WORKPLACE ENVIRONMENT ASSESSMENT NURS-6053 Discussion Example

BY DAY 3 OF WEEK 7

Post a brief description of the results of your Work Environment Assessment. Based on the results, how civil is your workplace? Explain why your workplace is or is not civil. Then, describe a situation where you have experienced incivility in the workplace. How was this addressed? Be specific and provide examples.

BY DAY 6 OF WEEK 7

Respond to at least two of your colleagues on two different days by sharing ideas for how shortcomings discovered in their evaluations and/or their examples of incivility could have been managed more effectively.

      • Main Post 

         

        My Clark Work Environment Assessment showed that my workplace is mildly healthy. Reading through all the questions and answering them made me think about my current workplace and my old one. I realized that I work at a much healthier place now, but I also learned of some things that could change at my current hospital, even though it scored a 70, which was mildly healthy. Based on my results, my current hospital is mildly civil as well. Although that could be better, it is better than not having any. Incivility in the medical field can result in dangerous working conditions, subpar patient care, and higher medical expenses (Clark et al.,2011). My workplace displays civility in some ways, but I see a lack of it in many other areas. Regarding trust between leadership and staff, we score high in civility.

        Mutual respect often takes place in my workplace, and leadership does a great job showing what they expect by displaying the behavior and respect they want. To deliver high-quality services, a civil workplace environment is required. Nurses and doctors will interact more when they have a greater possibility of working in a civil environment (Hossny & Sabra,2021). My workplace also shows civility regarding joint decision-making, policy change, and governance. We have much teamwork in my unit, and my boss includes us in decision-making as we are the ones who directly work with policy change. It is not one-sided with my boss as she finds that trust and a collaborative approach make a healthy workplace. My boss believes in building “Cohesive and Effective Teams,” just as Broome & Marshall (2021) mention, and she exemplifies this well by showing civility and excellent leadership skills.

        Some areas where civility tends to lack are when it comes to the wellness of staff and when it comes to a reasonable workload that is distributed fairly. The workload has not felt reasonable lately, as we have had 6 to 7 patients per nurse. The workload and stress of that patient load are dangerous and exhausting. They do not respect us nurses and what we do when they continually allow us to work understaffed. That leads to poor staff wellness as we are working extra hours, doing extra work, and are expected to come in on days off. Our days off are meant to recoup and recover from poor working conditions. As nurses, people’s lives depend on us, and if my workplace had more civility, they would have more staff, so the patient load would fairly and safely be distributed. Nothing has been done yet to resolve this issue, but they always say they are working on it.

         

         

        Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

         

        Clark, C. M. , Olender, L. , Cardoni, C. & Kenski, D.  (2011).  Fostering Civility in Nursing Education and Practice.  JONA: The Journal of Nursing Administration,  41 (7/8),  324- 330.  doi: 10.1097/NNA.0b013e31822509c4.

         

        Hossny, E. K., & Sabra, H. E. (2021). Effect of nurses’ perception to workplace civility climate on nurse-physician collaboration. Nursing open, 8(2), 620–627.    https://doi.org/10.1002/nop2.666Links to an external site.

         

         

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    • Collapse SubdiscussionHannah Timmer

      Main Post 

       

      My Clark Work Environment Assessment showed that my workplace is mildly healthy. Reading through all the questions and answering them made me think about my current workplace and my old one. I realized that I work at a much healthier place now, but I also learned of some things that could change at my current hospital, even though it scored a 70, which was mildly healthy. Based on my results, my current hospital is mildly civil as well. Although that could be better, it is better than not having any. Incivility in the medical field can result in dangerous working conditions, subpar patient care, and higher medical expenses (Clark et al.,2011). My workplace displays civility in some ways, but I see a lack of it in many other areas. Regarding trust between leadership and staff, we score high in civility.

      Mutual respect often takes place in my workplace, and leadership does a great job showing what they expect by displaying the behavior and respect they want. To deliver high-quality services, a civil workplace environment is required. Nurses and doctors will interact more when they have a greater possibility of working in a civil environment (Hossny & Sabra,2021). My workplace also shows civility regarding joint decision-making, policy change, and governance. We have much teamwork in my unit, and my boss includes us in decision-making as we are the ones who directly work with policy change. It is not one-sided with my boss as she finds that trust and a collaborative approach make a healthy workplace. My boss believes in building “Cohesive and Effective Teams,” just as Broome & Marshall (2021) mention, and she exemplifies this well by showing civility and excellent leadership skills.

      Some areas where civility tends to lack are when it comes to the wellness of staff and when it comes to a reasonable workload that is distributed fairly. The workload has not felt reasonable lately, as we have had 6 to 7 patients per nurse. The workload and stress of that patient load are dangerous and exhausting. They do not respect us nurses and what we do when they continually allow us to work understaffed. That leads to poor staff wellness as we are working extra hours, doing extra work, and are expected to come in on days off. Our days off are meant to recoup and recover from poor working conditions. As nurses, people’s lives depend on us, and if my workplace had more civility, they would have more staff, so the patient load would fairly and safely be distributed. Nothing has been done yet to resolve this issue, but they always say they are working on it.

       

       

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

       

      Clark, C. M. , Olender, L. , Cardoni, C. & Kenski, D.  (2011).  Fostering Civility in Nursing Education and Practice.  JONA: The Journal of Nursing Administration,  41 (7/8),  324- 330.  doi: 10.1097/NNA.0b013e31822509c4.

       

      Hossny, E. K., & Sabra, H. E. (2021). Effect of nurses’ perception to workplace civility climate on nurse-physician collaboration. Nursing open, 8(2), 620–627.    https://doi.org/10.1002/nop2.666Links to an external site.

       

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      • Collapse SubdiscussionFatimah Johnson

        Hi Hannah,

        It is great that you work in a healthier work environment now. A healthy work environment is crucial for patient safety. My organization also has an issue with unsafe staffing conditions; in fact, most healthcare organizations do. According to Dall’Ora et al. (2022), there is a casual relationship between poor nursing staffing and patient mortality. Providing appropriate staffing to meet healthcare demands is essential in creating a healthy environment.

        You also mentioned that a civil workplace with mutual respect is important, especially between nurses and doctors. Mahboube et al. (2019) state, “effective relationship and collaboration between doctor and nurses are considered the main factor in achieving positive medical results” (para. 1). Training healthcare professionals to establish healthy relationships is crucial for efficient patient care.

         

         

        References

        Dall’Ora, C., Saville, C., Rubbo, B., Turner, L., Jones, J., & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Journal of Nursing Studies134, 104311. https://doi.org/10.1016/j.ijnurstu.2022.104311Links to an external site.

        Mahboube, L., Talebi, E., Porouhan, P., Orak, R., & Farahani, M. A. (2019). Comparing the attitude of doctors and nurses toward factor of collaborative relationships. Journal of Family Medicine and Primary Care8(10), 3263. https://doi.org/10.4103/jfmpc.jfmpc_596_19Links to an external site.

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    • Collapse SubdiscussionJeanne Baleng Okuwobi

      Week 7 Discussion: Main Post 

       

              Based on the Clark workplace assessment, my current workplace is healthy, scoring 90. I’m currently on a new assignment with a hospital about one hour from home. It is an excellent workplace because the manager and staff are very welcoming and supportive. “Nurses have the potential to lead the way in improving health and health care for all, but in order to realize that potential, they must operate in an environment that is safe, empowering, and satisfying” (Healthy work environment for nurses, 2017). The hospital where I’m currently working is a well-known institution highly rated; however, my unit is an orthopedics unit, relatively small, with ten beds. I work at night, and we always have myself, the charge nurse, and a tech. The ratio is 1:5; the charge nurse gets the other half. Techs are highly trained; they can draw blood, insert IVs, insert and remove foley, and straight cath ( which we do a lot on this unit) because some of our patients have post-op anesthesia effect/foley removal difficulties. I never see a hospital where techs do so much; it is impressive. Moreover, the manager is very inclusive, and she acknowledges everyone by their name.  She sends a text message daily  to say thank you for our hard work. I’m pleased to experience this good side of nursing. According to the American association of critical care nurses, Creating a healthy work environment enables nurses to provide the highest quality and compassionate patient care while being fulfilled at work, leading to a high staff retention rate. (Aacn.org, 2022).

       

                                                  Uncivil Workplace  

            I have  previously worked in places where the staff was not friendly with contract/travel nurses because of the difference in pay. It often makes the work environment toxic and unsafe because the newcomers get the most patients with complex acuity. In 2021, I was a contractor on a Neuro unit. The place of work was  uncivil, mostly because the charge nurses had poor communication skills, and there were lots of microaggressions  occurring in the unit.  I understand that stress in the workplace can affect people’s behaviors, however, there should be no room for poor behaviors  at work.  According to an article online  “ stressful healthcare workplace, it’s no wonder nurses and other healthcare professionals sometimes fall short of communicating in respectful, considerate way”.  That does not excuse incivility in the workplace.  The patient ratio was 1:5, and our patients on this unit were 90% of the time total care, and we often did not have techs. What made it more challenging was the unfairness that took place. For instance, staff nurses were assigned more stable patients, and if we were lucky to have a tech, staff nurses would get the techs, and contract nurses did not. It was emotionally, physically, and mentally draining to complete my 13 weeks contract at that hospital. The unit manager did nothing to attempt to help despite all the complaints brought to her.  According to Griffin, “workplace incivility can negatively impact employee physical and mental health, job satisfaction, productivity, and commitment to the work environment. In addition, workplace incivility also creates a heavy financial burden for health care organizations”. Most nurses do not renew their contracts in this place; thus, the organization has to hire all the time, which can be costly.

                                                   Reference 

      Aacn.org. (2022).  Accesses  from https://www.aacn.org/nursing-excellence/healthy-work-environments#:~:text=Research%20shows%20that%20a%20healthy,while%20being%20fulfilled%20at%20work. 

      Conversations more civil workplace – American nurse. (2015).  Accessed from https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf 

      Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542. doi:https://doi.org/10.3928/00220124-20141122-02

      Healthy work environment for nurses: Ana enterprise. ANA. (2017, October 14). Retrieved January 9, 2023, from https://www.nursingworld.org/practice-policy/work-environment/ 

       

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      • Collapse SubdiscussionDallas Wilcox

        Week 7 Response #1: Jeanne Baleng Okuwobi

        Jeanne, I thoroughly enjoyed reading about how your current place of employment fosters a civil work environment. It appears as this is so rare nowadays, so I love to hear about the good experiences.

        Unfortunately, I have heard the same complaints you had about contract/travel nurses being treated poorly on more than one occasion. Leadership has a crucial role in advocating, and they need to improve upon these skills to be effective continuously. Walden University (2022) explains that collaboration and assisting in meeting staffing needs ensures retention among staff and better patient outcomes due to happier staff. It sounds like the leadership at your one contract needed to understand and enact more collaboration and assistance in meeting the staff needs. Clark (2015) noted that many times when an organization is going through change, vulnerabilities and power struggles among regular staff could be heightened. Although their treatment is by no means acceptable, it may be that they felt threatened by contract nurses.

        In the situation where you dealt with incivility in the workplace, the suggestions I have for leadership were all based on improving the culture of that environment. Benedictine University (2022) explained that for work environments to be healthy, leaders must demonstrate fairness, show respect, and address workload concerns. A way to accomplish this is to offer educational opportunities to leaders surrounding accountability, collaboration, and positive interactions (St. Catherine University, 2021).

        I hope you continue to have travel nursing experiences as you currently have. This makes all the difference in the world for job satisfaction. Good luck to you!

         

        References

         

        Clark, C. (2015). Conversations to Inspire and Promote a More Civil Workplace. American Nurse Today10(11).

        Five ways nurse leaders impact performance. Benedictine University. (2022, March 1). https://online.ben.edu/programs/msn/resources/five-ways-nurse-leaders-impact-performance

        Nurse bullying: Why it happens and how to prevent it. St. Catherine University. (2021, December 17). https://www.stkate.edu/academics/healthcare-degrees/nurse-bullying

        What nurse leaders can do to create a healthy work environment. Walden University. (2022, April 18). https://www.waldenu.edu/online-masters-programs/master-of-science-in-nursing/resource/what-nurse-leaders-can-do-to-create-a-healthy-work-environment

         

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      • Collapse SubdiscussionBeth Howell

        Beth Howell Discussion Response 1 

         

        Hi Jeanne, 

             Thank you for sharing your experience. You certainly experienced both ends of the civility spectrum. I find it impressive that your manager sends thank-you messages daily. What a terrific way to show appreciation and recognition. She sounds like an authentic leader expressing appreciation (Morton, 2015). 

              It is disheartening to read about the microaggression and inequity in your former work situation especially because you have brought relief to their staffing shortage. I wonder if you had reapproached the unreceptive manager and used the CUS approach if she would have had a different response. CUS is short for concerned, uncomfortable, and safety (Clark, 2018). It might have looked something like this: “I am concerned about the care our patients receive. I am uncomfortable when there is a lack of teamwork and for the patient’s safety, could we talk about more collaboration?”. 

             Bullying, incivility, and microaggressions like you experienced range from 25% to 66% when nurses are surveyed (Broome & Marshall, 2021). The resulting unsafe environment affects the quality of care. I applaud you for addressing your concerns with your manager at the time and using your voice which is a good start in addressing incivility (Clark, 2015). 

         

         

        Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer. 

        Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23.        https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site. 

        Clark, C. (2019). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44 (2), 64-68. doi: 10.1097/NNE.0000000000000563.
         

        Morton, P. G. (2015). Creating and sustaining healthy work environments. Journal of Professional Nursing31(3), 165–167. https://doi.org/10.1016/j.profnurs.2015.04.002 

         Reply to Comment

        • Collapse SubdiscussionFabio Anifrani

          Response # 1

          Beth,

          Thanks for sharing your thoughts and experiences at your workplace. I was present with the idea that conflict resolution and addressing issues in a safe and open environment can be helpful to the growth of your organization(Broome & Marshall, 2021). I also want to acknowledge your leadership team for being motivated enough to learn how to improve how they relate to the staff improved way of relating to the staff which, as you noted, is not surprising with the current high civility score. I also agree that using “I” statements, as described in the Caspersen model, promotes open communication, especially during uncomfortable situations involving conflict (Clark, 2019). Ultimately, it is safe to claim that a lack of teamwork and the inability to collaborate effectively can lead to breakdowns in communication that contribute to unhealthy work environments and potential medical errors (Walden University Producer, (2018).

          References:

          Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

          Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 (11), 18–23.

          https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

          Walden University, LLC. (Producer). (2018). Diagnosis: Communication Breakdown [Video file]. Baltimore, MD: Author.

           Reply to Comment

      • Collapse SubdiscussionIvy Dzivenu

        RESPONSE #2

        Hi Jeanne,

        Great post on your workplace assessment tool. I also did travel nursing and encountered a similar unsafe environment and I will say it was very stressful physically, emotionally, and psychologically. Imbalanced workload and unclear roles contribute to incivility because employees would read mischief (Ogunbote, 2020).

        According to Gibson (2021), the solutions to nursing workplace incivility should focus on enhancing the nurses’ relationships at work and ensuring the nurse’s welfare and fulfillment are achieved. Developing a civil communication culture would increase staff morale, empowerment, and productivity.

        Apart from respect and dignity as the pillars for achieving a civil workplace environment, the best action is for every company to implement good communication skills to encourage a civil workplace environment. Another practical solution to the oppression behaviors is developing a conflict resolution committee where the victims would report the perpetrators for appropriate action.

         

        References

        Gibson, C. G. (2021). Nursing Workplace Incivility and Mindfulness. https://digitalcommons.gardner-webb.edu/cgi/viewcontent.cgi?article=1039&context=nursing-dnpLinks to an external site.

        Ogunbote, J. (2020). Culturally Diverse Nurse Educators’ Perception of Faculty-To-Faculty Incivility (Doctoral dissertation, Capella University). https://search.proquest.com/openview/fb91c2a597b28898c57a11d4113e4ea8/1?pq-origsite=gscholar&cbl=18750&diss=yLinks to an external site.

         

         

         

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      • Collapse SubdiscussionPaulphielle Mcqueen

        Response #2:

        Jeanne,

        Great discussion post, I really enjoyed reading your post about your organization! A healthy work environment is something I have learned is especially important and can make or break the success of an organization. Healthy work environments are empowering, healing and safe environments that have been shown to be correlated with employee engagement and organizational commitment (Lee, 2018). Civil communication is so important that the American Nurses Association (ANA) includes fostering a safe, ethical, civil workplace in their code of ethics, to ensure a workplace which is civil and kind (Clark, 2018). 

        Reference 

        Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23. Retrieved From https://www.americannursetoday.com/wp content/uploLinks to an external site. 

        Lee, J. W. (2018). Environmental best practices, it begins with US: Business, local 

        governments, and international community should work together. International Journal of Environment and Sustainability,7(2).https://doi.org/10.24102/ijes.v7i2.910Links to an external site. 

         Reply to Comment

      • Collapse SubdiscussionPamela Corona Laroya

        Hello Jeanne,

        I enjoyed reading your discussion this week. I can sense you are happy in your workplace. You mentioned it as an excellent workplace because the manager and staff are very welcoming and supportive. If you have exceptional leaders, you feel proud to share good things about your workplace. According to Doherty (2021), nurses should be working where they are the experts; their skills, knowledge, education, and training are utilized to benefit the areas of specialty in which they deliver excellent care. You also mentioned that you work with a highly trained tech. Working with a team that shows excellence in skills makes our work easier. Bullying and incivility cause harm not just to the person but to the ability to provide accurate, timely, safe patient care (Doherty, 2021). According to Clark (2019), as nurses, we must foster civility and healthy environments to protect patient safety. Addressing uncivil behavior can be difficult, but effective communication, conflict negotiation, and problem-solving are effective strategies. Nurses working in a toxic environment cannot provide high-quality care and transform healthcare systems to improve clinical standards and patient outcomes while experiencing bullying while on duty (Alquwez, 2023).

         

        References:

        Alquwez, N. (2023). Association between nurses’ experiences of workplace incivility and the culture of safety of hospitals: A cross‐sectional Study. Journal of Clinical Nursing (John Wiley & Sons, Inc.)32(1/2), 320–331. https://doi.org/10.1111/jocn.16230Links to an external site.

        Clark, C. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44 (2), 64-68. Doi: 10.1097/NNE.0000000000000563.

        Doherty, G. (2021). Healthcare Worker Violence: Part II Incivility in the Workplace. New Mexico Nurse66(3), 4–5.

         

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      • Collapse SubdiscussionPamela Corona Laroya

        Response#2

        Hello Jeanne,

        I enjoyed reading your discussion this week. I can sense you are happy in your workplace. You mentioned it as an excellent workplace because the manager and staff are very welcoming and supportive. If you have exceptional leaders, you feel proud to share good things about your workplace. According to Doherty (2021), nurses should be working where they are the experts; their skills, knowledge, education, and training are utilized to benefit the areas of specialty in which they deliver excellent care. You also mentioned that you work with a highly trained tech. Working with a team that has skills and knows the basics and routine in the unit makes nurse life easier. Bullying and incivility cause harm not just to the person but to the ability to provide accurate, timely, safe patient care (Doherty, 2021). According to Clark (2019), as nurses, we must foster civility and healthy environments to protect patient safety. Addressing uncivil behavior can be difficult, but effective communication, conflict negotiation, and problem-solving are effective strategies. Nurses working in a toxic environment cannot provide high-quality care and transform healthcare systems to improve clinical standards and patient outcomes while experiencing bullying while on duty (Alquwez, 2023).

         References:

        Alquwez, N. (2023). Association between nurses’ experiences of workplace incivility and the culture of safety of hospitals: A cross‐sectional Study. Journal of Clinical Nursing (John Wiley & Sons, Inc.)32(1/2), 320–331. https://doi.org/10.1111/jocn.16230Links to an external site.

        Clark, C. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44 (2), 64-68. Doi: 10.1097/NNE.0000000000000563.

        Doherty, G. (2021). Healthcare Worker Violence: Part II Incivility in the Workplace. New Mexico Nurse66(3), 4–5.

         

         Reply to Comment

      • Collapse SubdiscussionMleh Porter

        Hello Jeanne,

        I enjoyed reading your post. I especially enjoyed reading about your current workplace and how your current nurse manager fosters inclusivity and a civil work environment. It was sad to read about your previous experience of incivility as a contract nurse staff. Unfortunately, workplace incivility among nurses is a common issue in healthcare. Incivility in the workplace can lead to emotional and physical distress for those that experience it and affects the quality of patient care (Armstrong, 2018). There is a severe shortage of nursing staff in the United States today, and contract nursing staff like you, are there to help with that nursing shortage and should not be mistreated. Workplace incivility has been reported as the reason for about 30% to 50% of new nurses leaving the profession within their first 3 years of practice, costing the healthcare system about $24 billion annually (Kisner, 2018).

        The healthcare organization must adopt a zero-tolerance policy to manage this type of incivility in the workplace. Staff members should clearly understand that behaviors exhibiting incivility will have consequences. Since the charge nurses and managers were contributing to the problem, a staff development program on incivility should be held for staff and managers. The staff development program should promote communication skills and challenge those that perpetrate incivility (Kisner, 2018).

        Promoting civility in the workplace environment improves patient safety, excellent nursing care, collaboration, and nursing staff retention (Kisner, 2018).

        References

        Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health &      Safety66(8), 403–410. https://doi.org/10.1177/2165079918771106Links to an external site.

