NR 500 Discussion Healthful Environments
NR 500 Discussion Healthful Environments
Incivility in the workplace can happen in a variety of ways. Sometimes, it can be happening around us without us noticing the effects of it right away. One situation that I can recall involving incivility in the workplace happened with one of our new graduate nurses in the emergency room. This new graduate nurse was one of our own nurse techs who transitioned to a nurse upon obtaining her license. She was overall a great person, but she was very attentive to details and asked many questions, as new nurses should do. This sometimes caused some of the other nurses to be annoyed with her. Some nurses became passive aggressive with her. McNamara (2012) states, “Passive aggressive behaviors are typically more subtle behaviors, but they can be just as disruptive to the work environment. These include failure to support a coworker, setting someone up for failure, treating someone with silence or refusal to communicate, being impatient with another’s inquiry, communicating incomplete information that results in sabotage, and expressing a negative attitude that affects a coworker’s confidence.”
Unfortunately, she caught onto other people’s actions and was afraid to ask questions anymore. I honestly felt bad for the girl. I took her under my wing whenever she needed help and told her that it was okay to ask questions because that’s how you learn. I reminded her that everyone started out as a new nurse in their career. The consequences of the incivility in the workplace caused her to eventually transfer to another department in the hospital. This negatively affected the work environment because we lost a potentially great emergency room nurse who was very knowledgeable. The situation could have easily been prevented if everyone would realize and remember that they once were a new nurse who had to learn by asking questions. “To help prevent lateral violence in nursing, a culture of safety is needed to create and sustain an environment where team members are encouraged to speak up to leaders and peers.” (Stanton, 2015. P8)
McNamara, S. A. (2012). Incivility in nursing: unsafe nurse, unsafe patients. AORN Journal, 95(4), 535-540. doi:10.1016/j.aorn.2012.01.020
Stanton, C. (2015). Action needed to stop lateral violence in the perioperative setting. AORN Journal, 101(5), P7-P9.
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According to the American Nurses Association (2016), “Nurses should model respect and a professional demeanor to help reinforce civility and positive norms.” I feel like this is the most important strategy to use to promote a healthy work environment and decrease incivility within nursing. Nurses should always treat their coworkers and other nurses with respect. By doing this, nurses should offer assistance and encourage and support other nurses. If this was implemented more often by nurses, then the situation I described in my previous post could of easily been prevented and we would not have suffered a loss of a potential great ER nurse.
Another strategy to prevent further occurrences, such as the one I described in my previous post, would be to create an environment that encourages nurses to speak up to leaders. “To help prevent lateral violence in nursing, a culture of safety is needed to create and sustain an environment where team members are encourages to speak up to leaders and peers.” (Stanton, 2015). If nurses aren’t afraid to speak up, then these situations of nurses leaving the job before solving the problem could be prevented.
American Nurses Association. (2016). Downloadable graphics: Preventing bullying and civility best practices. Retrieved from http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/bullyingworkplaceviolence/Preventing-Bullying-and-Civility-Best-Practices.htmlLinks to an external site.
Stanton, C. (2015). Action needed to stop lateral violence in the perioperative setting. AORN Journal, 101(5), 7-9.
Unfortunately, like you stated many times the acts of incivility in nursing not only impact the individual but the unit and patients as well. Incivility, is a form of bullying that leaves the individual being bullied feeling alone, afraid to ask questions, and helpless. For the nursing unit incivility can cause frustration and division within the unit. Nurses being bullied will move on to other nursing units, find a new organization to work for, or quit the nursing profession all together. Incivility, bullying, and workplace violence are part of a larger complex phenomena, which includes a constellation of harmful actions taken and those not taken in the workplace (ANA, 2015), that needs to be recognized and stopped. Staff nurses and leaders within the environment must build an environment of trust, respect, teamwork, and education to eliminate incivility behaviors that have been long known behavior in nursing practice.
American Nurses Association. (2015). Incivility, bullying, and work place violence [Position Statement]. Retrieve from file:http://C:/Users/User/Downloads/PosStat-Endorsed-ANA-Incivility-Bullying-Violence.pdf
Incivility in the workplace is a prevalent concern in nursing and healthcare settings. The knowledge of incivility and lateral violence in nursing is not an uncommon issue. It has been around for decades and remains a strong presence in nursing today. This causes me great sadness for the profession I hold dear. Uncivil workplace behaviors can be characterized as rude and discourteous, with no regard for others (Phillips, Smith, MacKusick, & Whichello, 2018). This repeated act that is essentially bullying, whether verbally or silently, can lead to absenteeism, low job satisfaction and morale, burnout, poor productivity, mental, and physical health problems for the recipient of this poor treatment (Phillips, et al., 2018). The nursing profession must take a continual stand against incivility to assure the safety and well-being of our nurses and ultimately our patients whose care can be affected by work incivility.
As a nurse of many years, I have been witness to and also the target of workplace incivility. As a novice NICU nurse many years ago, I remember the leadership in my department setting an intimidating tone for new employees. There were cliques and gossiping that ultimately led to low morale and fear. This is truly a sad and dangerous place to be when caring for the precious lives of others. In an ICU setting, nurses need to be able to work as a team to deliver effective care. The ability to discuss care situations with colleagues and receive their input in a supportive, non-judgmental way is how nurses grow in their knowledge and expertise, ultimately fine tuning their trade. When intimidation and condescending attitudes are present, nurses will question their ability to provide good care and may eventually leave the department or the profession.
