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.

Incivility in healthcare: the impact of poor communication

Incivility is a common issue within healthcare in the UK and internationally. Experienced by at least one-third of staff within the UK National Health Service, incivility has been demonstrated to have significant negative implications on both patient care and healthcare staff. These include contributing to direct medical errors, diagnostic inaccuracy and team communication, with a large associated cost burden, while for staff it has significant negative impacts on retention, productivity and morale. Proposed methods do already exist to both prevent and address incivility, and it is in the interest of healthcare institutions, for their patients and staff, to investigate incivility and adopt these methods. This review explores existing literature on the effects of incivility, researched strategies to address it, as well as the proposed ways of integrating these. Through raising awareness and exploring these issues, our aim is to increase recognition of incivility, as well as inspire healthcare managers and leaders to collectively take efforts to reduce the rates of incivility.

Workplace incivility and the professional quality of life in nurses

BACKGROUND

Workplace Incivility is a common issue in the nursing profession. Nurses who are affected by such behaviors may experience distress.

OBJECTIVES

This study aimed to assess the relationship between workplace incivility and nurses' professional quality of life.

RESEARCH DESIGN

This cross-sectional correlational study was conducted in 2021 in "Tehran". Data were collected using a demographic questionnaire, the Nursing Incivility Scale (NIS), and the Professional Quality Of Life scale (ProQOL). Data analysis was performed through the Pearson correlation and multiple linear regression, using the SPSS v.16.

PARTICIPANTS AND RESEARCH CONTEXT

Participants were 200 nurses randomly recruited from selected hospitals of "TUMS".

ETHICAL CONSIDERATIONS

The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation.

FINDINGS

The mean age of participants was 32.30 ± 7.22, and 76.5% were female. There was a significant correlation between the professional quality of life and workplace incivility (r = -0.23, p = .001). Multiple regression analysis between the subscales of workplace incivility and professional quality of life demonstrated that the incivility from the supervisor (β = -0.29, p = .001) and incivility from patients (β = -0.27, p < .001) can predict the compassion satisfaction dimension. The incivility from the supervisor (β = 0.24, p = .001) and incivility from patients (β = 0.26, p < .001) can explain burnout. The incivility of the patients can explain secondary traumatic stress (β = 0.14, p = .02).

CONCLUSION

This study showed that workplace incivility is significantly related to professional quality of life. Therefore, the reduction of behaviors of incivility can lead to the improvement of the professional quality of life.

Bullying in Academic Medicine: Experiences of Women Physician Leaders

PURPOSE

Bullying is defined as offenders abusing positions of authority and intentionally targeting individuals through persistent negative behaviors to impede education or career growth. This study sought to estimate the prevalence and nature of bullying experienced by women physician leaders in academic medicine.

METHOD

In this survey-based study, 547 physician graduates of an executive women's leadership training program were invited to complete a survey that measured workplace bullying in 2021. Participants were asked whether and when they had been bullied, how it impacted their careers, and remedies for bullying. Descriptive statistics were used to profile mistreatment and bullying experienced by the respondents during their professional careers and the nature of bullying. Content analysis of open-ended comments was used to describe how bullying impacted women physicians and outline recommendations for bullying prevention and mitigation.

RESULTS

The survey response rate was 64.7% (354/547). Most women (302/354 [85.3%]) had experienced mistreatment during their careers, with more than half experiencing bullying while an attending physician (198/302 [65.6%]). Many women (187/302 [61.9%]) who screened positive for mistreatment also reported that they had been bullied at work. Of these 187 respondents, 173 (92.5%) experienced bullying from men and 121 (64.7%) reporting bullying from women (effect size = 0.34, P ≤ .001), and 115 (61.5%) reported that bullies were their immediate supervisors. Qualitative findings suggested that bullying harmed individuals' career advancement, mental health, reputation, and relationships with others. Many had to change roles or leave jobs. Participants proposed that initiatives by top-level leaders, clear definitions of bullying behavior, reporting mechanisms, and upstander training for faculty and staff could mitigate bullying.

CONCLUSIONS

Most women physician leaders have experienced bullying. These results highlight the need to address bullying in academic medicine so that women can reach their full career potential.

Mediating role of emotional labour strategy in the association between patient/visitor incivility and nurses' fatigue: a cross-sectional study

OBJECTIVE

Fatigue is a common problem among nurses, and patient/visitor incivility is thought to lead to nurses' fatigue. However, the mechanism by which patient/visitor incivility leads to nurses' fatigue has not been well studied. The aim of this study is to examine whether the association between patient/visitor incivility and fatigue among Chinese nurses is mediated by emotional labour strategy.

DESIGN

A cross-sectional study.

