Be specific and provide examples.
Among the many important areas a leader can influence in their organization, influencing the culture is fundamental (Broome & Marshall, 2021). The results of my work environment assessment were 40. Since it is less than 50, it is indicative of a very unhealthy work environment (Clark, 2015). Based on these results, there is a high chance for incivility to occur in my workplace (Clark, 2015). While there is a high chance for incivility to occur, I feel as a whole my workplace is civil even though the work environment assessment was poor. There are occasionally some instances of incivility between management and line staff, but thankfully we have a strong union to represent our interests.
Situation of Incivility
As a nurse, I have always remained professional, even when confronted in an uncivil manner. While I have never been confronted in an uncivil manner by a fellow line staff nurse, I have been confronted by a supervisor uncivilly only a handful of times. The most glaring example occurred when my charge nurse in my previous employment in the NICU approached me in an uncivil way. I was up to receive admission and usually, on the floor, we set up equipment on the admission incubators so that we have everything we need when the neonate comes. However, I had heard during report that per our assistant nurse manager, we were not supposed to set up the beds since that practice was not kosher with the auditing body that was there during the shift. Later that night, during my dinner break, the charge nurse barges into the break room yelling and screaming that we are getting an admission and wondering why my admission bed is not ready. I calmly told her that I would normally set up for admissions however I was told in report not to for the next couple of days due to the auditing body’s presence and that all the equipment I would normally have on the bed, was staged in the cart in the room. She proceeded to verbally reprimand me in front of other nurses because my admission bed was not set up. The admission went on without a hitch, however, her incivility left a bad taste with me and my fellow line staff nurses. Other senior nurses later explained to her that what she did was wrong, and she later apologized and explained she had other personal things on her mind, but I never looked at her the same.
Nurses have a professional obligation to foster a safe and civil work environment to protect patient safety (Clark, 2018). If improperly handled, incivility can lead to adverse patient outcomes such as mistakes, harm, or death to the patient (Clark, 2018). Through my experience as a nurse, I have learned the proper way of handling volatile situations. Workplace incivility takes many forms including publicly criticizing an employee which is what happened to me (Kisner, 2018). Other examples of workplace incivility include nonverbal abuse such as eye-rolling, and making faces, and bullying such as expecting someone to do another’s work (Kisner, 2018). I tend to avoid confrontation, so when I am confronted with incivility, I try and defuse it as soon as possible. However, the workplace culture can be enhanced if nurses can communicate effectively and resolve issues in order to promote patient safety, better nursing care, and improved staff morale and retention (Kisner, 2018).
My Clark Healthy Workplace Inventory assessment gave a score of 86, which is considered to be a “moderately healthy”, work environment. In an ICU, emotions can sometimes get the best of us, creating high workplace tension and leading to incivility (Layne, 2019).
Incivility in the workplace can lead to poor patient outcomes. Healthcare is a high-stress environment, and patients rely on professionals to provide care and support during their most vulnerable moments. In such an environment, acts of incivility, such as rudeness, bullying, or disrespect, can negatively impact patient outcomes (Alquwez, 2020). Incivility can lead to decreased job satisfaction, stress, burnout, and a decreased sense of commitment to the job. When healthcare professionals are distracted or upset due to acts of incivility, they may not be able to provide the best care to their patients, leading to poor patient outcomes.
I have encountered feelings of incivility in the workplace from one of our general surgeons, who is known to be hard to deal with. Although I know he has the patient’s best interest at heart, he can be demanding and hostile towards the nursing staff when we are occupied with saving the lives (literally) of other patients that are not as critical as his at the moment. The one time I felt disrespected by him was when we were at our peak of high patient acuity during covid. Beds were full, staffing was short, and patients needed to improve. It was generally stressful, but this provider insisted all of his post-surgery patients spend at least the first 24 hours post-op in the ICU because he wanted “round-the-clock care” for them. Although I understand his concerns about having CCRNs caring for his patients, when they were not ICU-level ill, we could not keep them due to them already being full. He got upset that one of his patients had to be transferred to a step-down unit. He called me and acted belligerently rudely because the patient was moved per protocol without his permission. I had to report the situation to our nurse manager, and she handled it, but it made my already tiring and stressful shift even more draining.
Overall, SOMC, I believe, does demonstrate civility in the workplace. Similar to my situation, when you have a team of leaders behind you that will back you, it makes you feel better about coming forward about cases of incivility.
Civility is essential in promoting patient safety. When healthcare professionals respect one another, they are more likely to communicate openly and honestly, share information, and work together to address patient safety concerns (Akerman-Barger, 2021). This can improve patient outcomes, reduce medical errors, and increase patient satisfaction.
After completing the Clark Healthy Workplace Inventory Questionnaire, I discovered that my hospital scored a 78 which is Moderately Healthy. Most categories scored well, but as I have discovered recently, career advancement is not a strong suit. I would say that my organization works in a civil manner, in most situations. This does not mean that incivility does not occur. The concept of nurses “eating their young” is found to be a learned and processed negative behavior that is transferred amongst individuals today (Clark, et al., 2011). A health organization requires shared values, organizational visions, creativeness, good team work, and good leadership (Clark, 2015). I would say that my organization exemplifies all of those examples. Civility leads to a decrease of negative behaviors and an increase in the overall positivity of the workplace (Garcia, et al., 2021).
My Incivility Experience
I have worked at my current work place for the last 4 years. In that time, I have worked incredibly hard. I consider myself to be a hard working, reliable, a quick learner, and I always go above and beyond. On multiple occasions, I have asked to assist with training new employees, which I have previous experience doing. I have also asked to be apart of a team that was being created to revamp the orientation process. The responses that I received were always very neutral and felt avoided. Over time, I got tired of it and it made me feel that I was not going to be able to grow in my role. Soon after a position opened on my unit and I decided to apply. I knew going into the interview that if I did not get the position that it was time for me to move on. I needed growth and at this point, it was more that obvious this was not going to happen. I of course did not receive the promotion which lead me to applying to Walden University’s FNP Program. The incivility came from when my superior informed me that I was not getting the position due to my educational path. At the time, I was attending WGU for my Masters in Nursing Education. She felt that once I finished my degree that I would just up and leave. She did not want to hire me and waste time for me to leave. The position that I was applying for was an educational position, but she felt that I would leave for more money. All of this was very unprofessional in my opinion. I decided at that point that I was done wasting my time. I was given to push that I needed to pursue my education even further. I informed her two weeks later that I was going back to school for my FNP which you could tell she was upset about. I just let her know that I needed growth and I wanted more. FNP was something that I had always considered pursuing and now I’ve had the push I needed to go for it.
As I mentioned previously, one of the areas lacking within the organization is career advancement. When I decided to go back to further my education as a FNP, I figured that I would have no issues finding a job. I have since discovered that is very incorrect. In fact, all I hear is how happy everyone is that I have decided to go back and advance in my career, yet they are sad because that means Ill be leaving our health organization. I’m being told this is due to wanting FNPs with experience vs wanting to train new FNPs. This is extremely flawed in my opinion. Our hospital has experienced big loses by not hiring valuable employees. Instead, close, competing hospitals are hiring and gaining what we have now lost.
Workplace Environment Assessment
Clark (2011) writes that incivility in healthcare organizations leads to unsafe working conditions, poor patient care, and increased medical costs. The Clark Healthy Workplace Inventory consists of 20 statements that are rated and result in an overall score where one can then determine how healthy, or unhealthy, their workplace environment is. The purpose of this discussion post is to post a description of the results of my assessment and to explain whether my workplace is civil or not as well as to describe a situation where I experienced incivility and how it was addressed.
After completing the Clark Healthy Workplace Inventory, my healthcare organization scored a 57 which is classified as unhealthy. I somewhat agree with these results. I view my workplace as decently healthy but after going through all 20 statements, I can see more unhealthy ways than I was able to recognize before. Statement number two touches on trust between leadership and staff. I rated this a five as it is completely true in my workplace. There is a lot of trust among staff and leadership gives us on the floor a lot of freedom to do what is best for the unit. This strategy has been working for years and I think that is why there is such a strong sense of trust. Opposing, I rated statements 17 and 19 a one. Statement 17 has to do with competitive salaries and wages and statement 19 has to do with the organization attracting the “best and the brightest”. Both of these statements are completely untrue. As for 17, the organization where I work is known for paying staff very low wages. This goes along with statement 19 as due to this, people only come to gain a year of experience so that they can move on to someplace else. This means that the turnover rate is high and that those who are applying typically tend to be new graduate nurses with little to no experience. After
Incivility in the Workplace
Our book states that it is fundamental for an effective leader to influence culture (Broome & Marshall, 2021). It is important for nurse leaders to be aware of this as the other staff looks to them for direction. When asked about an example of incivility that I have experienced, one situation comes to mind. When I was being oriented to my unit and trained at the beginning of my employment, I had some differing views as my preceptor. He had told me many negative opinions of our fellow coworkers as well as strategies that were not conducive to a healthy workplace environment. These things, plus a few others, made me very uncomfortable to be involved with and I let my supervisor know. My supervisor agreed with my concerns and was able to change my preceptor. I am glad at the way this was handled but still to this day, my first preceptor still makes me feel like the workplace environment is not healthy. I know that nowhere is perfect and am thankful for the way that leadership handled my concerns though I still have some issues with this specific coworker.
