Fostering Civility Among Nursing Staff

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Incivility is a common issue among nursing staff in health care settings. Any rude or disruptive behavior directed toward another nurse or co-worker is considered an act of incivility. Although this inappropriate behavior is not always meant to cause harm, it violates social norms and professional workplace standards. The harm caused by incivility ranges from distracting or irritable behavior to physical violence, which lowers morale.

The first step to fostering civility among nursing staff is to understand what triggers this behavior and the effects incivility can have on the well-being of both nurses and patients.

The causes of incivility

Research shows that incivility has become a more common problem among nursing staff in recent years. Approximately 85 percent of nurses experience incivility, and experienced nurses are often the perpetrators. One study published in MEDSURG Nursing Journal showed that when researchers asked the 37 clinical teachers who participated to list keywords or phrases they thought described incivility, “hurtful and disruptive” and “opinions not heard by others” were among the most popular.

One frequent cause of incivility is high stress, burnout and long work hours. Approximately 70 percent of U.S. health care institutions do not have programs or policies in place to properly address workplace incivility or violence. Another factor that may contribute to incivility is the presence of social media, as it provides an accessible and anonymous platform for workers to post everything from messages to photos that bully co-workers. These actions can be difficult for managers to monitor.

The consequences of incivility

Incivility among nursing staff not only affects workplace morale but also patient safety and care outcomes. Higher burnout rates have been linked to incivility and are frequently caused by the direct effect of inappropriate behavior from patients, patients’ families, doctors or supervisors. Incivility can also result in reduced workplace commitment among nursing staff. However, when this is the case, it’s more often caused by indirect incivility, according to research published in the Journal of Korean Academy of Nursing Administration.

Incivility among nurses in health care settings can cause an increase in patient adverse events and overall patient safety risk. Recent analysis revealed that all forms of disruptive or violent behavior, whether physician or co-worker incivility, has similar impacts on patient safety outcomes. Each can have direct effects on the reported frequency of adverse events and nurse-assessed quality of care. Even seemingly harmless behavior directly decreases care quality. How does incivility translate to reduced patient safety?

When there are negative interpersonal interactions between nurses and supervisors or doctors, effective communication regarding patient needs and processes begins to suffer. This result ultimately hinders high-quality care delivery and increases the likelihood of negative patient outcomes.

Best practices for enhancing civility

There are a few steps that health care leaders and supervisors can take to encourage civility among their nursing staff:

Establish a strict zero-tolerance policy for violence, in addition to behavioral guidelines following the American Association of Critical-Care Nurses’ healthy workplace standards. The AACN regulations include skilled communication, true collaboration, effective decision-making, meaningful recognition, appropriate staffing and authentic leadership. When health care settings are built on these standards, incivility becomes less of a risk, as strong leadership and communication are critical to preventing disruptive and violent behavior among nursing staff.
Provide education and counseling programs. These programs are fundamental to ensuring nurses understand and know how to cope with disruptive or inappropriate behaviors they encounter at work. Counseling programs are particularly important for stress management and conflict resolution. Continuing education programs also benefit leaders, as they should be equipped with the knowledge and tools that allow them to better assist staff members when dealing with incivility.
Create a reporting system for incivility cases and closely monitor those incidents. Nurses should be able to report disruptive behavior without fear of criticism or retribution from co-workers or supervisors. The reporting system should address these cases as close to the time of occurrence as possible. Open communication between leadership and staff will improve trust and will help support resolution of inappropriate behavior.
Educate leaders on how to act as role models of appropriate behavior. A health care setting’s culture of safety will improve when leaders learn to demonstrate respectful conduct and positive behavior toward other leaders and members of their staff. This will help show that unacceptable behaviors are not tolerated.

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