        Kisner, T. (2018). Addressing workplace incivility. Nursing Critical Care13(6), 24–29.                                                                                    https://doi.org/10.1097/01.ccn.0000546311.07792.74

         

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      • Collapse SubdiscussionMarphene Joseph

        response 2

        Great post! I like learning about your current work responsibilities from you, and I felt compelled to answer to someone who works in a healthy workplace as opposed to an unhealthy one. Some nights are worse than others in the involuntary psychiatric ward where I presently work, so as an employee, I would really appreciate a text from the nurse manager thanking me for my efforts. By fostering a positive workplace culture, nurses may deliver the most compassionate patient care possible while enjoying their jobs (aacn.org, n.d). This class taught me a lot about the many kinds of leaders and the kind of leader I would like to be if I ever found myself in a position of authority. A good leader can truly influence how others act, and I believe that if my present manager showed more teamwork, my coworkers would follow suit. A team is only as good as its leader. The morning and evening shifts are currently at odds at my workplace, and as someone who works the night shift, I do think the morning staff receives more assistance and back up from the nurse manager. The manager always makes sure that there is enough personnel in the morning and at times leaves the night shift very unstaffed. The nurse manager picks everything about the night shift apart and is always quick to inform us about the morning shift’s complaints. When we as the night shift try to complain about the morning shift, she reverses it back to the night shift. It has gotten to the point where no one on the night shift even bothers to address any of our concerns about the morning shift because we know we will be met with push back from the manager.  Organizational leaders and nurse managers must create an environment where nurses feel free and empowered to speak up (clark, 2015). We definitely have some incredible nurses working on my ward, but we need to start working as a team. Hopefully my manager can bring the team together.

        reference:

        Healthy Work Environments. AACN. (n.d.). Retrieved January 14, 2023, from https://www.aacn.org/nursing-excellence/healthy-work-environmentsLinks to an external site.

        Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10.Links to an external site.(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

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    • Collapse SubdiscussionJan Griffin

                  The Clark Healthy Workplace Inventory’s findings showed that my workplace’s civility is seriously unhealthy. My employer’s facility does not have an excellent track record for retaining personnel over time. Most employees at my company come here for the priceless experience of working in a burn and level one trauma center. The hospital offers expertise and information that cannot be acquired anywhere else in the region because it is the only level-one trauma center and burn center within a 150-mile radius. Staff generally leave after they get the experience needed for school or to advance to another position, leading to a high turnover rate.

      First, I was aback by how much the survey emphasized rewarding and recognizing employees for a job well done. Second, the survey’s extensive list of unfavorable findings against my facility startled me. The fact that my facility did not respond to the yearly employee engagement survey was one finding from the study that did not surprise me. Although it is claimed that the annual poll is anonymous, employees do not believe this. When employees respond poorly, management is expected to cheer them on. Employees believe that in most hospital units, management and leadership staff might single out an individual for a poor response, which is why many employees have yet to respond to the survey. Another factor is that management should make changes in light of the results of the study.

      The assessment’s findings do not present a flattering portrait of my facility but an accurate one that emphasizes areas needing development. Nurses with more experience tend to “devour their young” in nursing. Unfortunately, our profession is familiar with the idea of this reality. The facility’s leadership needs to be helping this problem among the nursing staff. Most recently, upper management started a program for nursing residents to change this issue and inspire new nurses. A year into the program’s existence, it was discontinued, and replacement initiatives have yet to be made. To improve the workplace, a facility’s general cleanliness and civility must be a constant goal (Clark, 2015).

      I found self-care as a stress management idea in one of the articles, and it was fantastic for the nursing staff. To begin with, being a nurse is a difficult job that might cause rudeness at work. Fixing the issue starts with acknowledging that it exists and, according to Clark et al. (2011), will be less likely if the workplace encourages people to take care of themselves. If my institution and many others do not recognize or understand the stress that the personnel underuse this idea, it would be non-beneficial. The assessment questions made it clear that the hospital where I work lacks a system for rewarding good work or providing positive reinforcement. When staff members believe they are only acknowledged for the bad, even a small gesture like giving them a pat on the back can go a long way. Building trust among team members, workers, and leadership is beneficial in a collaborative environment. Positive reinforcement will increase the dedication of the team’s leaders and employees, as well as two other qualities of a strong team, such as accountability and attention to results, all of which will improve patient outcomes (Laureate Education, 2009a).

      References

      Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23, Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

      Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice: Nurse leader perspectives. Journal of Nursing Administration, 41(7/8), 324-330. Doi:10.1097/NNA.0b013e31822509c4

      Laureate Education (Producer). (2009a). Working with Groups and Teams [Video file]. Baltimore, MD: Author.

       Reply to Comment

      • Collapse SubdiscussionHannah Timmer

        Jan,

        Going through this evaluation also made me realize many things about my workplace, how healthy it was in some areas and how unhealthy it was in others. The areas that ranked lower in my evaluation were some that are so important in any job. Incivility in the medical field can result in dangerous working conditions, subpar patient care, and higher medical expenses (Clark et al.,2011). Rewarding and recognizing employees is essential, as they are critical in the workforce. Employees who do not feel respected, appreciated, or wanted leave and go where they will be appreciated.

        Rewards and nurses’ motivation to work are directly and favorably correlated. In the nurses’ opinion, the lack of adequate rewards from their employers has led to low levels of job motivation. Customer happiness and health quality effectiveness depend on how motivated the company’s staff are (Negussie, 2012). To better acknowledge staff and make them feel appreciated, your workplace can do simple things like expressing affirmation, helping on the floor during stressful times, or even little gifts like a t-shirt or something. The little things make staff feel appreciated and facilitate a healthier work environment for you and your colleagues. Stress management through self-care is also a great way to create a healthier environment. If we do not care for ourselves, we will be unable to care for others.

         

         

         

        Clark, C. M. , Olender, L. , Cardoni, C. & Kenski, D.  (2011).  Fostering Civility in Nursing  Education and Practice.  JONA: The Journal of Nursing Administration, 41 (7/8),  324- 330.  doi: 10.1097/NNA.0b013e31822509c4.

         

        Negussie N. (2012). Relationship between rewards and nurses’ work motivation in addis ababa    hospitals. Ethiopian journal of health sciences22(2), 107–112.

         Reply to Comment

        • Collapse SubdiscussionJan Griffin

          Response #2

          Dr. Cornell,

          The information I obtained by taking the Clark Healthy Workplace Inventory showed that the facility I presently work in has a lot to work on. The facility not keeping the yearly employment survey anonymous needs to change immediately. When you work in a department with minimal employees, the responses are easy to place blame on. By not having the employees state which department they operate in, there will be more results and less chance of the staff thinking the upper management will figure out who they are. Also, giving the results back to the employees promptly is very important. According to Rank and Wilson (2017), employees usually need help remembering what they answered and why because of the delay in announcing results.

          The nurse residency was a great idea, and unfortunately only lasted within our facility. With the staff shortage, we need to learn to work together as a team to give our patients the best care. Implementing a new way for a young nurse to be placed next to a seasoned nurse in the unit is one way for them to lead and guide while receiving assistance simultaneously. According to Wolf et al. (2021), bullying has been linked to a hospital system retention issue. Placing new and old nurses together and requiring them to work together will decrease the problems of bullying within the workplace.

          References:

          Rank, V., & Wilson, P. B. (2017). Is It Time to Ditch the Annual Employee Survey? HR Magazine62(1), 20–21.

          Wolf, L. A., Perhats, C., Delao, A. M., & Martinovich, Z. (2021). Validation of a grounded theory of nurse bullying in emergency department settings. International Emergency Nursing56https://doi.org/10.1016/j.ienj.2021.100992Links to an external site.

           Reply to Comment

      • Collapse SubdiscussionDinorah Abigail De La Cerda

        Response #1

        Jan,

        Thank you for your post. I, too, was shocked about the emphasis on rewarding employees. It seems like, at my facility, the only time you get called out is for a mistake you have made. In fact, when I first started working at this facility, when the previous supervisor would ask to see me, I would immediately think it was something bad and that I was going to get fired. Recognition of achievements allows employees to feel valued and cared for, allowing for growth and positive change (Amoatemaa, 2016). I have also seen the nurses eat their young trope play out in my facility. This makes working certain shifts harder than others and always affects the attitude of nurses, and creates a space in which patient care is hindered (Clark et al., 2011).

        I like how you mentioned self-care as a form of stress management. Stress management is essential when working in a bad work environment. We live in the age of self-care. There are so many ways to practice this idea, from taking a long shower or getting a massage. Nursing is stressful as it is, and we must take care of our bodies so that we may continue to bless others.

        References

        Amoatemaa, A. S., & Kyeremeh, D. D. (2016). Making Employee Recognition a Tool for Achieving Improved Performance: Implication for Ghanaian Universities. Journal of Education and Practice7. Retrieved from https://files.eric.ed.gov/fulltext/EJ1126683.pdf.

        Clark, C. M. , Olender, L. , Cardoni, C. & Kenski, D.  (2011).  Fostering Civility in Nursing  Education and Practice.  JONA: The Journal of Nursing Administration, 41 (7/8),  324- 330.  doi: 10.1097/NNA.0b013e31822509c4.

         Reply to Comment

      • Collapse SubdiscussionMarphene Joseph

        response 1
        great post Jan
        My Clark healthy workplace inventory also showed that I worked in very unhealthy work environment. my work environment was so unhealthy and toxic to my mental well-being I had to take a step back and reevaluate what my expectations were from this job. Reflecting on the workplace culture and our relationships and interactions with others is an important step towards improving individual team and organizational success (Clark, 2015).  The nurses at my facility recently became unionize and prior to the union election the hospital president was ambient about showing her face on all units and asking nurses what we wanted and needed. she would address our simple concerns like fixing a broken locks on the door or providing nurses lunches and hosting ice cream parties but soon as the union was voted in she was never seen again. she also shut down the CCU  (step down) unit as they were the nurses who initiated 1the whole union ordeal. Nurse leaders need to be extremely attentive and supportive towards the success of the nursing practice and sustainment of a healthy work environment (Clark et al. 2011). how can we expect nurse managers or even our  co-workers to display civility and humanity to other nurse when the individual running the facility is unable to do it.

         

        Reference:

         

        Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice .Links to an external site. The Journal of Nursing Administration, 41(7/8), 324–330.

         

        Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10.Links to an external site.(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

         

         Reply to Comment

      • Collapse SubdiscussionFabio Anifrani

        Response # 2

        Hello Jan,
        I, too, found out my workplace is seriously unhealthy once I took the Clark Healthy Workplace Inventory. Like your employer, mine also has a track record of high turnover and low morale (Clark, 2015). I particularly appreciated your comments about the annual poll and how employees do not believe it is anonymous. The lack of teamwork and the inability to collaborate leads to communication breakdown. The breakdowns in communications also contribute to unhealthy work environments, leading to potential medical errors (Walden University Producer, 2018). I also appreciate your perspective on the nursing profession being familiar with the idea of incivility being a reality. Leadership needs to be helped by improving how they relate to their staff. One of the best ways to address this problem is to promote conflict resolution in a safe and open environment to help healthcare organizations and those working in them grow (Broome & Marshall, 2021). Thanks for sharing your thoughts and experiences at your workplace.

        References:

        Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

        Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 (11), 18–23.

        https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

        Walden University, LLC. (Producer). (2018). Diagnosis: Communication Breakdown [Video file]. Baltimore, MD: Author.

         Reply to Comment

    • Collapse SubdiscussionBeth Howell

         Week 7 Initial Discussion Post -Beth Howell 

                  Work Environment Assessment  

            A healthy work environment produces better patient outcomes and happier staff members (Broome & Marshall, 2021). A healthy work environment is created by the purposeful nurturing of team building through clear communication, conflict resolution, respect, leadership growth, and shared perspectives (Clark, 2015). In addition, six characteristics of a healthy workplace environment were created by the American Association of Critical-Care Nurses which also emphasized communications skills, teamwork, professional growth, adequate staffing, appreciation, and effective problem-solving (Broome & Marshall, 2021).  

            In the office where I am a nurse educator, the Clark Healthy Workplace inventory score was 94 placing the civility score in the very healthy workplace tier (Clark, 2015). The leadership team has had the tremendous opportunity to have a performance counselor in the past to assist in team building and conflict resolution. The civility score would not have been as high in the past, but the leadership team has been motivated to learn an improved way of relating. I am not surprised at the current high score. The work environment assessment template identified two areas that could be improved: conflict resolution and communication at all levels of the organization. I would add emphasis to “at all levels” of the team, not just the leadership team. At this organization, there is a tendency to involve triangle communication where one staff member with a conflict talks to another staff member and not directly to the person they are having an issue with (Hicks & McCracken, 2014). One way to manage the triangle is to provide guidance or role-play on how the two individuals can resolve conflict healthfully (Hicks & McCracken, 2014). Conflict addressed in a safe and open environment can help the organization grow (Broome & Marshall, 2021). The assessment suggests that the organization is healthy and civil, and continued modeling and instruction of direct, civil communication, and conflict resolution would be beneficial and lower the likelihood of triangle undercurrents. 

                                                                                                        Incivility Event Observed 

           When COVID was in full swing and tension was high, we had a different system for the delivery of care including telephonic visits, triaged office visits, and modified office procedures. For example, the staff had their own individual room, patient rooms were double cleaned between appointments, scribes were 100% remote, and only necessary imaging was completed. During this period, two staff members who had different approaches fought over trash removal. One of the staff members shoved her body into the other nurse and started yelling insults. The aggressor left and said she quit, leaving the office short-staffed that day and until a new staff member could be hired. One week later she returned as if nothing happened and without comment. She felt an apology was not owed and did not see her culpability or growth opportunity. She was not rehired because there is zero tolerance for physical altercations, and she was not willing to explore what could have been done differently. The debriefing in this situation might have produced learning and insight (Clark,2019). There was an attempt to improve communication skills, but the individual was not open. In their debriefing meeting, the leadership team realized a clear policy for trash disposal was needed and measures to reduce stress and isolation. 

                                                                                                                 Caspersen Model 

           Before this altercation occurred, a conversation using the Caspersen model would have helped. In the Caspersen model, you use “I” statements and state how you feel and why, and end with a request (Clark, 2019). In this example, the Caspersen model would have looked like this: “I feel disrespected, when you do not throw the trash away as I requested, because it creates more work for me, would you be willing to throw the bulk trash away in the large trash can?”. The Caspersen model can be learned and practiced encouraging open communication despite having some degree of discomfort or conflict (Clark, 2019). 

                                                                                                                  Conclusion 

           In conclusion, the organization is a healthy and civil organization. Growth and nurturing will improve happiness and productivity and will be facilitated by continued instruction and modeling of conflict resolution and clear communication behaviors. Additionally, a debriefing and assessment of what has been learned after a misfire would be helpful for team building and improvement. 

                                                                                                           References

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.
       

      Clark, C. (2019). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44 (2), 64-68. https://doi: 10.1097/NNE.0000000000000563. 

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today 11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site. 

      Hicks, J., & McCracken, J. (2014). The dreaded drama triangle. Physician Leadership Journal1(1), 6 

       Reply to Comment

        • Collapse SubdiscussionBeth Howell

          Hello Dr, Cornell, 

          Thank you for your question. Having a healthy workplace environment (HWE) is everyone’s duty. Patient outcomes, staff happiness, and retention all improve with a healthy workplace environment (Johansen et al., 2021). 

          A qualitative peer review study was published by Nurse Leader which used focus groups that were either clinical nurses or nurse managers. Using the HWE standards from the American Association of Critical Care Nurses (AACN) as a backdrop, the qualitative study strove to investigate features of a healthy work environment by these two groups (Johansen et al.,2021). AACN defines the standards as “skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership” (Broome & Marshall, 2021). The primary issue identified by the focus groups was sufficient resources, including supplies and organization, which the AACN does not directly address outside of the appropriate staffing standard. With the effective decision-making standard, the study identified a knowledge gap as the clinical nurses did not perceive that they were involved with effective decision-making, while the nurse managers felt the opposite. A strategy to enhance an HWE is to educate clinical nurses and provide positive feedback on the effective decision-making that is being done (Johansen et al.,2021). A strategy for meaningful recognition that both groups identified was that the type of recognition should be tailored for and defined by the individual. Additionally, nurse managers identified that daily recognition should be improved. The authentic leadership standard was defined differently between the two groups. Clinical nurses identified authentic leadership as leaders who are available and involved. Nurse managers identified authentic leaders as mentors (Johansen et al., 2021). While small, this interesting study highlights subtle differences that may occur with dissimilar roles and strategies to create an HWE. 

           

           

          Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer. 

          Johansen, M. L., de Cordova, P. B., & Weaver, S. H. (2021). Exploration of the Meaning of Healthy Work Environment for Nurses. Nurse Leader, 19(4), 383–389.:https://doi.org/10.1016/j.mnl.2020.06.011Links to an external site. 

           Reply to Comment

      • Collapse SubdiscussionDaniel Russell Wright

               Thanks for your post, Beth. Your workplace appears to be a really healthy and respectful place to work. That unquestionably results from excellent leadership that may foster positive team dynamics. Qualities of successful teams include trust, the capacity to resolve conflicts, dedication to one another, responsibility, and the ability to focus on outcomes (Walden University, 2009). Conflict might, however, result from an additional stress element. The importance of self-care and stress reduction is underscored by the fact that stress is a significant cause of incivility (Clark et al., 2011). In addition to taking steps to lessen the negative impacts of stress at work, leaders need to put in place effective codes of behavior and policies to promote civility in the workplace (Clark et al, 2011). My belief is that workplace culture extends well beyond codes of behavior and policies, but there must be a systematic system of control in place so that, if required, disciplinary action may be applied.

        I appreciated your discussion of triangular communication. Numerous issues, including a decline in involvement and trust as well as an increase in stress and worry, are brought on by the communication triangle. According to the ANA, the DATA Driven Discussion Model, which offers a framework for direct input, could be shared among team members to facilitate more direct communication. DATA stands for the straightforward four-step process of direct communication:

        D: Describe the situation.

        A: Ask questions and listen.

        T: Talk through solutions.

        A: Agree on next steps.

        The intention is to reduce emotions and concentrate on the truth so that people won’t take criticism personally or get defensive. The team member should describe the problem, allow the other person an opportunity to explain, and then continue (2014). Thank you again for your interesting post!

        References

        ANA. (2014, August 8). Squashing the Communication Triangle. American Nursehttps://www.myamericannurse.com/squashing-the-communication-triangle/Links to an external site.

        Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering Civility in Nursing Education and Practice: Nurse Leader Perspectives. JONA: The Journal of Nursing Administration41(7/8), 324–330. https://doi.org/10.1097/NNA.0b013e31822509c4Links to an external site.

        Walden University, LLC. (Producer). (2009a). Working with Groups and Teams [Video file]. Baltimore, MD: Author.

         

         Reply to Comment

      • Collapse SubdiscussionPaulphielle Mcqueen

        Response #1

        Beth

        Thank you for your contribution to this week’s discussion, I really enjoyed seeing how positive your work environment is. Communication among nurses is fundamental to patient safety, patient satisfaction, and excellent care. That is a particular area, and I can see why your facility is healthy. As indicated by Kourkouta and Papathanasiou (2014), effective communication needs a comprehension of the patient and the encounters they express and requires the actual purpose of the nurse to comprehend what was said. Marquis and Huston (2017) reveal that all types of communication incorporate three things, a sender, a recipient, and a message. They are all vital aspects of communication. Organizational communication is said to be at risk for poor communication because of the lack of a chain of command, clearly your facility has an effective communication system. 

        References 

        Kourkouta, L., & Papathanasiou, I. (2014). Communication in Nursing Practice. Materia 

        Socio Medica, 65-67. 

        Marquis, B. L., & Huston, C. J. (2017). Leadership Roles and Management Functions in 

        Nursing: Theory and Application. Philadelphia: Lippincott Williams & Wilkins. 

         

         

         Reply to Comment

      • Collapse SubdiscussionFabio Anifrani

        Response # 1

        Beth,

        Thanks for sharing your thoughts and experiences at your workplace. I was presented with the idea that conflict resolution and addressing issues in a safe and open environment can be helpful to the growth of your organization(Broome & Marshall, 2021). I also want to acknowledge your leadership team for being motivated enough to learn how to improve how they relate to the staff improved way of relating to the staff which, as you noted, is not surprising with the current high civility score. I also agree that using “I” statements, as described in the Caspersen model, promotes open communication, especially during uncomfortable situations involving conflict (Clark, 2019). Ultimately, it is safe to claim that a lack of teamwork and the inability to collaborate effectively can lead to breakdowns in communication that contribute to unhealthy work environments and potential medical errors (Walden University Producer, (2018).

        References:

        Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

        Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 (11), 18–23.

        https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

        Walden University, LLC. (Producer). (2018). Diagnosis: Communication Breakdown [Video file]. Baltimore, MD: Author.

         Reply to Comment

    • Collapse SubdiscussionPaulphielle Mcqueen

      Main Post- week# 7 Discussion  

       

      According to recent studies, organizations have widespread workplace incivility and disregard for it (Clark et al., 2011). It is stated that an organization should create a workplace culture of respect, fairness, and kindness to aid in promoting a healthy work environment (Bailey, 2019). Nurses are handworkers and always the ones to put the patient first (Clark et al., 2011). According to Clark Health Workplace Inventory Assessment, my workplace is barely healthy. The results did not raise me because I figured my workplace would score low. The score is low because of the way management treats the employees and the exceptionally low staff morale we have. Upper management must do a better job in creating a decent work environment for their nurses. 

      The definition of Incivility is rude or disruptive behaviors that can result in psychological or physiological distress (Griffin & Clark, 2014). Many minor disputes have happened at my workplace amongst managers and charge nurses. In my eyes the reason my facility has such a low score is because of the lack of nurses. SO, the nurses and charge nurses are placed at a strain all the time because we do not have enough nurses working. Members at my workplace tend to leave after their one-year contract or even after their two-year contract. The organization is trying to do the best they can to retain the nurses that they even gave us a retention bonus for nurses to stay.  

