Incivility in nursing: from roots to repair

Factors associated with clinical nurse's mental health: a qualitative study applying the social ecological model

BACKGROUND

The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions.

METHODS

This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed.

RESULTS

Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy.

CONCLUSIONS

Our study provides a nuanced understanding of the multifaceted factors influencing nurses' mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings.

TRIAL AND PROTOCOL REGISTRATION

The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676 .

REPORTING METHOD

This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

From incivility to outcomes: tracing the effects of nursing incivility on nurse well-being, patient engagement, and health outcomes

BACKGROUND

Nursing incivility, defined as disrespectful behaviour toward nurses, is increasingly recognized as a pressing issue that affects nurses' well-being and quality of care. However, research on the pathways linking incivility to outcomes is limited, especially in Saudi hospitals.

METHODS

This cross-sectional study examined relationships between perceived nursing incivility, nurse stress, patient engagement, and health outcomes in four Saudi hospitals. Using validated scales, 289 nurses and 512 patients completed surveys on exposure to incivility, stress levels, activation, and medication adherence. The outcomes included readmissions at 30 days and satisfaction.

RESULTS

More than two-thirds of nurses reported experiencing moderate to severe workplace incivility. Correlation and regression analyzes revealed that nursing incivility was positively associated with nursing stress. An inverse relationship was found between stress and patient participation. Serial mediation analysis illuminated a detrimental cascade, incivility contributing to increased nurse stress, subsequently diminishing patient engagement, ultimately worsening care quality. Conclusions The findings present robust evidence that nursing incivility has adverse ripple effects, directly impacting nurse well-being while indirectly affecting patient outcomes through reduced care involvement. Practical implications advocate for systemic interventions focused on constructive nursing cultures and patient empowerment to improve both healthcare provider conditions and quality of care. This study provides compelling information to inform policies and strategies to mitigate workplace mistreatment and encourage participation among nurses and patients to improve health outcomes.

Nurse leadership in promoting and supporting civility in health care settings: A scoping review

AIM

This scoping review aimed to identify the existing evidence on how nurse leaders promote and maintain civility amongst nurses in health care settings.

BACKGROUND

Research on managing workplace incivility in nursing, a prevalent and concerning issue worldwide, recommends nurse leaders to command cultural change through strong leadership and civility interventions. However, there is very little empirical evidence summarizing and analysing how nurse leaders pragmatically achieve civility, and combat workplace incivility, in the health care setting.

EVALUATION

A scoping review was undertaken using the electronic databases CINAHL, Emerald Insight, MEDLINE, PsychINFO, PubMed and Scopus. Google Scholar was used to search for grey literature.

KEY ISSUES

The eight studies included in this review describe how nurse leaders promote and maintain civility under four key themes: (1) creating a shared vision, (2) educating self and others, (3) fostering accountability and (4) providing support.

CONCLUSION

The review provides an overview of commonly used strategies and actions that pragmatically promote and maintain civility in the health care setting by nurse leaders, while also highlighting areas of future research needed to strengthen the evidence base.

IMPLICATIONS FOR NURSING MANAGEMENT

It is important for nurse leaders to gain an understanding of evidence-based practices when addressing workplace incivility in order to address this prevailing problem for the future and safety of nurses moving forward.

Creating respectful workplaces for nurses in regional acute care settings: A quasi-experimental design

AIM

To examine self-reported exposure and experiences of negative workplace behaviour and ways of coping of nursing staff before and after educational workshops.

DESIGN

A Quasi-experimental design.

METHOD/SETTING/PARTICIPANTS

Data were collected pre- /postworkshops using a structured questionnaire. Nurses (N = 230) from 12 units in four regional acute care hospitals were invited to complete a pre-intervention survey. Educational workshops were then implemented by the organization at two of the hospitals, after which, follow-up surveys were undertaken.

RESULTS

There were 74 responses in the pre-intervention and 56 responses in the postintervention time period. There were 111 participants who attended the educational intervention, 20% (n = 22) completed the follow-up survey. Participants were more likely exposed to work-related bullying acts and they used problem-focused coping strategies and sought social support as a way of coping when exposed to the negative behaviours. Overall, there was a decrease in both bullying and incivility experienced by participants; however, our findings were unable to establish that a statistically significant difference was made due to the implementation of the intervention.

