Nurses have a responsibility to patients and each other to create a healthful environment in which respect and civility are key elements. The issue of incivility in nursing is a major one, due to the fact that it creates an unhealthy work environment and negatively affects patient outcomes and nursing practice (McNamara, 2012). If incivility is left unchecked, it can develop into bullying behavior, which has an even greater negative effect (Hunt & Marini, 2012). As such, it is important to consider what constitutes incivility and the best practices that can be used to create a healthful working environment. The purpose of this paper is to reflect on incivility in nursing environments and how nurse leadership can demonstrate fair interactions to promote a healthful workplace. It will discuss some of the current research on the topic and describe an experience where the author has witnessed incivility in the workplace.
The Issue of Incivility
Workplace incivility is a major issue in nursing, and one that Khadjehturian (2012) decribes as a culture. There are several types of incivility that can impact on individual nurses and reduce the efficacy of nursing practice: intimidation, humiliation, verbal abuse, poor relationship-building, and unprofessional challenges (Khadjehturian, 2012). One study of 152 students found that 133 of these had experienced uncivil treatment by others, and were able to identify four of the worst elements of incivility (Lasiter, Marchiondo & Marchiondo, 2012). These were that incivility occurred in front of someone, that the individual talked to others about the victim, that the victim was made to feel stupid, and that the victim was made to feel belittled (Lasiter et al., 2012). The main issue with incivility in nursing is that it is contrary to caring, which is at the core of the nursing profession: respect for others should not stop at the patient.

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The issue of incivility is challenging because it needs to be approached from a grassroots perspective: there are underlying issues and causes of the problem that need to be addressed (Mikaelian & Stanley, 2016). Negative working behaviors between team members can be uncomfortable for others on the team, patients, and family members, and addressing this can be a complex process. Incivility in the workplace can also lead to nurse burnout, which adds an extra layer of challenges: we are globally facing a nursing shortage and it is necessary to retain the well-trained staff that are already in the profession (Mikaelian & Stanley, 2016). Condon (2015) suggests that workplace incivility does not only lead to bullying, but can also be classed as a form of bullying, which makes it a very serious issue: these acts are disruptive and harmful to both the individual and the institution.

Best Practices for Healthful Environments
Nurse leaders have a duty to foster workplace environments that are healthful and allow for the growth of all members of staff. Clark, Olender, Cardonio and Kenski (2011) suggest that nursing education is one of the most effective ways of dealing with incivility in the workplace. They describe a protocol that involves teaching essential skills to promote civility between nurses, including communication skills and mediation (Clark et al., 2011). The first strategy is to ensure that civil behaviors are set as the norm in the workplace. Civil behaviors can be fostered by promoting respect, honoring differences between different staff members, active listening, and seeking common ground (Mikaelian & Stanley, 2016). Best practices in this area would include ensuring that disputes and disagreements are dealt with quickly and efficiently, as well as setting an example of civil behavior during nurse leadership. This can help foster an environment where incivility is kept to a minimum.

Another strategy that nurse leaders can use to improve the workplace environment is to create a system of regular meetings where staff members can talk about their issues (Clark et al., 2011). These meetings allow nurse leaders to get information about incivility issues that they may not have seen during the working day, but also offer an opportunity for mediation before incivility turns into burnout or bullying. Again, it is important that this issue is addressed because it can cause significant psychological damage to nurses working in uncivil environments (Condon, 2015). A final strategy is to ensure that civility is promoted and discussed in nurse education programs so respect and communication become the norm in nursing environments even before the nurse has qualified (Clark et al., 2011).

Incivility in the Workplace
Incivility in the workplace has a significant impact on individuals. Evidence shows that incivility and bullying in the workplace are the main causes of nurse burnout (Mikaelian & Stanley, 2016). Incivility can also lead to nurses underperforming: they are unable to concentrate on the task at hand because they are worried about potential effects from their coworkers. As noted, being called out in front of other coworkers is a big source of stress for nurses, and ensuring that they do not make mistakes in public can, conversely, lead them to make more mistakes as they question their judgment (Mikaelian & Stanley, 2016). In essence, workplace incivility puts a lot of strain on the individuals involved. It can also have negative impacts on those working with the individuals engaging in uncivil or rude behavior, even if they are not directly impacted – it can create tension in the workplace that increases stress for everyone within that workplace.

The impact on the workplace goes beyond the negative, high-stress environment caused by individuals. Incivility in nursing can lead to patients and family members being uncomfortable as they pick up on signs that relationships between nurses are not running smoothly (Condon, 2015). This can lead to a loss of finances for the organization, which in turn reduces the amount of available funds for dealing with incivility using the strategies noted above. To deal with this, the best two strategies for someone who is preparing for a Master’s in Advanced Nursing are to ensure that civil behaviors and respect are at the very core of the nursing process. Nurse educators need to put civility at the core of their teaching: nurses should have respect for the patients but also for each other (Condon, 2015). Family nurse practitioners and other leaders within the workplace should lead by example and ensure that they always display civility.

Conclusion
Overall, the issue of incivility in the workplace can have significant effects on nurses and the nursing profession: higher levels of stress and burnout, mistakes, and a loss of revenue are all issues that stem from incivility. As such, it is important to use strategies to minimize the impact: leading by example, promoting education that includes notions of civility, and working closely with staff members in reporting and mediation protocols are all useful strategies for dealing with the issue. If incivility is not tackled, there can be significant negative effects on both individuals and the workplace. Individuals may make more mistakes or leave the profession entirely, while workplaces suffer from the loss of personnel and potential loss of income. Nurses in a variety of Master’s prepared roles can have a positive impact on reducing the impact, mainly through education and leading by example within the workplace.

    References
  • Condon, B. B. (2015). Incivility as Bullying in Nursing Education. Nursing Science Quarterly, 28(1), 21–26. https://doi.org/10.1177/0894318414558617
  • Hunt, C., & Marini, Z. A. (2012). Incivility in the practice environment: A perspective from clinical nursing teachers. Nurse Education in Practice, 12(6), 366–370. https://doi.org/10.1016/j.nepr.2012.05.001
  • Khadjehturian, R. E. (2012). Stopping the culture of workplace incivility in nursing. Clinical Journal of Oncology Nursing, 16(6), 638.
  • Lasiter, S., Marchiondo, L., & Marchiondo, K. (2012). Student narratives of faculty incivility. Nursing Outlook, 60(3), 121–126.e1. https://doi.org/10.1016/j.outlook.2011.06.001
  • McNamara, S. A. (2012). Incivility in nursing: Unsafe nurse, unsafe patients. Association of Operating Room Nurses. AORN Journal, 95(4), 535.
  • Mikaelian, B., & Stanley, D. (2016). Incivility in nursing: from roots to repair. Journal of Nursing Management, 24(7), 962–969. https://doi.org/10.1111/jonm.12403