How to Cultivating Healthful Environments

Incivility 

Incivility is a form of disruptive behavior that is still tolerated today in the healthcare system and which affects various functions. ANA defines this concept as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them” (America Nurses Association n.d) and can be in the form of bullying and workplace violence. Some types of behaviors in incivility include making rude comments, using offensive language, making racial or sexual jokes, calling others names, public criticism, screaming, as well as failure to regard the efforts that other disciplines make towards patient care (Lachman, 2015 p.57). These behaviors, whether healthcare workers or patients display them, cannot be tolerated in the workplace because they negatively impact the delivery of services. ANA protects nurses from workplace conflicts through various ways such as the use of advocacy, policy, and resources. Incivility affects the entire healthcare environment, and there is a need for nurses, other healthcare workers, and the public to work together towards creating and nurturing a safe and respectful environment that will foster positive delivery of patient care. 

Impact of Incivility 

Incivility and other violent behaviors affect individuals, microsystem work environments, and the profession of nursing. The victims of the actions of incivility often experience changes in their physical and mental health and experience burnout as a result of stress (McNamara, 2012). These burnouts could be physical or emotional exhaustion and result from long-term effects of working in an unhealthy and demanding work environment. Furthermore, incivility affects the quality and safety of care that individual nurses provide to patients because such behaviors affect their confidence, competence, and overall performance; and the most affected are those who are young in the profession. “The victim may experience low self-esteem, frustration, or a feeling of being powerless” (Stanton, 2015, p.7). Therefore, incivility has various impacts from an individual to the organizational level, and the effects on a person affect their delivery of services in the healthcare environment. 

Incivility is of great concern to the nursing profession because of its negative impacts and nurses should not ignore it because of fear or lack of knowledge about the concept. One effect is that the practice is the primary cause of nurses’ turnover or plan to quit the profession. “Other negative effects include decreased job satisfaction, reduced organizational commitment, decreased personal health, and added direct and indirect costs to employers and RNs” (American Nurses Association, 2015 p.4). Providing a safe workplace for nurses will increase job satisfaction, and incivility lowers their morale to work under a disrespectful and harmful environment that affects their physical and mental state. As a result, they plan or opt to quit, and this means that employers will have to find extra resources to employ other nurses. In this case, there are direct and indirect costs associated with incivility, and this affects the nursing profession at large, from the nurses to the employer. 

A Scenario of Incivility in a Practice Setting 

Incivility takes different forms of behavior within the workplace and can be performed by a colleague or a patient. For example, some individuals do not take race jokes lightly, and this leads to dire consequences within an organization. Once there was a time when a certain nurse joked about African Americans being lazy at work and failing to act fast when attending to patients. The victim did not take this lightly and had to report the offender to the hospital’s management. The management had to investigate the issue and manage the situation before it got out of hand. Investigations revealed that it was not the first time that the offender (a nurse) made such comments in the workplace and other victims had not reported the issue. The facility’s management had to look deeper into the matter to ensure that it made proper corrective action to prevent the case from reoccurring in the future. 

The incivility behavior of the racist nurse had various impacts on the victim, offender, and the organization. Investigations revealed that the victim had suffered mentally because of the anger and rejection they felt in the work setting. Additionally, they thought that the comments ruined their self-esteem. The incident had direct financial impacts on the facility. “The costs of incivility increase when one takes into account the expenses associated with supervising the uncivil employee; managing the situation; consulting with attorneys; interviewing witnesses; and recruiting, hiring, and training new employees” (American Nurses Association, 2015 p.5). The consistent behavior of the offender made him get fired from the organization, and the facility had to incur other expenses in recruiting and training new employees. Therefore, the incivility behavior above shows the massive impacts of the action on the nursing profession. 

Strategies for Creating a Healthful Environment 

Incivility has negative impacts on the individual to the organizational level. A healthcare facility should create a culture of civility and ensure that nurses and other healthcare workers respect other individuals within the workplace. One strategy is to educate individuals within the entire organization about disruptive behaviors of incivility (Stanton, 2015, p. 8). They should be aware of what these behaviors are as well as the impacts that they will have on individuals and the organization at large. A facility should involve its nurses in creating a healthful environment that will improve the delivery of services and care to patients. 

Furthermore, a facility should establish a code of conduct that guides nurses and employees in their delivery of services and care. The system of conduct is a document that “defines acceptable and unacceptable behaviors and identifies actions to be taken when there is a breach of the code, then enforce this uniformly throughout the organization” (Stanton, 2015 p. 8). However, in some situations, the documented efforts may not have a positive impact on employees. Hence, there is a need for another strategy which is to take disciplinary action (Stanton, 2015). Nurses, employers, and the public should jointly work towards establishing a healthful environment. 

Strategies in a Master’s-Prepared Advanced Practice Role 

Nursing informatics is a specialty track that involves interacting with patients frequently and having access to their information. There is a need to create a healthful environment, free of incivility, to ensure a safe working environment for the nurse, patient, and third-parties (America Nurses Association, 2016). One strategy for establishing and maintaining civility is to be committed and responsible for forming and promoting healthy interpersonal relationships within and outside the healthcare team (ANA, 2015). As a result, it is easier to interact with patients and work with others in the provision of services and care. “RNs should establish an agreed-upon code word or signal to seek support when feeling threatened (ANA, 2015 p.8). Nursing informatics deal with all types of individuals and at times situations may be uncomfortable especially if patients exhibit incivility in their behavior. The strategy of establishing a code word or language will deter negative perceptions of patients. Nurse informatics should work closely with healthcare team members and develop and foster better interpersonal relationships in the creation of a healthful environment. 

Conclusion 

Incivility continues to be a significant issue in the healthcare sector, and this affects nursing practice. Incivility takes various forms which show disrespect, and this has negative impacts or outcome at an individual, professional, and organizational level. There is a need for nurses and nurse informatics to implement various strategies that cultivate a culture of civility. Some of the approaches to take to create and promote a healthful environment include training people about disruptive behaviors of incivility, establishing a code of conduct that guides nurses on their behavior, taking disciplinary action in case of unacceptable practices, and establishing and maintaining healthy interpersonal relationships within and outside team members. Such strategies will lead to high-quality care and services. 

References 

America Nurses Association. (2016). Healthy nurse, healthy nation. Retrieved from 

http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse 

American Nurses Association. (2015). Incivility, bullying, and workplace violence.  Silver 

Spring, MD: Author . Retrieved from https://www.nursingworld.org/~49baac/globalassets/practiceandpolicy/nursing-excellence/official-policy-statements/ana-wpv-position-statement-2015.pdf 

American Nurses Association. (n.d.). Violence, incivility and bullying. Retrieved from 

http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/bullyingworkplaceviolence 

Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and 

horizontal/lateral violence.  Urologic nursing ,  35 (1), 39-43. 

McNamara, S. A. (2012). Incivility in nursing: Unsafe nurse, unsafe patients.  AORN 

journal ,  95 (4), 535-540. 

Stanton, C. (2015). Action needed to stop lateral violence in the perioperative setting.  Journal of 

the Association of Perioperative Nurses ,  101 (5), P7-9.