STUDY REGISTRATION

Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).

Effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses: a randomized controlled trial

Background

Witnessing or experiencing of incivility affected the nurses’ perception of the ethical climate and quality of their work life. The aim of this study was to investigate the effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses.

Method

This study was conducted as a randomized controlled parallel group clinical trial. Eighty emergency nurses participated in this study and were randomly assigned to intervention and control groups during December 2019—March 2020. Cognitive rehearsal program (include of definitions of incivility, ten common incivilities and appropriate practice methods for responding to each and role-plays) was delivered in five two-hour sessions over three weeks on different working days and shifts. The control group received only written information about what incivility is and how to deal with it before the implementation of intervention and one month after the completion of the training sessions, the demographic information form and the incivility scale were completed by the nurses.

Results

The results showed that there was a significant effect on overall incivility, general incivility, and supervisor incivility between the intervention and control groups. However, these significant reductions were seen in control group who received only written education. There were no significant differences in nurse's incivility towards other nurses, physician incivility, and patient/visitor incivility between the two groups.

Conclusion

The cognitive rehearsal program did not decrease perceived incivility among emergency department nurses in the short term.

Trial registration

Our research was registered on clinicaltrials.gov. Registration number: IRCT20200714048104N1, first registration 16/07/2020.

The Relationship Between Workplace Incivility and Psychological Distress: The Moderating Role of Servant Leadership

BACKGROUND

The relationship between workplace incivility and psychological distress among nurses has been well-documented in the nursing literature. Management practices to reduce the negative impact are less clear. This study aimed to examine perceived servant leadership as a moderator between workplace incivility and psychological distress among nurses in Chinese hospitals.

METHODS

This study used a cross-sectional design and was conducted between September and October 2020. We recruited 1,604 nurses from 13 Chinese hospitals across different regions in China ranging from 18 to 55 years in age (M = 28.48 years, SD = 6.53 years). Multiple linear regression was used to analyze the data.

FINDINGS

The results showed that workplace incivility (β = 0.40, p < .001) and perceived servant leadership (β = -0.13, p < .001), as well as their interaction (β = -0.11, p = .002), predicted nurses' psychological distress. Perceived servant leadership moderates the relationship between workplace incivility and psychological distress.

CONCLUSIONS/APPLICATION TO PRACTICE

Servant leaders can create an ethical work climate, display empathy and compassion, and facilitate resilience. Our findings can assist hospital management with support from occupational health providers to recruit, train, and assess nursing supervisors. Also, occupational health providers in collaboration with nursing administration can monitor incivility, psychological distress, servant leadership levels, and impact.

A bibliometric analysis of workplace incivility in nursing

AIM

This research aims to present a general summary of researches on workplace incivility in nursing using bibliometric indicators.

BACKGROUND

Nurses regularly experience incivility from their working environment. However, evidence shows that it has significant potential for harmful consequences, both in terms of their health and in terms of productivity. Therefore, nursing and hospital managers have a crucial role in creation and maintenance of civil behaviour.

METHOD(S)

This research reports on a bibliometric analysis using a systematic review of academic literature on workplace incivility in nursing. A search of Web of Science databases was performed, and a total of 269 abstracts were investigated. Calculation of bibliometric indicator was done in Excel, and tag clouds had been created in VOSviewer.

RESULTS

Nursing incivility literature is growing, and the United States contributed the largest number of papers. Studies have been carried out on nurses working in hospitals and nursing students in general. Topics are mainly focused on the organisational consequences of uncivil behaviour.

CONCLUSION(S)

This study reveals that there are not enough studies on workplace incivility in nursing.

IMPLICATIONS FOR NURSING MANAGEMENT

As a result obtained from this research, it especially recommends health care and nursing managers to research some risky groups and subject less studied yet.

