incivility also contributes to staff turnover, medical errors, staff disengagement, staff suck leave use, loss of productivity and many other effects. Additionally, argued that when a nurse is unhappy while at the workplace, there is the possibility that it may results to the patient being unhappy with the services being offered by the nurse. These disdained behaviors by the nurses can affect a patient too besides the nurse.
How to minimize or prevent the horizontal or vertical violence/incivility With all the negative impacts that incivility has on nursing, it is proper to come up with preventive mechanisms to help intervene the problem before it gets fatal. The various experiences identified above and the impacts need to be minimized in the healthcare setup. Prevention of incivility has been a hard job for the nurses since undertaking to prevent it by an individual is quite hard. As such, there is need to come up with a multidimensional rather than mono-dimensional solution through various steps by the nurses themselves and the healthcare as a whole and even alongside the help of the society and the media so as to do away with this problem totally if not to reduce it.
Nurses should be forefront in preventing incivility as they are parties to this problem and have first-hand experience. The first solution could be for the nurses ensure that they undertake to do their work perfectly to completion so as to avoid any problems that may arise. When nurses fail to complete tasks, there is brought about misunderstanding and the other parties or managerial staff and even the patents feel offended and are forced to bring about the disgraceful behaviors that instill incivility among them. Also, when there is respect at the workplace, the professional and skilled nurse act in a respectful manner while at work. Good communication at the work place is a good technique that can also help prevent incivility. Various views collected at the nursing and healthcare environs showed that the bad attitude that was introduced by care staff was a great risk to the Work Place Incivility compared to other personal characteristics.
The risk of aggravating incivility was greatly increased by poor communications between the various parties in the nursing environment. A study conducted by Babayi et al., indicated that an inappropriate relationship between the personnel at the nursing workplace was among the root causes of the abusive behaviors as many of the patients highlighted. Also, if the nurses and the patient listen more and talk more respectively, the level of incivility and violence in the nursing environment will be greatly reduced. Research identified that the mental health patients could acknowledge improvements when the nurses behave ethically while at work.
It was also noted that the communication related concerns are to the patients described in the form of respect. Strategies to prevent incivility among the nurses and which are communication related include talking gently to each other and calming each other when need arises. It also includes maintaining interpersonal skills, spending time with each other, showing a kind and nice attitude towards each other and displaying a calm relaxed form of attitude. Another preventive method would be the pointing out where there is a high workload and shortage of staff among the nurses as it would minimize the incidences of incivility from arising. Heavy workload was identified as a situation that initiates incivility repeatedly. This is because the nurse who is overworked get tired and stressed and overburdened which then results to unfamiliar behavior.
Decreasing workload at the workplace will therefore help the nurses relax and be stress free and this will positively impact to minimize incidences of incivility. Some studies have set forth in their research that a huge workload instills a feeling of frustration to the nurse and intensifies time pressure and stress which eventually results to an increased perception of engaging into uncivil actions. Also, when someone is having a workload and is stressed up, there is a possibility of having a weaker ability to judge fellow nurses behavior in an accurate manner and they also tend to display lower tolerance to the usual activities.
Fonseca et al, (2013) in his research identified the cognitively loaded persons to show less political responses even to a normal action. As such, the people who experience workload will view the uncivil behaviors as being rightful for them to be in a position to accomplish their duties. They think that being nice to others will be a waste of time. Unprofessional conduct leads to the rise of incivility in the workplace. It is therefore important to address the issue of workload at the workplace in order to minimize incidence of violence or incivility at the workplaces. Another significant resource or mechanism to minimize incidence of violence or incivility at the workplace can be the supportive resource. Nurses at the workplace who experience a better supervisor who supports them would be in a good working mood and will protract positive attitude towards the job compared to presenting negative results.
The support at the workplace is to some extend connected to the stress among the nurses and also present when someone is experiencing burnout all of which contribute to incidence of incivility among the nursing environment. When the managers and the top staff in the nursing hierarchy are not supportive of the ordinary nurses; other nurses equally do not have the morale or lack the mood to support each other at the workplace. Rules could also positively contribute to minimizing incivility at the workplace. Rules tend to prevent occurrence of violence. The presence of a rules which set out their manner of clear and constant application and their policies on how they regulate the conducts of the nurses and their behavior at the workplace were seen to positive impact to ensuring the reduction of incivility at the workplace.
A good example is the ANA’s Code of Ethics that regulates the conduct of nurses by its provisions such as the interpretive statement that require the nurses ‘to create an ethical environment and a culture of civility and kindness, treating colleagues, co-workers, employees, nursing students and others with dignity and respect. The researcher further correlates the culture of emotional safety to be upheld among nurses who portray incivility at the workplace. Studies indicated that incivility was caused by a lack of strong rules as was identified by some of the patients in the study. This therefore calls for the need for identification of a clear expectation among the nursing body so as to prevent incivility. In order to improve the safety of the workplace there was a need to advance policies that surround incivility and violence. In Sweden, the patients and staff identified rules to have positively impacted to doing away with presence of the acts of ill behaviors at the work place that could instill incivility.