In conclusion, a healthy workplace is key to fostering safe working conditions and excellent patient care. The Clark Healthy Workplace Inventory helps nurses to assess whether they work in a civil or not civil work environment. It can be beneficial for nurses to know this information so that they can recognize how to help change the environment when in a leadership position. Overall, I found out that my workplace is considered unhealthy and now can use this information to make improvements.
Work Environment Assessment
Reading through the literature on workplace civility, Clark et al. (2011) stated that incivility in the workplace is normalized now. I’ve been in nursing for 16 years, I’ve seen this unfold before my eyes. Completing the Work Environment Assessment, I am not surprised that my workplace is considered barely healthy with a score of 62. Looking at what makes for a healthy workplace, I see where the breakdown is. According to Clark (2015), six standards for sustaining a healthy work environment include: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. There is a true breakdown in each of these standards in my work environment.
As stated above, my workplace assessment scored to be barely healthy. The six standards identified above to sustain a healthy work environment are lacking within the organization. Workplace incivility is defined as “low-intensity deviant workplace behavior with an ambiguous intent to harm” (Agarwal et al., 2023). Skilled communication and effective decision-making are two problems within the organization. Leaders are not listening or communicating with staff and decisions are being made that are running off nurses. Appropriate staffing is one of the biggest problems. The chief of nursing told us not to staff with consideration of the “what if.” I work on an acute psychiatric ward for veterans, it is vital for the safety of staff and veteran to be prepared for the “what if.” Mental health is unpredictable, anyone in a position to be a leader should have experience in the field and no better. This leads to the next issues, appropriate staffing and authentic leadership. Nursing leaders are telling staff nurses that we are to have a minimum number of staff per shift, but then the communicating to the nursing supervisors that we can work with less staff. The staff feels the leadership is not authentic or honest. Collaboration between departments rarely happens, there is a lot of rumors and gossip. Change is another factor, the policies seem to change almost weekly. In a study done by Raza et al. (2023), frequent change within an organization leads to workplace incivility. High turnover rates are happening and based on the research, incivility in the workplace leads to burnout and high turnover rates. On top of everything, RNs received a significant raise in pay but the LPNs and NAs did not. This created incivility as well between the RNs and other staff members. The work environment is not one that is civil or healthy.
Situation of Personal Incivility
I’ve been at my current organization for approximately 3 months, during that time I have experienced incivility multiple times. One time that stands out to me is on my 2nd day off orientation I was put in the position of charge nurse. It was a very busy day and we were understaffed as usual. There were 2 RNs (including myself), one LPN, and a nursing assistant. The RNs are the only staff allowed to do admissions and discharges. Within two hours we received 4 admissions. While the RNs were working vigorously to get the admissions done, the other two staff members were playing on their phones and not offering to do anything to help. There were other tasks needing to be done but the comment was made by the NA, “we don’t get paid the big money you guys get paid so why should we help?” Throughout the shift the LPN and the NA were rolling their eyes at us and being disrespectful. I had put up with it all day but I reached a point that I had to address it. I called a staff meeting between the four of us. I called out the disrespectful behaviors and informed them that if they couldn’t be team players then I’d have to notify our manager. Further, I pointed out that I understand there is animosity because of the increase in pay RNs received and they didn’t. I explained that was not the RNs fault, and further explained the RNs hadn’t had a raise in pay in years at the VA and they were underpaid compared to other hospitals. I made sure to point out that I value their jobs and respect them, and would appreciate the same respect. I said I’d much rather work in an environment that is conducive to team work then a stressful, tense environment. The NA then said to me, “I’m sorry and you’re right, it’s not your fault and I should have never been so nasty towards you guys.” We finished out the shift as a team and the teamwork has been much better since. There is still incivility and poor attitudes because of poor communication, staffing issues, and lack of leadership authenticity. I hope this incivility improves soon, it’s not a pleasant environment to work in.
Work Environment Assessment
I actually did two assessments for both workplaces that I am currently employed. The reason I wanted to do two different assessments is because I see very different work environment between the emergency department and the correctional facility. I am glad I had the opportunity to compare them. I work most of my time in the emergency department. After completing the assessment, it shows that it is a moderately healthy work environment. Most of the staff in the ER understand, adopt, and recognize the need for teamwork. We all help each other out. Honestly, if we didn’t help each other out not only would the patient care suffer, but our morale would be affected, and job satisfaction would decline. I have worked in many different places in my career so far (mainly as a travel nurse). But I have seen many different team dynamics and I can say without a doubt that this ER functions like a well-oiled machine and most staff are completely satisfied with their job, coworkers, and the work they do there.
The prison, however, is completely the opposite. I found, after completing the assessment, that it is very unhealthy. I worked there as a nursing supervisor but left to go back to the ER full time. I still currently work there through an agency occasionally to help with staffing needs. It was surprising to see how different the atmosphere in the medical department changed after I left. I don’t mind working there because I enjoy the work as a correctional nurse but the morale in that department is very negative amongst the staff. It seems like some of the nurses are against each other and a lot of them are against the administration. When I worked there as a nursing supervisor there were many times I had to address certain staff for their attitude and hostility towards other staff. Many times, there was one nurse I had to pull in privately and counsel them on their professional conduct. We had a disciplinary process to follow there. First, you give the person a chance to change their behavior or actions through verbally counseling them. Then, it goes to written counseling, written reprimand, suspension, and termination. I don’t like this process. I think if someone does something severely wrong, we should be able to make the decision ourselves as supervisors to suspend or terminate. This isn’t the case there and it is mostly because everyone is protected by the unions.
One example is a nurse got into a verbal altercation with another nurse in the department. They were heard by other staff yelling and screaming at each other in the pharmacy in the department. They were counseled separately about the incident. Administration, HR, and the unions would not allow us to suspend or terminate either of them because we had to follow the disciplinary process to get to that point. I don’t agree with this. I think it sets a bad example for everyone else that you can basically do whatever you want and there are no repercussions, at least not for a while. This can cause a hostile and sometimes violent workplace. It also makes staff lose respect for their superiors. These two staff members are currently still employed at the prison and still show disrespect towards each other as well as other verbal altercations.
Leaders must work to develop a level of respect and have a zero-tolerance policy for safe workplace environments (Broome & Marshall, 2021). They should also develop ways to address incivility and workplace bullying before they lose all control over the situation. Finding the root cause and ending it as soon as possible in the early stages is important. Many times in workplaces, bullying and violence turns into confrontation and leaving the job (Hampton et al., 2019). I have seen this a few times in my career. Staff try to go to administration for an issue in the workplace with another coworker and nothing is done about it so they leave the job. As a leader, you try so hard to have a team that works well together, gets along, does the job well, and never goes against each other. But all too often, you don’t get all of those traits in your team. I think it is important to establish your expectations early on, empower your nurses as a team, and support them. Nurse leaders can promote civility and end incivility among their team by fostering trust, building rapport, and recognizing hard work (Ota et al., 2022).
A healthy workplace environment is essential for satisfactory staff performance, safety, and positive patient outcomes. On the contrary, dissatisfaction with working conditions can lead to depression and anxiety associated with work, decreased performance, and unsafe practices and mistakes. According to Shein (2021), “depression interferes with a person’s ability to complete physical job tasks by 20% and reduces cognitive performance by 35%, while anxiety also affects productivity, work relationships, job satisfaction and […] turnover” (para. 4). “Clark Healthy Workplace Inventory” attempts to evaluate working conditions from different angles, “assess the perceived health of an organization, and determine strengths and areas for improvement” (Clark, 2015, p. 19). My completed Inventory scored 73 points, which represents a mildly healthy workplace. I was not discouraged or upset about the results, as I filled in the questionary individually, representing only my subjective point of view. I had to respond to many questions as “Neutral” since I could not answer for all company employees. For example, on question 2, “There is a clear and discernible level of trust between and among formal leadership and other members of the workplace,” I have chosen a neutral option as I cannot assess the “level of trust” of team members (Clark, 2015, p. 20). Additionally, on question 3, “Communication at all levels of the organization is transparent, direct, and respectful,” I had to answer neutrally; since, to my observation, communication always seems to be respectful, but the level of transparency and directness is challenging to assess in all situations (Clark, 2015, p. 20). However, communication is an essential part of a healthy working environment in all circumstances. Effective communication can be affected and challenged by people’s “attitude, assumptions, intentions, beliefs, emotional state, physical conditions, history, culture, and experience” (Marshal & Broome, 2021, p. 167). On the contrary, effective communication skills can alleviate the stress of the working environment, “address incivility, […] reduce its incidence and effects, and can assist in fostering cultures of civility” (Clark et al., 2011, p. 325).