Negative workplace behavior and coping strategies among nurses: A cross-sectional study

Negative workplace behavior affecting nurses is an internationally recognized problem. This study examines the types and extent of negative workplace behavior experienced by nurses in non-metropolitan, regional acute care settings and their ways of coping when subject to that behavior. A cross-sectional study was conducted involving 74 nurse participants in four regional hospitals in Australia. The structured questionnaire consisted of four parts: demographic questions, the Negative Acts Questionnaire - Revised, questions on exposure to bullying and/or incivility and policy awareness and use of pathways, and the Ways of Coping Questionnaire. Overall, 34% of participants were exposed to bullying and 49% to incivility over the previous month. The most common type of negative workplace behavior reported was "work-related bullying," which included exposure to excessive workloads, unrealistic deadlines, and information being withheld. Nurses reported the use of a variety of coping mechanisms, including problem-focused coping strategies and seeking social support. The findings imply that negative workplace behaviors occur not only at individual nurses' level but also derive from the broader contexts of organizational management and systemic factors.

Clinical leadership and rural and remote practice: A qualitative study

AIM

To explore how clinical leadership is perceived by nurses in rural and remote areas of New South Wales, Australia.

BACKGROUND

There are few empirical studies aimed at understanding clinical leadership from a rural and remote perspective.

METHODS

A qualitative approach, based on interpretive phenomenology, used thematic analysis of recorded and transcribed interviews. Ethical approval was secured, 56 interviews were undertaken, across 14 different rural and remote health facilities, with nurses across the spectrum of practice.

RESULTS

Thematic analysis led to five themes and findings that support an understanding of clinical leadership from a rural and remote context. Clinical leaders were seen to considerably impact on the initiation of change and quality of care. They also faced barriers if the health facility was poorly staffed, lacked support and if the community were strongly co-dependent.

CONCLUSION

In rural and remote areas, clinical leadership is evident to support change, innovation and care quality.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers should be aware that staff shortages and challenges to staff retention or the initiation of change are affected by poor clinical leadership. This paper suggests that managers who facilitate clinical leadership are better able to support professional education and greater efficiencies in the delivery of quality health care.

Systems Perspective for Incivility in Academia: An Integrative Review

AIM

The purpose of this integrative review was to identify evidence of systems thinking on civility in academic settings.

BACKGROUND

Incivility is present in academic systems, including nursing education. What is learned in academia translates to the workplace. Systems-based solutions may promote quality and safety in health care.

METHOD

Whittemore and Knafl's integrative approach guided this study.

RESULTS

Forty-nine articles were reviewed. Themes emerged describing incivility in nursing as embedded within layers of a performance-driven, oppressive hostile bureaucracy, trickling down, instilling fear, and reinforcing uncivil behavior among and between members. Other themes defined faculty-to-faculty and faculty-to-student incivilities, reasons for it, reactions to it, and suggestions for improved civility.

CONCLUSION

The systems awareness model is offered as a means of promoting civility in nursing education. A lack of evidence to support how incivility in academia transfers to quality and safety in practice settings is identified as a gap for future study.

Violence-prevention climate in the turnover intention of nurses experiencing workplace violence and work frustration

AIMS

To determine the moderating effect of a violence-prevention climate and the mediating effect of work frustration on the relationship between workplace violence (WPV) and the turnover intention of nurses.

BACKGROUND

To maintain the stability and work quality of nurses, WPV should be studied to provide effective prevention measures.

METHODS

A cross-sectional study with a convenience sample was adopted. Participants were nurses from three hospitals in Taiwan. Of 1,531 questionnaires, 973 were valid for analysis (63.6%).

RESULTS

A total mediating effect of work frustration on nurses' own experiences of WPV increased turnover intention. Witnessing WPV toward coworkers caused a significant partial mediating effect on work frustration that further increased turnover intention. A violence-prevention climate had a significant moderating effect on the work frustration and turnover intention of nurses after they had witnessed violence against others.

CONCLUSION

Effective policies and an incentivized reporting system can foster a safe and friendly work environment not only for nurses who experience violence but also for those who witness violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers and leaders must create a positive consultative pipeline to ensure a safe climate and environment for both the victims of WPV and the nurses who witness violence against others.

