In the present day, the concept of civility in nursing attracts particular attention to become a basic element of professional etiquette in the health care system. According to the American Nurses Association Code of Ethics for Nurses with Interpretive Statements, nurse practitioners are responsible for fostering civil, ethical, and safe workplaces based on respect and dignity (Clark, 2015). Even though a stressful health care environment, demanding patients, and workloads may negatively impact the ability of nurses to communicate in appropriate, respectful ways, the culture of kindness and civility should be promoted in any medical facility. At the same time, any form of unacceptable harassment, bullying, intimidation, threats, manipulation, or violence against nurses from colleagues, management, patients and their families, and visitors is regarded as incivility.
To be precise, incivility in nursing refers to disruptive and rude behaviors that include non-verbal behaviors (smirking, eye-rolling, offensive gestures, walking away in disgust), overt behaviors (spreading rumors, demeaning remarks, marginalizing or excluding others, gossiping), and workplace sabotage (Clark, 2016). The latter implies the refusal to share essential information concerning patients’ care, collaborate, assist, and support a coworker. All these actions should not be tolerated as they affect nurses’ loyalty to an organization and ability to work and cope with stress in a highly negative way. As a result, the entire medical facility and patients in particular experience the impact of incivility as high-quality and safe patient care may not be delivered.
Competent, collaborative, ethical, trustworthy, and principled nurse leaders play an immeasurably significant role in the prevention of incivility and fostering healthy workplaces. Both official and nonofficial leaders affect team communication and functioning that directly influence the delivery of patient care. They establish the tone of professional interactions based on role-modeling civility, model appropriate behaviors, and address inappropriate ones (Clark, 2016).
According to the results of the Clark Healthy Workplace Inventory tool determined to evaluate the level of civility and the assessment score of 92 out of 100, it is possible to conclude that the civility and health of my workplace are positive. In general, as already mentioned high civility level and a positive environment keep employees highly motivated. Moreover, additional factors, including ethical guidelines, productive organizational culture, properly managed human resource welfare, and the contribution of nurse leaders in the establishment of appropriate communication between employees have affected the civility of my workplace as well.
The first fact that surprised me was the unexpectedly positive results. My workplace may be characterized by support, mutual respect, general employee satisfaction, and transparency, however, I anyway faced cases of incivility, especially related to employees’ remuneration. In addition, I was surprised by the impact of monitoring systems identified by Clark (2015) as I have expected autonomy to be the essential factor that contributes to employee effectiveness and satisfaction. At the same time, regardless of actual results, I anyway expected a relatively high level of civility at my workplace due to the trust that exists between my colleagues and the support that all qualified employees are always ready to give to newly assigned inexperienced team members. In general, my workplace’s environment and level of civility are satisfying. There are always areas that require improvement, however, I believe that nurse leaders of my unit undertake all efforts to make my workplace highly civil, safe, and comfortable.
Multiple types of research address incivility in health care organizations, and the majority of highly reliable studies belong to Cynthia M. Clark. For instance, in the article “Fostering civility in nursing education and practice: Nurse leader perspectives,” Clark et al. (2011) identify the concept of incivility in nursing and its adverse effect on patient care, and working environment, and the facility’s budget. Subsequently, the authors state that both nursing education and practice are responsible for safety in the workplace and investigate various factors that may cause inappropriate behaviors in medical settings, strategies that may help foster civility, and essential skills that nurses should obtain during their education for efficient communication.
Later, in her work “Conversations to inspire and promote a more civil workplace,” Clark (2015) defines speaking up as an effective strategy to stop incivility in nursing practice. Shared team norms, organizational vision, values, and the contribution of formal and informal leadership play a highly essential role in the development of a healthy working environment. However, according to the author, “engaging in clear, courteous communication fosters a civil work environment, improves teamwork, and ultimately enhances patient care” (Clark, 2015, p. 18). Thus, she provides several essential guidelines for nurses to help them prepare for challenging conversations with uncivil coworkers.
These guidelines include reflecting, probing, and committing, creating a safe zone, preparing for the conversation in advance, and using particular speaking techniques on the scene (Clark, 2015). In other words, to stop incivility and maintain a healthy conversation, a nurse should primarily reflect on the purpose and goals of this conversation, choose an appropriate time and place, prepare physically and mentally for this challenge, and finally speak to a colleague following particular ground rules, such as using respectful and calm tone, sticking to essential and objective information, avoiding personal attacks, and talk in turns.