      At my workplace, I can name a few examples of incivility I have noticed, one is every day we have a specific nurse that is trained to aid the pediatric surgeons or OBs in circumcisions, they are referred to as the Nursery resource (NRA). Well one of the floor nurses let the NRA know two hours later that a baby needed a circ after she said they did not want one. So, the surgeons were already gone, and the floor nurse was incredibly angry with the NRA. They started arguing in the circumcision room and even putting hands on each other. It was so bad that the NRA quit that very moment and management without watching or even hearing her side of the story said she needed to leave anyway. It is sad because we are so short-staffed that everyone is so short-fused and instead of trying to figure solutions the nurses take their anger out on each other. 

      Workplace evaluation ensures company activities are done efficiently. Workplace civility is also vital for ensuring that all employees are treated equally and fairly (Marshall Broome, 2017). It is especially important for my organization to recognize the elevated level of incivility to aid in increasing workplace health and wellness in our work environments and for future healthcare providers that decide to work here. 

       

       

       

      References 

      Clark, C.M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education And practice: Nurse leader perspectives. Jornal of Nursing Administration, 41(7/8),324-330. doi:10.1097/NNA.0b013e31822509c4  

      Griffin, M., & Clark, C.M. (2014). Revisiting cognitive rehearsal as an intervention against 

      Incivuility and lateral violence in nursing: 10 years later. Journal of Continuing 

      Education in Nursing, 45(12), 535-542. Doi:10.3928/00220124-20141122-02 

      Marshall, L., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer. 

       

       

       Reply to Comment

      • Collapse SubdiscussionIris Cornell

        Response from the instructor 

         

        Paulphielle thanks for sharing. As the most caring profession sometimes nurses do not treat each other well (Warner, 2016, as cited in Handzel, 2020). Warner continued to share that 27 to 85% of nurses have experienced some form of incivility in their nursing work life. A strategy that was used by one organization was to promote civility workshops. Handzel (2020) found that 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. Do you think a good strategy for all organizations would be to promote workshops on addressing incivility? Why or why not?

        Reference
        Handzel, S. (2020, October 19).   Incivility in nursing: An approach for change.    https://www.wolterskluwer.com/en/expert-insights/incivility-in-nursingLinks to an external site.

         Reply to Comment

      • Collapse SubdiscussionTammy Young

        Paulphielle, I can really relate to the concerns you expressed in your post.

        Maintaining a healthy work environment is essential for patient safety and care quality and plays a fundamental role in the retention of healthcare professionals (Wei et al., 2018). The AACN identified six essential standards for maintaining a healthy work environment. These standards include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership (Shirey, 2017). While most nurses are not formally trained to make workplace civility their focus, they must learn and practice skills to address uncivil encounters and help create a safe, ethical, and civil workplace (Clark, 2015).

        Incivility in the workplace may be seen as rude or disruptive behavior that can result in psychological or physiologic harm. It may start as just disgruntled employees or a lack of commitment to the success of the healthcare facility and then progress to unsafe or threatening situations (Kroning & Annunziato, 2023). I can relate to the description of the incivility that takes place in your workplace. I also work in an environment that scored unhealthy on the Clark Work Environment Assessment. The morale is at the lowest point of any place I have ever worked. The management fails to acknowledge the contributions and dedication of their employees. Team members find they need to be better trained to perform the expected tasks, which leads to more frustration.

        To create civil workplace environments, nurses must find ways to connect through common goals, maintain a positive attitude, collaborate with their peers, and use constructive communication skills (Shirey, 2017). Effective communication is crucial to conflict negotiation and problem-solving. Healthcare professionals must engage in productive conversations to resolve negative situations. Regardless of personality differences or opposing opinions, nurses need to communicate respectfully with each other to keep our focus on providing safe, effective patient care (Clark, 2015).

         

        References

         

         

        Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 Links to an external site.Links to an external site.(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

        Kroning, M. & Annunziato, S. (2023). New strategies to combat workplace incivility and promote joy. Nursing, 53 (1), 45-50. doi: 10.1097/01.NURSE.0000891960.69075.73. https://oce.ovid.com/article/00152193-202301000-00013/HTMLLinks to an external site.

         

        Shirey, M. R. (2017). Leadership Practices for Healthy Work Environments. Nursing Management48(5), 42–50. https://doi.org/10.1097/01.NUMA.0000515796.79720.e6Links to an external site.

         

        Wei, H., Sewell, K. A., Woody, G., & Rose, M. A. (2018). The state of the science of nurse work environments in the United States: A systematic review. International Journal of Nursing Sciences5(3), 287–300. https://doi.org/10.1016/j.ijnss.2018.04.010Links to an external site.

         Reply to Comment

      • Collapse SubdiscussionDaniel Russell Wright

               Paulphielle, hearing about your unpleasant employment situation makes is saddening. Everyone has a right to work in a setting where they are respected, heard, and safe. The negative acts of incivility, including bullying and lateral violence in a professional setting can harm, humiliate, offend and cause high levels of distress to other members leading to reduced job satisfaction levels, psychological trauma and eventual downturn in patient outcomes (Broome & Marshall, 2021). Workplace rudeness is a well-known source of stress, which has a negative impact on the recruitment of new nurses. The ongoing cycle of recruiting and losing nurses, particularly recent graduates, is a factor in the growing nursing shortage. Hospitals’ treatment of new nurses and incivility at work might exacerbate their psychological discomfort and eventually lead to job burnout (Shi et al., 2018). High levels of resilience in new nursing staff may successfully mitigate the detrimental consequences of workplace rudeness, and they can also partially heal psychological damage after being exposed to rudeness. According to this concept, nursing managers should focus on new nurses’ growth and development as they gain experience in nursing management, strengthening their resilience and lowering their anxiety (Shi et al., 2018). This will increase work efficiency and save management costs by lowering the rate of job burnout among new nurses. Research also offers a fresh theoretical contribution and useful advice for preserving the new nurses’ physical and mental wellbeing (Shi et al., 2018). Consequently, future nursing organization loss may be avoided.

        The DESC model of communication was completely unknown to me before I began to research for this class, but I could see it bing helpful in your situation. DESC stands for describing the situation, expressing the emotion or effect is has on you and your peers, solution, and conclusion. It is considered an assertive way of communicating your concerns (Larrass, 2021). Your situation appears to include a leadership problem, which is made more challenging by the fact that you may lack the necessary tools or a forum to address these matters. There are several strategies for addressing this problem. Create a group of peers before approaching leadership to ensure that the dialogue is professional. When having a conversation with leadership, use your own emotional intelligence. Make sure you and your peers provide ideas and solutions, and keep the conversation focused on constructive methods to deal with the problem (Zangaro, n.d.).

         

        References

        Broome, M. E., & Marshall, E. S. (2021). Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (3rd ed., pp. 155-231). Springer Publishing Company.

        Larrass, S. (2020, December 21). The DESC Model – A Framework for Assertive Communication and Effective Feedback. SylviaLarrasshttps://www.sylvialarrass.com/the-desc-model-a-framework-for-assertive-communication-and-effective-feedbac/Links to an external site.

        Shi, Y., Zhang, S., Guo, H. (2018, February 20). Impact of Workplace Incivility Against New Nurses on Job Burn-out. BMJ Openhttps://bmjopen.bmj.com/content/bmjopen/8/4/e020461.full.pdfLinks to an external site.

        Zangaro, G. (n.d.). Recognizing and Overcoming Toxic Leadership . RN Journalhttps://rn-journal.com/journal-of-nursing/recognizing-and-overcoming-toxic-leadershipLinks to an external site..

         

         Reply to Comment

      • Collapse SubdiscussionFatimah Johnson

        Pauphielle,

        I am sorry to hear about your stressful working conditions. A “barely healthy” work environment is not ok. You mention that the incivility at your facility all stems from understaffing, and from your examples, I agree. Cooke and Baumbusch (2021) state that peer incivility impacts the delivery of quality care due to the lack of collaboration and cooperation between staff.  Organizations must evaluate their staffing ratios for the good of their employees as well as their patients.

        Your facility offers incentives in attempt to reduce or prevent nursing turnover. I am curious to know why this is a typical “solution” instead of addressing the problem at hand for long-term effects. Leadership must identify effective strategies to retain nurses, their most valuable assets (Duru & Hammoud, 2021). Monetary benefits only place a band-aid on a national healthcare issue. Suitable work environments are essential for better nursing outcomes.

         

         

        References

        Cooke, H. A., & Baumbusch, J. (2020). Not just how many but who is on shift: The impact of workplace incivility and bullying on care delivery in nursing homes. The Gerontologist61(4), 563–572. https://doi.org/10.1093/geront/gnaa203Links to an external site.

        Duru, D., & Hammoud, M. (2021). Identifying effective retention strategies for front-line nurses. Nursing Management29(1), 17–24. https://doi.org/10.7748/nm.2021.e1971Links to an external site.

         Reply to Comment

    • Collapse SubdiscussionSergio Aguirre

      Main Post:

      Dr. Cornell and class,

      Nurses must create and sustain a civil, and health work environment where communication is clear, and conflict is managed in a responsible and respectful way (Clark, 2015). Upon completion of Clark’s Healthy Workplace Inventory survey, my workplace setting had a barely healthy rating of +64. I work in a psychiatric state hospital and this environment, is ran a lot different than acute hospitals in the region. The environment here is influenced by law enforcement, as the state hospital has correctional officers, and its own police department. Our patient population is rough, and has people convicted of crimes, such as murders, rape, and child molestations. I believe that since this is the case, staff gets jaded, and many patients are treated like inmates rather than mentally ill patients.

      Barriers to productive interprofessional collaboration include poor communication, lack of knowledge of other disciplines, and diminished perspectives (Broome & Marshall, 2021). I noticed a lot of neutral and somewhat untrue remarks on my survey. I filled out the survey quickly and objectively as I wanted my gut reaction to be my final answer. In my healthcare organization collaboration between administration and staff is weak, and for the most part non-existent. Protocols tend to change frequently thus policy must be checked daily in order to fulfill duties to administrator’s preference. A lot of the disorganization is due to the fact, that many of our managers are not registered nurses nor have worked in an acute care setting.

      Incivility is a passive-aggressive behavior that has an intent to harm workplace targets such as subordinates, colleagues, and personnel from other departments (Gabriel et al., 2018). An example of unprofessionalism, I encountered in my current position, was a situation when a patient appeared to have a hard fall. When the patient fell, I noticed that none of the other four staff members, in proximity, went to go check on him. After I was done with the task I was working on, I checked on the patient and informed the shift lead that the patient had a hard fall. No sense of urgency was noticed from the shift lead, and when I communicated my concerns to the nurse in charge, she also had a nonchalant attitude. When I respectfully confronted the shift lead about the situation, I expressed to him my concern, and that I was always willing to help. To this day, this particular shift lead has refused to acknowledge or even be courteous with me, when he always used to in the past. This leadership style I consider to be unethical/uncivil, due to impaired communication, pettiness in the workplace, and incompetence. To be honest, I was a little surprised and shocked by the reaction.

      A second example, I would like to provide, is that we haven’t upgraded our COVID-19 policy, as we have outdated quarantine protocols that have not changed from the onset of the pandemic. When a patient in our unit test positive for COVID-19, we transfer them out the unit: one by one, to a COVID isolation unit, rather than isolating them in their rooms or solitary section of the department. Many of staff gets exhausted with the mountain of redundant paperwork that is needed to transfer the patient to the unit literally next door to us. Within a couple of weeks, most of the patients end up testing positive thus slowly trickling down to the next unit. This intervention would be appropriate if we had no vaccines, knowledge of effective handwashing, nor isolation procedures. Staff morale gets down, due to the limited communication and input with administration. This is an unfortunate circumstance, affecting my current healthcare organization, with no end to the problem in sight.

      Although I’ve been direct, and critical about my healthcare organization, it does have potential, and the organization does keep us properly staffed. I believe once we get an electronic health record, we can focus on competency, cultural shift, and professionalism. Currently they are attempting to cut cost, on wasteful spending, and questionable overtime paid to staff. It appears that they are attempting to budget as a private organization would; the state is ran very different, and not necessarily ran like a business. With a mountain of issues, I feel this a step in the right direction, in an organization that is need of a cultural change, training, and a more civil workplace environment.

      Reference

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert

           clinician to influential leader (3rd ed.). Springer.

      Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. Let’s end the

      silence that surrounds incivility. American Nurse Today, 10 (11), 18-23.

      file:///Users/sergio/Desktop/WK%206%20INTERPROFESSIONAL%20CLARKS.pdf

      Gabriel, A. S., Butts, M. M., Yuan, Z., Rosen, R. L., & Sliter, M. T. (2018). Further

      understanding incivility in the workplace: The effects of gender, agency, and communion.

           Journal of Applied Psychology, 103(4), 362–382. https://doi.org/10.1037/apl0000289

       Reply to Comment

        • Collapse SubdiscussionSergio Aguirre

          Hello Dr Cornell,
          To be honest, the workplace survey was interesting. I truly believed the score would have been lower than it was. I’m currently training for a supervisor position, and coincidentally taking this class at the same time. The insight in this class is invaluable, as I don’t feel that I’m a natural leader. I prefer going to work, doing my job, and avoiding the headache. Clark (2015) states competence in civil communication takes time, training, experience, and feedback from colleagues, and mentors. Supervising employees is a science, and very psychological as what works with one person, may not work with another. I’ve learned a lot these last four months, that I’ve been training. One thing I have learned is that active listening, is quite a tool, and may assist with rapport and compliance from staff. Nurses in leadership positions, assist others with new roles, help maintain employee satisfaction, and motivate others to do the best they can (Broome, & Marshall, 2021). Perhaps one day, with practice, and awareness of my strengths, I can achieve a high level of leadership to service employees, colleagues, and community.
          Reference
          Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert 
               clinician to influential leader (3rd ed.). Springer.
          Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. Let’s end the
          silence that surrounds incivility. American Nurse Today, 10 (11), 18-23.
          file:///Users/sergio/Desktop/WK%206%20INTERPROFESSIONAL%20CLARKS.pdf

           Reply to Comment

    • Collapse SubdiscussionDinorah Abigail De La Cerda

      Main Post

      My Clark Work Environment Assessment showed that my workplace is barely healthy, with a score of 55. When taking this assessment, I tried to be as unbiased as possible. I am one of the lucky ones and had favor with direct supervisors; therefore have always felt supported and supported others. I have always worked really hard and have been rewarded for that work. However, this is not the case for the majority of my workplace.
      Recently s lot of nurses have come forward with their grievances, and why they are not happy with the work environment of the ED I work in. This past year the ED had a huge change in management, and we got a new director and manager. Unfortunately, it is taking a while for the staff to get on board with this change. The ED is now uncivil, and incivility fosters unsafe working conditions and poor patient care (Clark et al., 2011). Older nurses in our ED used to get preferential treatment from previous management that they now have come to expect, and since they are being met with resistance, they are bringing bad attitudes along with them. These two or three older nurses tend to make working with them miserable, and it feels like the younger nurses are walking on eggshells around them or are scared of them. No one wants to work understaffed and in an area without mutual respect. The ANA code of Ethics states that to have a safe, ethical environment, we must have civility and treat others with dignity and respect (Clark, 2015). Respect is found to reduce stress and help increase productivity and collaboration, which are necessary to find workplace balance.
      I have always had good experiences in my workplace, but while answering the inventory questions, I realized that the workplace’s wellness was terrible. Staff nurses have poor work distribution, and the load is only sometimes fair. We do not have competitive pay or education opportunities for growth. There are only two hospitals in my city, which is why a lot of nurses stay despite the harmful environment. After completing this assessment, I let the director know my findings, and we are currently looking into ways to motivate and foster a better workplace attitude.

       

      References

      Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice. The Journal of Nursing Administration, 41(7/8), 324–330.

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 (11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

      Ponomareva, A. N. (2022, June 25). Respect in the workplace – why it’s essential for your business. Horizons. https://nhglobalpartners.com/respect-in-the-workplace/#:~:text=Respect%20reduces%20stress%2C%20maximizes%20productivity,spent%20on%20training%20and%20onboarding.

       Reply to Comment

      • Collapse SubdiscussionSergio Aguirre

        Reply post #1
        Hello Dinorah and class, 
        Change is so difficult in the workplace environment, especially in the emergency room setting with new management. According to White et al. (2021) nurse leadership should be aware and educated about maturity differences that come with managing multiple generations in the workforce. Many of us that have been in the nursing profession, have encountered the seasoned nurse who is comfortable working in a particular manner. As you mentioned, some may be very difficult to work with, and may even be toxic to the younger nurses, especially new grads. Nurses must strive to sustain a civil, and healthy work environment, that fosters communication and helps manage conflicts when they arise (Clark, 2015). Although challenging, nurse leadership should have strengths that they can rely on, to promote a healthy work environment for both seasoned, and younger nurses.
        Reference
        Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. Let’s end the
        silence that surrounds incivility. American Nurse Today, 10 (11), 18-23.
        file:///Users/sergio/Desktop/WK%206%20INTERPROFESSIONAL%20CLARKS.pdf
        White, J., Hepworth, G., Alvardo, J., Lemmon, C., & Brijnath, B. (2021). Managing workplace
        change: Intergenerational perspectives from Victorian public hospital nurses, Collegian, 28
        (2), 178-183. https://doi.org/10.1016/j.colegn.2020.06.006.

         Reply to Comment

      • Collapse SubdiscussionMichele Cleary

        Reply #1

         

        Dinorah,

        Your post is all too common. It is vital for a healthy work environment that teams work together; the common goal is appropriate patient care and patient satisfaction. The Clark Work Assessment would rate much higher if we all had more respect for each other and could work together. One problem I see is leadership. Leadership must create an environment of the whole, not the one. Characteristics of a good team include trust (trusting each other), recognizing conflict (not ignoring it, but fixing it), and Commitment to each other and the team, such as respect, accountability, and paying attention to the results (assessing and making changes.) (Walden, 2009). Leadership must foster a positive work environment, leading by example. An effective team magnifies the power of a leader, and the leader who empowers team members expands the capacity of the whole organization at all levels (Broome & Marshall, 2021). It is up to the leader to reduce incivility and promote a healthy environment. Influential leaders can do this by encouraging communication and speaking up when disrespect occurs (Clark, 2015). One of the keys to a successful unit is its leaders. They can make a difference very simply. As said in your post, they are creating a bit of discontent between the older and newer nurses by allowing bad attitudes toward one another. I love that you shared your results with the director. I hope your facility can find ways to improve and create a healthier work environment for all.

        Michele

         

        References:

        Broome, M. & Marshall, E.S. (2021). Transformational leadership in nursing: From expert

                    clinician to influential leader (3rd ed.). New York, NY: Springer.

        Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American

                    Nurse Today, 10 links to an external site. (11), 18-23. Retrieved from https://

        www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-Links to an external site.

        1023.pdf

        Walden University, LLC. (Producer). (2009a). Working with groups and teams. [Video file].

        Baltimore, MD: Author

         Reply to Comment

        • Collapse SubdiscussionPamela Corona Laroya

          Response #1

          Hello Michelle,

          Your discussion post reflects how I appreciate the workplace where I am right now and the leaders of our company. You mentioned your co-worker’s attitude, a nurse that was late every day, very lazy, spent more time trying to find others at fault instead of doing her job, and could have been more kind to patients; this is frustrating. Since one nurse does not do her job as expected.  Incivility is rude or disruptive behaviors that often result in psychological or physiological distress for the people involved. If left unaddressed, it may progress into threatening situations or temporary or permanent illness or injury (Griffin & Clark, 2014). According to Clark (2019), as nurses, we must foster civility and healthy environments to protect patient safety. Addressing uncivil behavior can be difficult, but effective communication, conflict negotiation, and problem-solving are effective strategies. Nurses must focus on the sake of the patient by providing safe, effective patient care and communicating respectfully with each other (Clark, 2015). Effective communication among nurses is fundamental to patient safety, patient satisfaction, and excellent care, and a healthy work environment produces better patient outcomes and happier staff members (Broome & Marshall, 2021).

           

          References:

          Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

          Clark, C. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44 (2), 64-68. Doi: 10.1097/NNE.0000000000000563.

          Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

          Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: The Journal of Continuing Education in Nursing, 45(12), 535-542. https://doi.org/10.3928/00220124-20141122-02Links to an external site.

           

           

           

           Reply to Comment

    • Collapse SubdiscussionNavtej P Singh

      The Clark Healthy Workplace Inventory’s findings showed that my workplace’s civility is unhealthy, scoring 51 (Clark, 2015). I was not very surprised by this result because specific issues are evident to the bare eye, but it is a secondary priority for the management. Uncivil workplaces generally start with upper management due to the leaders’ lack of skill and competence. My workplace is a state-owned psychiatric hospital, and the upper management is changed with new leadership in the state capitol. After an election or serious issues arise, we are in the news. In both instances, new leadership is brought in to fix the hospital. I have been with the hospital for about 15 years and have seen 7 CEOs with entirely different leadership styles, from Laissez-Faire to complete autocrats (Broome & Marshall, 2020).

      Another reason for this hospital to be uncivil is the internal turf war between clinical and psychological staff. CEOs are usually psychology people or political and tend to favor psychology in general. The nursing staff brings their issues to their chain of command, and nursing leadership is not supported by upper management, thus making nurses angry at nursing management, further deteriorating the nursing leadership’s position because they think that nursing leadership is not in touch with their nurses. This is a vicious cycle; nurse leaders resort to punitive methods to fix nurses, and this causes serious staffing issues via turnover. I was yelled at by our CNO when I questioned the validity of temp checks at the door during Covid-19. The hospital is large, and staff walks outside from their vehicles to the entrance. I told them I was either hypothermic in winter and with seriously high temperatures in summer and no one at the gate cared because they knew that temps were incorrect because of the outside environment. I was told to shut up and follow the policy. Our hospital wasted an average of 10 people 24 hours a day for 2.5 years and did not find a single person with an elevated temp that was asked to leave the monitoring station. This type of behavior by upper management increases stress and disengages nurses from bringing the issues to upper management, thus impacting the quality of care for the worse (Griffin & Clark,2015).

