Nurses want to practice the best possible medicine so that their patients can have the best possible outcomes. Doctors, nurses, and patients all have anecdotal claims regarding what constitutes the best in medical practice. However, for the best outcomes, nursing practice must be evidence based. Therefore, topics of interest have been researched to develop a search strategy for finding the evidence to support best practices.

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Clinical Question
The problem assigned to the group was the topic, incivility between nurses. The focus of concern is not only that of a hostile workplace and low job satisfaction, but also how this might impact nurse staffing and thus patient safety.

The significance of the problem is that incivility leads, directly or indirectly, to the possibility of decreased patient safety (Blevins, 2015). Incivility exhibits disrespect, promotes conflict, and increases stress. In short, it is bullying and creates a hostile workplace. The extent of the problem is incredible. Approximately 50% of nurses have reported being the victims of bullying; about 90% have witnessed abusive behavior in the workplace (Blevins, 2015). As a result, nurses may avoid those who are uncivil, to the point of finding a new job. About 37% of nurses have reported leaving a job because of incivility. As a result, its financial impact is estimated to be about $300 billion per year (Blevins, 2015). Increased turnover leads to a higher patient-to-nurse ratio until new nurses are recruited and trained, and that recruitment and training leads to increased costs for hospitals.

Worse, the JCAHO has reported that incivility caused 3500 sentinel events over ten years, and so has required zero tolerance policies (Blevins, 2015). The nature of caring for the sick and injured means that, nurses’ jobs are stressful enough under the best of circumstances. Therefore, interventions that educate nurses regarding civility and allow them to work free from bullying and hostility are vital.

Thus, the PICOT question in support of the group topic is, “Can nurses be taught to increase civility, and will doing so decrease stress and improve patient safety?”

The purpose of this paper is to describe the search strategy that is used to retrieve journal papers of interest to answer the PICOT questions in support of our topic.

Levels of Evidence
The type of question asked is causal regarding our intervention. Can education improve civility adequately in enough people that stress levels decrease? If so, then this should help improve patient safety. This is not therapy in the strict sense, but a class on civility will contain some elements of cognitive-behavioral modification. Obviously, people cannot be randomly assigned and blinded to the experiment; they know whether or not they are receiving training in civility, and on the same unit they will talk with each other.

Therefore, the best evidence found to answer the question are repeated measures on surveys covering the incidents of incivility in the workplace that the participants experience and their levels of stress as a result (Oore, et al., 2010; Warner, Sommers, Zappa, & Thornlow, 2016). Subjects fill out questionnaires before and after the intervention, a class educating nurses on issues of civility and incivility in the workplace, raising awareness, and teaching nurses how to act civilly and how to respond when facing incivility.

Search Strategy
Search terms. First, the terms “incivility between nurses” were used. This yielded adequate numbers of articles of interest. However, many were off topic; articles regarding interventions were preferred. Therefore, a further refinement adding the term “intervention” was attempted. This returned no new articles of interest.

Databases used. The Chamberlain College of Nursing Library database was searched first. “Incivility between nurses” yielded 18 related articles. Adding “intervention” reduced that list to zero. The search was repeated for “incivility between nurses” on Google scholar and returned 6770 articles. Adding “intervention” reduced the list to 3760 articles.

Refinement decisions made. The databases themselves eliminate duplicates. Articles that focused on recruitment and retention were eliminated. Articles that were not related to the hospital setting were eliminated. Articles focusing on students were eliminated. Of the articles that remained, most described the severity of the situation but did not address it directly. Articles were sought that created an intervention and tested its effects.

Identification of the two most relevant articles. As far as could be determined by reading abstracts, only two articles fit our final criteria, that an intervention be created and tested. These papers are listed on the References page (Oore, et al., 2010; Warner, et al., 2016). The Blevins editorial was selected because it is a good, brief overview describing the extent of the problem to be addressed. However, it is helpful in the introduction; it is not the focus of our literature review.

Warner, et al. (2016) found that awareness of the problem did not change much with intervention. They did find, however, that incidents of incivility decreased after intervention. However, this was only significant for physicians, and the numbers were not impressive. Therefore, they did not investigate further regarding incidents affecting patient safety. Oore, et al. (2010) found substantially more evidence regarding the positive impact of intervention on both mental and physical stresses and strains experienced by nurses on the job. Thus this can be expected to positively affect patient safety, but they did not measure this outcome. Clearly, more research needs to be done in this important area, to determine how best to improve the working environment for nurses and therefore optimize patient safety.

  • Blevins, S. (2015). Impact of incivility in nursing. MedSurg Nursing, 24 (6), 379-380.
  • Oore, G., Leblanc, D., Day, A., Leiter, M.P., Laschinger, H.S., Price, S.L., & Latimer, M. (2010). When
    respect deteriorates: Incivility as a moderator of the stressor-strain relationship among hospital
    workers. Journal of Nursing Management, 18, 878-888.
  • Warner, J., Sommers, K., Zappa, M., & Thornlow, D.K. (2016). Decreasing workplace incivility.
    Nursing Management, 47(1), 22-30.