Another preventive mechanism could be limiting the presence of family. Family presence was identified to be a causative agent of incivility. The presence of availability of the attendant for long during hospitalization was observed to be a form of family presence that triggered incivility, which has forced some countries to set up rules that regulate and prevent the relatives or companions of the patients from accessing the workplace as they cause violence against the nurses. Setting in place rules that limit the time such that the companions appear to visit the patient for a shorter time will help prevent violence or incivility at the workplace. By so doing, the nurses are prevented from disruption and the family are allowed to supportively vie their patients since proving such violence is close to impossible.
Additionally, improving the public image of the nursing profession could also be a preventive mechanism to minimize incidences of incivility. The public image is diverse and not only appropriate. This is due to the fact that nurses are most times not so much in the limelight and their image is not visible enough. The nurses’ public image is also hidden due to their maintenance of the self-concept and professionalism at the work place, their work value, social cultural values and education. For a nurse to place their profession in the public domain there has to be some effort instilled. They can only be seen of what they do through light shed in the social media. They could make the public know about their carrier by publicizing their image through the media so as to ensure they obtain a strong position and promote their public image out of the work place.
More so, the nurses can present their image to the public by use of strategies such as the case manager to the clinical nurse specialist taking it to address the public on their behalf and make people know that entails in their day-to-day life. Incivility is at times caused by the lack of the basic knowledge about the profession of the people who are involved especially in this century of technology. The lack of knowledge extends to the lack of awareness of the procedures involved in medical treatment and which can cause the parents or their relatives to be triggered to cause a scene or violence due to satisfaction of the expectations they had from the conducts of the nurse at the work place.
Low awareness incites incivility and therefore, provision of the basic knowledge of the nursing profession and all the procedures would be a mechanism to minimize violence and acts of incivility at the workplace. Liaising with the media producers especially those dealing with film production could be a solution to educate the public via social media and keep them informed appropriately and cut short their extraordinary expectations. Team building can also be a preventive mechanism since it allows the victims of incivility to air out their feelings to the perpetrators and the group at large as compared to them solving the problem on their or being frustrated and opting to quit thinking it is the appropriate solution. The perpetrators are equally given a chance to openly speak out so that the oppressed and the perpetrators both feel that their voice is heard. By being provided the chance to air out their views, people accept and move on from their differences.
Team building will, therefore, present a suitable structure that buries away the negativity among the nursing colleagues. Griffin & Clark (2014) in their article center on the use of cognitive rehearsal as a shield for lateral violence. They update the literature on cognitive rehearsal and reviews the use of cognitive rehearsal as an evidence-based strategy to address incivility and bulling behaviors in nursing. They have also emphasized on the need for successful application of cognitive rehearsal in the nursing environment or settings as an evidence-based practice. Additionally, the article emphasizes on the difficulty, yet successful use of cognitive rehearsal intervention.
Effective work relationships are quite essential in ensuring a healthy nursing working environment. Incivility as has been evaluated above has a fatal impact towards the productivity among the nurses as well as the cost that loops from the lost productivity. So much literature has been written on describing what qualifies as incivility within the nursing work environment yet very little has been written on the solution to address how to minimize this effects that the nurses experience. Solution may be provided through acculturation efforts.
The incivility acts that have infiltrated the organizational and professional culture that is slowly becoming an acceptable behavior can imperatively be addressed and changed. Besides the nurses, other professions like the officials and the people as clients will need to be involved to address the issue before it becomes complex and uncontrollable. The nurses need to improve their communication skills at the workplace which can be done through training or vocation programme to promote self-care strategies, which will be very useful. Creating the public image to the people could improve awareness and public knowledge about the healthcare and its procedures which could contribute minimize WPI. Incivility should be considered at both the national, local and global level.
- American Nurses Association. (2015). Position statement: Incivility, bullying, and workplace violence. Nursing World Web site. Available at http://www.nursingworld.org/MainMenu Categories/WorkplaceSafety/Healthy-Nurse/bullyingwork placeviolence/Incivility-Bullying-and-Workplace-Violence.html. Published.
- Castronovo, M. A., Pullizzi, A., & Evans, S. (2016). Nurse bullying: A review and a proposed solution. Nursing outlook, 64(3), 208-214.
- Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542.
- Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. Urologic nursing, 35(1), 39.
- Lee, Y. J., Bernstein, K., Lee, M., & Nokes, K. M. (2014). Bullying in the nursing workplace: Applying evidence using a conceptual framework. Nursing Economics, 32(5), 255.
- McNamara, S. A. (2014). Incivility in nursing: Unsafe nurse, unsafe patients. AORN Journal, 95(4), 535–540.
- MacLean, L., Coombs, C., & Breda, K. (2016). Unprofessional workplace conduct… defining and defusing it. Nursing management, 47(9), 30-34.
- Stanton, C. (2015). Action needed to stop lateral violence in the perioperative setting. AORN Journal, 101(5), 7–9.
- Vuolo, J. C. (2017). Student nurses’ experiences of incivility and the impact on learning and emotional wellbeing. Journal of Nursing Education and Practice, 8(4), 102.