I am currently serving my fourth year as an assistant nurse manager in the pediatric operating room where I am employed. Upon immediate receipt of this promotion, I felt that the staff who were once my colleagues, but now my direct reports started to treat me differently. Suddenly, I became the enemy in some employee’s perspectives as I became responsible for scheduling, assignments, time and attendance tracking, and evaluations. My determination from the start to was model kindness and compassion towards others despite often times not receiving it in return. At the end of the day, I like to reflect upon the questions: Did I do my best? Was I fair to everyone? Was there anything I could have done better? Unfortunately, even with putting my best efforts forward in communication, organization, and compassion towards others, there are those few in the department that intend on holding grudges and forming untrue opinions about me. We live in a world where very little grace is extended towards others and that is something I intend to provide more of the older I get. Presently, I am dealing with a situation with a particular surgical technologist that refuses to speak to me unless she has too. She talks to everyone around me and is generally well liked by all. She has never taken the time to get to know me personally but became very irritated with me on a few occasions when I assigned her to surgical cases. Instead of immediately coming to me with her frustrations, she would complain to her co-workers. It would be weeks of the silent treatment before I would figure out that she was upset with me. I have tried repeatedly to rectify the situation, exemplify kindness by asking how she and her family were doing, and have unfortunately gotten nowhere. She complained to our manager that I speak to her like a child and give her unfair assignments.
We sat down with our manager to discuss the situation further which led to 30 minutes of her telling me how she has never liked me and does not want me to speak to her and even threatened human resources involvement. During this interaction, I wish that I handled it differently but I did let anger and defensive mechanisms take over, taking the opportunity to call her out on the poor behavior she exhibits towards me on a daily basis. In the end, not much was resolved, my leader advised us to start anew and try to leave negative feelings towards each other in the past. I go to work each day with a desire to provide exemplary care to my patients and support to my team. Unfortunately, not much has changed with my interactions with this surgical technologist as she refuses to speak to me still unless it is a work-related matter, and then she does it begrudgingly. In a recent attempt to improve this situation, I reached out to my manager and fellow leadership group to let them know that despite efforts, this employee continues to display negativity to me in and out of my presence as has been told me to by other employees. My fellow leadership team did not provide the clarification and support I was seeking, but instead responded that I was just one person and this individual is a ray of sunshine to others. One fellow leader responded that she expects staff to talk negatively about us and not agree with everything we do. This response has ultimately left me feeling more isolated and alone in this situation. I am currently at a loss as to how to proceed. I have worked many years to reach my current position. Through hard work and dedication, I have been able to advance my nursing practice and hold my professionalism to a high standard. Phillips, Stalter, Winegardner, Wiggs, & Jauch (2018), describe workplace incivility and its consequences such as nursing resignations, mental anguish, and potential patient safety concerns. Personally, I have felt mental anguish over this situation and have indeed considered other positions. As present, I have decided to stick with it and continue to strive for excellence and maintain dignity despite the discomfort I feel when I am around this individual.
Having known earlier how this employee felt about me and addressing the issue upfront could have potentially led to a different outcome. Over time, tension and frustrations tend to build up in individuals which can lead to grudges and long-lasting opinions. Knowing this, I intend to address concerns and disagreements immediately from now on. I also feel that pursuing my MSN and addressing concepts such as incivility through scholarly review is empowering me to look past personal matters and seek out the root cause of incivility, better equipping me with a deeper knowledge base towards the subject. This in turn will help me develop better leadership skills in my current and future positions as a master’s prepared nurse.
Strategies that support a healthy work environment are education on incivility in the workplace and how to counteract this detrimental behavior. This should be provided upon hire and repeatedly through computer based learning, staff meetings, and educational retreats. If a healthcare system invests in creating a just culture that maintains accountability for behaviors and actions, civil behavior will grow and support a healthy work environment (Phillips, et al., 2018). Leadership should have zero tolerance for incivility and be able to role model appropriate behaviors that promote team cohesiveness and support.
Phillips, G., MacKusick, C., & Whichello, R. (2018). Workplace incivility in nursing: A literature review through the lens of ethics and spirituality. Journal of Christian Nusing, 35(1), 7-12. doi: 10.1097/CNJ.0000000000000467
Phillips, J., Stalter, A., Winegardner, S., Wiggs, C., & Jauch, A. (2018). Systems thinking and incivility in nursing practice: An integrative review. Nursing Forum, 2018, 1-13. doi: 10.111/nur.12250
The workplace incivility I described has been occurring for quite some time. Up until now, strategies I have implemented to improve the situation have been role modeling positive behavior, confronting the incivility face to face with this employee, meeting with our nurse manager in a neutral environment, and sharing the incivility with my spouse and close friends as a means to release my feelings without being met with judgment while also receiving feedback. Green (2018) discusses a strategy to combat civility by practicing a mindfulness approach when communicating and interacting with others in the workplace. This would involve personal reflection in order to deal with frustrations and stressors as related to incivility. I am trying to remember that mere man does not define me and that I answer to a higher calling other than myself and those around me. Other strategies that I will start to implement since the situation has yet to resolve and I am not receiving the leadership support that is needed to reflect zero tolerance of such uncivil behaviors is keeping personal documentation of every event including location, date, and time. This will help me to list this negative behavior factually as opposed to trying to remember every event from memory should it become necessary to escalate the situation further or defend my own actions. I personally despise unhealthy conflicts, especially in the work environment where patient care is my focus. I look forward to a day where incivility in nursing workplaces are frowned upon by all and never tolerated as a way to survive the complex environments we are a part of.
Green, C. (2018). New nursing faculty and incivility: Applying mindfulness-based strategies. Holistic Nursing Practice, 32(1), 4-7. doi: 10.1097/HNP.0000000000000246