A situation where I have experienced incivility in the workplace involved impaired communication between nurses and a physician due to a physician’s arrogant manner of communication. In the long-term facility where I work, nurses report all new findings, such as a change in vital sign patterns, skin rashes, falls, and behavioral changes, etc. to physicians, review lab work and radiology results, review medications of newly admitted patients, and discuss other questions that require current orders change with physicians. Therefore, attending physicians receive an enormous number of phone calls during the day, have to keep close attention to what is happening in the facility even if they are not physically present there, and perhaps, experience continuous stress due to constantly arising work-related issues. Most physicians, however, can manage this intense working environment and maintain respectful, friendly, and professional relationships with the nursing staff. Except for one physician who was noted communicating abruptly, doubted the nursing assessment’s validity, and expressed a feeling of being bothered on multiple occasions with different nurses. Eventually, nurses felt uncomfortable and hesitant to call this physician and tried to avoid communication, which ultimately delayed and impaired patient care. Grissinger (2017) pointed out that disrespectful behavior in the working environment causes “fear, anger, shame, confusion, uncertainty, isolation, self-doubt, depression” and may lead to “adverse events, medical errors, compromises in patient safety, and even patient mortality” (p. 74).
Unfortunately, this situation was not addressed for a prolonged amount of time. Nurses did not feel empowered to speak up and resolve an uncomfortable situation. Silence, gossiping between nursing staff, and inability to oppose physician attitude through open conversation persisted daily, undermining the “civil work environment,” teamwork, and high-quality patient care (Clark, 2015, p. 18). Eventually, the physician’s disrespectful manner of communication was reported to the Director of Nursing (DON), who was able to convey staff concerns to that doctor in a private conversation, which notably changed the physician’s demeanor. Mahboube et al. (2019) noted that collaboration between doctors and nurses, as well as creating “teamwork becomes particularly important in patients that require long-term care” (p. 3264). The authors conducted research investigating “doctors’ and nurses’ attitude” towards collaboration, teamwork, “caring as opposed to curing, physicians’ dominance, [and] nurses’ autonomy” (pp. 3264, 3265). The study revealed “the significant difference between attitudes of doctors and nurses in most factors associated with doctor-nurse collaboration” (Mahboube et al., 2019, p. 3266). Therefore, healthcare organizations’ management, administration, and nurse leaders must develop a mutually respectful working environment where personnel feel safe and empowered to express concerns and speak up if collaboration and communication between the staff of all levels and disciplines feel impaired.
Disruptive and incivility behavior in healthcare workplaces is on the rise but is often overlooked. Organizational culture can legitimize or prolong incivility and disruptive actions, especially during restructuring or downsizing. This is hypothesized to be a result of the inherent ambiguity, value disparities, personal exposure, and power battles that arise inside companies during times of transition (Clark et al., 2011, pp. 324–325).
Civility in my Workplace
Clark’s piece on creating a civil workplace was interesting. After completing the survey, my employer received an 80. The office climate is satisfactory. To that extent, my workplace is one of the healthiest I have ever participated in. Since our company is structured as a corporation, I can only speak for the department I am employed in. My RN director has made it her duty to know each of her staff members. She realized that not all employees are managed in the same way. Some workers require constant praise to feel motivated, while others can get by with occasional constructive criticism. Influencing an organization’s culture is one of the most crucial roles a leader can play (Broome & Marshall, 2021).
Like any other work group, we occasionally find ourselves at odds. When people have arguments at work, they tend to let it go quickly and move on. We have less than thirty workers here, so it is a relatively tiny office. We have an excellent team dynamic. All of the workers hold one another in high regard. Employees’ interactions with one another can significantly impact the quality of care provided to patients, staff retention, and organizational loyalty (Clark, 2015).
Incivility in my Workplace
It has been about four years since I had an incident with incivility at my current workplace. They employed RNs in an experimental role as liaisons between clients and business development managers. I was responsible for informing local doctors about hospice care and elevating our organization’s standing in the eyes of those who could make referrals. I planned on pursuing my FNP, so I wanted to continue as a nurse case manager while in school to maintain my clinical expertise. I was given a new position and asked to simultaneously keep five patients under my care. The original five patients quickly ballooned to a total of 22. I hate to be that person, but when covid hit, and I was the only RN at my workplace escorting covid patients home to pass with their families, it was too much. When I told my director that I could not safely care for so many patients, she said I could not help until they found someone else to outsource the services to. After about two months, I realized I could not handle being the middleman between the company and the client, so I approached the company’s business development managers and informed them of my decision to resign. As I described my situation, they assured me they would do whatever it took to keep me in my current role because they saw me as an educational resource for the community. During our discussion, I was relieved of my case management duties but asked to stay on as a liaison and keep spreading the word about hospice’s many advantages to those in need. This turned out wonderfully and made my transition back to school a breeze.
For the creation and maintenance of a healthy work environment, nurse administrators must be extremely attentive and supportive towards the success of the nursing practice. Indeed, it has been demonstrated that promoting a positive organizational culture is a successful strategy associated with increased nurse manager participation in authentic leadership. As healthcare providers, we all have an ethical obligation to care for those who care for others. In particular, nurse leaders must create and foster a caring work environment. This includes promoting a culture of civility in clinical settings (Clark et al., 2011, p. 329). Any incivility within the company can have long-lasting repercussions and take years to fix. Communicating effectively and politely helps create a pleasant workplace, boosts teamwork, and ultimately benefits patient care.
My Work Experience Assessment
Based on completing the Clark Healthy Workplace Inventory questionnaire (Clark, 2015), my current workplace has a score of 57 out of 100, equating to an unhealthy workplace. I have only been working at this facility for about three weeks now but have gotten a sense of the workings of the facility. Unfortunately, I was not surprised by the results of the questionnaire and easily answered the questions because I agree and think the hospital, overall, has a poor work environment, at least for the adult care units. This suggests that my current workplace is not only unhealthy but suffers from issues of incivility as well because unhealthy conditions in the workplace promote and support incivility (Clark et al. 2011).
An idea I believed in that was confirmed by the assessment and information overall was that effective communication is important to achieve excellence in all the topics portrayed in the statements of the assessment and to foster a healthy work environment (Clark, 2015). Furthermore, adequate communication in the workplace creates a safe work environment that promotes respectful expression of opinions, speaking up and out when holding each other accountable in different situations, successful expression of ideas and team information exchange, and engaging in difficult conversations. Many of the issues that I have witnessed in this facility could be remedied if communication was better, whether that be communicating the needs of a unit to promote policy change or advocating for more efficient physician rounds. Communication, and effective listening, are essential.
The theory or concept I chose in relation to my assessment questionnaire is that incivility and disruptive behavior exists in nursing educational settings and persists into the nursing clinical settings, which is caused by several issues including high stress levels and lack of adequate education/skills, is mitigated by organizational structure and leadership, and can lead to an unhealthy work environment (Clark et al., 2011). Specifically, the stressors that cause incivility in nursing education are similar to those that cause incivility in nursing clinical practice. And communication and education about incivility are crucial to reduce incivility and promote civility. I chose this concept because I have witnessed and experienced this since I began my nursing journey and see signs of it in my current workplace. As Broome and Marshall (2021) discussed, it is important for there to be partnerships between academia and clinical practice to, for example, sponsor mutual respect, enhance skills and education for practice preparedness, and build trust; but, it is important to note that networking, building of relationships, improvement of skills, and increase in productivity cannot happen without adequate communication. Perhaps by recognizing that this partnership is important and that we need to improve our communication skills, many of the issues that I have recognized can be resolved over time.
Current Workplace (In)civility
As stated above, my current workplace would be labeled as unhealthy with a score of 57 out of 100. Again, an unhealthy work environment promotes incivility and vice versa. Because of this, I would say that my current workplace has issues of incivility. Clark et al. (2011) discussed that unhealthy work conditions and incivility create a vicious cycle in which they feed into each other; just as incivility can cause high stress levels, dissatisfaction, poor performance and outcomes, psychological and physiological distress and manifestations, and high turnover intention and rates, these things promote an unhealthy environment that feeds more into the incivility. I knew within my first two shifts at this hospital that there were issues with the environment being unhealthy and with incivility based on how I was oriented to the environment, things I overheard and were told, and even the lack of or conflicting information I received from seasoned staff when I asked questions. The hospital has symptoms of unhealthiness and incivility including numerous callouts each shift, reports of bullying, lack of adequate support from management, and travel nurses prematurely ending their contracts, to name a few. This hospital, like many other hospitals, has the potential to be great but has many obstacles to overcome.