      It was in a meeting where upper management was present, and it seemed that CEO’s office enjoyed the clinical staff fighting on the issue that CEO’s office mandated. I believe it was never addressed, at least that I knew of. I have seen more Chief Nursing officers fired from jobs than CEOs because they cannot control their nurses. I work with the union, and no staff can be terminated without Just cause. We have 18 nurses reassigned away from patient care areas for investigations. This a become an intimidation tactic for managing to accuse staff and keep them away but continue to pay.  Last 3 months hospital reassigned nurses for multiple reasons, and only 8% were given oral reprimands, and the rest were allowed to return to work without any discipline. Communication breaks and lack of clear education on teamwork keep our hospital behind.

       

      References:

      Broome, M. E., & Marshall, E. S. (2020). Transformational Leadership in Nursing: From Expert

      Clinician to Influential Leader. Springer Publishing Company.

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse

      Today10(11), 18-23.

      Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility

      and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing45(12), 535-542.

       Reply to Comment

      • Collapse SubdiscussionMarrisa Montano-White

        Marrisa Montano-White

        January 12, 2023

        Module 4 Discussion

        Colleague Response 1

        Hello Navtej,

        I am sorry you have experienced so much incivility in your workplace. It is truly disheartening to hear how so many healthcare facilities fail to listen to their nurses when they attempt to speak up in the best interest of patient care. According to Griffin and Clark (2014), workplace incivility has devastating and lasting effects, such as affecting employees’ physical and mental health, job satisfaction, productivity, and commitment which ultimately is very costly. Unfortunately, you have seen these effects at your workplace due to incivility in your leadership.

        Importance of Nurse Leadership

        You mention the constant turnover of nurse leadership in your workplace, such as seven new CEOs over 15 years. In addition to having unstable leadership, you have what would be considered toxic leadership. According to Farghaly Abdelaliem and Abou Zeif (2023), toxic leadership is negative leadership that involves systematic and destructive behavior that harms individuals and organizations by demeaning, belittling, and discouraging employees in addition to being rude, threatening, not listening, and micromanaging. Having toxic leaders is costly in the long run, causing wasted time, high turnover, and decreased patient satisfaction. Finding consistent strong leadership is the key to attracting and maintaining quality employees, improving morale and productivity, improving patient satisfaction, and saving organizations money.

        References

        Farghaly Abdelaliem, S. M., & Abou Zeid, M. A. G. (2023). The relationship between toxic leadership and organizational

        performance: the mediating effect of nurses’ silence. BMC Nursing22(1), 1–12. https://doi.org/10.1186/s12912-022-Links to an external site.

               01167-8Links to an external site.

        Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence inLinks to an external site.

                nursing: 10 years laterLinks to an external site.Journal of Continuing Education in Nursing, 45(12), 535–542.

         Reply to Comment

      • Collapse SubdiscussionKatie Saletel

        Response #2

        Navtej, I’m saddened to read about such a tumultuous hostile workplace.  I’m curious about your reasons for staying 15 years, not because I think it is terrible that you’ve stayed but because I am interested.  Psychiatric facilities are so limited throughout the world; I commend you for working to care for psychiatric patients.  The incivility and unjust culture for staff and patients sadden me for you, your coworkers, and your patients.  Phillips et al. (2018), through an integrative review, demonstrate the failure of the systems thinking approach to the safety of staff and patients will break down the safety of all through unsafe staffing and errors in patient care, which can be fatal.

        Allowing incivility throughout the organization can cause the organization more financial strife than necessary as onboarding frequently due to a revolving door of employee resignation, challenges in recruitment and retention as other healthcare workers have heard of the work dynamics and choose not to work in that type of environment (Griffin & Clark, 2014).  Accrediting bodies are linking quality improvement benchmarking to workplace discourse that carries over to reimbursements as insurance companies shift to value-based reimbursements.  This will continue to challenge organizations to find healthy and impactful training for everyone to create a culture of civility and respect toward each other.  This will carry over to safe and meaningful patient care.

        Effective communication is vital in any situation, and I found Clark (2019) describes cognitive rehearsal as an impactful exercise in learning essential communication skills that are rehearsed and practiced in a place that is safe for the group or two people to rehearse and develop muscle memory in approaching incivility and lateral aggressive type behavior.  You could use this as a suggestion in your presentation to the administration for the week nine assignment.  Thank you again for sharing, and I’m sorry you’ve had to endure so many years of incivility.

        References

        Clark, C. (2019). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44 (2), 64-68. https://doi.org/10.1097/NNE.0000000000000563Links to an external site.

        Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542. https://doi.org/10.3928/00220124-20141122-02Links to an external site.

        Phillips, J. M., Stalter, A. M., Winegardner, S., Wiggs, C., & Jauch, A. (2018). Systems thinking and incivility in nursing practice: An integrative review. Nursing Forum53(3), 286–298. https://doi.org/10.1111/nuf.12250Links to an external site.

         Reply to Comment

    • Collapse SubdiscussionTammy Young

      It is well known that the stressors placed on healthcare professionals create challenges to maintaining a positive, civil work environment. The types and frequency of incivility are increasing and have become a significant problem among healthcare professionals (Clark et al., 2011). It is essential that those members find effective ways to work through the stress and communicate professionally. To deliver safe, high-quality patient care, it is essential to maintain a civil, healthy environment to manage differences of opinion respectfully (Clark, 2015).

      Results of Work Environment Assessment

      Based on the Clark Work Environment Assessment, my workplace rated at the very low end of unhealthy, at 51 (Clark, 2015). Many factors in the healthcare environment, such as poor communication, lack of knowledge of other roles, and the need for training in team function, lead to an unhealthy workplace ( Broome & Marshall, 2021). The weakest aspects of the office environment were related to the need for a shared vision of trust, respect, and collegiality. Employees do not feel a common bond with each other or with the facility’s mission. In addition, the level of employee satisfaction and morale was rated at the lowest rating. Staffing issues and a weak administration have contributed to rapidly descending employee satisfaction, according to employee surveys. The workplace rated poorly in joint decision-making and policy development. One area identified as a significant weakness is in mentoring or training. Employees voice their lack of confidence in performing tasks as there needs to be more training. Also, disputes among staff are handled in an unprofessional manner in front of patients or other staff members.

      Workplace incivility is widely reported in nursing. One study showed that 85% of nurses reported workplace incivility, and 37% indicated they instigated incivility toward others (Wei et al., 2018).

      Based on the Work Environment Assessment, my workplace is not a civil work environment. The office lacks civility in many ways. Team members feel they need to be treated more respectfully and fairly. A lack of effective conflict resolution leads to incivility and a lack of loyalty. The employees do not share a common commitment or trust in the management. The overall lack of effective leadership resonates throughout the environment, and the effects are apparent in the rapid turnover of employees. Patients make complaints stating they feel the staff is inconsiderate and inattentive.

      Shortly after starting at my current job, I was faced with an incident where a clerical staff member misunderstood something that I said about another clinical co-worker. The clerical member took this misinformation to the clinical employee. Unfortunately, that employee became enraged, sought me out, and began shouting at me and threating to hurt me. The incident took place in a patient care area, in front of other employees.  I was so surprised that I stood silently in awe.

      Later she and I were called into the manager’s office and told we really needed to work out our differences. My attempt to discover what prompted the outburst was dismissed, and I was unaware of the reason for several months until another co-worker made me aware. That employee never received any consequences for her actions, and I was never given any opportunity to address the incident. The manager’s decision to ignore this employee’s abusive language and threats left me feeling completely unsupported. In addition, the other employees were aware of the situation, including that there was no repercussion for her behavior. This set a tone of tolerance for bullying and abuse.

       

       

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.).

       

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 Links to an external site.Links to an external site.(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

       

      Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice Links to an external site.Links to an external site.The Journal of Nursing Administration, 41(7/8), 324–330.

      Wei, H., Sewell, K. A., Woody, G., & Rose, M. A. (2018). The state of the science of nurse work environments in the United States: A systematic review. International Journal of Nursing Sciences5(3), 287–300. https://doi.org/10.1016/j.ijnss.2018.04.010Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionJulie Robinson

    Hello Dr. Cornell and class,

    Based on the Work Environment Assessment, my organization scores an 80 making my organization moderately healthy. My organization is civil. That might be due to the policies and procedures that we have in place about incivility. Our mission and values of the organization pride us in treating others with respect. Our organization encourages colleagues to report all incidents of harassment or violations of this policy. If a colleague experiences any job-related harassment based on race, color, religion, sex, gender, national origin, age, pregnancy, disability, sexual orientation, gender identity or expression, genetic information or protected veteran status, or status in any group protected by federal, state or local law; believe that they have experienced job-related harassment or were treated in an unlawful, discriminatory manner; or experiences disrespectful behavior, this includes incivility, the colleague should promptly report the incident to their supervisor and Human Resources, who will investigate the matter and take appropriate action. Without effective decision-making and communication, no networking can be done (Broome & Marshall, 2021).

    I, unfortunately, have experienced incivility in the workplace. Not at my current organization but at a previous workplace. A few years back, I was precepted in an emergency room. I was a new graduate. According to a limited but growing body of data, rudeness and disruptive behavior are especially frequent among newly graduated nurses and nursing students in the clinical context (Clark et al., 2011). I am familiar with emergency care, considering I have about 15 years of EMS medic experience. I am not about to preach about age, but my preceptor was about 20 years younger than me and kept making comments about how slow and old I was and how I would never make it as a nurse.

    Incivility is defined as unkind or disturbing behaviors that frequently cause physiological or psychological distress for the individuals involved (including targets, offenders, bystanders, peers, stakeholders, and organizations). If these behaviors are not addressed, they may develop into threatening situations or even result in short- or long-term illness or injury (Griffin & Clark, 2014). Many more comments were made to me, but those were the nicest ones I could put here on this discussion board. And those reading this are probably wondering why she did not speak to management. Well, the answer is yes, I did three times. I was told I was not giving the preceptor a chance and that I needed to speak with the preceptor about the comments. I talked to the preceptor, and the words got worse when I did. I got to where I could not sleep and was constantly sick. I kept thinking to myself, I was trying to give this a chance, but my heart said that was enough, so I quickly quit. Before I left, I typed a note and sent it to human recourse and the ethics committee. They couldn’t pay me enough to go back to that facility.

    To ensure the safety of their patients, nurses have a moral and professional commitment to promote respect and wholesome working conditions (Clark, 2018). To this day, I have never forgotten that facility and how I was treated. When it comes to incivility or education about it, I share my story. It needs to be heard. You will learn about conflict resolution, communication, and decision-making during your career; therefore, you must be willing to pass what you know to others (Broome & Marshall, 2021). I love my current facility. They do not tolerate incivility, and we treat nursing students equally. It is a learning experience, not a domination of intelligence. Everyone has their strengths, but the best strength is taking the time to teach others.

    I want to take a second to say thank you for letting me share my story. I genuinely appreciate it. I hope you all have a wonderful day.

     

    References

    Broome, M., & Marshall, E. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer       Publishing Company.

    Clark, C. M. (2018). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator44(2),     64–68. https://doi.org/10.1097/nne.0000000000000563Links to an external site.

    Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice. JONA: The Journal of     Nursing Administration41(7/8), 324–330. https://doi.org/10.1097/nna.0b013e31822509c4Links to an external site.

    Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10     years later. The Journal of Continuing Education in Nursing45(12), 535–542. https://doi.org/10.3928/00220124-20141122-02Links to an external site.

     Reply to Comment

    • Collapse SubdiscussionIris Cornell

      Response from the instructor 

       

      Julie thanks for sharing. Incivil behavior does, in some instances, create the victim to worry more, avoid the bully, withdraw from work, and sometimes make them so angry they take their frustrations out on others (Porath & Pearson, 2013). Bad behavior needs to be corrected. However, as Porath and Pearson (2013) said, some organizations avoid taking action, and sometimes many incidents go unreported because the staff knows nothing will be done. Does the staff feel comfortable reporting such behaviors? Is there a policy of zero tolerance for such behaviors?

      Reference

      Porath, C. L., & Pearson, C. (2013). The price of incivility. Harvard Business Review, 91(1–2), 115–121. https://qualitymanagementinstitute.com/images/hrsolutions/HBR-ThePriceofIncivility.pdfLinks to an external site.

       Reply to Comment

      • Collapse SubdiscussionJulie Robinson

        Hello Dr. Cornell and class,

        Thank you for your questions. The staff feels comfortable reporting such behaviors, and a zero policy is in place. Protections for confidentiality shall be used when resolving complaints. If it is found that this policy was broken, the offending coworker will face appropriate disciplinary action, up to and including termination of employment. The level of discipline imposed as a result of an investigation, however, is usually a private matter between the employer and the employee who will be disciplined, and it cannot be disclosed to third parties. It is strictly forbidden to retaliate against a coworker who makes a good faith complaint by this policy or helps investigate a complaint, even if the inquiry lacks evidence to back up the claim. Because safe patient care may depend on these crucial abilities, incivility in the healthcare industry must be appropriately addressed (Clark, 2018). Our organization is built on a platform of inclusiveness, compassion, and respect for our patients and one another is the cornerstone of special treatment. Our organization practices this to avoid increased stress levels, physical and mental distress, job discontent, poor performance, and an intention to quit are all effects of impolite behavior (Clark et al., 2011).

        Thank you for your questions again. I appreciate your feedback. I hope you have a great day.

         

        References

        Clark, C. M. (2018). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator,             44(2), 64–68. https://doi.org/10.1097/nne.0000000000000563Links to an external site.

        Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice. JONA: The Journal of              Nursing Administration41(7/8), 324–330. https://doi.org/10.1097/nna.0b013e31822509c4Links to an external site.

         Reply to Comment

        • Collapse SubdiscussionJulie Robinson

          Dr. Cornell,

          I don’t know what happened to the settings here, but the references are below.

          References

          Clark, C. M. (2018). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator44(2), 64–68. https://doi.org/10.1097/nne.0000000000000563

          Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice. JONA: The Journal of Nursing Administration, 41(7/8), 324–330. https://doi.org/10.1097/nna.0b013e31822509c4

           Reply to Comment

    • Collapse SubdiscussionJeanne Baleng Okuwobi

       Hello Julie,

      Your discussion on incivility in nursing is spot on. Nurses believe that “they have to eat their young ”; however, it is horrible to be bullied at your workplace because it makes a person’s performance worse, and creates emotional and mental distress. I resigned from my first job as a nurse because I was  being targeted by one charge nurse, who complained about me to the manager every single time we worked together, and the manager believed her, he called me to his office every morning after my shift to reprimand me. I still do not understand how he did not see that she was just being a bully.  I became very insecure, and even scared of going to work because she requested that my schedule should  be the same as hers, now I had to work with her all the time. I was terrified about making mistakes. According to the American association of critical care nurses, Creating a healthy work environment enables nurses to provide the highest quality and compassionate patient care while being fulfilled at work, leading to a high staff retention rate. (Aacn.org, 2022). Thus, nurses are at higher risk of  making mistakes in poor work environments.

      I  was still in the residency program for new graduates and wanted to complete that, and I resigned the very same day that I graduated from the program.  Many other people have complained and resigned from that unit because of bullying, and nothing was being done. I was too scared to complain to HR and others. According to Griffin, “workplace incivility can negatively impact employee physical and mental health, job satisfaction, productivity, and commitment to the work environment. In addition, workplace incivility also creates a heavy financial burden for health care organizations because they have to constantly hire a train new staff” (Griffin & Clark, 2014)

       

      References

       

      Aacn.org. (2022).  Accesses  from https://www.aacn.org/nursing-excellence/healthy-work-environments#:~:text=Research%20shows%20that%20a%20healthy,while%20being%20fulfilled%20at%20work.

      Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542. doi:https://doi.org/10.3928/00220124-2014112

       Reply to Comment

    • Collapse SubdiscussionDallas Wilcox

      Week 7 Response #2: Julie Robinson

      Julie, I was saddened to read about your experience with incivility in the workplace, but you brought up great points throughout your discussion.

      While reading about your negative ER preceptorship experience, I recalled the information in one of the articles assigned for our weekly readings. Hostility and negative work behaviors can be learned in academic and/or clinical settings (Clark, 2015). To address this type of behavior, leadership needs to take action quickly to ensure it does not spiral. St. Catherine University (2021) explains that leadership needs to acknowledge a problem, encourage reporting, and quickly respond to reports of bullying to let staff know the complaints are taken seriously.

      It was disheartening to read that even though you took the necessary steps and reported the behaviors, they were not handled. Moody (2022) explained an important aspect of involving HR is keeping detailed documentation of the harassment and/or bullying that has or is occurring. HR has to build a case before interventions are taken, so thorough and detailed documentation of the events is crucial.

      I want to say I am so sorry you experienced such a horrible preceptor throughout your ER experience. I, too, have similar ER experiences and have made a conscious effort to support any preceptee I can now to ensure they do not have to go through the same experiences I did. I hope you can take those experiences you had and advocate for any new nurse that may be going through that as well. Here is to a better and bullying-free nursing profession!

       

      References

      Clark, C. (2015). Conversations to Inspire and Promote a More Civil Workplace. American Nurse Today10(11).

      Moody, J. (2022, August 25). Bullying in nurses: Why it happens and how it can be stamped out for good. Post University. https://post.edu/blog/nurse-bullying-why-it-happens/

      Nurse bullying: Why it happens and how to prevent it. St. Catherine University. (2021, December 17). https://www.stkate.edu/academics/healthcare-degrees/nurse-bullying

       

       Reply to Comment

    • Collapse SubdiscussionTammy Young

      Julie, I appreciated your perspective n workplace incivility and creating a healthy environment.

      Workplace incivility and burnout result in poorer mental health and higher turnover rates among nurses. Nurses report higher levels of workplace incivility and bullying compared to other healthcare professionals despite nursing codes of conduct outlining zero tolerance for bullying and harassment (Ota et al., 2022).

       

      I applaud your organization for scoring an 80 on the Work Environment Assessment. I agree that it is vital that a workplace has policies regarding bullying and that they enforce those regulations. The medical office where I work is owned and operated by a large medical organization with policies against bullying and discrimination. However, all too often, I witness an incident involving bullying that is brushed aside and considered insignificant. While I understand that addressing uncivil behavior can be difficult, not addressing or minimizing the problem can increase employee dissatisfaction and create an acceptance of incivility (Kroning & Annunziato, 2023). I agree that effective decision-making and communication are vital to encouraging a healthy workplace and civility. Positive leadership is essential in working to promote good communication among staff.

       

      Stressors placed on healthcare professionals create challenges to maintaining a positive, civil work environment. However, all healthcare workers must take responsibility for learning how to navigate these stressors while maintaining a workplace environment that is healthy and operates with civility (Clark, 2015). It is important that any form of incivility in healthcare settings is addressed and removed to encourage a positive culture. Hospital and nursing managers should make it a priority to create an environment where employees feel safe in reporting any incivility in the workplace ( Kroning, & Annunziato, 2023).

       

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 Links to an external site.Links to an external site.(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

      Kroning, M. & Annunziato, S. (2023). New strategies to combat workplace incivility and promote joy. Nursing, 53 (1), 45-50. doi: 10.1097/01.NURSE.0000891960.69075.73. https://oce.ovid.com/article/00152193-202301000-00013/HTMLLinks to an external site.

       

      Ota, M., Lam, L., Gilbert, J., & Hills, D. (2022). Nurse leadership in promoting and supporting civility in health care settings: A scoping review. Journal of Nursing Management, 30( 8), 4221– 4233. https://doi.org/10.1111/jonm.13883Links to an external site.

       Reply to Comment

    • Collapse SubdiscussionMichele Cleary

      Wow, Julie.  Your story reminds me of one when I was in nursing school. It was our last semester, and we were rotating through other departments. I was assigned to the OR. I heard about the nurse there and how mean and rude she was to nursing students. She was not quite mean to me but was far from friendly. We took lunch at the same time and were at the same table, about 4 feet apart. I asked her if she minded if I asked her a question during her lunch or if she would prefer when she was back on the clock. She said it would be ok to ask now, and I asked her why some of the nurses we looked up to and respected were so mean to nurse students. Wouldn’t nurses want to teach us and help us be great nurses so we can complement their care?  I told her how much we valued their/her knowledge and experience. From that moment on, she took an active role in being more helpful. It is true nurses eat their young, and I never understood why. Maybe people need a gentle reminder of how they are acting and how acting positively could benefit everyone. Speaking up and addressing incivility when it happens can be the most effective way to stop it (Clark, 2015). Younger nurses don’t understand what value EXPERIENCE has over any textbook. It is vital that our nursing leaders stop incivility and make sure that it is NEVER tolerated (like at your new job). Nursing leadership is critical in stopping or controlling incivility (Broome & Marshall, 2021).

      Thanks for sharing your post,

      Michele

       

       

      References:

      Broome, M. & Marshall, E.S. (2021). Transformational leadership in nursing: From expert

                  clinician to influential leader (3rd ed.). New York, NY: Springer.

       

      Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American

                  Nurse Today, 10 links to an external site. (11), 18-23. Retrieved from https://

      www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-Links to an external site.

      1023.pdf

       Reply to Comment

  • Collapse SubdiscussionElin Danelian

    Main Post

    Workplace Environment Assessment

    The workplace environment can be used to evaluate productivity levels and job quality. Nurses must promote a civil and ethical workplace by cultivating a caring, courteous, respectful, and dignified atmosphere (Clark, 2015). A successful organization is made up of dedicated individuals with a clear mission and vision and effective techniques. The team, management, and leadership play a major role in this. Incivility can include unpleasant, rude, disrespectful, and other actions that go against social expectations (Broome & Marshall, 2021).