Heroism and nursing: A thematic review of the literature

OBJECTIVES

Nursing history is replete with examples of heroic individuals acting courageously to meet the needs of vulnerable patients and communities. Heroism exemplifies the pinnacle of self-actualised behaviour. It fuels the plots of countless human stories, and enthrals and inspires people. Yet, heroism may be seen as an extreme behaviour that only exceptional individuals are capable of enacting, and may thus be seen as out of reach for ordinary nurses, and something that could be risky to teach and disseminate. An alternative view is that altruistic professions such as nursing are often regarded as being heroic by nature, and that nurses therefore need to be encouraged to understand, deepen and exercise their potential through a recognition of acts of heroism in nursing - whether these can be classed as exceptional or everyday acts of nursing heroism. The purpose of this article is to provide a thematic review of the literature on heroism in nursing, in order to understand how recent research in heroism science is being, or could be, applied to the nursing discipline. Heroism science is an emerging research area that is of interest to nursing leaders, educators and all those seeking to advance the social change agenda in healthcare.

REVIEW METHODS

A literature review was undertaken in 2017 using CINAHL, PUBMED, Cochrane, Medline, and Google Scholar. The search was limited to papers that were peer reviewed, in English, and published in the last ten years.

RESULTS

Four books and 33 papers were identified.

CONCLUSION

Gaining a clear understanding of what constitutes a hero and heroism is essential to applying heroism to nursing and to education of students so they are inspired to act courageously.

Testing the reciprocal associations among co-worker incivility, organisational inefficiency, and work-related exhaustion: A one-year, cross-lagged study

In spite of the considerable number of studies on co-worker incivility, knowledge on this topic needs to be further enhanced. In particular, no studies have focused on the reciprocal nature of the relationship of incivility with other important aspects of working life, i.e. employee well-being and the quality of the working process. The aim of the present study was to examine the cross-lagged associations among co-worker incivility, work-related exhaustion, and organisational efficiency in a sample of healthcare workers. Based on the conservation of resource theory, we hypothesised that those three variables affect each other reciprocally over the time. Data from a two-wave study design (with a one-year time lag) were utilised, and cross-lagged structural equation models were performed. Results confirmed that incivility and efficiency affected each other reciprocally over time. On the other hand, whereas incivility positively predicted exhaustion and exhaustion at inversely predicted organisational efficiency, the opposite paths were found to be not significant. The study suggests that efficiency is crucial for understanding incivility because it operates both as its cause and as its outcome. Interventions aimed at promoting civility and respect in the workplace may help prevent co-worker incivility, work-related exhaustion, and enhance organisational efficiency.

Systems thinking and incivility in nursing practice: An integrative review

BACKGROUND AND PURPOSE

There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient-related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level-headed thinking from which patient-centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings?

METHODS

Whittemore and Knafl's integrative review method guided this study. The quality of articles was determined using Chu et al.'s Mixed Methods Assessment Tool.

RESULTS

Thirty-eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice.

IMPLICATIONS FOR PRACTICE

This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety.

Organisational efficiency and co-worker incivility: A cross-national study of nurses in the USA and Italy

AIM

To examine the relationship of co-worker incivility with organisational efficiency, workload and intention to leave in nursing samples from two different countries, the USA and Italy.

BACKGROUND

Organisational efficiency has received little attention as a possible correlate of co-worker incivility in the nursing management literature. Studies on co-worker incivility have primarily been carried out in North America and no cross-national studies are available.

METHOD

Data were collected by a self-report questionnaire involving nurses from the USA (n = 341) and Italy (n = 313).

FINDINGS

Organisational efficiency was negatively associated with workload, co-worker incivility and intention to leave in both samples. The path from co-worker incivility to intention to leave was also positive and significant in both samples. Workload was positively associated with co-worker incivility and intention to leave in the US sample, but not in the Italian sample.

CONCLUSION

The present study suggests that organisational efficiency is central to understanding both co-worker incivility and intention to leave among nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators should adopt interventions aimed at fostering organisational efficiency in an effort to reduce nurse co-worker incivility.