Example of Workplace Incivility
Luckily, I have not been the target or subject of workplace incivility at this facility, but I have been told of instances of it by the nurses experiencing it. One instance involves a new graduate nurse. She reported that she only has four weeks of orientation left before being on her own but does not feel like she is being prepared properly. She clarified that when she asks questions she is brushed off, made to feel inadequate, or told that the task is performed a certain way because that is how it has always been; this is affecting her confidence and ability to critically think in the clinical space. There was no threatening behavior or speech, but she felt like she was not being supported adequately as a new nurse. I encouraged her to speak to management if she feels like her preceptor or the charge nurse are not preparing her well enough, and to communicate her needs so that she is successful when on her own.
Another, more troubling example involved a travel nurse who shared her experience during change of shift report. Prior to her lunch break, her newly admitted patient was complaining of pain and requested pain medicine. Based on the pain reported by the patient, recent medications administered, and the pain regimen orders available, the nurse administered Norco to the patient before being sent on her lunch break. While eating her food, the charge nurse comes into the break room and yells at the nurse because the patient’s pain had worsened and now the patient was screaming and yelling at staff. The charge nurse proceeded to tell the traveler that she has poor nursing judgement, and to stop eating her food to come back onto the floor and administer morphine. The nurse did as she was told and then returned to finish her break. The travel nurse was clocked out during this time, as it is required for breaks at this facility, and the charge nurse, who was covering her break, failed to care for the patient as she is trained to do. The staff nurses who witnessed the situation urged the travel nurse to file an incident report and stated that some nurses have had issues with this charge nurse in the past. This situation just happened a few days ago and I have not worked with this nurse since then, but I hope that she did file the incident report so that this issue can be addressed.
Nurses must provide a civil and healthy work environment to ensure that the patients are adequately and safely cared for. Incivility influences the staff and patients, and it also causes self-esteem issues, confidence issues, and causes poor judgment. If incivility is not taken care of it can cause detrimental errors and can lead to harm and death (Clark, 2019).
The results of my workplace were 82/100, which indicates a moderately healthy work environment (Clark, 2015). Most of my ratings were fours, except one three and two fives’. This score is not quite as indicative of the work environment I work in daily. Some petty things go on, like people talking behind others’ backs, being passive-aggressive, etc. This will be in just about anywhere you work, to be quite honest. The manager that we have, though, does not tolerate disrespect or immaturity. She expects that we handle things with one another in an adult manner, and then if there are issues, they are brought to her. One of the best ways to address incivility in the workplace is to stop and speak up at the time of occurrence.
Most of the time, as nurses, we can respectfully handle manners by discussing issues that may arise. Some in the clinic are passive-aggressive with comments and situations in general. When this happens, I talk civilly to the person, explain my end of things, and try to work it out (Clark, 2015). I would say the biggest conflict we have is being so busy in the clinic, and some nurses think they get stuck doing the “dirty jobs” or working in the same tougher clinics. They tend to get grumpy and think the others are lazy or not doing enough out of frustration. We are always encouraged to speak up and ask for help like grown adults should because otherwise, how are people supposed to know that you are drowning in work? So, I would say that the place where I work is a civil place to be. Otherwise, I know our manager would do something about it because she has a low tolerance for disrespect.
Example of Incivility
Incivility can occur in many ways, such as verbal and nonverbal abuse, aggression, and bullying. To begin with, the best way to handle incivility is to refrain from tolerating it and educate staff on examples of incivility and how to handle it if it arises (Kisner, 2018). The best example I know of incivility since being at the place I work at was when a new employee was hired to work in the clinic, and the current nurse working there was not receptive to whom they hired and the fact that they hired someone in general. She, in my opinion, treated her poorly, didn’t show her the ins and outs of the job, and had to where the new nurse did not even want to share the office with her. From my understanding, the manager we had at the time had a couple of talks with the established nurse, but the new nurse quit after the ordeal. Looking outside, I don’t believe it was handled appropriately because if it had been, I don’t believe the nurse would have quit.
Patient care and the professionalism of the team as a whole can be jeopardized by a culture of disrespect. Bullying, passive-aggression, and other forms of passive-aggressive behavior are all examples of incivility. Establishments can combat rudeness by implementing a zero-tolerance policy and providing training in techniques like cognitive rehearsal, simulation, and mixed-intervention (Kisner, 2018, p. 24).
However, between 30 and 50 percent of new nurses will quit the field during the first three years of their employment, contributing to the nationwide shortage that the United States currently faces. The annual cost of workplace incivility is estimated to be $24 billion. All types of rude behavior result in unhealthy interactions between coworkers, which has been related to more turnover and poorer patient care (Kisner, 2018, p. 24).
In a Meta-analyses by (Wax et al., 2022) it is shown that negative workplace gossip is linked to more negative effects for individuals, relationships, and the workplace as a whole than positive gossip. Also, our results show that people who are the subject of negative gossip have worse job attitudes, emotional states, and relationships with coworkers than people who send or receive gossip. Unexpectedly, the results also show that people who send or receive negative talk may also have very bad experiences at work. In fact, the data showed that gossip participants’ well-being, engagement/performance, supervisor relationships, and organizational outcomes were all worse than those of their targets, although the direction of causality for these relationships has not yet been proven. Overall, our data show that organizations and managers should see negative workplace gossip as a threat to the health of the organization as a whole. On the other hand, positive rumors can be used to help the group (Wax et al., 2022).
All leadership should ensure that they are putting a stop to gossip as soon as it starts. And stopping the destruction that it can cause for the company (Broome & Marshall, 2021). In many situations, the best way to stop incivility is to say something about it when it happens (Clark, 2015).
Workplace incivility is an issue in any workplace, especially healthcare. Armstrong (2018) discusses incivility and states “It has the potential to cause emotional and physical distress in victims and potentially affects the quality of care provided”. Leaders must act quickly if they suspect someone is acting in a malicious or disrespectful manner as it can lead to workplace fatigue and create a high turnover rate. Most people that deal with this in the workplace don’t enjoy coming to work and it reflects in their work performance. This can obviously be detrimental in a healthcare setting.
After reviewing and scoring my workplace with the Clark Healthy Workplace Inventory in the Clark (2015) article I have found that my workplace is barely healthy, scoring a 67. I don’t feel like the morale of the employees has anything to do with this score. We all work well as a team and rarely have conflicts. The problem is more so with our leadership team and the lack of support we are offered. I work in a small rural hospital that is hard to staff so you would think they wouldn’t make us feel replaceable, but they do. We are understaffed and most of the time we are made to feel like we are complaining for no reason. Instead of trying to fix the issue we are told all hospitals are run this way and to basically just deal with it.
I experienced workplace incivility at my last place of employment. The Director of Nursing displayed the worst leadership style I have ever encountered. She would directly call anyone out for anything possible in front of peers. She would also discuss personal issues about team members with staff that had nothing to do with the situation. One situation, in particular, was when she informed me that one of the other nurses was telling everyone that I was working too slowly. The DON did tell me that she reviewed all of our patients for the day and that we all had the same amount, so she didn’t feel it was true therefore she didn’t approach me right away. It wasn’t until she had a personal issue with this staff member that she told me in front of other nurses. Broome & Marshall (2021) stated that “as a mentor, it is critical to develop a relationship that facilitates trust”. This director did not foster trust in any of her relationships with staff acting this way. She belittled employees in front of peers and patients all the time. This created a huge dent in the workplace dynamic and culture and ultimately the reason I left.
A healthy work environment includes authentic leadership, open communication, effective decision-making, meaningful recognition, and appropriate staffing. After completing the Clark Healthy Workplace Inventory Questionnaire, my workplace scored forty-two, which is very unhealthy. The results would have differed if this assessment had been performed six months ago. However, with the current staffing and the little to no support from the administration, the work environment has transformed from civil to uncivil (Broome & Marshall, 2021; Clark, 2015).
The uncivil of the workplace comes majority from the current staffing of the emergency department (ED). Adequate staffing is vital for a civil and healthy workplace. My workplace is a rural hospital with a twelve-bed and three-trauma room ED. We are supposed to be staffed with four nurses per shift. We see a patient load of fifty to seventy patients per day. Currently, we are the only staff with two nurses per shift. There is no outreach of support from the administration, and when help is requested by staff, the request goes unanswered. The ED went from twelve full-time staff nurses to five in the last eight weeks due to the organization not providing competitive salaries, benefits, or rewards. This is what created the current short-staffing problem of the ED. I want to note that the only thing keeping the remaining five full-time nurses from leaving is contract obligation, childcare needs, and for myself being thirty-two weeks pregnant (Clark,2018).
Incivility in the Workplace
I am currently experiencing incivility in the workplace with the current staffing of the ED. My coworkers and I address this by following the chain of command, effectively reporting and documenting the issues to the administration, and acting within our scope of practice to protect our nursing license. The administration is addressing the problem by offering an incentive pay policy. This policy gives nurses in ED five additional dollars an hour for working short shifts. However, any pro re nata (PRN) nursing staff gets five additional dollars for any shift. In contrast, the full-time staff only get the incentive pay for picking up extra shifts outside of the mandatory shifts, no matter if they work short-staffed on their mandatory shifts. This policy has yet to be successful (Clark, 2015).
