The concept of civility in healthcare right now is of utmost importance. The industry has experienced significant challenges and pressures to adapt to a rapidly changing reality in the last two years. Nurses, specifically those on the frontline of providing care throughout the COVID-19 pandemic, have felt the full weight of increased expectations but fewer resources. Many nurses have been left feeling underappreciated, overworked, and now have an overall discontent with the healthcare system (El Ghaziri et al., 2022). The need for nurses is getting continually greater and greater therefore, it is necessary to address the incivility in healthcare in an attempt to improve nursing job satisfaction and desire to join and stay in the profession. Civility in healthcare looks like showing kindness, respect, and treating others with dignity. On the other hand, an environment that is incivil will have bullying, intimidation, manipulation, and disrespect (Clark, 2015). The key to creating a workplace that is civil is creating a culture that promotes civility and strongly opposes and condemns acts of incivility (Broome & Marshall, 2021).
Cynthia Clark created a tool to assess the overall civility of a workplace. The tool scores a workplace on a scale of 20-100, with lower scores correlating to high levels of incivility and higher scores correlating with high levels of civility (Clark, 2015). I utilized the tool to assess the level of civility at my current workplace, and got a score of 58. According to this tool, my workplace has a barely healthy environment, and I would agree. My workplace is actively working to implement a culture of civility, but are just not quite there yet. I believe that the infrastructure to address incivility and make civility the standard are being developed within my healthsystem but consequences for incivility are lacking. A personal example of the incivility I have experienced in my workplace was not that long ago. I was working in a very busy COVID-19 Intensive Care Unit (ICU). I had been working on this unit since the first day our hospital had a COVID patient, so I felt like my knowledge of the standard of care given to these patients was pretty solid. As the new residents started their rotation with the ICU, I often felt that my concerns and assessments were being ignored and dismissed by the new resident team. Although I had been working with COVID patients for close to two years, and this was the new residents first rotation in the ICU, they somehow had a much better understanding of how to care for these patients than I did. When I would address my concerns with nursing management, and even the resident coordinator, I was dismissed and told that this was just the way things worked. By allowing the seasoned ICU nursing staff to be belittled, ignored, and dismissed by the resident team, it created a culture of hostility and incivility. By management refusing to take action to intervene in this situation, it resulted in many nurses leaving the unit to seek employment elsewhere, a huge loss for the healthsystem.
Nursing leaders are looking to current research on strategies to address incivility and create a culture of civility among their teams. One strategy that has been shown to be very effective is cognitive rehearsal. Cognitive rehearsal is when training is provided to help equip individuals to deal with instances of incivility in the moment that they happen. By practicing and rehearsing what to say, how to control your emotion, and to know when to walk away, one can learn to identify, confront and resolve incivility(Griffin & Clark, 2014). Health systems that are serious about creating a civil workplace should implement cognitive rehearsal training.
Broome, M., & Marshall, E. S. (2021). Creating and shaping the organizational environment and culture to support practice excellen. Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). pp. 237-272. New York, NY: Springer.
Clark, C. (2015). Conversations to inspire and promote a more civil workplace: Let’s end the silence that surrounds incivility. American Nurse Today 10(11). https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf
El Ghaziri, M., Johnson, S., Purpora, C., Simons, S., & Taylor, R. (2022). Registered Nurses’ Experiences With Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-State Survey. Workplace health & safety, 70(3), 148–160. https://doi.org/10.1177/21650799211024867
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. http://dx.doi.org/10.3928/00220124-20141122-02
The assessment of my work setting implied that I am currently in a moderately healthy setting. This twenty-question analysis used to assess the general health and civility in the atmosphere. In this analysis, each of the expressions can be independently rated on a range between one and five. A result of five implies the description is absolutely true, and one determining the depiction is absolutely incorrect. Surveys that generate this information are significant because they drive an all-encompassing aspect of civility in the organization. If not executed regularly, no one will grow aware of the degeneration in an establishment until the calamitous effects are observed. Routinely evaluating the work setting will grant early detection and intervention. The effect of an uncivil work setting can not only progress into a decline in patient care, but also acquire a significant financial cost (Schilpzand et al., 2016).
When I finished the Healthy Workplace Inventory, I discovered many crucial areas that concluded in a decreased score. If these sectors could progress, my organization could become an extremely healthy work environment. Employee wellness is what I believe to be our lowest area. While there are various programs endorsed to hospital employees, no attempt is made to permit nursing staff to be present at any of these affairs. Due to the workflow for nursing staff, it is impractical to take part in any anticipated wellness affairs. The second area of weakness is poor workload distribution. Attempts are made at the beginning of shifts to stabilize workload, but as an organization, we do not do enough to redistribute work as the shift goes on. In the nursing profession, the setting is ever changing. What was thought to be an assign acceptable assignment at the beginning of a shift, can many times become a disastrous workload. As a facility, we should enhance our mid-shift interventions to harmonize workloads (Clark, 2013).
An illustration of the failure to encourage a healthy work environment was when the corporation initiated a daily group exercise program. The objective was to bring employees together to promote fitness and health. Nevertheless, nurses with the inability to dissociate from their daily routines felt omitted from the project. To incorporate nursing staff in activities, planning the activities must comprise of a method for nursing staff to be covered and allowed to participate. Having the opportunity to dissociate from work for 45 minutes or so per shift to place attention on health would be extremely helpful in enhancing the health of the workforce comprehensively (Schilpzand et al., 2016).
At present, no one has acknowledged the issues with nursing health promotion. Nonetheless, there is one resolution that could enhance the access nurses have to affairs organized around health. By having a nurse that could assume care of patients and relieve other nurses to partake in engagements throughout the shift, nursing staff could be present at events and have the affirmation their patients were getting good care. This method would assure the incorporation of nursing staff in affairs developed for staff health and enhance the general health of the work environment (Hossny & Sabra, 2021).
One accepted approach to decrease workplace incivility is cognitive rehearsal. The main goal of cognitive rehearsal is to ensure all staff comprehend that uncivil conduct is unacceptable. For nurses, cognitive rehearsal can be an extremely helpful mechanism to develop a healthy work environment. Three strategies are utilized in the cognitive rehearsal comprising of partaking in didactic guidance, researching and reiterating particular phrases utilized during uncivil encounters, and taking part in practice sessions to strengthen instruction and rehearsal. By putting cognitive rehearsal into action, the employee obtains knowledge on not only civil conduct, but rehearses to construct a real comprehension of practices that cripples the workplace (Clark, 2018).
In closing, the Civility Index is a solid indicator employed to gauge concepts of civility, generate recognition, and promote group debates regarding recognized conditions of civility in the work setting. The Workplace Civility Index may be done as an independent activity, or collectively to make similarities between insights of workplace civility and delineate sections of strength and enhancement. It has been utilized in various programs and work environments to refine healthcare workers’ understanding of the effect of incivility on workforce traditions and patient safety (Hossny & Sabra, 2021).
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