    Using the Clark Healthy Workplace Inventory, my workplace ranks at 75. Based on this score, it is considered to be a moderately healthy work environment. Based on the findings, it appears that my organization has an open culture and that administrators routinely accept fresh ideas from employees. The nurses adhere to the same mission and vision, there is mutual respect and trust among the staff, and there is open communication at all levels. The results include the presence of teamwork and collaboration. However, the part where the assessment did not score high is that the organization does not distribute the workload equally and the organization does not offer competitive salaries. I have experienced incivility because of short staffing. There are several factors that indicate an uncivil workplace environment in my organization that I was surprised that it scored at moderately healthy. Those aspects include short staffing, increased workload and burn out for the nurses. Incivility at work has a detrimental impact on employee satisfaction, which raises turnover rates (Namin et al., 2022).  If these issues are resolved, the workplace environment at the site will significantly improve. When there are staffing shortages, the nursing staff does not feel valued. In this situation, individuals experience a lack of value, which lowers their motivation for the facility to develop and succeed.

    I have experienced incivility during high census times in my organization. For example, during the pandemic and now during the high flu season. Incivility was experienced with management and the administration staff. Our manager and administrators fail to recognize the increased workload and stress they have caused, especially in these last couple of months. Our organization built a new emergency department that was significantly bigger than the old one. The hospital units and staff remained the same, however the emergency department hired more nurses to be able to see more patients than before. The administrators did not realize the repercussions that came along with building a bigger ER, this resulted in admitting more patients that the units and staff can handle. The managers push nurses to discharge and transfer patients to make room for new admissions. This makes it unsafe for patients and it lacks respect for nurses. It increases an unethical standard of care and causes more stress for the nurses. Lack of appreciation for the work or efforts of others is a sign of poor work ethics. A healthcare facility’s lack of civility can result in dangerous working circumstances and endanger patient safety. To address this issue, our unit stewards have reached out to our union and now they are in discussion with the hospital administration to find a solution to these issues that cause incivility.

    References

    Broome, M., & Marshall, E. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 (11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

    Namin, B., Ogaard, T., & Roislien, J. (2022). Workplace Incivility and Turnover Intention in Organizations: A Meta-Analytic Review. International Journal of Environmental Research and Public Health, 19(1), 25. https://doi.org/10.3390/ijerph19010025

     Reply to Comment

      • Collapse SubdiscussionElin Danelian

        Response 1

        Hello Dr. Cornell,

        Thank you for your response and question. I believe sharing the workplace environment with my unit would be extremely beneficial. A successful organization is made up of dedicated individuals with a clear mission and vision and effective techniques. The team, management, and leadership play a major role in this. The incorporation of the workplace environment assessment would provide a larger viewpoint and assist to put things into perspective. The effectiveness of teamwork has a direct impact on how well and safely care is delivered (Rosen et al., 2019). Doing this assessment as a unit and implementing changes would greatly increase teamwork and job satisfaction. Low levels of employee engagement, satisfaction, and morale have a negative effect on the workplace at the institution (Khan et al., 2021). The workplace assessment completed by the employees will provide the managers with an outlook of what changes need to be worked on. If those issues are resolved, it will result in an improved workplace environment.

        References

        Khan, M., Elahi, N., & Abid, G. (2021). Workplace Incivility and Job Satisfaction: Mediation of Subjective Well-Being and Moderation of Forgiveness Climate in Health Care Sector. European Journal of Investigation in Health, Psychology and Education, 11(4), 1107-1119. https://doi.org/10.3390/ejihpe11040082

        Rosen, M., Diaz, D., Dietz, A., Benishek, L., Thompson, D., Pronovost, P. & Weaver, S. (2019). Teamwork in Healthcare: Key Discoveries Enabling Safer, High-Quality Care. American Psychologist, 73(4), 433–450. https://doi.org/10.1037/amp0000298

         Reply to Comment

    • Collapse SubdiscussionJulie Robinson

      Hello Elin and class,

      Thank you for your post. I agree with you that nurses do need to promote incivility. Additionally, workplace rudeness places a significant financial strain on healthcare companies (Griffin & Clark, 2014). That is why we must all make an effort to establish and maintain respectful, responsible conflict management practices as well as clear and compelling lines of communication within our workplaces (Clark, 2015).

      I am sorry that you have experienced incivility at work. It is indeed not fun, funny, or pleasant. I, too, have experienced the same. The most important thing is that we have learned from it and know what to look for in the future. Throughout your work, you will encounter lessons in decision-making, communication, and conflict resolution; thus, you must be eager to impart what you have learned to others (Broome & Marshall, 2021).

      Thank you for sharing your post. I enjoyed the read. I hope you have a good day.

       

      References

      Broome, M., & Marshall, E. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 (11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

      Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing45(12), 535–542. https://doi.org/10.3928/00220124-20141122-02Links to an external site.

       

       Reply to Comment

    • Collapse SubdiscussionJeanne Baleng Okuwobi

      Hello Elin

      There are lots of incivilities from management to nurses because management often has these unrealistic expectations, and they  expects nurses to fulfill these agendas without consideration on  the hardships  that we experience. That is due to the lack of emotional intelligence because they lack empathy. According to a source online, “Emotional intelligence in nursing is the ability of a leader/nurse to understand, use, and manage their emotions in ways that promote effective communication, empathy for others, conflict resolution, and stress reduction” ( 12 simple tips, 2023).  Management needs to put themselves in our shoes and realize they putting too many expectations/demands on bedside nurses. Covid 19 might not be as scary as it once was, but we still have units in hospitals filled up with Covid patients, Flu, and others; however, there is not enough staff to assist, which leads to more stress for the working nurses because their workload is unsafe. According to the Nurse Journal, “There are many challenges that cause nurses to leave the field of nursing, however, one of the recent common ones is the mentality that nurses need to take one for the team” ( How to cope, 2022) Nurses need to speak up and stand up for themselves because we take one for the team every day, it’s endless, and it affects us physically, emotionally, and mentally.

       

      References

      Conversations more civil workplace – American nurse. (2015).  Accessed from https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

      How to cope with the challenges faced by working nurses today. NurseJournal. (2022, August 2). Accessed from https://nursejournal.org/articles/top-challenges-faced-by-working-nurses/

      12 simple tips to improve emotional intelligence in nursing. ( 2023.).  Accessed from https://www.nursingprocess.org/emotional-intelligence-nursing.html#:~:text=Emotional%20intelligence%20in%20nursing%20is,conflict%20resolution%2C%20and%20stress%20reduction.

       

       Reply to Comment

    • Collapse SubdiscussionTiffany Johnson

                                               Workplace Environment Assessment Response 1

      Hi Elin,

                Thank you for your post. I can completely identify with your concerns in your facility. We have done something similar at my facility. We built a new robotics center without increasing staffing. Every January the finance department within out company lowers our productivity numbers. This means the expectation is to do more with less. The nurse at Vanderbilt that made a fatal medication error is a prime example of how environments can wreak havoc on nursing. The system failed the nurse and the patient. In many facilities, nurses are hesitant to report medication errors for fear of retaliation from leadership and lack of confidence from coworkers (Covell, 2010). Patients are provided safer care when the nurses feel safe and supported to report a mistake. A nursing school created a council “diversity, equity, and civility” to help nursing students learn how to cope with what to expect once out in the nursing world (Lee & Miller, 2022). This would be a great asset to many facilities to help create a culture of trust and belonging which would improve staff satisfaction and create better outcomes for the patients.

                                                                               References

      Covell, C. L. (2010). Can civility in nursing work environments improve medication safety? JONA: The Journal of Nursing Administration40(7/8), 300–301. https://doi.org/10.1097/nna.0b013e3181e93733Links to an external site.

      Lee, S., & Miller, K. (2022). Developing a diversity, equity, and civility council to advance health equity in nursing academia and practice. Nursing Administration Quarterly46(3), E16–E23. https://doi.org/10.1097/naq.0000000000000528Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionJessica Slavin

    WK7 Main Post

    Unfortunately, the results of the Workplace Environment Assessment did not surprise me. After answering the inventory questions, my score totaled 51 giving an “unhealthy” result.  My current healthcare facility recently through a union vote that caused a great divide between formal leadership and the nursing staff. The week of the vote, workplace incivility and tension could be felt throughout every hallway you walked down. Safe patient care hinges on the ability to cope with stress effectively, manage emotions, and communicate respectfully (Clark, 2015). The pandemic was a game changer for everyone, but it mightily impacted nursing safety in multiple facets of healthcare. Patient-to-staff ratios, shift mandates, and late schedule changes were all the concerns voiced to human resources by nurses at my current employment before forming a union vote, but just this week a video update was sent out voicing the need to continue extra shift mandates for all direct care nursing staff and critical staffing bonuses were coming to an end now that covid relief funds were no longer being received.

    Workplace incivility is a well-documented issue in nursing. It has the potential to cause emotional and physical distress in victims, and potentially affect the quality of care provided. Disrespectful and uncivil behaviors in healthcare settings can have detrimental effects on individuals, teams, organizations, and patient safety including life-threatening mistakes, preventable complications, or harm to a patient (Clark, 2019). The ANA code of ethics stands true to its word of supporting nurses in having a moral obligation and ethical imperative to create and sustain healthy work environments, but unfortunately in my experience administrators have a lack of respect for their core values as an organization.
    Having an effective team is important to promote a forward-thinking culture (Broome & Marshall, 2021, p. 217). A large part of the job of any leader is to build a strong support team that includes providing a clear vision and giving a sense of community to an organization. Future goals for my organization as a nurse practitioner are to recruit stronger leaders that can collaborate and have the same vision for our current and future nurses so that they feel more supported in the safety of their practice and are given a stronger sense of civility in the workplace.

    References
    Broome, M. E., & Marshall, E. (2021). Transformational leadership in nursing: from expert clinician to influential leader (3rd ed.). Springer Publishing Company.
    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 Links to an external site. (11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf
    Clark, C. M. (2019). Fostering a culture of civility and respect in nursing. Journal of Nursing Regulation, 10(1), 44–52. https://doi.org/10.1016/s2155-8256(19)30082-1

     

     Reply to Comment

      • Collapse SubdiscussionJessica Slavin

        Response #1

        Dr. Cornell,
        Sustaining healthy work environments is a multidimensional activity that leadership has identified as an integral aspect of achieving this aim. A healthy work environment requires the support of nurse leaders who authentically strive toward, and engage others in its development and sustainment. The AACN Standards for Establishing and Sustaining Healthy Work Environments identify 6 essential standards for HWEs: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership (Dimino et al., 2021)
        Workload and stress are also two key factors that cause unhealthy work environments, especially in nursing. Having a mature emotionally intelligent nurse manager is said to play a huge role in the difference between a healthy work environment and the stability of staff members. Significance being 2nd highest on my Clifton Strengths assessment was admirable to me from a leadership perspective. The need to feel admired as credible, professional, and successful and also wanting to associate with others who are credible, professional, and successful (Rath, 2007) are all qualities any management team would want to see from a leader who is trying to improve workplace civility.

        References

        Dimino, K., Learmonth, A. E., & Fajardo, C. C. (2021). Nurse managers leading the way: Reenvisioning stress to maintain healthy work environments. Critical Care Nurse, e1–e7. https://doi.org/10.4037/ccn2021463Links to an external site.

        Rath, T. (2007). Strengths Finder 2.0. GALLUP Press.

         Reply to Comment

    • Collapse SubdiscussionHannah Timmer

      Hi Jessica,

      I enjoyed reading your post and getting an idea of what you are working with. The last facility I worked at also tried starting a union for the nursing staff. This brought out the worst in our workers, our leadership, and even the hospital president; it created this divide that made work unenjoyable and toxic to the point where I began searching for new jobs. This divide among leadership factored into so much more than a union; it began to affect our patients, their safety, and even the nurse’s safety. It got out of hand and showed what leadership should not be. A key indication for healthcare companies that can aid in enhancing patient outcomes, nurse job satisfaction, and care quality is transformational leadership. Top management should cultivate transformational leadership behaviors among nurse managers/leaders and create such environments with empowerment and autonomy to support their follower nurses to prevent harmful events in healthcare organizations. This will enhance the quality of care and lead to the desired results (Asif et al.,2019).

      In your case, a starting solution to the many issues could have been a survey passed out amongst the staff that asked what was going wrong and analyzed what they could do better to avoid having a union. Getting anonymous surveys from staff going to leadership can give a good insight into the issue leadership might be blind to. Often, someone in a leadership role is not out on the floor caring for patients like we are, so they genuinely do not know what is happening on the floor. Once they see the survey results and how many nurses the same concerns have, issues can be addressed, and solutions can be formed with leadership and nurses. Including both parties in the solution facilitates a healthier relationship and allows for trust development. Addressing conflict in a welcoming climate can aid organizational growth (Broome & Marshall, 2021). Of course, all of this is easier said than done, but it takes small steps in the right direction to resolve conflict.

       

       

      Asif, M., Jameel, A., Hussain, A., Hwang, J., & Sahito, N. (2019). Linking Transformational       Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care:    Assessing the Role of Job Satisfaction and Structural Empowerment. International           journal of environmental research and public health16(13), 2381.     https://doi.org/10.3390/ijerph16132381Links to an external site.

       

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert       clinician to influential leader (3rd ed.). Springer.

       Reply to Comment

    • Collapse SubdiscussionSergio Aguirre

      Reply Post: #2

      Hello Jessica,

      Broome and Marshall (2015) recognize that a complex environment of healthcare must develop effective strategies to guide nurses, and patients through chaos and ambivalence. Your post was interesting to read, as the forming of a union is something I’ve never experienced. But good for you guys, as there are many advantages to having one, in particular pay and holding management accountable. At my last union job, in the emergency room, we could not get out of ratio, especially with ICUs; once we got a critical patient, they would immediately take them away from us, to preserve agreed upon ratio. Depending on where in the states, you live, and political climate, I can see how the forming of a union could be controversial. According to Clark (2015), it’s the nurse’s obligation to promote a safe, ethical, and civil workplace. As you mentioned, one of the most contentious issues in the recent past has been the COVID pandemic, and its effect on healthcare, politics, and world economy. Hindsight is 20/20, hopefully we as a society, learn from this trying experience, and do better as a whole. Thank you for sharing.

      Reference

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert

           clinician to influential leader (3rd ed.). Springer.

      Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. Let’s end the

      silence that surrounds incivility. American Nurse Today, 10 (11), 18-23.

      file:///Users/sergio/Desktop/WK%206%20INTERPROFESSIONAL%20CLARKS.pdf

       Reply to Comment

  • Collapse SubdiscussionDallas Wilcox

    Week 7 Main Post

    Work Environment Assessment

    I found the Clark Healthy Workplace Inventory fascinating as it yielded results I was surprised to find out. I work for the Department of Veterans Affairs, and when I completed the inventory, the VA scored a 66, which equates to a barely healthy workplace. I was surprised to see this rating for numerous reasons. First, I genuinely feel happy in my work within the VA and feel it is a healthy environment. Second, I have worked in three other positions outside of the VA that I thought were what I would have deemed as “barely healthy,” so I was surprised to see the place I feel is a healthy work environment rated so low.

    How Civil Is My Workplace?

    As stated above, until completing the inventory, I felt that the VA was a place of civility. I never thought anything differently until evaluating the questions within the questionnaire and realizing there may be improvement areas. A rating of 66, equating to a “barely healthy” environment, was eye-opening. Clark (2015) discussed the top traits of a healthy work environment as “communication, collaboration, effective decision-making, appropriate staffing, recognition, and authentic leadership” (para. 5). I began evaluating if the VA possessed these traits and realized some areas required improvement. These areas include communication, effective decision-making, and authentic leadership. I would not consider my workplace uncivil due to these areas; I feel improvements could be made to strengthen civility. Porath and Pearson (2019) explain that during surveys with companies, a staggering amount did not understand what civility was and do not recognize behavior that is considered uncivil. They explained that sometimes companies simply need to teach civil behaviors they would like to see, which can assist with the problem. This is the case for my workplace, and education may suffice to address some of the abovementioned issues.

    My Experience with Incivility and How it was Addressed

    Since beginning at the VA, there have been very few instances where I have experienced uncivil behavior directed toward me. The one example I can think of was under new leadership in my previous department. Trudel (2012) gave instances of incivility in the workplace, such as reprimanding publicly, talking about someone without them present, and disrupting meetings. The new supervisor for this department completed all three of these examples in one scenario. I had been scheduled to see clients this day, but a coworker had called off, and I was required to see her patient’s as they were a higher priority due to their needs. A policy in this department was to always have your electronic calendar up to date, so the supervisor knew our whereabouts. Due to the last-minute schedule change, I forgot to update my calendar and had my previous client’s schedule on there. The supervisor then proceeded to reprimand me in the public department-wide TEAMs channel. I was then told by numerous coworkers in the office at this time that the supervisor was talking poorly about me to them during this situation. Not only did all of this occur, but the supervisor proceeded to interrupt our staff meeting the next day to publicly reprimand me again. I was appalled to say the least. Unfortunately, I addressed this with the supervisor and explained how this was humiliating and made me feel, and she did not receive it well. I then went to my second-line supervisor, who listened empathetically, but nothing was addressed. After more scenarios like this one, I left the department because I felt the environment under this supervisor was toxic.

    Conclusion

    Although I have only had negative experiences with one leader within the VA, it was enough to cause me to see a different department. I can see the trickling effect that incivility can cause within an entire workplace if not addressed appropriately or promptly. It was interesting to learn that the VA, where I reside, rated so low regarding civility in the workplace, as it is a wonderful place to work. This goes to show that any place can continuously strive for improvement.

     

    References

    Clark, C. (2015). Conversations to Inspire and Promote a More Civil Workplace. American Nurse Today10(11).

    Porath, C., & Pearson, C. (2019, March 19). The price of incivility. Harvard Business Review. https://hbr.org/2013/01/the-price-of-incivilityLinks to an external site.

    Trudel, J. (2012, April). Managing Incivility in the Workplace. NCDA. https://www.ncda.org/aws/NCDA/page_template/show_detail/57724?model_name=news_article#:~:text=Uncivil%20behaviors%20include%20making%20condescending,your%20eyes%2C%20and%20yelling%20at

     

     

     Reply to Comment

  • Collapse SubdiscussionDaniel Russell Wright

           I would have described the present level of civility at my workplace as extremely healthy had I not taken the Clark Healthy Workplace Inventory. I have only been employed by my current organization since I graduated from nursing school. However, after speaking with many of my coworkers who joined from other healthcare systems in my area, it became clear that my current healthcare system has the most staff support, the highest employee morale, and the lowest turnover. Though, I was reminded of a few instances of dispute when I completed the survey and could not award a perfect 5 score. For instance, in response to Clark’s query about open, direct, and courteous communication at all organizational levels, an event involving a small number of workers who were in conflict for a short time came to mind (2015). These conflicts or bad attitudes against management were few and have now been resolved. The communication in my organization, on the whole, is excellent.

    In sum, my organization scored 87 after scoring a 4 or 5 on each of the Clark’s Inventory questions, which is considered moderately healthy. It was just slightly short of 90, which would have been considered a “very healthy workplace.” Our OR teams, both the general teams and the specialty teams, are pretty tight. As a critical component of our success, our administration and management focus on culture and team development. Healthcare organization leaders have a significant role in team development; they must give sufficient resources, plan activities to strengthen the team, inspire the team, educate and train the team, and intervene appropriately (Marshall & Broome, 2021). Marshall & Broome assert that the leader must also be accessible, which is true, in my view, of all of our management leaders (2021). Furthermore, our OR has the qualities of a strong team, including responsibility, dedication to one another, trust, the capacity to resolve conflicts, and a focus on outcomes (Walden University, 2009). We must all try to establish and maintain polite, healthy work environments where we can communicate openly and effectively and handle disputes in an appropriate, mature manner. Incivility is the alternative, which may have detrimental and long-lasting effects. The culture of an organization has a significant impact on employee attraction, retention, and work satisfaction (Clark, 2015).

    Within my organization, there was one instance in particular when incivility was a serious enough problem to spark arguments among numerous employees. Two separate charge nurses, along with several other staff nurses, were having arguments with a number of the night shift nurses because some individuals were friends while others were not, leading to accusations of favoritism or “clicks.” To remedy the problem in this instance, many staff meetings were organized. The management team was highly accessible, open, and honest and employed language and strategies similar to those in Clark’s Conversations to encourage and promote a more civil workplace at these employee meetings (2015).

    Evaluation of existing knowledge of incivility in the workplace gave evidence of nursing experiences that negatively impact nursing professionalism (Smith et al., 2018). Results suggest incivility provides examples of workplace mistreatment that injures the ethical climate of an organization. Incivility can damage the reputation of an organization and individual nurses; it should always be viewed as ethically unacceptable behavior. Recent studies on the rise of rudeness and other disruptive behaviors in academic and clinical nursing are worrisome, particularly when considering the effect on patient and staff safety. When one considers the difficulty of building a culture of politeness, the proverb “it takes a village” rings true (Clark, 2011). Researchers have also shown that lousy working habits may be picked up over time and are probably made worse in demanding institutional and professional contexts. On the other hand, the promotion of civility in nursing education and practice may also be a learned process and, as such, be responsive to beneficial interventions. To co-create and maintain a good work environment, nurse leaders must pay close attention to and support nursing practice and education collaboration (Clark, 2011). Promoting a healthy corporate culture is a practical approach linked to a rise in nurse manager participation in genuine leadership. We all have an ethical duty to look out for those who look out for others as healthcare professionals (Smith et al., 2018).

    References

    Broome, M. E., & Marshall, E. S. (2021). Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (3rd ed., pp. 155-231). Springer Publishing Company.

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

    Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering Civility in Nursing Education and Practice: Nurse Leader Perspectives. JONA: The Journal of Nursing Administration41(7/8), 324–330. https://doi.org/10.1097/NNA.0b013e31822509c4Links to an external site.