Description of Results
Culture is crucial in a workplace, the culture in a workplace involves the values, knowledge, beliefs, and attitudes that are shared within the group of people in the organization. The success of a workplace all comes down to the culture to give its purpose and its focus (Broome & Marshall, 2021). The results of the Clark healthy workplace for my work environment was 82, which falls in the moderately healthy category. I believe that my workplace is civil. My coworkers work very well with one another and communicate well with one another. We have a very low turnover rate and support each other in our personal and professional lives. At times I do feel like my workplace is too close. Work environments that communicate well with one another and manage conflicts in a healthy way are more civil. An organizations culture determines retention, communication, work environment, job satisfaction, and recruitment (Clark, 2015).
Situation of Incivility
I do feel that my workplace does not have resources or opportunities for professional growth and development. In the peri-operative department we have three permanent charge nurses. To get this position you must be trained to be a relief charge first and have some seniority in the department. There was a position open for one of these positions at the beginning of last year and I applied for it as well as two other nurses in the department. I had the most experience out of the three that applied and was strongly encouraged to apply by my manager. I ended up not getting the position and I feel like it was unfair because it was more of a popularity contest. The nurses who were on the panel that made the decision happened to be close friends with the nurse who got the position. The whole process of choosing was done very poorly in my opinion and very unprofessional. This is one of the reasons I decided to pursue my nurse practitioner when I did. I have always wanted to go back for my nurse practitioner, but this instance pushed me to do it sooner. When I told my manager I was going back to school she supported me eventually, but she took it very personal and was very unprofessional when I first told her. This instance changed my mind set about upper management and helped me to realize that I want more than just that position eventually. I want to keep learning and developing my skills. I do believe everything happens for a reason and am very thankful I have chosen this path.
The nursing profession has changed drastically in the last ten years that I have been a nurse. The number of patients with multiple comorbidities has increased as well as the number of sick patients to nurse ratio. When I first started nursing, floor nurses only had four patients to take care of at night. Now nurses are expected to take up to six patients a night and the charge nurses on the floors have only been in the profession for two years. Stress levels in nurses have increased as well as the amount of burnout they face. New graduate nurses are leaving the profession after six months due to high stress levels and because they do not feel supported. Newer nurses are getting bullied by older nurses and this has led to sentinel events and unsafe working environments. Nurse leaders play a big part in the environment of their teams and need to address incivility in their workplaces (Clark et al., 2011). Nurse leaders need to promote communication, define roles and expectations, and create a workplace that uplifts new graduate nurses.
The success of any organization is adversely affected by a lack of civility in the workplace. Toxicity in the workplace has become more prevalent, and many employees have come to accept toxic behaviors as the standard and have waved the white flag, surrendering, and believing there is nothing that can be done about disrespect, gossip, bullying, poor communication, and cultural insensitivity, to name a few in some working environment. Incivility in the healthcare industry can result in hazardous working conditions, subpar patient care, and higher medical costs (Clark et al., 2011). For safe workplace environments, leaders must seek to foster a culture of respect and adopt a zero-tolerance policy (Broome & Marshall, 2021). An organization’s culture can go from positive to toxic with just a few unproductive personnel, and while some individuals welcome and entertain these behaviors, improved healthcare outcomes, an outstanding patient experience, and a better working environment for employees and patients will result from upholding respect, decorum, and a healthy work environment. More than ever, workplace etiquette is essential because it encourages employees to perform at their highest level. As a result, businesses can grow by maintaining a stable work environment, which positively affects employee productivity and loyalty.
Work Environment Assessment
Before completing Clark’s healthy workplace assessment, I would be open to say I worked in a moderately healthy workplace environment; however, after completing the assessment with a score of 57, it revealed that I work in a barely healthy workplace environment which would suggest that my working environment is uncivil. The outcome is a consequence of a lack of and poor communication between employees and supervisors, which causes high turnover and more stress and dissatisfaction. The inability of the organization to treat staff as an asset to the facility rather than a liability and the lack of recognition and equity among staff are two additional reasons for working in an uncivil environment. These factors can sometimes make staff members feel underappreciated and uncelebrated, which lowers their morale and confidence. Organizations must make deliberate efforts to construct systems and cultures that will improve employee satisfaction and organizational performance to create a positive work environment (Owolabi, 2022). The lack of cultural sensitivity, racial biases, and inequality are among my organization’s deficiencies. Not striking a balance among all members of the team will result in further inefficiencies and inadequacy among the team.
I remember working with a physician in the ICU whom I called attention to a patient with an abnormal heart rhythm. After interpreting the patient’s arrhythmias and having her re-evaluate the patient’s EKG strips, she dismissed my claims with a loud outburst and was condescending, disrespectful, and rude. I initially felt embarrassed as it was done openly amongst other staff and passersby relatives. In the initial encounter, I did not say anything to her; however, at the end of my shift, I pulled her aside, and I told her that instead of making the event a teachable one, she made me feel disrespected, embarrassed, and not wanting to approach her in the future. Her response was dismissive with no remorse, so I eventually did a Midas report on the situation and emailed my manager and other senior supervisors about the event.
After a few weeks, I heard nothing about what had transpired. I expressed my dissatisfaction in a letter to my manager, who assured me it was being handled and a detailed investigation was being conducted. A few months passed, and her contract was not renewed; she had openly stated that the organization was not interested in continuing her contract because nurses reported her as a bully and not facilitating learning among staff in the critical unit. She attempted to apologize to me before leaving the organization, but I was already over it by then and did not entertain her gesture.
Bullying, gossiping, disrespect, rudeness, and mockery should not be in the workplace. The level of incivility that is being tolerated should be dismissed and should never go unnoticed. By setting and upholding respect standards, training employees to have uncomfortable conversations, and emphasizing the importance of rest and recuperation, employers can prepare their staff to deal with inappropriate behavior (Advisory Board, 2022). Staff should try to change things, especially considering the increased stress brought on by staff shortages and burnout in the healthcare industry. Research has shown that working in a civil setting makes us more creative, helpful, cheerful, and healthier. Whether at work, school, home, online, or in our communities, we can all improve our working environments by being more attentive and acting to uplift others around us.
Upon completing the Clark Healthy Workplace Inventory Questionnaire, my hospital achieved a score of 76, indicating a Moderately Healthy workplace. While most categories garnered high scores, career advancement emerged as an area for development. To build a healthy organization, it is essential to foster shared values, organizational visions, creativity, good teamwork, and good leadership (Clark, 2015). Furthermore, promoting civility in the workplace can help to reduce negative behaviors and enhance overall positivity.
I personally put in great effort to develop my skills and seek opportunities for growth and advancement in the organization. Despite encountering resistance and indifference from my superiors, I decided to apply for an available position within my unit but was ultimately passed over for the promotion. My supervisor cited my pursuit of a Masters in Nursing Education as a potential reason for leaving the organization for a better-paying job. This action was viewed as unprofessional by me, and I decided to enroll in a Master’s program to become a Family Nurse Practitioner (FNP) to further my education and career growth.
I was determined to not let the setback of not getting the promotion discourage me. I knew that furthering my education was crucial for my career growth and development (Clark, 2018). Eventually my enrolment in an FNP program would expand my skillset and knowledge base. The program was challenging, but I am holding on as I am looking forward to become a fully licensed Family Nurse Practitioner.
As a current student in a Masters of Family Nurse Practitioner (FNP) program, I am keenly aware of the challenges that lie ahead in pursuing a career in this field. While I am excited about the prospect of becoming an FNP and providing care to patients in need, I am also aware of the competitive job market that exists for newly trained FNPs.
Despite the increasing demand for healthcare providers in the United States, many hospitals and clinics seem to prioritize hiring experienced FNPs over investing in the training of new ones. This trend can be disheartening for aspiring FNPs like myself who are seeking opportunities for career advancement and professional development.
I believe that organizations have a responsibility to invest in their employees and support their growth and development. By providing opportunities for training, mentorship, and career advancement, organizations can help attract and retain top talent in the field of nursing and improve the overall quality of care for patients.
While the job market for new FNPs may be challenging, I remain committed to pursuing my career goals and making a positive impact in the lives of my patients. With dedication and hard work, I am confident that I can overcome the obstacles that lie ahead and achieve success as an FNP.
In conclusion, my personal experience has taught me that career advancement is essential for a healthy work environment. Organizations should prioritize employee development and provide opportunities for growth and advancement. It not only benefits the employees but also benefits the organization as a whole by creating a positive and supportive work culture (Clark et al., 2011).
