Healthcare is a sphere of human activities focused on helping people overcome the diseases, obstacles created by medical conditions, and improve their overall physical well-being. However, working with people is inherently linked with irritation, dissatisfaction, disappointment, and other negative emotions. The more negativity is accumulated, the more likely the staff and the patients are to lose control and surrender to emotional outbursts. One expression of such a loss of self-restraint is incivility in a clinical setting.
Workplace incivility is a recurring problem in healthcare facilities. The absolute majority of nurses report encountering some form of bullying, impolite behavior or intimidation during education or practice (Armstrong, 2018). Incivility has an adversarial effect on the delivery of healthcare services, which manifests in high nurse turnover, dissatisfaction with the quality of patient care and can even lead to risks to patient safety. Ultimately, nursing incivility is a sign of inefficient management and a culture of workplace bullying. Understanding what constitutes the essence of nursing incivility is essential in ascertaining the ways of mitigating inappropriate behaviors in healthcare settings.
Impact of Incivility on Nurses’ Judgement
Incivility disrupts the most important factor of healthcare professionals’ competencies, which is the ability to use clinical judgment. Probably, the most common expression of incivility is interaction with nurses who are recent graduates. Newcomers feel stressed in a setting where staff members decide to use the lack of work experience as an excuse to delegate duties (Armstrong, 2018). For example, a more experienced nurse instructs a junior one while using informal language. In this case, the newcomer has no choice but to follow the instructions for the fear of being deemed incompetent. As a result, the medical worker feels stressed, pressured, and is not able to recognize their own duties and responsibilities.
Another example where incivility negates the nurse’s skills is the impolite behavior, which stems from the patient. Clients can have numerous reasons to express dissatisfaction with the care provided. They range from shyness and inexperience to personal bias and ethnic prejudice. In any event, a nurse begins to experience anxiety and pressure to meet the demands of the client. Furthermore, nurses are limited in the choice of responses, when the incivility originates from patients (Ma et al., 2018). Satisfaction of the client is a priority for medical organizations, which implies that some of the indecent behavior can be overlooked. When nurses encounter such conduct, they are forced to accept it, even though it may insult their sense of dignity and cloud the nurse’s judgement of the patient’s well-being.
Analysis of Common Issues
Social media allows the clients and nurses to post almost any information they want online. Co-workers can publish photos, which may embarrass their co-workers, or threaten them with it in order to achieve their goal. Accessibility of the Internet constitutes a point of potential expression of incivility. For instance, a co-worker can use offensive words when describing the work of the healthcare professionals. Managers are not able to monitor the informational output of their subordinates on social media, which practically makes them free to post any insulting information without the fear of sanctions.
Another problem is the absence of an objective indicator of incivility. Most of the communication is verbal, which means there is no record of the said words aside from the accounts of the witnesses. Subsequently, the only way for the manager to acknowledge the fact of improper conduct is to use the complaints as the primary evidence of incivility (Smith et al., 2017). Hospitals may implement procedures, which enable the workers to file their complaints in written form, yet they will still constitute a subjective source of information. When faced with contradictory testimonies, the administration will have to choose which side to believe because there are few other ways of verifying the statements of the accuser.
Finally, incivility may be a consequence of work organization in a hospital. It is not rare for medical organizations to experience shortages of nursing staff, which leads to overload with work (Smith et al., 2017). Those few nurses who are available have to compensate for the lack of other co-workers and work extra shifts. As a result, many professionals feel pressured and can experience burnout, which may manifest in the loss of interest towards the job. Subsequently, nurses may lose control and resort to violent and rude behavior. Therefore, the way the clinical setting is managed is also critical in preventing the cases of nursing incivility.
Impact of Incivility on Communication
Incivility impairs communication by decreasing the motivation to follow common ethical rules. When people experience hostility from their interlocutors, they become inclined to respond in a similar manner. As rudeness begets more incivility, the vicious cycle perpetuates, thus creating a culture of distrust. It affects both co-worker relations and the attitude of the patients towards the nurses. It becomes increasingly challenging to end the hostility and restore meaningful communication once improper conduct is displayed. Such conflicts are a reality of many healthcare settings because communication is an essential component of the nursing profession.
An important part of decent professional conduct is clear and concise communication. Many medical procedures performed by nurses are potentially painful and cause discomfort. When patients are not prepared, they may express their worries via offensive words, refusal to follow the nurses’ requests, and may even blame them for the inconvenience (Abdollahzadeh et al., 2017). Likewise, a similar reaction may also originate from the nurses, who may blame the patients for their ignorance. In both cases, the reason for incivility lies in the lack of mutual understanding.
The solution to such dilemmas is introducing appropriate communication. A nurse ought to explain exactly what a particular procedure entails and what sensations a patient may experience. When patient understand that the professional warns them and attempts to minimize the discomfort, they will be less motivated to engage in incivility. The same formula can be applied to co-worker relations, especially when the delegation of duties is required (Abdollahzadeh et al., 2017). When a junior nurse is requested to perform a procedure, which should be done by another person, they may feel revulsion. However, if the co-worker explains the necessity and the reason why they have to delegate, the chances are that the request will be fulfilled without the breakup of rules of proper behavior.
Initiatives to Decrease Incivility
The first approach is to expand the educational curricula to include training in prevention of nursing incivility. There are programs requiring nursing students to participate in simulation activities (Sauer et al., 2018). Such scenarios prepare the students for the possible collision of interests and opinions, which may result in improper conduct. As a result, upon graduation nurses are adequately prepared and less likely to instigate cases of incivility.
Another solution is implementing the zero-tolerance policy for incivility. The administration of the medical organization can accentuate workplace standards of the American Association of Critical-Care Nurses, which prohibit inappropriate communication (Abdollahzadeh et al., 2017). In order for such a policy to function, a reporting system is critical. It can be done via messengers, such as WhatsApp and Viber or any other online medium, which allows instantaneous communication.
One more opportunity to resolve the issue of incivility is presented by the managerial policy, which decreases the workload. As it has already been stressed, the overload with work makes nurses anxious and more prone to mistakes and communicative violations (Smith et al., 2017). The administration should impose limits on the number of night shifts a nurse has in a row. It will allow more time for nurses to recuperate, rest and return to work without the sense of extreme pressure.
Altogether, it should be evident that incivility is negative phenomenon, which should be eliminated from the healthcare setting. Not only does it decrease the level of customer satisfaction and nurses’ content with work, but it can also result in the rise of risks to patient health and safety. Finally, incivility is a sign of a poorly managed organization with a heightened sense of mutual distrust. The possible solutions include expansion of medical education, implementation of zero-tolerance policy, and effective organization of workload. Combined with the rules of proper communication, such measures will decrease incivility in medical organizations and make the clinical setting more hospitable and effective in the delivery of healthcare.
Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. Web.
Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. Web.
Ma, C., Meng, D., Shi, Y., Xie, F., Wang, J., Dong, X., Liu, J., Cang, S., & Sun, T. (2018). Impact of workplace incivility in hospitals on the work ability, career expectations and job performance of Chinese nurses: A cross-sectional survey. BMJ Open, 8(12), 1-9. Web.
Sauer, P. A., Thompson, C. E., & Verzella, M. M. (2018). Empowering nursing students to address incivility. Clinical Simulation in Nursing, 21, 40-45. Web.
Smith, J. G., Morin, K. H., & Lake, E. T. (2018). Association of the nurse work environment with nurse incivility in hospitals. Journal of Nursing Management, 26(2), 219-226. Web.