In addition, Clark (2015) proposes a DESC model as one of the strategies that help structure a civility conversation, enhance teamwork and communication skills, and, as a result, improve health care delivery to patients. In general, the DESC model has four basic elements: describe the specific situation, express concerns, and state other alternatives and consequences stated (Clark, 2015). This model was found to be highly effective in my workplace when I faced incivility related to the absence of civil conversation and understanding between employees and management when the latter failed to propose a rewarding system and professional opportunities. However, during a meaningful dialogue when workers respectfully explained the existing problem and appropriately expressed their concerns, the management team proposed several alternatives and finally incorporated the CICAP program.
As previously mentioned, there are always ways for improvement, and there should be additional strategies applied to prevent incivility and minimize the causes of its occurrence. Thus, in my workplace, it is possible to apply a behavioral technique of cognitive rehearsal that traditionally include three main parts: the participation in didactic instruction concerning lateral violence and incivility, the identification and rehearsal of particular phrases to address violence and incivility, and practice of using these phrases to become aware (Griffin & Clark, 2014). In practice, the application of the cognitive rehearsal approach implies the initial distribution of information among newly assigned nurses about lateral violence and incivility in medical settings. Later, they should be instructed on appropriate responses to intolerable behaviors. In addition, every new nurse practitioner should receive a laminated card with summarized information concerning incivility, accepted behavioral expectations, and several responses to the most common forms of incivility.
In the present day, interprofessional teamwork is regarded as the collaboration, coordination, and cooperation expected among members of various specialties in delivering high-quality and sage patient-centered care collectively (Eggenberger et al., 2014). At the same time, the creation of a healthy and positive working environment in an interprofessional team is not always a natural process. Thus, it is a significant challenge for nurse leaders to help team members pass through all day-to-day duties, workload, communication problems, and inevitable conflicts to attain organizational goals. However, within the framework of team interdependence and synergy, civility, dignity, and mutual respect are essential for a team’s efficient performance as the absence of these concepts may lead to devastating consequences, especially for patients. Communication breakdowns and ineffective interprofessional teamwork frequently jeopardize patient safety, cause the majority of medical errors, and even correlate with higher mortality. At the same time, an efficient interprofessional team approach provides multiple opportunities in key areas, including discharge planning, medication reconciliation, end-of-life issues, care transitions, length of stay, reducing 30-day readmissions, and error disclosure (Eggenberger et al., 2014). In general, high-performance interprofessional teams share common characteristics that are the following:
- Clear goals understood by everyone in a team;
- Clarity about the role and contributions of every team member;
- Clear, open, and respectful communication;
- Effective decision-making;
- Trust among members;
- Engagement of all team members;
- Effective conflict management;
- Appreciation of diversity concerning culture, generation, and thinking;
- Cooperative relationships;
- Participative leadership (Eggenberger et al., 2014).
- To create an efficient, high-performance interprofessional team, three strategies may be applied:
- Crafting a compelling and shared organizational vision and shared values statement. Nurse leaders may conduct a comprehensive and careful review of the workplace’s foundational statements to make sure that its vision, philosophy, and missions are based on the principles of respect, dignity, and civility. A clear organizational vision traditionally helps coworkers understand the unit’s main goals and articulate “a collective sense of a desirable future” essential for patient safety, high-quality care, and successful team functioning (Clark, 2016, p. 33).
- The creation and following of ground rules, or team norms. Originated from shared values and vision, team norms determine the behaviors of employees. When norms are affirmed, established, and operationalized, incivility is avoided, thus, the performance of a team is more efficient. Functional team norms may include the maintenance of respectful interactions, the avoidance of spreading rumors and gossiping, good listening, fostering a healthy environment that promotes collaboration and respect, support for coworkers and thinking the best of them, and having good intentions towards colleagues.
- The development and implementation of procedures and policies that address health in the workplace. A unit may implement a confidential non-punitive system to address all cases of inappropriate, disruptive, and uncivil behavior, bullying, and intimidation. Moreover, all policies should be consistent, fair, clear, and widely disseminated.
Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23.
Clark, C. M. (2016). Principled leadership and the imperative for workplace civility. American Nurse Today, 11(11), 32-33.
Clark, C. M. Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice: Nurse leader perspectives. The Journal of Nursing Administration, 41(7-8), 324-330.
Eggenberger, T., Sherman, R. O., & Keller, K. (2014). Creating high-performance interprofessional teams. American Nurse Today, 9(11), 12-14.
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), 535-543.