For nurses, incivility often results in poorer mental health, which, in turn, leads to decreased job performance. For some, it also factors into decisions to leave employers for other work opportunities. But patient care is also impacted—many studies link incivility between nurses to lower quality patient care and increased risk to patient safety.
Efforts to combat incivility in the healthcare workplace can take many forms. The October issue of Nursing2020 features a workshop developed at Saint Luke’s Health System that demonstrates how nurse leaders can educate staff and find solutions to reduce incivility in any hospital unit.
There is no one definition of incivility—in reality, this problem occurs across a spectrum. On the less serious end, incivility may take the form of eye-rolling or sarcasm directed toward a specific person. More seriously, incivility may progress into gossip, exclusion and, in some cases, intimidation through hazing or physical aggression.
Even if an act of incivility seems minor, it shouldn’t be downplayed. Even milder behaviors can turn good nursing units into hostile work environments, leading to poor teamwork, high turnover, and even increased rates of patient harm.
A workshop to reduce incivility
Saint Luke’s Health System uses a two-pronged approach to reduce incivility among nursing staff; action is taken on the unit level and is followed by action on a personal level, which may, in fact, be more effective.2
The healthcare system has adopted the Civility Index Dashboard into its professional culture to address incivility more broadly. Both float nurses and regular staff nurses working outside their usual unit receive weekly emails that include a survey to measure incivility on particular units. The Civility Index Dashboard asks nurses to rate questions using a Likert scale of 1 to 5, with 1 being “strongly disagree” and 5 being “strongly agree”. Questions include:
- I felt welcome on the unit.
- Staff showed concern for my well-being.
- I received appreciation for my work.
Survey results are tabulated each month, and unit managers receive reports to compare data among similar units. Units scoring 3.5 or lower are at higher risk for deeper issues related to teamwork and professional environments, and managers may choose to act by scheduling civility workshops for staff members.
Nurses who participate in civility workshops take an active role in presentations and exercises designed to improve self-reflection, build teamwork, and identify strategies to oppose incivility. Each workshop is led by nurses who use real world examples and relatable stories to engage the participants.
First, nurses are asked to describe the ideal healthcare team. Using this information, nurse educators may lead a discussion on the attributes of a healthy practice environment while also defining incivility and introducing the idea of the incivility spectrum. When the nurses reach a clear understanding of incivility, they’re asked to reflect on a specific example from their own practice when they may have been perceived as less-than-civil. Then, the event is categorized into one of three descriptions: misunderstandings, burnout, or anger.
After uncivil behaviors are identified and categorized, each nurse is asked to brainstorm strategies to address incivility. Some of these strategies include:
- Taking a deep breath.
- Practicing meditation to reduce stress, anxiety, depression, and burnout.
- Identifying ways to promote positive change within the healthcare organization.
- Scheduling a meeting with nurse leadership and bringing examples of deficits and specific ideas for solutions.
The final portion of the workshop educates nurses on giving and receiving feedback, including constructive criticism. Nurses may practice both giving and receiving feedback with nurse educators or their peers. After, they are encouraged to reflect on the exercise to identify what information is useful to help drive behavioral change.
Taking steps to address incivility between nurses is essential for creating and maintaining a safe, effective practice environment. Steps to reduce incivility may be most effective when unit-level interventions are coupled with a personalized, more targeted approach to behavioral change.