When I filled out the Clark Workplace Inventory, my workplace scored a 77, Mildly healthy according to the Clark guidelines (Clark, 2015). I was surprised to find the health level as low as it shows. I do agree that the level of respect fostered in our company could be higher. Our management does meet most of the definitions of respect put forth in Broome and Marshall (2021), but there is still room for improvement. Uniformity of outcomes and adherence to the workflow protocols sometimes overrides the “value of uniqueness” (Broome & Marshall, 2021). However, I would not say that this rises to the level of incivility. Incivility can have a more significant impact on healthcare than just on providers’ attitudes. Incivility can cause self-doubt, leading to adverse patient outcomes (Clark, 2018).
Incivility in the Workplace
The most incivility that I have been subject to in my career was from a supervisor in home health. While working as the clinical supervisor, I received a call from a field clinician to ask for advice on patient treatment. I walked her through the treatment and went on about my other duties. Later that day, I received a phone call from our regional manager, who started the call by denigrating my education, questioning my competence, and threatening my job. All this before I was able to say much more than my name. After I could ask what the problem was, I was informed that the patient from earlier had called in a complaint about the fact that the field nurse needed to be walked through the treatment. I calmly informed the manager that the policy manual was followed and that he had signed off on the policy. I assured him that I would hold training for the field staff on that procedure on our next scheduled training day. It was hard to hold my tongue and not bite back during the interchange, but someone had to be professional. I later received a call from the district supervisor with an apology.
Experiencing incivility has a negative impact on a nurse’s ability to care for their patients (Alquwez, 2020). If the nurse does not feel safe in their environment, they will be unable to ensure the safety of those entrusted to them. My background has given me the ability to deflect and diffuse a volatile situation and have it not affect the work that I am engaged in. It does, however, affect my actions and attitudes when I am out of that situation. Proper training and practice in dealing with incivility can help mitigate the negative effects on the nurse (Clark, 2018). Good leadership can change the culture in the organization and its culture making incivility unwelcome and less prevalent (Broome & Marshall, 2021).
Work Environment Assessment
Healthcare workplace cultures have an essential impact on an organization’s ability to retain staff. The American Nurses Credentialing Center (ANCC) has five connected components to the culture of excellence in their Magnet Model: transformational leadership, structural empowerment, exemplary practice, new knowledge, innovation, and improvements, and, finally, empirical outcomes (Broome & Marshall, 2021). Incivility in the workplace threatens many aspects of this model and, if unchecked, creates an environment that is not conducive to a team-like environment. According to the Workplace Assessment Tool (Clark, 2015), my workplace is neutral. There are areas in dire need of improvement, such as competitive pay and manageable workloads, and areas where they are doing well, such as sufficient advancement opportunities and an environment that promotes teamwork.
Incivility in the Workplace
I have experienced many cases of incivility in the workplace. The first place I worked as a nurse was highly toxic. I worked as a tech while waiting for boards and helping a nurse with vitals. She got a drastically different temp than what I had and yelled at me in front of several staff about how I did not know what I was doing. As it turns out, there was an equipment issue, and the thermometer she had used was supposed to have been pulled and sent to Biomed for calibration. She used the equipment that was tagged for repair anyway. She never apologized; I only interacted with her when necessary until I left. Management sat us both down and never provided any resolution or discipline.
Kisner (2018) states that when conflicts of this nature arise, mediated conversations may be necessary to repair the relationship. These are known as crucial conversations, and this approach states that both sides present their side of the story, all facts are presented one at a time, and a solution is jointly reached (Kisner, 2018). My current workplace utilizes this method, and it has been helpful in repairing working relationships and moving forward with retaining the team environment.
Workplace incivility has a detrimental effect on the health of individuals, impacting various aspects of health, such as cardiac, gastrointestinal, mental, and emotional (Kisner, 2018). It is one reason many nurses leave the profession, and it is preventable by creating a positive organizational culture that does not tolerate incivility. Culture shifts can take time to make, but they are worth it for the health of your staff, the retention of staff, and even the organization’s financial health.
Workplace Environment Assessment
Every organization seeks to perform exceptionally in its field of specialization. As such, it is every employer’s dream to have the best performing human resource at their disposal. However, this is not always the case in every workplace. When employees are comfortable, there is the requisite optimal productivity, which translates to desirable organizational performance. Conversely, when the workplace environment is not conducive for the workers, performance is significantly affected. In this paper, we shall use Clark’s Workplace Inventory Assessment tool to examine the score of quality of my workplace environment regarding physical, social, psychological, and organizational health.
The results from the analysis indicated a score of 75 out of the possible 100, which is marked within the ‘moderately healthy’ position. Physical, psychological, and organizational health assessments registered commendable outcomes, whereas, there were notably pertinent concerns regarding the workplace environment’s social health. Most of the employees felt that they were sidelined and their opinions disregarded in the decision to implement the new language policy that has been viewed by many to undermine the employees’ privacy privileges.
According to the feedback I obtained from my colleagues, the entire human resource body could not make sense of the new language policy since the teams’ have upheld professionalism in all official commitments and the results of their performances are consistent and exemplary. Most of the maintained that it was uncivilized to formulate and implement such a controversial policy without seeking employees’ input. According to Muliira et al., (2017), such actions by the management demoralizes employees and could negatively impact staff turnover and retention.
In the article, Fostering Healthy Work Environments, Clark, C. M. (2016) provides a considerably comprehensive insight into how to create and maintain a healthy workplace environment. Her ideologies could be instrumental to bolster the fairly well-performing aspects, while also improving the poorly scoring attributes like social health and civility on the leadership side.
Based on the test provided by Clark (2015), my current workplace lands in the “mildly healthy” category with a total of 75 points. This makes sense in the context of my workplace. On my unit specifically, I think we do a great job of speaking to one another respectfully, but recognition is one thing that is lacking. There are certain people who have different communication styles than I do, and it’s taken me a while to learn how to communicate effectively with these individuals. At first, I would take things personally, but as I’ve grown both in my career and as an individual, I’ve learned that not everything is meant to be taken personally.
Incivility and Bullying in the Workplace
Unfortunately, I, as well as many other nurses, have experienced incivility in the workplace. Incivility is described as “rude or disruptive behaviors that often result in psychological or physiological distress for the people involved…” (Griffin & Clark, 2014). This sometimes can progress to bullying, most often with new nurses or nursing students on units (Clark, et al, 2011). We’ve all heard the saying that “nurses eat their young.” I believe this saying has come from decades of nurses bullying or otherwise harassing new graduates. Luckily though, I have seen this being phased out. Many newer preceptors and teachers have taken over and come from a place of wanting to educate rather than wanting others to conform.
I have had a few experiences of incivility in the workplace. Without going into too much detail, I was physically assaulted by another nurse while orienting to a unit. I was not a new nurse, just new to the unit. This was very troubling for me, and honestly still is to this day. I brought it up to my manager and was told I would no longer work alongside this individual. No corrective action was taken. This played a part in my leaving the position and moving away.
Incivility should be taken seriously, before it gets to the point of bullying and assault. Because we work such high stress jobs, it is imperative that we are able to depend on our team to be professional and cooperative.
My workplace Mildly healthy with a score of 70 on the Work Environment Assessment Template. The workplace has good camaraderie, but employees are often overworked and put in dangerous siturations to increase company profitability. The organization provides support for professional growth, but there is a disconnect between employees and management (Clark, 2015). I suggest mandatory time for managers to work on the unit and a monthly meeting for core unit staff to voice questions and concerns to improve communication and bridge the gap between employees and management. It is crucial for nurse leaders and managers to prioritize creating a healthy work environment and make employyee well-being a top priority, even in the face of financial pressures (Brito, 2020).
Incivility in the Workplace
Just recently staffing ratios were tight in my acute inpatient general adult psychiatric unit. With a full census of 24 patients 3 of them were 1:1 at all times. We had 4 Behavioral Health Associates (BHAs) 3 automatically gone to 1:1’s and the remaining on safety checks. That left the unit vulnerable to aggressive unstable patients. I was the charge nurse working with a new nurse who was still unable to sign into the medication dispense system. I asked for another med nurse and asked for relief from the geriatric unit which has 10 patients and 3 nurses. The nurse was unwilling to float to our more acute unit and was allow to go home sick. We were left in a tough situation where I was the more experienced nurse in the med room dispensing medication and not being utilized as charge nurse who now had to be a new grad with no experience. I would have liked to see more support by management with reprocussions to the other nurse for insubordination for walking out on an assignement and if that was allowed nurse managers needed to step up and make the unit safe. And provide a more supportive environemtn for health and healing for the patients (Clark et al., 2011).
As a leader our leadership can have a direct influence within the organization itself. The culture of an organization is what I consider to be the most important feature or aspect of an organization, especially a successful one (Broome & Marshall, 2021). As a travel RN, moving from city and organization to organization, I based my survey scores on my current assignment.