METHODS

In November 2019, a stratified cluster sample of 1207 nurses from two hospitals in China was used to collect data on fatigue, patient/visitor incivility and emotional labour strategy through online questionnaires. Emotional labour strategy has three dimensions: surface acting (SA), deep acting and natural acting. Complete responses were provided by 1036 (85.8%) participants. Student's t-test, one-way analysis of variance, Pearson correlation analysis and the PROCESS procedure (A modeling macro installed in SPSS to analyse mediation.) were adopted to analyse the data.

RESULTS

Patient/visitor incivility and SA were positively related to fatigue (p<0.01), while natural acting was negatively related to fatigue (p<0.01). SA played as a mediator in the association between patient/visitor incivility and nurses' fatigue (95% CI 0.047 to 0.113, p<0.05).

CONCLUSION

Patient/visitor incivility could contribute to Chinese nurses' fatigue. When nurses were exposed to patient/visitor incivility, they were more likely to use the SA emotional labour strategy, which would lead to fatigue. Nursing administrators should be aware of the seriousness of nurses' fatigue.

Frequency and Outcomes of Workplace Incivility in Healthcare: A Scoping Review of the Literature

AIMS

To evaluate the frequency and outcomes of workplace incivility in healthcare for nursing management.

BACKGROUND

Incivility in the workplace is a significant problem that is important to nurse managers, as it goes directly against the fundamental values and ethics of providing high-quality care to patients. The Joint Commission (2021) and the American Nurses Credentialing Center have called on healthcare organizations to identify and intervene in the problem of workplace incivility.

EVALUATION

Studies included in this scoping review were those that measured and analyzed the frequency and outcomes of workplace incivility in healthcare. Four databases were searched, and 28 articles were reviewed. Evaluation was based on general quality, including study characteristics, instruments, and statistical analyses.

KEY ISSUES

Studies used a quasi-experimental design, and most focused on the Registered Nurse population. The Workplace Incivility Scale was the most commonly used instrument to measure workplace incivility frequency. The most frequently studied work-related outcomes were burnout, satisfaction, and turnover.

CONCLUSIONS

Although the frequency of workplace incivility in healthcare is not clear, its consequences are substantial. Multiple studies have revealed significant relationships between workplace incivility and work-related outcomes that are important to nurse managers. Research is needed on non-nursing healthcare professionals, and validation studies are needed on instruments used to measure workplace incivility frequency.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this review can help nurse managers better understand the phenomenon, frequency, and impact of workplace incivility in the healthcare setting and move toward addressing the problem of workplace incivility among nurses and other healthcare professionals.

How workplace incivility leads to work alienation: A moderated mediation model

Workplace incivility remains a prevailing issue and has significant potential for harmful consequences. This study aims to investigate the influencing mechanism of workplace incivility on work alienation from the perspective of targets. Based on the social exchange theory, our research examines the role of interpersonal trust as a mediator along with the moderator of career resilience in the said association. Through a two-wave-time-lagged quantitative research design, a sample of 315 nurses from China was investigated with questionnaires on workplace incivility, work alienation, interpersonal trust, and career resilience. The results indicated that workplace incivility was positively related to work alienation with interpersonal trust as a mediator. Workplace incivility caused a decline in interpersonal trust, which led to work alienation. Career resilience buffered such an impact. High career resilience weakened the association linking workplace incivility to interpersonal trust. Organizations should pay more attention to workplace incivility and consider empowering nurses’ career resilience, which could alleviate the negative impact of workplace incivility.

Predictors of events of violence or aggression against nurses in the workplace: A scoping review

AIM

To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts.

BACKGROUND

Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence.

EVALUATION

A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus.

KEY ISSUES

After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'.

CONCLUSIONS

The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it.

IMPLICATIONS FOR NURSING MANAGEMENT

The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.

The effect of covert narcissism on workplace incivility: The mediating role of self-esteem and norms for respect

There has been an abundance of research on narcissism in the workplace. However, most research has focused on the overt (grandiosity) form of narcissism, as well as the effect of narcissism on uncivil behaviors of employees; research focusing directly on the effect of covert (vulnerability) narcissism on the employees’ experience of workplace incivility is lacking. The present research examined whether the personality trait (covert narcissism) of employees affects their experience of incivility considering two potential explanatory variables: self-esteem and perceived norms for respect. A total of 150 participants completed an online questionnaire, which consisted of four well-known measures: the Hypersensitive Narcissism Scale, the Rosenberg Self-esteem scale, the Perceived Norms for Respect, and the Workplace Incivility Scale. The results showed that employees with higher levels of covert narcissism are likely to have greater experiences of workplace incivility through the mediating role of perceived norms for respect. Although the relationship was not explained through the mediating role of self-esteem, it was instead observed that self-esteem and perceived norms for respect jointly affect employees’ experience of incivility at work. These findings broaden our understanding of workplace incivility by simultaneously considering the influences of personality traits, self-esteem, and workplace norms.

Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review

Background

Recent studies suggest that displays of unacceptable behaviour, including bullying, discrimination and harassment, between healthcare workers (HCWs) may impair job performance, and in turn, increase the frequency of medical errors, adverse events and healthcare-related complications. The objective of this systematic review was to summarise the current evidence of the impact of unacceptable behaviour occurring between HCWs on clinical performance and patient outcomes.

Methods

We searched MEDLINE, Embase, PsycINFO and CINAHL from 1 January 1990 to 31 March 2021. The search results were screened by two independent reviewers and studies were included if they were original research that assessed the effects of unacceptable behaviour on clinical performance, quality of care, workplace productivity or patient outcomes. Risk of bias was assessed using tools relevant to the study design and the data were synthesised without meta-analysis.

Results

From the 2559 screened studies, 36 studies were included: 22 survey-based studies, 4 qualitative studies, 3 mixed-methods studies, 4 simulation-based randomised controlled trials (RCTs) and 3 other study designs. Most survey-based studies were low quality and demonstrated that HCWs perceived a relationship between unacceptable behaviour and worse clinical performance and patient outcomes. This was supported by a smaller number of higher quality retrospective studies and RCTs. Two of four RCTs produced negative results, possibly reflecting inadequate power or study design limitations. No study demonstrated any beneficial effect of unacceptable behaviour on the study outcomes.

Conclusions

Despite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours.

The mediating effect of workplace incivility on organization culture in South Korea: A descriptive correlational analysis of the turnover intention of nurses

PURPOSE

The purpose of this study was to understand the mediating effect of workplace incivility on the relationship between nursing organizational culture and turnover intention among nurses.

DESIGN

A descriptive survey was used to collect data. The participants were 170 nurses with more than six months of clinical experience at university hospitals or hospitals with over 500 beds in South Korea.

METHODS

Data were collected using self-report questionnaires. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Scheffé test, and Pearson's correlation. Baron and Kenny's three-step hierarchical regression analysis and the Sobel test were used to determine the mediating effect of workplace incivility on the relationship between nursing organizational culture and nurses' turnover intention.

RESULTS

This study found a full mediating effect of workplace incivility on the association between relationship-oriented culture and turnover intention (Z = -3.02, p = 0.003) and a partial mediating effect of workplace incivility on the association between hierarchy-oriented culture and turnover intention (Z = 2.36, p = 0.018).

CONCLUSION

This study empirically confirmed that nursing organizational culture and workplace incivility directly or indirectly influenced turnover intention, which highlights the seriousness of workplace incivility.

CLINICAL RELEVANCE

This study suggests that there is a need to establish a concrete strategy to avoid a hierarchy-oriented culture and create a relationship-oriented culture. It is important to develop a variety of intervention programs to reduce workplace incivility in order to prevent nurses' turnover.

Workplace bullying and risk of burnout in nurses: a systematic review protocol

OBJECTIVE

The objective of this review is to assess the association between workplace bullying and nurse burnout.

INTRODUCTION

Internationally, workplace bullying has been linked to nurse burnout. Burnout is of significant concern due to its association with nurses' intent to quit, job dissatisfaction, reduced empathy and patient satisfaction. While there have been systematic reviews conducted on workplace bullying, none have explored its association with nurse burnout.

INCLUSION CRITERIA

This review will consider studies that include licensed nurses in any clinical setting in any country. Only studies in which the Negative Acts Questionnaire-Revised was used to measure licensed nurses' exposure to workplace bullying and in which the Maslach Burnout Inventory was used to measure burnout (i.e. the outcome of interest) will be considered. Prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies will be considered for inclusion.

METHODS

Key information sources to be searched for studies in English from 1990 to the present include CINAHL, Embase, PsycINFO, PubMed and Scopus. Two independent reviewers will screen titles, abstracts and full texts of selected citations against the inclusion criteria and appraise for methodological quality. Two reviewers will independently use the standardized data extraction tool to extract data from studies used in the review. Studies will, where possible, be pooled in a statistical meta-analysis. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation, where appropriate.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019128798.

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.

The Target of Incivility Cannot Be an Island

Abstract. To address the inconsistencies regarding the effects of incivility on employee productivity and career satisfaction, this study adopted a multilevel approach to examine the cross-level moderating effect of department-level incivility on the negative impact of individual-level incivility. We tested our hypotheses using data from 717 faculty nested within 79 departments at a southwestern university. The hierarchical linear modeling results supported that individual-level incivility negatively related to career satisfaction but not productivity. Further, department-level incivility moderated the negative effects of individual-level incivility such that the negative effects of individual-level incivility on career satisfaction and productivity were reduced when most people in the department experienced incivility or when individuals were not singled out for being mistreated. Theoretical and practical implications are discussed.