    Smith Phillips, G., Isaac MacKusick, C., & Whichello, R. (2018). Workplace Incivility in Nursing: A Literature Review Through the Lens of Ethics and Spirituality. Journal of Christian Nursing35(1), E7–E12. https://doi.org/10.1097/CNJ.0000000000000467Links to an external site.

    Walden University, LLC. (Producer). (2009a). Working with Groups and Teams [Video file]. Baltimore, MD: Author.

     

     Reply to Comment

    • Collapse SubdiscussionKasondra Lewis

      Module 4 Peer Response #2

      Hello Daniel, your post was fascinating this week; I enjoyed reading it. You mention that you would have previously considered your place of work very healthy prior to taking the assessment, which revealed your place of work as only moderately healthy, and interesting. In my post, I mentioned that while I was satisfied with my job, many staff were dissatisfied. Both of our explanations reveal that perception can primarily affect the results obtained in the assessment. Several factors, such as personal or organizational, can affect the level of job satisfaction for everyone (Baljoon et al., 2018). Your example of incivility is something I have seen before in my workplace. Your management team addressed incivility and implemented a plan to make the workplace more civil. Their actions were correct. According to Kisner (2018), organizations should address incivility and work towards zero-tolerance policies to help prevent incivility in the workplace. Again, I enjoyed the topics you presented and look forward to completing the semester with you.

       

      References

      Baljoon, R. A., Banjar, H. E., & Banakhar, M. A. (2018). Nurses’ work motivation and the factors affecting It: A scoping review. International Journal of Nursing & Clinical Practices, 5(1), 277.

      Kisner, T. (2018). Workplace incivility. Nursing48(6), 36–40. https://doi.org/10.1097/01.nurse.0000532746.88129.e9Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionIvy Dzivenu

    Main Discussion Post

    Workplace Environment Assessment

    After completing the Clark Healthy workplace inventory, our organization appears as a mildly healthy civil working environment considering the overall score of 66 points. The workplace inventory for our organization yielded a mildly healthy working environment with a score of 66 points. While most of the parameters at the top leadership organizational level reflect a moderately civilized working environment, the lower organization level relationships reflect an uncivilized work environment, which contributes to the uncivil working environment.

    One of the reasons our workplace is a civil working environment is the high levels of trust, respect, and adherence to the shared vision of dignity at the formal leadership, which encourages civilized relationships. The company policies require nurses to apply respect, dignity, and professionalism under the American Nurses Association (ANA) standards and ethics. ANA obligates nurses to offer a safe and civil workplace by respecting colleagues and patients and discouraging bullying, harassment, or intimidation (Clark, 2015). Therefore, the organization has implemented the ANA’s guides in fostering safe nursing practice and civil workplace.

    Carrol (2023) highlights that improving civility in the nursing workplace requires investment in the nursing-teaching environment through open and frank dialogue. The nurses are expected to adhere to the ANA’s ethical standards of respectful communication and an open and transparent communication approach. Although most of the parameters in the civil workplace assessment reflected high scores, some did not meet the average scores. For instance, the inter-employee issues at a lower level of the organization reflected an uncivilized workplace environment. Some employees reported instances where they encountered disrespect, bullying, and mobbing. Besides, an instance where a physician colludes with some nurses to side talk or intimidate other colleagues. The lack of comprehensive mentoring programs and unfair workload distribution contribute to an uncivil workplace environment characterized by disrespect and miscommunication. Therefore, management should balance the roles and workload equally.

    I vividly remember an instance of workplace incivility during my nursing attachment. Gloria was a physician I worked under during my first week of joining our organization who often gossiped with another colleague Jeff. During one afternoon shift, while they did not notice I was inside the patient preparation room, I overheard her gossiping and side-talking that I sought a bribe from a patient to complete her preparation for the theatre examinations. While I remained calm and quiet for about five minutes, I walked to them and said hi. Although Jeff responded to my greetings, Gloria chuckled and accused me of interrupting their conversation. I told her sorry for interrupting, and she went ahead and insulted me. I remained calm, resisted the urge to confront her, and walked away from them despite feeling offended. I was stressed, and my morale and job satisfaction dropped for a while. At the time, I was supposed to attend to a patient in the ward, but I missed the duty because I was psychologically stressed. After the incident, I did not take an abrupt approach to pursue the matter with Gloria as I knew her to be short-tempered and often used vulgar language during confrontations. I, therefore, decided to reflect on the next course of action.

    Considering Clark’s (2015) suggestion that nurses in healthcare should speak up when faced with uncivil issues and not remain silent, I decided to raise the matter with her in a safer zone. I settled on taking a direct approach to resolve the conflict by asking her for a suitable date and place where we would discuss the matter. However, my plans backfired as she declined my proposal, and considering that patient safety was at stake, I decided to involve the management to resolve my differences with Gloria. Luckily, when I raised the matter with the department leader, the matter was resolved, and Gloria was suspended from work for her uncivil conduct.

    The manager commended me for speaking up about Gloria’s incivility of gossiping and insulting colleagues. The manager reiterated during the departmental meeting that everyone should speak up against incivility, such as bullying, mobbing, and disrespecting one another. Another solution to incivility that the department adopted after the incident was encouraging nurses to adopt team building and rebuilding the working relationships with nurses. According to Gibson (2021), the solutions to nursing workplace incivility should focus on enhancing the nurses’ relationships at work and ensuring the nurse’s welfare and fulfillment are achieved.

     

     

    References

    Carroll, K. (2023). Language That Respects Dignity in Nursing Practice. Nursing Science Quarterly36(1), 21-23. https://journals.sagepub.com/doi/pdf/10.1177/08943184221131963Links to an external site.

    Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace: Let’s end the silence that surrounds incivility. https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

    Gibson, C. G. (2021). Nursing Workplace Incivility and Mindfulness. https://digitalcommons.gardner-webb.edu/cgi/viewcontent.cgi?article=1039&context=nursing-dnpLinks to an external site.

     

     

     

     Reply to Comment

    • Collapse SubdiscussionIris Cornell

      Response from the instructor

       

      Ivy, thanks for sharing. Bennett and Sawatzky (2013) stated that leaders and those emerging leaders, in particular, may not be equipped with the tools to deal with bullying and may choose to overlook it. These two authors further indicated that emotional intelligence as a strategy for leaders would give them a better ability to recognize earlier signs of bullying. Do you think emotional intelligence would be good to teach all staff and leaders in the organization? Why or why not?

       

      Reference

      Bennett, K., & Sawatzky, J.A. (2013). Building emotional intelligence: A strategy for emerging nurse leaders to reduce workplace bullying. Nursing Administration Quarterly, 37(2), 144-151. https://doi.org/Links to an external site. 10.1097/NAQ.0b013e318286de5f

      Edited by Iris Cornell on Jan 10 at 8:24am

       Reply to Comment

      • Collapse SubdiscussionIvy Dzivenu

        RESPONSE #1

        Hi Dr. Cornell,

        Emotional intelligence is a critical instrument in giving employees the self-protection they need to be able to perform at their best and maintain strong mental health. Employees with higher emotional intelligence naturally work better as a team, deal with change, has greater self-control, and can handle tough conversations. According to Bennett and Sawatzky (2013), Individuals with higher emotional intelligence are better equipped to recognize early signs of negative behavior, such as bullying. Therefore, promoting emotional intelligence in emerging nurse leaders may lead to less bullying and more positive workplace environments for nurses in the future.

        Nurse leaders are responsible for identifying and maintaining zero tolerance for uncivil conduct in the workplace (Green, 2019). While resolving the uncivil conduct between the nurses, the nurse leaders should not align with the nurses who commit uncivil conduct but instead advocate for equality. Uncivil communication characterized by lateral psychological violence committed by managers and physicians in authority cause disrespect and lowers staff dignity. Lateral and horizontal violence comes in the form of bullying, mobbing, and gossiping which leads to a toxic working environment and possible mental health issues for the victims.

         

         

        References

        Bennett, K., & Sawatzky, J.A. (2013). Building emotional intelligence: A strategy for emerging nurse leaders to reduce workplace bullying. Nursing Administration Quarterly, 37(2), 144-151. https://doi.org/.Links to an external site.10.1097/NAQ.0b013e318286de5f

        Green, C. A. (2019). Workplace incivility: nurse leaders as change agents. Nursing Management,50(1), 51-53. https://journals.lww.com/nursingmanagement/fulltext/2019/01000/workplace_incivility__nurse_leaders_as_change.10.aspxLinks to an external site.

         

         Reply to Comment

    • Collapse SubdiscussionKasondra Lewis

      Module 4 Peer Response #1

      Ivy, I enjoyed reading your discussion this week. Like you, my workplace assessment also yielded a score of 66. You also mention that while the workplace scores high on specific parameters, there is room for improvement in other areas. I agree with your ideas about the need for improvement. According to research from Razzi and Bianchi (2019), to help decrease nursing incivility, leadership must address factors contributing to staff dissatisfaction. This ideology supports the need to improve staff satisfaction which will also promote civility in the workplace. Seeing both staff satisfaction and civility as both separate issues and issues that depend on one another is essential. Your experience with incivility had many similarities to my example of incivility. I overheard a conversation about myself and was afraid to speak up. I also let this experience negatively impact my job satisfaction. According to Kile et al. (2018), decreased job satisfaction and morale are expected consequences of workplace incivility. I was happy to hear that your experience with incivility was properly addressed once you escalated the issue. I would like to know if my experience with incivility would have been addressed better had I pushed the issue more. Again, I enjoyed your post and looked forward to working with you during the remainder of this semester.

       

      References

      Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2018). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543–552. https://doi.org/10.1111/jonm.12709

      Razzi, C. C., & Bianchi, A. L. (2019). Incivility in nursing: Implementing a quality improvement program utilizing cognitive rehearsal training. Nursing Forum, 54(4), 526–536. https://doi.org/10.1111/nuf.12366

       Reply to Comment

    • Collapse SubdiscussionAbie Kamara

      Hello Ivy, i enjoyed reading your post and thanks for sharing.It is the responsibility of nurses to demonstrate professionalism when interacting with other people, such as patients, managers, and colleagues. Having a good work environment and adhering to societal standards can improve the quality of care.
      The respect and civility displayed by hospital units when dealing with other people can create a favorable work environment and increase job satisfaction. Collaboration between doctors and nurses can improve the quality of care. Although studies have been conducted on the link between civility and healthcare professionals, they have yet to examine the exact effects of this issue.
      The importance of collaboration between healthcare professionals is an acknowledged concept that can help improve patient care quality.
      Until recently, the relationship between doctors and nurses has been fluctuating. Some studies indicated that the level of collaboration between the two healthcare professionals was low, and others noted that the working relationship between nurses and doctors was high.
      Collaboration between physicians and nurses is a cooperative process that involves sharing responsibilities and resolving problems.
      Nurses and managers are responsible for maintaining a civil and professional atmosphere in the clinical setting. Their legal, moral, and ethical obligation is to create safe working environments that will benefit the well-being of staff members, patients, and their families

      References

      Al-Hussami, M., Al-Ghananim, R., Saidat, S., Malak, M. Z., Al-Hussami, R., & El-Hneiti, M. (2022). Factors influencing compliance to the novel coronavirus (covid-19) infection control precautions among healthcare professionals in jordan. Nursing and Health Care4(2). Retrieved January 14, 2022, from https://doi.org/10.30654/mjnh.10008Links to an external site.

      Optimizing the relationship between healthcare professionals, patients and caregivers: Five conversations that can help improve health communication and care for elderly patients. (2015). The Gerontologist55(Suppl_2), 669–669. Retrieved January 14, 2022, from https://doi.org/10.1093/geront/gnv346.22Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionFabio Anifrani

    Module 4 Discussion: Workplace environment assessment Initial Post

    The Clark Healthy Workplace Inventory’s overall civility score of this writer’s workplace is 46, which can be described as very unhealthy (Clark, 2015). The results of this writer’s work environment assessment reveal the need to address multiple issues regarding civility. Based on the results, it is safe to claim that this writer’s psychiatric emergency work environment has much work to do to achieve the status of a civil workplace. One of the reasons there is a lack of civility has to do with a severe lack of leadership. For example, the management team is often so far removed that staff working in direct patient care feel they need to be supported. There are multiple occasions when nursing staff has gotten into arguments over whether or not a patient is appropriate for transfer to the emergency psychiatric assessment center embedded within the emergency department.

    This writer was involved firsthand in a situation where a patient was kept in triage for four hours. The patient was symptomatic with hypertension, visual and auditory hallucinations, and tremors. This patient reported leaving detox earlier that day and withdrawing from alcohol. When this writer asked the triage nurse if the emergency room physician had seen this patient, the triage nurse became argumentative and defensive. It is true that with staffing shortages, everyone has been overwhelmed and that things can easily be missed. However, it is not an excuse not to provide safe patient care. This writer inquired about what stage of treatment the patient was at that point. In order to direct their care best, the writer was about to assume care for this patient. The triage nurse’s words exactly were: “would you like me to hold your hands and show you how to care for your patient?” Condescendingly and dismissively. This writer should not have been surprised, considering the constant struggles in the emergency department. However, this writer felt he had no choice but to turn to wonder. The writer asked the triage nurse to help this writer understand how they reached their conclusion. The triage nurse expressed frustration with how little support was provided to them that evening. The triage nurse then explained that the patient was seen earlier, but the provider must still need to document their findings. This kind of behavior does not promote civility in the workplace.

    Ultimately, this writer brought the patient back to the writer’s psychiatric assessment center within the emergency department and provided the appropriate care. The more one considers the impacts of incivility on the workplace, the more one realizes the following. As Clark et al. (2011) argued, the increasing prevalence of incivility related to disruptive behaviors in the nursing academic and clinical settings is becoming increasingly concerning since it is bound to impact patient and staff safety. In the example provided in this discussion post, the patient was lucky to have had a positive outcome. However, considering the risks involved with leaving a patient in active withdrawals from alcohol, sitting in an emergency room triage area waiting for at least four hours after the initial assessment is dangerous. From the adage, “it takes a village, “it will also take another village to address the problems related to civility or lack thereof to achieve meaningful change in healthcare (Clark et al., 2011). The conflict described above can be characterized as a breakdown in communication. These communication breakdowns are among the most dangerous threats to health healthcare organizations, including patient outcomes, as evidenced by the risky situation described above (Walden University Producer, (2018). With the lack of teamwork displayed in the encounter with the triage nurse and the inability to collaborate effectively, the case can be made for why a communication breakdown contributes to unhealthy work environments leading to potential medical errors (Walden University Producer, (2018).

    References:

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 (11), 18–23.

    https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

    Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice. The Journal of Nursing Administration,

    41(7/8), 324–330.

    Walden University, LLC. (Producer). (2018). Diagnosis: Communication Breakdown [Video file]. Baltimore, MD: Author.

     

     Reply to Comment

    • Collapse SubdiscussionElin Danelian

      Response 2

      Hello Fabio,

      I enjoyed reading your informative discussion post. It is unsettling to learn that your workplace received a low score on the Clark Healthy Workplace Inventory. The key to having a healthy and civil workplace is having a good environment and culture (Jia et al., 2018). Respect and courtesy are not just reserved for those in positions of authority inside organizations. Everyone should uphold these fundamental principles and others. The most important responsibilities of a leader and a nurse are to promote a respectful, moral, and safe workplace (Parandeh et al., 2016). The situation with the triage nurse that you shared did not meet those expectations. I would suggest telling the nurse how you felt or speaking to the manager about this matter. In this way, leadership can exert some control over the culture and working conditions to stop them from getting worse and more uncivil.

       

      References

      Jia, Y., Fu, H., Gao, J., Dai, J., & Zheng, P. (2018). The roles of health culture and physical environment in workplace health promotion: a two-year prospective intervention study in China. BMC Public Health18(457). https://doi.org/10.1186/s12889-018-5361-5

      Parandeh, A., Khaghanizade, M., Mohammadi, E., Mokhtari-Nouri, J. (2016). Nurses’ human dignity in education and practice: An integrated literature review. Iranian Nursing, 21(1-8). https://doi.org/10.4103/1735-9066.174750

       Reply to Comment

    • Collapse SubdiscussionDinorah Abigail De La Cerda

      Response #2

      Fabio,

      I am so sorry your workplace scored so low on the Clark Healthy Workplace Inventory.  When working with psychiatric patients, a calm, healing environment is essential. Nursing plays a huge role in this. When staff is stressed and upset, patients tend to pick up the adverse influence (Sawada et al., 2021). As Clark et al., (2011) mentioned, workplace incivility can lead to patient safety issues. If you had not responded the way you did the patient could have had severe health complications. I commend you for your reasonable and responsible behavior amidst conflict.

      References:

      Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice. The Journal of Nursing Administration,41(7/8), 324–330.

      Sawada, U., Shimazu, A., Kawakami, N., Miyamoto, Y., Speigel, L., & Leiter, M. P. (2021, May 1). The effects of the civility, respect, and engagement in the Workplace (Crew) program on social climate and work engagement in a psychiatric ward in Japan: A pilot study. Nursing reports (Pavia, Italy). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608135/

       Reply to Comment

  • Collapse SubdiscussionAbie Kamara

      The civility of my workplace

    The Healthy Workplace Inventory is a tool that shows the overall health of the workplace. We can use it to identify areas where people can improve their skills and avoid conflict—one of the most critical factors that the inventory shows are the level of civility in the workplace.
    Nurse leaders at an organization are trained to resolve conflicts among their staff members. They are also willing to offer advice and solve problems for their colleagues. Supervisors ensure that every member does their job without burdening them with the responsibilities of others. For instance, new nurses must be respectful and avoid bullying others.
    The staff members know that people are different and must work together to achieve good results.

                                           Why the Workplace is Civil

    There are many reasons why the workplace is civil. One of these is that it has good communication. According to the inventory, openness allows issues to be resolved before they get out of hand. Moreover, there are effective ways of helping people resolve disputes.
    Good leaders are known to treat their subordinates with dignity and respect. They also lead by example and can solve problems through collaboration. Through shared governance, they can identify issues affecting their constituents and develop practical solutions. An organization is additionally dedicated to providing its staff members with the necessary resources and services to improve their lives (Clark et al., 2011).
                                   A Situation where I experienced Uncivility
    I was a victim of bullying by a senior nurse. She made me perform various tasks that I wasn’t comfortable with, and sometimes, she would make me perform roles that I wasn’t satisfied with. According to ( Griffin & Clark,2014), bullying is a common issue that affects people with less authority, such as nurses. The nurse who bullied me started threatening me before realizing I had to decline politely.

    Clark noted that communication is essential, and facilities should encourage staff members to express themselves to get satisfaction and help.

    References

    Kariuki, T. (2013). Conflict at the workplace and the management of an organization (1st ed.). LAP LAMBERT Academic Publishing.

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23. https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

    Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice. The Journal of Nursing Administration, 41(7/8), 324–330. 

    Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. Journal of Continuing Education in Nursing, 45(12), 535–542.

     Reply to Comment

    • Collapse SubdiscussionBeth Howell

      Hello Abie, 

      Thank you for sharing your thoughts and experiences. Being asked to perform tasks you are uncomfortable with and without proper guidance is a lost opportunity. The seasoned nurse could have taught you, and you would have quickly become more comfortable. At a minimum, she could have assessed if there was a particular step or extra information you needed. A transformational leader would have looked to develop your skills (Broome &Marshall, 2021). 

      The model conversation in Clark’s (2018) article using the caring feedback model would fit nicely. The model creates a positive start, describes what is going on, explains the outcome for you, you add a little compassion to her situation and finally a request.  

      Failure to assist is a form of bullying. One suggestion in dealing with bullying is to rehearse phases so that while amid the bullying, you can deliver the response steadily (Broome & Marshall, 2021). 

      On the one hand, it is unfortunate to have this exposure, and on the other, it is informative. As a leader you will have experienced the ill effects of this type of interaction and your own leadership style will be different as a result. Authentic leaders are seen as positive and have self-awareness to know their strengths and how their actions affect others (Vitello-Cicciu, 2019). 

       

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer. 

      Clark, C. (2018). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44 (2), 64-68. doi: 10.1097/NNE.0000000000000563. 

      Vitello-Cicciu, J. M. (2019). Am I an Authentic Nursing Leader for Healthy Workplace Environments? Nurse Leader, 17(3), 201–206. https://doi.org/10.1016/j.mnl.2019.03.011Links to an external site.
       

       Reply to Comment

    • Collapse SubdiscussionJessica Jarosky

      RESPONSE TO Abie from Jessica

      Hello Abie,

      Thank you for the insight into the behaviors within a civil workplace. Would you consider your workplace civil? My workplace scored barely healthy on the work environment assessment, and I have experienced bullying and intimidation first-hand within my workplace. When I received my RN license at 20 years old, many senior nurses treated me like a baby and would make snide remarks about my youngness while trying to intimidate me with unfair work assignments. As the saying goes, “nurses eat their young,” and unfortunately, I did experience this form of intimidation, incivility, and bullying within my workplace. As Alexis (2022) states, hostility towards young nurses or colleagues often seems like a rite of passage for those who are uncivil, creating a sense of initiation into the organization. As you said in your scenario, when the senior nurse was making you perform tasks you were uncomfortable with, you must speak up and advocate for yourself, especially if that task is outside your scope of practice or duties. Conflict will always be present within healthcare organizations. However, the workplace can become a healthier and more civil place by educating staff members on how to communicate effectively while acknowledging others’ opinions, viewpoints, and experiences (Broome & Marshall, 2021). On hire and annually, employees should receive education on incivility to bring awareness to uncivil behaviors to watch for and encourage reporting of uncivil behaviors to management personnel. Thank you for your additional insight on the topic!

       

       

      References

      Alexis. (2022, January 13). Why nurses eat their young and how to stop this damaging practice. AAPACN. https://www.aapacn.org/article/why-nurses-eat-their-young-and-how-to-stop-this-damaging-practice/Links to an external site.

