INCIVILITY IN THE WORKPLACE Patricia Obulaney, MSN, RN, ANP-C 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 OBJECTIVES

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. IS INCIVILITY A REAL PROBLEM?

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. INCIVILITY IN NURSING Definitions of workplace uncivil UNCIVIL

BEHAVIORS 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 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 & UNCIVIL BEHAVIORS violence 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) CLARKS CONTINUUM OF INCIVILITY 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 LATERAL VIOLENCE 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 INCIVILITY IN THE U.S. 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) Forni (2008) feels individuals are Vulnerable Stressed Unhappy

Rushed CAUSES OF INCIVILITY Mismatched Team Members Low Employee Morale Workplace Stress

Bad Employees/ Rude Behavior -Kate McFarlin (2012) INSTIGATORS OF WORKPLACE INCIVILITY Poor communication Different values Difference in personalities

Competition Varied educational backgrounds CAUSES OF EMPLOYEE CONFLICT Negative work environment which can cause medical mistakes Medical complications

Violence in workplace Even death INCIVILITY BREEDS 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

WHAT IS THE IMPACT? 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) IMPACT OF UNCIVIL BEHAVIOR Studies have shown students and graduate nurses are the most common victims of uncivil behaviors! Namie,

2005 THE UNFORTUNATE TRUTH WHAT DOES CIVILITY LOOK LIKE?? An authentic respect for others that requires time, presence, willingness to engage in genuine discourse, and intention to seek common ground that governs both speech and behavior toward others. 2011 WHAT IS CIVILITY??

Clark, 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 WHAT CAN WE DO? 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 HOW TO RESPOND 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 RECOMMENDED STRATEGIES 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 WHAT TO DO 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 FORMAL APPROACHES TO PREVENT INCIVILITY Accept share of workload Respect others privacy Be cooperative concerning shared

environmental conditions (temperature, lighting) Keep confidences Maintain eye contact during dialogue Avoid criticizing publicly Avoid conversations concerning peers PROFESSIONAL BEHAVIOR

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 BE PART OF THE SOLUTION FRIEND OR FOE? QUESTIONS? 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? Retrieved from Namie, G. (2005). Workplace bullying: Hazard for healthcare professionals. Clinical New, 9(11), 14-15 REFERENCES

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