INCIVILITY IN THE WORKPLACEPatricia Obulaney, MSN, RN, ANP-C

OBJECTIVES

Define workplace incivility in nursing profession-in both clinical and academic settings.

Describe civil and uncivil behaviors. List strategies and interventions to create a

civil environment 

IS INCIVILITY A REAL PROBLEM?

Incivility has increased in the workplace Occurs between manager and employee or

employee to employee Also seen in higher education settings:

between or among disciplines in higher education, faculty to faculty, faculty to student, and student to student.

INCIVILITY IN NURSING

Dr. Cindy Clark, faculty at Boise State University-consultant to nursing for workplace or learning institutions to foster an environment of civility.

Clark (2009, 2012): Rude or disruptive behaviors which often result in psychological or physiological distress for people involved-and if left unaddressed, may progress to threatening situations or result in temporary or permanent injury or illness.

UNCIVIL BEHAVIORS Definitions of workplace uncivil behaviors:

Low-intensity, deviant behavior with ambiguous intent to harm the target

Rude and discourteous behaviors Lack of regard for others

Causes atmosphere of conflict, disrespect, and STRESS

UNCIVIL BEHAVIOR

UNCIVIL BEHAVIORS

Insulting comments Denigration of the target's work Spreading false rumors Social isolation Bad manners Mean girls mentality Develop feelings of unfairness and anger; can lead to hostility & violence

CLARK’S CONTINUUM OF INCIVILITY

Begins with low risk or disruptive behaviors (eye-rolling, sarcastic comments, which eventually progresses to bullying & racial/ethnic slurs)

Progresses to high risk or threatening behaviors (intimidation, physical violence, even tragedy)

LATERAL VIOLENCE

Nonverbal innuendo (eyebrow raising, make faces) Undermining activities (not be available) Verbal affront (snide remarks, abrupt responses) Withhold information Sabotage (set up negative situation) Back stabbing (complain about individual to others) Failure to respect privacy Broken confidence Griffin, 2004

INCIVILITY IN THE U.S.

American acts of goodwill are declining Repeated public opinion polls indicate concern

of Americans over the attrition of civility KRC Research survey (2011) of Americans:

86% report being victims of incivility when driving and 72% while shopping

Six in 10 Americans surveyed admit they have acted in an uncivil manner

WHERE IS INCIVILITY?

• In the Workplace• In our Schools• On our Roads • In Politics• On the Web• In movies, television shows• Via phone (texting & speaking)

CAUSES OF INCIVILITY

Forni (2008) feels individuals are Vulnerable Stressed Unhappy Rushed

INSTIGATORS OF WORKPLACE INCIVILITY

Mismatched Team Members Low Employee Morale Workplace Stress Bad Employees/ Rude Behavior -Kate McFarlin (2012)

CAUSES OF EMPLOYEE CONFLICT

Poor communication Different values Difference in personalities Competition Varied educational backgrounds

INCIVILITY BREEDS

Negative work environment which can cause medical mistakes

Medical complications Violence in workplace Even death

WHAT IS THE IMPACT?

Lower job satisfaction Feelings of self-doubt, low self-esteem Absenteeism, tardiness, Unfavorable perception of work environment Greater intent to leave job Decreased communication, teamwork, collaboration Deterioration of morale Anxiety, helplessness, dejection and emotional pain

IMPACT OF UNCIVIL BEHAVIOR

RNs working day shifts experienced higher levels of verbal abuse than those working evening and weekend shifts.

Staffing shortfalls also were correlated with higher levels of abuse.

Intent to leave a job highly correlated with the levels of abuse new RNs experienced

RNs who reported no verbal abuse were least likely to plan to leave in the next three years.

Those who experienced moderate to high levels of abuse were most likely to say they intended to leave their positions in the next 12 months, but planned to stay in nursing.

(Budin, Brewer, Chao, & Kovner, 2013)

THE UNFORTUNATE TRUTH

Studies have shown students and graduate nurses are the most common victims of uncivil behaviors!

Namie, 2005

WHAT DOES CIVILITY LOOK LIKE??

WHAT IS CIVILITY??

“An authentic respect for others that requirestime, presence, willingness to engage in genuine discourse, and intention to seek common groundthat governs both speech and behavior toward others”. Clark, 2011

WHAT CAN WE DO?

Healthcare leaders should act as role models

Promote and uphold an atmosphere of respect

Create an example of harmony and collaboration for staff

Foster healthy communication Intervene when witnessing bullying

behaviors

HOW TO RESPOND

If you are the recipient of confrontational encounter, take a breath, consider what just happened, take time to chill, and carefully develop your response. After careful reflection, you might choose not to respond at all.

Dr. Clark recommends: before you act, ask yourself: "If I do not respond, what is the worst (or best) thing that can happen? If I do respond, what is the worst (or best) thing that can happen?"

HOW TO RESPOND

Admit that you are being treated poorly and take action

It is easier to ignore the problem than to deal with the unprofessional behavior

Can be an emotional burden Share your experience with a trusted colleague

or two and solicit feedback on how they perceive the situation.

Start a paper trail and document any encounters

RECOMMENDED STRATEGIES

A strong sense of community in the workplace, which views each individual as a valuable member of the team, is the best weapon against bullying and uncivil behaviors.

Dellasega, 2003

WHAT TO DO

Become cognizant of workplace bullying Recommend behavioral health services to

victims Increase awareness of negative effect of

incivility-loss of sleep, anxiety, eating disorders Develop effective communication skills

FORMAL APPROACHES TO PREVENT INCIVILITY

Incorporate stress reduction techniques. Initiate training regarding professional

behaviors, effective communication, and team building

Develop policies to address uncivil behaviors Document unacceptable behavior towards the

victim

PROFESSIONAL BEHAVIOR

Accept share of workload Respect other’s privacy Be cooperative concerning shared

environmental conditions (temperature, lighting)

Keep confidences Maintain eye contact during dialogue Avoid criticizing publicly Avoid conversations concerning peers

BE PART OF THE SOLUTION

Show respect to all office/hospital staff Employ open and honest communication Keep actions inclusive and collaborative Be non-judgmental and honest Avoid gossip Be a team-builder Foster forgiveness

FRIEND OR FOE?

QUESTIONS?

REFERENCES

Budin, W., Brewer, C.S., Chao, Y.Y., and Kovner, C. (2013). Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of Nursing Scholarship. DOI: 10.1111/jnu.12033

Clark, Cynthia and Carnosso, Joan. (2008). Civility: A concept analysis. Journal of Theory Construction & Testing, 12(1), 11-15.

Dellasega, C. (2003). Girl Wars: 12 strategies that will end female bullying. Forest City, NC: Fireside.

Forni PM. The Civility Solution. New York, NY: St. Martin's Press; 2008. Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention

for newly licensed nurses. Journal of Continuing Education in Nursing. 35(6), 257-263 McFarlin, K. (2013). What causes incivility in the workplace? Chron.com. Retrieved from

http://smallbusiness.chron.com/causes-incivility-workplace-10700.html Namie, G. (2005). Workplace bullying: Hazard for healthcare professionals. Clinical New, 9(11),

14-15