The results of my work environment assessment weighed in at a 73. Which as we can see reveals that my current workplace environment is an extremely healthy one. Based on this high score, the organization ranks high in includability and work at a highly civil level. The workplace is civil, coworkers include everyone, as does management. Their level of teamwork at all levels of the organization is outstanding.
Situation of Incivility
As a nurse and a working professional, I pride myself in working as a team. Especially when faced with life and death situation, it is important to know that other have my back. Knowing and being confident that I can depend on my co-workers to act and work as a team in any and every situation is of utmost importance. Through my years as a travel nurse, I have been at both ends of this spectrum.
In my current assignment I have only seen one example of uncivil behavior. The scenario was simply a nurse refusing to take a new assignment. Yes she had had two postpartum patients that consisted of couplet care. So, her patient load was 4 patients total. When census changed and she was needed to return to L&D due to an influx of laboring patients and needing to hand off her 2 couplet care patients to another nurse, she refused to take another patient. She provided useless reasons for why she shouldn’t have to take a new patient load and refused to have to work in both departments in one day.
As you can imagine, this was the most childlike and unprofessional behavior to have. When working in a unit, you are a part of a team. All team members must work together no matter how small or large your patient load is. There was no reason for her to behave in this manner, and she was reprimanded by managerial staff at the end of her shift.
Providing a safe work environment where civility is a required asset of the units members is what must be done and expected to provide proper care of our patients (Clark, 2018). We are bound and obligated by our Hippocratic oath to carry out this behavior. When incivility is mismanaged or blatantly ignored dangerous satiations in the workplace occur. These situations can include direct patient care or harm, nurse harm, or both.
As with the situation mentioned above, while I could see the level of unprofessionalism being displayed, I did not react to it. Upper management stepped in and as a team player I offered my assistance in any form or fashion to help in the resolution of the conflict at hand.
While working on the Clark Healthy Workplace Inventory, I had to really stop and think about my answers. While I wanted our report to be good, in actuality the report did not fare well. The facility in which I work in scored a total of 42 which by grading standards is considered very unhealthy. Within the facility I work in, there is a lot of bad culture floating around and that is because all the staff that have been within the facility for extended periods have always been allowed to act the way they do. This type of culture is detrimental to a growing facility and while we may look good on the outside, once inside we see the flaws. Of course not everything or everyone is flawed within the system, otherwise I honestly would have left already, however it becomes a constant battle to try and win. In an article I found by Kisner (2018) she says, “When senior nurses role-model workplace incivility to novice nurses in the workplace, those behaviors are perpetuated and become the social norm. This is particularly alarming because a culture of incivility undermines patient safety as well as professional teamwork” (para. 5). While this particular statement is regarding senior nurses, I feel this also contributes to administration as well. This is the type of behavior I see within the facility often. I would say we are more uncivil than civil within our facility because staff are allowed to speak to other staff and even patients in ways that create tension and hostility. The culture within the facility is that anyone that has been a part of the facility for a long time standing can act and do as they please.
My own personal incivility encounter is with a nurse practitioner/certified nurse midwife within the clinic I work. This provider has been allowed to be rude, harsh, abrasive, and condescending to clinical staff numerous times. When she first came into the facility, she seemed very nice and fun to work with. As time continued, within 3-4 months her attitude quickly changed. Her nurse that was initially hired with her, quit because she could take being verbally abused any longer. I had gone to my administration staff on multiple occasions due to her coming to me, yelling aggressively, pointing her finger at me and telling me what I was going to do with her patient even though I am not her nurse and was in the midst of working with my provider. While I have zero issues helping and stepping up when needed, being asked to do so goes much better than pointing your finger in my face and telling me what I am going to do. I brought this incident up to my admin staff who stated they would take care of it. I do not believe anything came of it due to never hearing from the provider with a simple apology. I have always given the provider respect and used a calm voice while talking with the provider. According to Clark (2019) when we use respectful voices and tones, we speak with confidence and are prepared, we can confront incivility and hopefully put an end to it. Again, I do not believe that the incivility that I encountered and quite honestly continue to encounter ever gets taken care of truly because the culture within the facility is lacking and poor. I also believe that because the facility is a rural facility and admin has had a hard enough time finding providers, especially in women’s health, they do not want to lose or fire a provider. According to Broome and Marshall (2021) that while there are a lot of stressors within the facilities, we cannot fully eliminate conflict. I agree with this, however, addressing conflicts to ensure they are discussed can help decrease not only conflict but stress. The stress incivility has on staff as well admin can be detrimental to growth and better culture.
The Clark Healthy Workplace Inventory is a tool that measures how well an organization’s work environment supports employee well-being. Developed by Dr. Sharon Clarke, it consists of 20 statements that assess aspects of a healthy workplace (Clark, 2015). It has been used globally and is valuable for employers prioritizing employee health and productivity. After completing the Clark Healthy Workplace Inventory assessment, my workplace scored a 78. According to Clark (2015), 78 is considered Moderately Healthy. Most statements scored in the completely true and somewhat true category; however, it is evident that communication, mentoring, and achievements are not strong suits. However, I still need to represent the civility of my place of work fully. For an organization to be healthy, it must have a standard set of values and visions shared among its members. Creativity, effective teamwork, and strong leadership are also essential (Clark, 2015). I highly recommend my organization to anyone in the medical career, as it represents all those and much more.
Incivility in healthcare can lead to unsafe working conditions, poor patient care, and increased medical costs (Clarke et al., 2011). When I think of workplace incivility, one incident comes to mind. I work at a small, rural family health clinic in Kansas with four physicians and three nurse practitioners. Each provider has a nurse; some have medical scribes and one nurse manager. You see, what I did not mention was any PRN nurses, CNAs, or CMAs. Without proper staffing, there is no backup help when a nurse is gone. Roughly one year ago, we had an incident where a nurse put in vacation time nine months prior and let out nurse manager, who oversees covering, know. Unfortunately, the nurse manager did not show much care, and no coverage was applied. When the time came for the nurse to take a vacation, I was told I would be covering for that provider, a different provider than I worked for. Lack of communication, preparedness, and laissez-faire leadership lead to staffing shortages, increased patient wait time, and decreased overall patient care. My provider told me I would not be pulled to cover for a different provider as that was not my responsibility. I am a very hardworking nurse and have no issue helping anyone out. The incivility comes from the nurse manager expressing little concern for patients, nurses, and providers. Ultimately, the nurse manager was told that she would be covering since she was not responsible enough to coordinate coverage.
As stated previously, in the Clark Healthy Workplace Inventory, a workplace with a score of 78 is considered civil, where employees are treated with respect and dignity and without tolerance for harassment or discrimination. My workplace is polite. Aside from the above scenario, my workplace fosters a sense of belonging, engagement, and overall well-being among its employees. There is always room for better communication. Though we scored lower on the assessment, it promotes open communication, collaboration, and teamwork, which are essential for a positive work environment. By creating a civil workplace, our organizations can improve employee morale, productivity, and retention, ultimately leading to increased profitability and success. In addition, my workplace also encourages creativity and innovation by providing employees with a safe environment to express their opinions and ideas without fear of retaliation. It also promotes a healthy work-life balance that reduces stress and improves job satisfaction, as employees feel valued and respected and that their personal lives are meaningful. Broome and Marshall (2021) suggest that leaders must cultivate a respectful culture and adopt a zero-tolerance policy towards unsafe work environments. Our workplace strives to adapt better to a zero-tolerance policy.
Skilled communication, collaboration, effective decision-making, appropriate staffing, recognition, and authentic leadership are standards needed to create a healthy work environment (Clark, 2015). When employees receive these standards from management, they have more apperception for their job, and it increases patient good outcomes. Incivility in the workplace can cause workplace violence, and dangerous occupations (Clark, 2011). The purpose of this discussion post is to discuss healthy workplace environments how my workplace is civil or not civil, and a situation where I have experienced incivility in the workplace.
Work Environment Assessment
Based off my results of the Work Environment Assessment, my workplace is mildly healthy. Some of the areas that my workplace scored lower in are, Employees are viewed as assets and valued partners within the organization, I scored this statement lower because as of lately, it can feel like we are just a number as employees and can be easily replaced. Another area that scored low is, There is an emphasis on employee wellness and self-care, at times it can feel like leadership cares more about whether a shift is fully staffed or not then the well-being of our nurses. An area that scored high is, The organization provides competitive salaries, benefits, compensations, and other rewards, my organization offers great salaries compared to surrounding hospitals and large bonuses for extra shifts worked. I feel that for the most part my work place is civil, and the areas that scored lower are mostly due to current nursing shortages. The workplace environment and culture is important aspects of health and behavior (Broome & Marshall, 2021).
Incivility in the Workplace
One time that my leadership acted uncivil towards me was, when I switched to PRN at my work because I had started school, I noticed I was always the one sent home early if there was low volume, even if other employees volunteered to go. I approached my managed about this, and she responded, “I care more about my full-time employees getting their hours then I do my PRN, you choose to go PRN, your hours are not guaranteed”. If I am being sent home due to a policy or procedure for order of people being sent home that is fine, I was just looking for a reasoning. After this conversation, my manager realized how she came off and apologized for the interaction and explained to me what the policies are for low volume.