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer.

       Reply to Comment

    • Collapse SubdiscussionMleh Porter

      Hello Abie,

      Thank you for sharing your experience with workplace incivility. Unfortunately, this issue is not uncommon among nurses in healthcare settings; hence the common phrase “nurses eat their young” is often used by nurses around the globe. Bullying among nurses is a severe issue that starts even in nursing school and continues throughout the nurse’s career. In a study, 78% of nursing students reported experiencing bullying, and over half of the students also reported witnessing some nurses bullying other nurses during their clinical rotation (Edmonson & Zelonka, 2019). In addition, many nurses leave their first nursing job because of incivility from their coworkers, making the already challenging nursing shortage even worse (Edmonson & Zelonka, 2019). Incivility in the healthcare setting is a hazard that affects the victim leading to poor mental health, burnout, and increased turnover. It also affects patient outcomes because staffs that experience incivility have an increased potential to make a mistake (El Ghaziri et al., 2021).

      Refusal by the more experienced nurse to provide critical information to allow you to complete the task you were told to complete and to make you complete roles you were uncomfortable with as a less experienced nurse is uncivil. Nurses must be empowered to speak out and call out the behaviors such as bullying, a form of incivility in the workplace. In this instance, in a calm demeanor, calling out the bullying behavior can be an effective strategy. It is also essential to report this behavior to the nursing leader. Unfortunately, many behaviors of bullying and other forms of incivility go unreported (Edmonson & Zelonka, 2019). To address incivility, the hospital management must implement a zero-tolerance incivility policy. Nursing leaders must address reports of incivility and help foster an environment where staffs are comfortable reporting uncivil behaviors. There are usually bystanders when these uncivil behaviors occur. Nurses can hold each other accountable. Empowering nurses to call out uncivil behaviors by their colleagues will decrease uncivil behaviors in the hospital setting (Edmonson & Zelonka, 2019).

      References

      Edmonson, C., & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly43(3), 274–279. https://doi.org/10.1097/naq.0000000000000353Links to an external site.

      El Ghaziri, M., Johnson, S., Purpora, C., Simons, S., & Taylor, R. (2021). Registered nurses’ experiences with incivility during the early phase of COVID-19 pandemic: Results of a multi-state survey. Workplace Health & Safety70(3), 148–160. https://doi.org/10.1177/21650799211024867

       

       

       

       

       

       

       

       

       Reply to Comment

  • Collapse SubdiscussionKasondra Lewis

    Module 4 Main Discussion Post

    The Work Environment Assessment from Clark (2015) revealed that my workplace is mildly healthy. The assessment revealed that most of my answers were a three or neutral. My highest score was a five or completely true; this score was on statement number 12, which stated there were multiple professional growth and development opportunities. The statement that received the lowest score, a two or somewhat untrue, was the statement that detailed a high level of employee satisfaction. I am satisfied with my place of employment. However, recently due to short staffing and changing leadership, others have expressed dissatisfaction frequently. According to research from Baljoon et al. (2018), several personal and organizational factors can affect an individual’s satisfaction on the job. This would explain the differences in satisfaction among staff at my facility. Overall, I currently consider my workplace to be civil and believe that most would agree.

    Incivility

    While I would consider my place of work to be civil, I have experienced incivility in the workplace. Incivility in the workplace is a common trend in nursing and involves negative behaviors with the intent to harm another individual (Layne et al., 2019). I experienced incivility more frequently when I was a new graduate. For example, I had been a nurse for about seven months. I had a patient suffering from an acute cardiac event; the physician ordered a heparin bolus higher than what we usually give. I verified this dose with the physician and the pharmacy, whom both revealed that this was an appropriate dose and explained why the amount needed to be larger than usual. The patient was very large, and the standard heparin bolus would not be therapeutic. I asked the other nurses to verify the dose with me, and they stated they would not because the dose violated policy. I tried to find the policy myself and asked them to help me locate it. They could not locate it; I called the house supervisor and asked for the policy. The house supervisor stated that there was no policy supporting that specific dose and that she would happily come to the unit to be my second verification. Afterward, I overheard the other nurses talking about me. The other nurses said they weren’t putting their licenses on the line for an idiotic new grad who thought she would save the world and kill someone instead. It was not my intention to prove them wrong or big the house supervisor to the unit. My only intention was to do what was best for the patient.

    Incivility Addressed

    At the end of the shift, the other nurses stayed over to meet with the dayshift charge nurse. Another department employee told me that the charge nurse agreed with their decision and said she would call the pharmacy to verify that I gave an inappropriate dose and take care of it. The other nurses and I returned that night for another shift; we were told by the charge nurse that sometimes larger doses were appropriate and that if we had questions about specific doses, we could call the pharmacy to confirm. The charge nurse pulled me to the side and told me that she had spoken to the director of the pharmacy and that I had not made an error. While the issue was addressed, it was not addressed directly. The avoidance of directly addressing incivility is expected because of organizational volatility and stress, and causes incivility to occur more often (Clark et al., 2020). As a nurse with more years of experience, I experience incivility less often and am more likely to address it myself. However, the degree at which I experienced incivility as a new graduate negatively impacted the start of my nursing career.

     

     

    References

    Baljoon, R. A., Banjar, H. E., & Banakhar, M. A. (2018). Nurses’ work motivation and the factors affecting It: A scoping review. International Journal of Nursing & Clinical Practices, 5(1), 277.

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 Links to an external site.(11), 18–23.

    Clark, C. M., Landis, T. T., & Barbosa-Leiker, C. (2020). National Study on Faculty and Administrators’ Perceptions of Civility and Incivility in Nursing Education. Nurse Educator, 46(5), 276–283. https://doi.org/10.1097/nne.0000000000000948Links to an external site.

    Layne, D. M., Anderson, E., & Henderson, S. (2019). Examining the presence and sources of incivility within nursing. Journal of Nursing Management, 27(7), 1505–1511. https://doi.org/10.1111/jonm.12836Links to an external site.

     

     Reply to Comment

    • Collapse SubdiscussionAbie Kamara

      Kasondra, thanks for sharing the experience you had at your workplace with incivility.
      Incivility refers to low-intensity behavior that’s aimed at hurting the target, and it’s also in violation of the norms of mutual respect. According to Pearson and Andersson, workplace incivility can be belittling, insulting, and rude.
      Incivility is a pervasive issue in healthcare settings, and it can harm the development of healthcare organizations. It can also affect the emotional and mental health of employees. According to studies, it can lead to depression and anxiety and prevent nurses from developing their work abilities. These adverse effects can make it hard for them to perform their duties.
      Incivility’s adverse effects can also negatively impact the development of nurses’ work environments. New nurses are prone to experiencing adverse effects from workplace incivility, and high career expectations can motivate them and prevent them from experiencing negative emotions.
      The effects of incivility on the work performance and career expectations of new nurses are essential factors that can be considered when assessing the prevalence of disrespect in the workplace.

      References

      Credland, N. (2022). Incivility at work can put patients and nurses at risk. Nursing Management29(4), 9–9. Retrieved January 13, 2022, from https://doi.org/10.7748/nm.29.4.9.s3Links to an external site.

      Pearson, C. M., Andersson, L. M., & Porath, C. L. (2006). Workplace incivility. In (Ed.), Counterproductive work behavior: Investigations of actors and targets (pp. 177–200). American Psychological Association. https://doi.org/10.1037/10893-008Links to an external site.

       Reply to Comment

    • Collapse SubdiscussionJared Munoz

      Response #2

      Kasondra,

      I understand working in an environment where it is mildly healthy and the struggles that come with it including as you said having dissatisfied nurses because of changes and short staffing. It is great once you find yourself in a healthy work environment where leadership is great and respects their staff and staff know how to work with each other despite differences or negative views towards the other. I work in such a place which I find is rare.

      I have like you experienced incivility as a new grad which ultimately made look for another opportunity in another hospital and start fresh. Every nurse has been there and understands what it is like, but I have noticed that the more we work and gain experience nurses tend to forget that like the nurses that were treating you unfair and with this it can “lead to unsafe working conditions” (Clark et al, 2011). With incivility it is our responsibility to addresses these issues to solve issues and create a healthy work environment for everybody. As nurses we can contribute to a healthy work environment by “our ability to cope with stress effectively, manage our emotions, and communicate respectfully” (Clark, 2015). I am glad to hear that you experience less as you gained experience but remember that we are a team regardless of if one person doesn’t like another person our job is to take care of our patients and work together to achieve quality of care to everybody.

      Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice Links to an external site.The Journal of Nursing Administration, 41(7/8), 324–330.

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 Links to an external site.(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf Links to an external site.

       Reply to Comment

    • Collapse SubdiscussionMarrisa Montano-White

      Marrisa Montano-White

      January 13, 2023

      Module 4 Discussion

      Colleague Response 2

      Hello Kasondra,

      I am sorry you experienced directed incivility due to being a new graduate. It is frustrating not to be taken seriously and disregarded just because you don’t have many years of experience. One would think that experienced nurses would want to help a new nurse rather than bully and isolate. According to Clark et al. (2011), staff nurses are vulnerable to bullying, more than 50% of nurses report experiencing bullying, and more than 90% witnessed bullying, which suggests this is a learned behavior passed down from staff nurses to new nurses and students. At some point, this cycle needs to be broken to help develop healthy work environments for nurses.

      Creating Healthy Work Environments

      Healthcare needs to be improved when establishing healthy work environments. It has been common to have healthcare workers frequently get burned out and adopt unhealthy work habits. Recently there has been more research looking into how the work environment affects nurses and patients to correct ongoing issues. According to Halm (2019), to strive for a culture of excellence, positive practices benefit patients, such as improved safety, satisfaction, and quality of care from nurses. In addition, healthy work environments enable nurses to have better relationships with physicians, improved autonomy and independence, and increased engagement and job satisfaction, leading to lower burnout and turnover (Halm, 2019). In time, more nurse leaders will focus on eradicating incivility from the workplace and adopting healthier behaviors. In time, the bullying you experienced will hopefully be an intolerable behavior of the past.

      References

      Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice Links to an external site.The Journal of

             Nursing Administration, 41(7/8), 324–330.

      Halm, M. (2019). The Influence of Appropriate Staffing and Healthy Work Environments on Patient and Nurse Outcomes.

             American Journal of Critical Care28(2), 152–156. https://doi.org/10.4037/ajcc2019938

       Reply to Comment

  • Collapse SubdiscussionJared Munoz

    Main Post Module 4

    I completed the Clark Work Environment Assessment and scored around what I thought I would score. My current work environment scored an 85 which is classified as a moderately healthy work environment. I believe my workplace is amazing because of the people who work there. It takes a special kind of person to work in a mental health facility and a few things we have in common at work are communication and trust with one another in order to make our work environment civil. My work stays civil with each other based “on our ability to cope with
    stress effectively, manage our emotions, and communicate respectfully” (Clark, 2015) to one another regardless of how we may feel towards our coworkers. Granted there are people you may not particularly like or get along with, but we all understand we have a job to do, and we work well together to get it done. Our current nurse leaders do a great job at including others, working with their staff and they understand that “the power of a leader is magnified by an effective team, and the leader who empowers team members expands the capacity of the whole organization at all levels” (Broome & Marshall, 2021).

    My first job after graduating nursing school I was working in MedSurg in Eastern Idaho. At first it was great then I started noticing the gossip and problems on the unit. I worked night shift and being the only male working I was asked a lot to help boost a patient or help a patient ambulate to the bathroom which I was glad to help but it took me away from my patients often. Then I noticed that depending on who the charge nurse was and the nurses working I would get most of the highly acute patients whereas the charge nurses friends got “easy patients”, so they have a good portion of the night to talk and hang out. I noticed the incivility because when I was drowning in my work with my patients and helping other nurses with theirs, I would ask for some assistance with my patients and I would receive attitude from the some of the other nurses that were hanging out with the charge nurse which “lead to unsafe working conditions” (Clark et al, 2011). Because of their attitude and being a new nurse, I was doubting myself to ask for assistance. I brought my concerns to my fellow nurses and charge nurse and worked it out among us instead of going to management at that time. I decided to quit that unhealthy work environment and decided to pursue a job in psych at a mental health facility where I love working there with my staff and my patients.

     

    Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

    Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice Links to an external site.The Journal of Nursing Administration, 41(7/8), 324–330.

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10 Links to an external site.(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

     Reply to Comment

    • Collapse SubdiscussionJessica Jarosky

      RESPONSE TO Jared from Jessica

      Hello Jared,

      It’s refreshing to hear about a moderately healthy inpatient psychiatric hospital workplace. With a stressful work environment, I’m sure you feel relieved with support from management and your leadership team. Your ability to manage your emotions in stressful situations and communicate respectfully with colleagues will contribute to a more civil workplace. As Clarke (2015) states, “An organization’s culture is linked closely with employee recruitment, retention, and job satisfaction” (p. 18). For example, my hospital scored barely healthy on the assessment, and we have a high nursing turnover rate and require contract and travel nurses to keep our units open. Often nurses are discouraged by the lack of support and effective leadership shown daily. Working in mental health requires effective and therapeutic communication and teamwork, and the patient and staff’s safety depends on it. As mental health nurses, we often interact with every patient in the milieu, compared to MedSurg nursing, when you’re assigned a specific number of patients. Teamwork is crucial as we are constantly assessing for any signs of escalating behavior. Having this sense of emotional intelligence allows us to speak therapeutically and civilly with our colleagues. As Dilks (2020) states, “As PMH nurses, we have high levels of emotional intelligence, thanks to the unique nature of our work and this ‘emotional intelligence’ translates to good leadership” (p. 216). When we begin working as nurse practitioners, I believe we will continue contributing to a civil and healthy workplace due to our vast knowledge and expertise in mental health. Thank you for your insight on the topic!

       

      References

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

      Dilks, S. T. (2020). Psychiatric-mental health nurses leading a culture of safety. Journal of the American Psychiatric Nurses Association26(2), 216–218. https://doi.org/10.1177/1078390320907094Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionJessica Jarosky

    MAIN POST

    Work Environment Assessment

    The results from the work environment assessment indicated that my workplace is ‘barely healthy’ with a score of 64. These results are not the best, but they do not surprise me. I have only worked in this one hospital in my career in healthcare, and I only have experiences with other hospitals during nursing school clinicals. This makes it challenging for me to compare civil versus uncivil workplaces. Civil workplaces promote kindness, trust, empathy, and effective communication and collaboration between coworkers, patients, and management. Uncivil workplaces often lack respectful and meaningful communication and have situations involving bullying, harassment, anger, humiliation, or violence (Tricahyadinata et al., 2020).

    Workplace Civility

    My hospital is a private inpatient psychiatric hospital with no union, though we have a nursing leadership team of 10 members. Our nursing leadership team has a reputation for playing favorites and creating rules and policies within the units without asking the floor staff their opinion. Often, I see policies implemented and changes to the patient’s schedule that simply do not work within the flow of patient care and tasks required every shift. You rarely see the nursing leadership team on the patient care units, though you frequently see emails about things that need to be changed, updated, revised, etc., on the unit. My manager avoids coming to the unit and simply refuses to speak with agitated patients. We often feel unsupported and unsafe while working with acute psychiatric patients and feel our concerns are not being heard when we voice them. As Clark (2015) states, within civil organizations, “leaders and managers must create an environment where nurses feel free and empowered to speak up” (p. 18). However, this is not the case within my organization, unfortunately. Our nursing leadership team is adamantly against supporting a union, and typically if staff start to gather support for a union, they get terminated. The nursing leadership team doesn’t want a union because they want to feel connected with their staff, though they often are never present for situations in which we truly need their support.

    Incivility in the Workplace

    Luckily, I have only experienced a few situations of incivility, specifically towards myself, since I started in my hospital nearly six years ago. One situation that stands out as uncivil was when I was hired as a mental health technician (MHT) at 18 years old. I was working with another MHT over 60 years old with an extensive history working in the mental health setting. We worked on the most acute unit when a patient became increasingly agitated, yelling and making threats. I had built a rapport with this patient and believed I could calm him down if I just had a few minutes to listen and talk to him. The patient was in their room, screaming, and I was standing in the doorway so as not to put myself in a dangerous position. My fellow MHT coworker came over to me because the patient hadn’t calmed down after just one minute. He then postured at me, clenched his fists, and loudly told me I needed to walk away or go into the patient’s room and shut the door because it was upsetting the other patients on the unit. Even though I was younger, newer, and had less experience in mental health, I was not going to comply and put my life in danger because he could not de-escalate the other patients on the unit who were upset. This coworker talked down to me disrespectfully and condescendingly while almost forcing me to put myself in harm’s way. I had never experienced anything like this before and was too shocked even to say a word. I had to remove myself from the situation as it was emotionally distressing. In the psychiatric setting, complex patient populations and workloads can contribute to increased stress, which could then lead to workplace violence such as this situation (Clark et al., 2011). However, when working in mental health, you must control your emotions and behaviors, as the psychiatric setting is very unpredictable.

    I do not know how this situation was addressed after the fact. I did report the incident to my manager but never received an apology, and the situation was never spoken about again. This coworker was one of the nursing leadership’s favorite staff, as he often worked 16-hour shifts five to six days a week. I believe that I never heard about the situation again because my organization feared losing someone who worked many hours and picked up many extra shifts. After that uncivil encounter, I never had another issue with this coworker, though I have heard of other instances from coworkers. After graduating with my RN, this MHT has treated me with the utmost respect, and we are cordial coworkers to this day.

     

    References

    Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice. The Journal of Nursing Administration, 41(7/8), 324–330. https://doi.org/10.1097/NNA.0B013E31822509C4Links to an external site.

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

    Tricahyadinata, I., Hendryadi, Suryani, Zainurossalamia ZA, S., & Riadi, S. S. (2020). Workplace incivility, work engagement, and turnover intentions: Multi-group analysis. Cogent Psychology7(1). https://doi.org/10.1080/23311908.2020.1743627Links to an external site.

     Reply to Comment

      • Collapse SubdiscussionJessica Jarosky

        RESPONSE to Dr. Cornell from Jessica

        Hello Dr. Cornell,

        Thank you for the question. My hospital has policies protecting against incivility in the workplace, with a no-tolerance policy for bullying, violence, harassment, or discrimination within the organization. Employees receive yearly continuing education on incivility in the workplace and are expected to report any signs of incivility to their manager or a human resources team member. My organization declares that no retaliation will happen for reporting uncivil behavior, and the situation will be investigated thoroughly. The organization encourages leadership and management team members to be involved and present in the patient care units to promote and monitor respect, dignity, and civil behavior from all.

         Reply to Comment

    • Collapse SubdiscussionJared Munoz

      Response #1

      Jessica,

      I also work in an inpatient mental health facility and its sad to hear that your work environment was “barely healthy” and that your administration plays favorites and creates policies that make it hard to do your job and make it hard for the patients flow. Our field can be difficult and not having a good work environment makes it worse. in order to have a good work environment we as nurses need to rely “on our ability to cope with stress effectively, manage our emotions, and communicate respectfully” (Clark, 2015). Without good communication and leadership our units and patients suffer. An example of a good work environment happened on another unit yesterday where we were short staffed and struggling on one of our adult units we had our facility director, education specialist and our clinical supervisor helping out by passing out needed meds, helping solve patient concerns and issues and sitting on a 1:1 for a time in order to help staff get caught up and basically not drown or be overwhelmed. to me that is an example of great leadership and a good work environment that supports its staff to maintain positive morale. A good administration will understand that “the power of a leader is magnified by an effective team, and the leader who empowers team members expands the capacity of the whole organization at all levels” (Broome & Marshall, 2021). Teamwork makes good work environments.

      Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

      Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice Links to an external site.The Journal of Nursing Administration, 41(7/8), 324–330.

       Reply to Comment

    • Collapse SubdiscussionJessica Slavin

      Response #2

      Jessica,
      I can imagine it is very difficult to compare or even score your facility not having experience in another health system to compare. I’ve worked in a small county hospital with an occupancy of 24 inpatient beds and massive healthcare systems with multiple hospitals with as many as 600 beds, both of which gave me a wide variety of experience when it comes to workplace maturity and civility. Workplace incivility is one of the issues in the nursing profession that may affect nurses’ performance at work, placing patient safety at risk and hindering the establishment of a safety culture (Alquwez, 2022). It sounds like in your instance you were put in a sticky situation where your safety was compromised and ultimately not supported by senior leadership. Workplace incivility includes any perceived or actual negative behavior that is repeated or persistently exhibited by a person or group who has power over another person, which makes the recipient feel humiliated, upset, and threatened, diminishes their self-confidence and causes interpersonal conflicts (Alquwez, 2022). I’m sure your years of experience since this incident has formed you into a strong nurse that knows the importance of an emotionally intelligent leader in staff support. Managing conflict well is a fine art, it is important to bracket your emotional responses which can help you frame conflict situations as opportunities for learning (Broome & Marshall, 2021, p. 226).

      References

      Alquwez, N. (2022). Association between nurses’ experiences of workplace incivility and the culture of safety of hospitals: A cross‐sectional study. Journal of Clinical Nursing, 32(1-2), 320–331. https://doi.org/10.1111/jocn.16230Links to an external site.

      Broome, M. E., & Marshall, E. (2021). Transformational leadership in nursing: from expert clinician to influential leader (3rd ed.). Springer Publishing Company.

       Reply to Comment

    • Collapse SubdiscussionNavtej P Singh

      Hi Jessica,

      Your experience in mental health and especially in acute care psychiatric situations is, I believe, very usual. Psychiatric situations are unique and can be very dangerous depending on the condition, size, strength, and the assistance available at a second’s notice if the situation spins out of control. The staff, especially those who had been at the institution for a long time, had developed and sustained behaviors that were not very healthy but had served them to stay safe for years. I believe the staff interacting with you was unprofessional and rude and must have used a different strategy to ask you to replace from the place you were in, and he feared the worst outcome. Our hospital has developed a protocol if any staff member believes their peer is in a dangerous situation and wants them to move; that person may say, “Referring staff by name, you got a phone call!”. This will assist in moving the staff from dangerous situations; why that staff felt that way is usually discussed at the briefing session after the situation. This is well-established that leaders must take responsibility for raising awareness and educating staff about collaboration (Broome & Marshall, 2020).

      Secondly, it is imperative that staff and leaders develop self-awareness in active situations, share their experiences, and learn from others (Bennett & Sawatzky, 2013 ). I have worked with individuals with my best interest at heart; at the height of stressful situations, I felt disrespected when I was told to remove myself from a situation. In the debriefing session, I realized how many ways I was making myself vulnerable when I was engaged in specific situations. I felt much better when I was told by the staff that I felt disrespected by that his intent was my safety and that he had my back. I end up feeling much better and trusting others in highly stressful situations.

       

      References:

      Bennett, K., & Sawatzky, J.A. (2013). Building emotional intelligence: A strategy for emerging

      nurse leaders to reduce workplace bullying. Nursing Administration Quarterly, 37(2), 144-151. https://doi.org/.Links to an external site.

      Broome, M. E., & Marshall, E. S. (2020). Transformational Leadership in Nursing: From Expert

      Clinician to Influential Leader. Springer Publishing Company.

       Reply to Comment

  • Collapse SubdiscussionMichele Cleary

    Week 7 Discussion.6053N

     

    My workplace environment assessment scored a 61, which is barely healthy. Our outpatient infusion center needs help with retention. I was not surprised by the score at all. Since becoming a corporation, many people have a managerial or supervisor role that is more interested in patting themselves on the back instead of solving problems and creating a positive work environment. Several nursing supervisors are reactive instead of active.  Part of the problem is paying less well for novice nurses. These nurses can go to the hospital or other infusion centers (once they have experience) and make more money. Retention is difficult in ancillary positions such as a front desk and medical assistants. Those positions have employees who are unprepared for just how busy the office is. Members of the organization share their values but need to lead by example. There is not a high level of satisfaction, as disrespect is allowed. Although surveys are given by a third party each quarter, rarely are changes made based on the results. The workplace has a hostile environment, and nurses could be happier. The nurses that have been there for a while, including me, stay because of the love of their patients and the difference we make in their lives. The office could improve by acting on the surveys and making changes, holding people accountable for the actions, and considering what changes can benefit the office.

    Healthcare has become so stressful it is easy to see how nurses can fall short in communication skills and respect toward others. (Clark, 2015). We can reduce incivility by speaking up when it happens, practicing meaningful dialogue, and effectively communicating. The incivility that I have seen has been more of a reversal incivility. We had a nurse that was late every day, very lazy, spent more time trying to find others at fault instead of doing her job, and was not kind to patients. When the nursing staff complained to the nursing supervisors, this nurse formally complained to Human Resources about two specific nurses saying they were saying negative things about her in the workplace. This prompted an HR investigation and put the whole unit on edge. After the formal complaint was made, other nurses did not want to interact with her. With this, the incivility came full circle. The other nurses exercise maturity, focus on patient care, and work with the rest of the team to provide the best care possible.  It is sad to see that one toxic person can weaken the group.

    Poor management has been linked to decreased cost effectiveness, poor patient outcome, and high turnover (Broome & Marshall, 2021). Solid management must create a team environment by guiding, positively influencing, coaching, and exercising core values (Broome & Marshall, 2021). Building a solid team has five main characteristics; trust, conflict resolution, commitment, accountability, and attention to results (Walden, 2009). Leaders must share their goals and lead by example. A solid team means trusting each other, solving problems, committing to the work and team, being held accountable, and checking the outcome. A team is only as strong as its leader. We must all work together to accomplish our common goal of providing excellent patient care. Therefore, it is vital to have strong leaders to share our goals and help us perform our tasks. My workplace has a lot of exceptional, educated, and wonderfully caring nurses who enjoy working with each other and the patients. It would be a fantastic place to work, with solid retention, if leadership were more decisive, held employees accountable, and worked better as a team.

     

     

     

    References:

    Broome, M. & Marshall, E.S. (2021). Transformational leadership in nursing: From expert

                clinician to influential leader (3rd ed.). New York, NY: Springer.

     

    Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American

                Nurse Today, 10 links to an external site. (11), 18-23. Retrieved from https://

    www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-Links to an external site.

    1023.pdf

    Walden University, LLC. (Producer). (2009a). Working with groups and teams. [Video file].

    Baltimore, MD: Author

     

     

     Reply to Comment

    • Collapse SubdiscussionJan Griffin

      Response 1 to Michele Cleary

      Michele-

      Your discussion post for this week seems like we work in similar environments. According to Mitchell and Maykut (2021), the pandemic affected the nursing population. Many nurses left the work world and still have not returned and may never return to the bedside again. Retention has been a big issue not only in my department but in the hospital as a whole. According to the World Health Organization (2020), the nursing population will continue to diminish unless we look at ways to invest in education, pay, and a healthy work environment for the years to come. Looking at ways to eliminate this problem is a topic that has reared its head multiple times ever since I began work at my organization, and you mentioned pay in your post. I sat down with my supervisor and asked her how a way for my years of experience was to be reflected in my salary. So many times, nurses hop from location to location due to receiving more. Why does the organization not reimburse the loyal employees so that the corporation does not spend thousands of dollars on training new employees when we already have capable employees? I sent an email to human resources with the nursing recruiting director tagged to ask them to assess my pay. I eventually received an email stating that an agreement had been made and that my coworkers and I would be receiving a raise. The hostility within the nursing community is also on the rise due to the low number of staff available and the job duties being stretched by the permanent staff. My hospital, as well as many others in the area, have attempted to increase the staffing numbers by hiring travel nurses. Yes, these nurses come in and do a job, but they also do not go the extra mile for the hospital. My employer serves the underserved, and our facility might not be the best, but it does the best with what it has. These travelers start by stating everything they need and what is wrong with the facility. I have and will continue to take pride in my job and hope that by the end of their assignment, they will also have learned to respect this place I like to call my home away from home.

      References:

      Mitchell, A., & Maykut, C. A. (2021). New Graduate Nursing Retention in 2020: A Multifactorial Analysis. International Journal for Human Caring25(3), 226–232. https://doi.org/10.20467/HumanCaring-D-18-00051Links to an external site.

      World Health Organization. (2020, April 6). State of the world’s nursing report – 2020. https://www.who.int/ publications/i/item/9789240003279

       Reply to Comment

      • Collapse SubdiscussionMichele Cleary

        Jan,

        Thank you for your reply. I feel your pain with hiring travel nurses. Invest in the nurses we have and show them we value them by giving them the resources, staff, and pay they deserve, then, you won’t need travelers!  You sound like me, taking pride in your job and wanting it to improve.  I hope you stay the course and wish you the best!

        Michele

         Reply to Comment

  • Collapse SubdiscussionPamela Corona Laroya

    Main Post

    Introduction

    The stress level in healthcare is high, and nurses and other healthcare professionals must communicate more respectfully. How people interact in the workplace can significantly affect their job, loyalty to the organization, and, most importantly, the delivery of safe, high-quality patient care (Clark, 2015). According to Martin and Zadinsky (2022), Incivility in the workplace is a significant problem leading to burnout, satisfaction, and turnover, which interferes with the values and ethics of providing high-quality care to patients.

    Work Environment assessment

    Based on the Work Environment Assessment, the organization where I work scored 80, making my workplace moderately healthy. I have been an employee for 14 years, and the leaders and all my coworkers have been supportive and satisfied with how our leaders manage the organization. According to Clark (2015), The American Association of Critical-Care Nurses has identified six standards for establishing and sustaining healthy work environments—skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership (pp.19). My hospital exemplifies and meets the standard of a healthy environment, as evidenced by the recognition and awards received for three consecutive years: Best Places to Work in Healthcare, Patient Safety Excellence Award, and One of the Nation’s Top 100 Hospitals. While reading through the assessment questions, I had to think about the vision, trustworthiness, professional growth, and much more that make my workplace moderately healthy. The result sounds right to me.

    Civility in workplace

    Civility is respecting others when a disagreement arises, which occurs by modeling kindness and empathy that seeks to understand differences and upholds common ground (Clark et al., 2011). Workplace incivility comprises rude and unprofessional behaviors of low-intensity and ambiguous intent that violate an organization’s acceptable norms of respect (Ota et al., 2022). According to Broome and Marshall (2021), individuals are difficult to work together if they lack shared values and regard for each other. In my facility, each individual has different values, but I know we treat each other with respect and humility. Core values in my organization include transparency, accountability, trust, flexibility, responsibility, openness, and caring (Broome & Marshall, 2021). I am happy in this place because everyone embraces our mission of care and improvement of human life. Nurses have a professional and ethical obligation to foster civility and healthy work environments to protect patient safety (Clark, 2019). I have been a charge nurse in the ICU, and this week I am transitioning to ICU manager, and the leaders treat each one in the organization with dignity and respect.

     Addressing Incivility in the workplace

    Workplace incivility can negatively impact employees’ physical and mental health, job satisfaction, productivity, and commitment to the work environment (Griffin & Clark, 2014). Nurses most vulnerable to uncivil work environments are those new nurses, new to a specific area of practice, transitioning to a new healthcare environment, and floating and per diem nurses (Clark et al. 2011). Incivility, bullying, and workplace mobbing take a heavy toll on individuals, teams, and organizations by negatively impacting employee retention, recruitment, and job satisfaction (Clark, 2019). During the Covid-19 surge, the travel nurses influx in the facility was enormous. They formed a group independently, and regular nurses had separate groups. Incivility within the unit was created, making the team unable to work harmoniously. Some nurses are absent and terminate their travel assignments when their group is not working.  Incivility, when left unaddressed, symptoms such as headache, interrupted sleep, intestinal issues, anxiety, depression, and feelings of stress may arise, potentially developing into post-traumatic stress disorder or even precipitating suicidal intent (Clark, 2015).

    Conclusion

    Committing coworkers to fostering a healthy work environment can promote civility, mainly when the obligation focuses on patient safety and quality patient care. Nurse leaders use to achieve civility in practice by pragmatically creating a shared vision,  educating themselves, fostering accountability, and providing support (Kroning & Annunziato, 2023).

    References:

    Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

    Clark, C. (2019). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44 (2), 64-68. doi: 10.1097/NNE.0000000000000563.

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today (11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

    Clark, C. M. , Olender, L. , Cardoni, C. & Kenski, D. (2011). Fostering Civility in Nursing Education and Practice. JONA: The Journal of Nursing Administration, 41 (7/8), 324-330. doi: 10.1097/NNA.0b013e31822509c4.

    Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against Incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542. doi:https://doi.org/10.3928/00220124-20141122-02

    Kroning, M., & Annunziato, S., (2023). New strategies to combat workplace incivility and promote joy. Nursing 53(1):p 45-50, DOI: 10.1097/01.NURSE.0000891960.69075.73

    Martin, L. D., & Zadinsky, J. K. (2022). Frequency and outcomes of workplace incivility in healthcare: A scoping review of the literature. Journal of Nursing Management (John Wiley & Sons, Inc.)30(7), 3496–3518. https://doi.org/10.1111/jonm.13783Links to an external site.

    Ota, M., Lam, L., Gilbert, J., & Hills, D. (2022). Nurse leadership in promoting and supporting civility in health care settings: A scoping review. Journal of Nursing Management (John Wiley & Sons, Inc.)30(8), 4221–4233. https://doi.org/10.1111/jonm.13883Links to an external site.

     

     Reply to Comment

  • Collapse SubdiscussionTiffany Johnson

                                                      Workplace Environment Assessment Initial Post

              The Clark Healthy Workplace Inventory assessment scored my current facility a seventy-four, which is moderately healthy, based on my answers (Clark, 2015). I work in a smaller community-type hospital. It is the type of place where everyone knows everyone. This comes with its pros and cons. This is where civility can become a problem. For the most part my hospital is civil. We have a very active C-Suite. They have an open-door policy and mean it. At any time, an employee can walk into the C-Suite offices and ask to speak with a member from the leadership team. If they are not available, they will make an appointment to make sure they hear the employees’ concerns. They hold everyone accountable, including themselves for their behavior. This creates a trickle-down effect within the staff.

              With eighty-five percent of nurses reporting some type of incivility in the workplace (Kroning & Annunziato, 2023), it is not a surprise that my survey was only moderately healthy in civility. Healthcare is stressful. The stress, working closely together, and spending more time with your coworkers creates the perfect environment for folks to be uncivil to each other. Unfortunately, my small facility is not immune to incivility. An example of incivility happened between me and a physician. I was the charge nurse on a very busy day on the preop department. A surgeon, who has been disciplined for his behavior with staff on numerous occasions, approached me looking for his paperwork that his office sent the day prior. He raised his voice to me at the nurses’ station letting me know that he looked “stupid” in front of his patient because he did know the patients health history. He did not have his paperwork to review prior to going into the patient’s room. He continues to berate me in front of other physicians and staff. At one point in the conversation, he asked me what I was going to do about the fact that he was so upset and we made a mistake. I could feel how red my face was with embarrassment. Unsure of how to respond, I chose humor. I replied, “I don’t know, quit my job?”. Initially, he did not seem amused. However, it did get him to stop yelling at the desk and move on with his morning. I assume after he cooled off, he remembered that this is not the way we treat each other at this facility or was on his last warning. He came back after his surgery and apologized to me and the others at the nurses’ station. I asked to speak with him privately outside of the nurses’ station and asked that next time he has a concern to please pull me aside and give me a chance to correct whatever was wrong. The surgeon agreed, apologized again, and asked to please ask him to step away if he gets angry again.

              The surgeon and I addressed this conflict together. Had that not been the outcome, I would feel safe taking that to my one-up and further if need be. The expectation for our unit is we treat each other with respect and hold each other accountable. There could be consequences for the patients if the staff are not feeling safe or happy in their work environment. The American Nurses Association states that we have a “moral and ethical obligation to ensure patient safety fostering healthy work environments and cultures of civility” (Clark, 2019). An angry surgeon could easily make a mistake in surgery, or a nurse could easily make a medication error if they are not in the right mindset due to incivility. I agree with the ANA that we must cultivate health, happy, work environments.

                                                                         References

    Clark, C. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today. https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdfLinks to an external site.

    Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator44(2), 64–68. https://doi.org/10.1097/nne.0000000000000563Links to an external site.

    Kroning, M., & Annunziato, S. (2023). New strategies to combat workplace incivility and promote joy. Nursing53(1), 45–50. https://doi.org/10.1097/01.nurse.0000891960.69075.73Links to an external site.

     Reply to Comment

      • Collapse SubdiscussionTiffany Johnson

                                                          Workplace Environment Assessment Response #2

        Dr. Cornell,

        Thank you for your response. I think sharing the response with my team would be beneficial in building relationships within our unit and among other units. My assessment ended with my unit being mildly healthy. I found this to be pretty accurate. I often find myself reminding my coworkers not to take things personally if they call and get report and the nurse on the other end of the call seems short or annoyed. Everyone has personal stressors along with work. Healthcare has been in a heightened state of stress since the start of the pandemic. The burnout amongst nurses is very high due to the staffing shortage, budget cuts, and the restructuring of healthcare. Burnout is found to be a negative factor on civility in healthcare (Osei et al., 2022). I think as leaders in healthcare we can do more to help our teams manage and decrease nurse burnout. I find it important to recognize when your team members are on the verge of burnout. I do not press or guilt nurses into picking up shifts. My view is we will always have short days and I want everyone to have a work life balance. I feel when nurses feel obligated to pick up shifts, it can bring morale down and you can see more incivility in the team. The short tempers are very visible when the team is stressed and overworked. We do monthly town halls that are put together by our C suite team. Many of the staff are cynical about expressing their true feelings about their job satisfaction. The team feels the meetings are redundant and not much changes afterwards. I stumbled on this article about how we rate stress in healthcare and how it should change to be more focused. Many of the questions about workplace satisfaction are generic versus geared towards the occupation itself (Menghini & Balducci, 2021).  It is important to pay attention to the exact needs of your team versus lumping everyone together. I think bringing the initial assessment of my facility as well as the idea to streamline the staff satisfaction to the team and upper leadership would be a great addition to our efforts to bridge the staff and leadership gap. It would give them team a sense of ownership in the civility of the unit. Being able to appropriately address the issues and concerns could help to reduce the stress of the unit.

         

                                                                                       References

        Menghini, L., & Balducci, C. (2021). The importance of contextualized psychosocial risk indicators in workplace stress assessment: Evidence from the healthcare sector. International Journal of Environmental Research and Public Health18(6), 3263. https://doi.org/10.3390/ijerph18063263Links to an external site.

        Osei, H., Konadu, I., & Osei-Kwame, D. (2022). The relationships between team burnout and team psychological safety and civility among hospital nurses during the covid-19 pandemic: The mediating role of team thriving. International Journal of Healthcare Management, 1–12. https://doi.org/10.1080/20479700.2022.2085847Links to an external site.

         

         

         Reply to Comment

  • Collapse SubdiscussionMleh Porter

         Workplace civility has been associated with positive individual and organizational outcomes (Erum et al., 2020). My Work Environment Assessment score came out to 88, which indicates a moderately healthy workplace (Clark, 2015). This means the workplace is generally a civil environment with good communication and collaboration between coworkers. There is a generally positive attitude, and employees feel their contributions are valued and respected. My workplace is civil because there is a culture of respect and appreciation for each individual’s contributions and ideas. Everyone is treated with kindness and courtesy, and there is an emphasis on collaboration and communication (Erum et al., 2020). Employees are motivated to work together to achieve common goals, and everyone is encouraged to share ideas and opinions. There is also a clear focus on creating a safe and inclusive environment for everyone.

    I also experienced incivility in the workplace when a coworker was consistently belittling my ideas and contributions during team meetings. This coworker constantly interrupted me while speaking and often made demeaning comments or jokes about my contributions. This coworker also refused to acknowledge my ideas and often ignored me when I was talking. This made me feel overwhelmed and disrespected, and I struggled to feel comfortable speaking up in meetings. This situation created a hostile and unwelcoming atmosphere, making it difficult to focus on the task. In response and guided by suggestions made by Shakiba et al. (2022), I talked with the coworker and respectfully voiced my concerns. I also spoke with my manager to ensure my ideas were taken seriously. I also clearly communicated my feelings and opinions so everyone could understand my perspective. With this approach, I fostered a more civil and inclusive environment in the workplace.

    Workplace incivility is a serious issue that must be addressed. It is more than an inconvenience; it also affects patient care and outcomes. Incivility is associated with poor mental health, high turnover, and burnout (Erum et al., 2020). Generally, my workplace is civil, with good communication and collaboration among the healthcare team.

    References

    Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today10(11), 18-23.                                                       https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

    Erum, H., Abid, G., Contreras, F., & Islam, T. (2020). Role of family motivation, workplace civility and self-efficacy in developing affective                         commitment and organizational citizenship behavior. European Journal of Investigation in Health, Psychology and Education10(1), 358-374. https://doi.org/10.3390/ejihpe10010027Links to an external site.

    Shakiba, B., Torabi, N., Alimoradzadeh, R., & Maghsoudi, R. (2022). “Medical workplace civility watch”: An attempt to improve the medical training       culture. Journal of Iranian Medical Council5(1), 227-228. https://doi.org/10.18502/jimc.v5i1.9594Links to an external site.

     Reply to Comment

    • Collapse SubdiscussionMleh Porter

           Workplace civility has been associated with positive individual and organizational outcomes (Erum et al., 2020). My Work Environment Assessment score came out to 88, which indicates a moderately healthy workplace (Clark, 2015). This means the workplace is generally a civil environment with good communication and collaboration between coworkers. There is a generally positive attitude, and employees feel their contributions are valued and respected. My workplace is civil because there is a culture of respect and appreciation for each individual’s contributions and ideas. Everyone is treated with kindness and courtesy, and there is an emphasis on collaboration and communication (Erum et al., 2020). Employees are motivated to work together to achieve common goals, and everyone is encouraged to share ideas and opinions. There is also a clear focus on creating a safe and inclusive environment for everyone.

      I also experienced incivility in the workplace when a coworker was consistently belittling my ideas and contributions during team meetings. This coworker constantly interrupted me while speaking and often made demeaning comments or jokes about my contributions. This coworker also refused to acknowledge my ideas and often ignored me when I was talking. This made me feel overwhelmed and disrespected, and I struggled to feel comfortable speaking up in meetings. This situation created a hostile and unwelcoming atmosphere, making it difficult to focus on the task. In response and guided by suggestions made by Shakiba et al. (2022), I talked with the coworker and respectfully voiced my concerns. I also spoke with my manager to ensure my ideas were taken seriously. I also clearly communicated my feelings and opinions so everyone could understand my perspective. With this approach, I fostered a more civil and inclusive environment in the workplace.

      Workplace incivility is a serious issue that must be addressed. It is more than an inconvenience; it also affects patient care and outcomes. Incivility is associated with poor mental health, high turnover, and burnout (Erum et al., 2020). Generally, my workplace is civil, with good communication and collaboration among the healthcare team.

      References

      Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today10(11), 18-23.                                                       https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

      Erum, H., Abid, G., Contreras, F., & Islam, T. (2020). Role of family motivation, workplace civility and self-efficacy in developing affective                         commitment and organizational citizenship behavior. European Journal of Investigation in Health, Psychology and Education10(1),                    358-374. https://doi.org/10.3390/ejihpe10010027Links to an external site.

      Shakiba, B., Torabi, N., Alimoradzadeh, R., & Maghsoudi, R. (2022). “Medical workplace civility watch”: An attempt to improve the medical                   training culture. Journal of Iranian Medical Council5(1), 227-228. https://doi.org/10.18502/jimc.v5i1.9594