To create a healthy work environment we must respect and take care of ourselves and respect and take care of others (Munro & Hope, 2020). Two areas I think my workplace can work on is treating employee as assets to the organization and putting an emphasis on employee health and well-being. One area that scored high for my employer is, they offer competitive wages and bonuses.
Workplace Environment Assessment
Incivility in healthcare can lead to unsafe working conditions, poor patient care, and increased medical costs (Clark et al., 2011). Following the conventions of formal etiquette and conducting oneself with decorum, such as by showing care for others, are examples of being courteous. Nursing can be dangerous because nurses are frequently more victims of workplace crime than other healthcare professionals. Increasing workloads, a more complex patient population, and deteriorating bedside interpersonal relationships all contribute to professional stress, one of the leading causes of workplace violence. A company’s culture may also normalize or promote rude and disruptive behavior, leading to increased stress, physical and mental suffering, job discontent, poor performance, and plans to leave the company. The objectives of this discussion post are to summarize the results of my evaluation, explain whether my workplace is civil, and describe an incidence of incivility I experienced and how it was addressed.
Work Environment Assessment
To assess the health of my workplace, I completed the Clark Healthy Workplace Inventory, which asked me to rate 20 items on a scale of 1 to 5, with one denoting utterly incorrect, three neutral, and five denoting absolutely true. The responses that most accurately reflect my opinion of my job showed that 12 of the 20 assertions received scores of 4, 8 of those statements had scores of 3, and one statement received a score of 2. According to the Clark Healthy Workplace Inventory’s result key, there are five different potential scores: 90 to 100 denotes a very healthy workplace; 80 to 89, moderately healthy; 70 to 79, mildly healthy; 60 to 69, barely healthy; 50 to 59, unhealthy; and less than 50, very unhealthy (Clark et al., 2011). According to the Clark Workplace Inventory, a score of 70 indicates that I thought my workplace was mildly courteous or mildly healthy.
Civility of Workplace
I have confidence in the company and high expectations of them because they have vowed to be committed to worker wellbeing, patient-centered care, community spirit, self-advancement, diversity and inclusivity, and non-tolerance of workplace violence, which is exemplified by their guiding principles, their purpose, goals, and values, as well as their future aims. I was surprised to see the score reflect a moderately civil result. They claim numerous prospects for professional growth and promotion, but they scored low marks, which astounded me. Although incivility is not new, its types and frequency are increasing and have become severe. Nurse managers seldom address these issues, primarily because the organizational culture is not continuously assessed, and no steps are taken to improve its culture of incivility. They will tell you that you need proof from other staff before they can do anything. Disruptive behavior is also on the rise and frequently ignored in the industry. Employees occasionally feel undervalued and disrespected, which increases employee satisfaction. Individual leaders and staff behavior have also caused moderate to severe problems, including a breakdown in communication and a lack of transparency (Clark et al., 2011).
The employer has imposed upon its staff manual on-call hours that have robbed staff of their time with their families, from mental and physical rejuvenation and workplace stress. Sometimes the nurse lead shows favoritism among staff members and seems to be drawn more to charismatic individuals because they are likable, exude unwavering confidence in their arguments, and can captivate others with their magnetic personalities and charm. Introverts who prefer to focus on their inner thoughts and ideas rather than what is happening outside of themselves sometimes miss out on promotion possibilities despite having substantial experience and knowledge. Introverts rarely have the same opportunities as extroverts because of the fierce and often cut-throat competition. The option to progress will be offered to a newly graduated nurse who is more outgoing and charming than seasoned workers. There is substantial employee discontent, low engagement, and declining staff morale. Both understaffing and significant employee turnover are present. Some leaders in the organization lack cultural competence, and I have seen this play out for staff and patients of different backgrounds. The staff of different cultures is oriented differently and given less information. The organization’s procedure will dictate how the explicit information is provided; however, this distinction becomes more apparent when transmitting strategic knowledge gained via expertise, observation, and experience. According to Clark (2015), nurses and other healthcare professionals sometimes fail to speak politely and compassionately to patients and colleagues, which is true at my healthcare organization. Incivility is an unpleasant and disrespectful behavior less severe than bullying and aggressiveness but may still be destructive because it impacts individuals and businesses (Cates, 2021).
However, managing stress, regulating emotions, and behaving appropriately in social situations are essential to providing safe patient care. Interactions to create a civic culture can affect employees’ capacity to carry out their duties successfully, their dedication to the company, and, most importantly, their ability to give safe, high-quality patient care. Practice and education must work together to create this culture (Clark et al., 2011). Procedures and standards must encourage decorum, be generally adhered to, and provide quantifiable outcomes. Conscious leadership, professionalism, cooperation, teamwork, and ethics are also required. Daily routines should incorporate stress management and self-care techniques.
Incivility Experienced in Workplace
I witnessed a nurse getting irritated with a patient from a different background who spoke a foreign language. The patient requested to leave against medical advice (AMA). The nurse did not hesitate to provide the form or educate the patient on the risks of leaving AMA. I entered the patient’s room and attempted to figure out why she requested the AMA form. The patient stated that she requested not to be given intravenous morphine since it gave her a strange feeling in her head and that she preferred solely oral pain medicines for her discomfort. The nurse did not utilize the translator because she assumed that she understood what the patient was saying and thought it meant that the patient did not want any pain medication. This caused the patient not to be given pain medicine, which caused greater agony and drove the patient to want to leave. The patient reported this to the leader, but no further action was taken.
Examining the workplace’s environmental features reveals how supportive it is of exceptional employee well-being, both in terms of a healthier and happier workforce and the general condition of the workplace. Once this is known, it is possible to identify the issues and develop a plan of action to solve them. An assessment of the working environment could reveal unforeseen expectations. One argument is that the healthcare industry has attempted to market its products and services as the best to recruit more clients and staff, but this may not accurately represent what was promoted. Assessments in the workplace might reveal a worker’s actual perspective based on their experiences, which can be upsetting and disheartening. Therefore, it is crucial to document instances of workplace rudeness so that comparisons may be drawn and the argument might be made more explicit. The fact that certain managers and other workers have been successful in fostering a hostile work environment because of their negative personality qualities is also notable. At the same time, many healthcare companies have worked hard to establish an atmosphere supporting productivity for staff and patients. Each worker is a representation of the hospital. Therefore, this is still detrimental to the workplace, and management should take all appropriate measures to rectify it.
Civility in nursing enhances work relationships and performance. People demonstrate civility in the workplace by maintaining mutual respect and standards for behaviors that promote a safe work environment. Healthcare organizations implement policies that direct employee conduct at work and establish actions taken when they display damaging behaviors (Hossny & Sabra, 2021). Incivility in nursing affects some personnel more than others. For instance, nurse graduates and female staff are more vulnerable than their experienced and male counterparts. From this perspective, excellent leaders should aspire to make the workplace civil and safe for all persons (Clark et al., 2011). The discussion post will describe civility in the workplace depending on my Work Environment Assessment findings. The post will also highlight a situation of incivility and how it was resolved.
The findings of the Work Environment Assessment revealed a total score of 99 out of 100. The outcomes confirm that the workplace is very healthy (Clark, 2015). The workplace culture of collaboration and transparent communication fosters the environment. The healthcare organization’s leadership emphasizes respect towards colleagues regardless of rank, patients, and other partners in care provision. As a result, the facility has enjoyed a long-term reputation for delivering quality healthcare. Besides, it is known as the best workplace by healthcare providers and professionals seeking employment. The facility has a history of retaining the workforce for a long time, which has contributed to its lasting performance and excellence in the field. The environment present at work plays a role in the cooperation between physicians and nurses. Thus, the professionals share responsibilities and participate in decision-making, which enhances improved patient care (Hossny & Sabra, 2021).
However, cases of incivility are inevitable in a diverse workforce because the staff has distinct beliefs and norms shaping their behavior and attitude towards others. An example of a case witnessed at work involved two interns. One of the interns was a male accused of harassing a female colleague. The accusations involved comments the victim alleged were ‘sexual’ because they were about her body size and shape. The incident was ugly because the two interns confronted each other without following the established policy. The Registered Nurse (RN) addressed the issue by summoning the two interns and explaining that the confrontation demonstrated incivility. The two interns and others enrolled in training to learn about the institution’s harassment policy to avoid repeating the scenario. Besides, the RN investigated the accusations and warned the offender (Bernardes et al., 2020).
Incivility at work has detrimental effects on employees and the healthcare organization. Leaders should ensure that the workplace culture and policies reinforce moral behaviors to avoid incivility. A civil environment promotes health and performance among healthcare providers, which translates to improved patient outcomes and excellence.