Creating a culture of respect and interprofessional teamwork on a labor and birth unit: a multifaceted quality improvement project

Interprofessional teamwork is essential to high-quality healthcare, however disrespect and incivility amongst team members is a challenge to creating and sustaining effective teams. We describe and assess the impact of a multifaceted improvement project with the primary intervention being a Compassionate Communication (CC) training on a Labor and Birth unit. Our hypothesis was this improvement project would increase staff members' capacity for perspective-taking and self-reflection, which would in turn correlate with positive interpersonal interactions, respect and teamwork. Secondly, we hypothesized that enhanced respect and teamwork would correlate with enhanced affective commitment to the organization. Staff was surveyed midway through the project and 6 months after the CC training. A total of 74 (57%) staff completed the initial pre-training surveys and 50 (38%) staff completed post-training surveys. At 6 months post-CC training we saw changes in self-reflection and an awakening of self-awareness. There were no significant changes in perspective-taking. However, we did see changes in staffs' perceptions of respect and teamwork. Team members' affective commitment to the organization increased. In this Labor and Birth setting, a multifaceted improvement project with the primary intervention being CC training was beneficial in improving a culture of respect and interprofessional teamwork.

Negative Behavior Among Healthcare Professionals: Integrative Review of Instruments

BACKGROUND

Behaviors that undermine a culture of safety pose a serious threat to the overall wellbeing of healthcare workers as well as to patient outcomes.

PURPOSE

The purpose of this integrative review is to compare reported psychometrics, feasibility, and identify commonalities among available instruments measuring negative behaviors among healthcare professionals.

METHODS

Whittemore and Knafl's integrative review methods were used to analyze pertinent instruments designed to measure negative behaviors among healthcare professionals. Multiple computerized databases including CINAHL, MEDLINE, and Scopus databases were searched in the fall of 2017 without date restrictions.

RESULTS

Violence, incivility, and bullying are the most frequently measured behaviors in healthcare workers, and a robust number of valid and reliable instruments are available.

CONCLUSIONS

To date a comprehensive review of psychometric properties and feasibility of administration is lacking. This review synthesizes the instruments measuring these behaviors, providing a resource for future research focused on mitigation and intervention strategies.

Examining the presence and sources of incivility within nursing

AIMS

Examine the presence and various sources of incivility among nursing staff working within an academic medical centre utilizing the Nurse Incivility Scale (NIS).

BACKGROUND

Evidence suggests various forms of negative behaviour including incivility exist among nurses. Established consequences of these behaviours include increased employee turnover rates, decreased job satisfaction, decreased productivity and increased absenteeism.

METHODS

A descriptive survey design was used which included the NIS instrument to measure the presence of incivility within the nursing workforce and specific sources of these behaviours among 414 nurses in an academic medical centre.

RESULTS

Hospital nurses working within the intensive and intermediate care unit experienced significantly greater incivility from patients and families than other participants within the study [F (3, 413) 8.62, p = .001]. No other significant differences existed in sources of incivility between various levels of direct care.

CONCLUSIONS

Nursing staff working within high-risk areas for incivility such as the intensive care and intermediate care units may require additional interventions to reduce perceptions of incivility from patients/families.

IMPLICATIONS FOR NURSING MANAGEMENT

Findings suggest further research is necessary to develop targeted interventions for nurses practicing within intensive care and intermediate units to alleviate the perceived burden of incivility from patients/families.

Testing a Communication Assessment Tool for Ethically Sensitive Scenarios: Protocol of a Validation Study

Background

Although well-designed instruments to assess communication during medical interviews and complex encounters exist, assessment tools that differentiate between communication, empathy, decision-making, and moral judgment are needed to assess different aspects of communication during situations defined by ethical conflict. To address this need, we developed an assessment tool that differentiates competencies associated with practice in ethically challenging situations. The competencies are grouped into three distinct categories: communication skills, civility and respectful behavior, clinical and ethical judgment and decision-making.

Objective

The overall objective of this project is to develop an assessment tool for ethically sensitive scenarios that measures the degree of respect for the attitudes and beliefs of patients and family members, the demands of clinical decision-making, and the success in dealing with ethical conflicts in the clinical context. In this article, we describe the research method we will use during the pilot-test study using the neonatal context to provide validity evidence to support the features of the Assessment Communication Tool for Ethics (ACT4Ethics) instrument.

Methods

This study is part of a multiphase project designed according to modern validity principles including content, response process, internal structure, relation to other variables, and social consequences. The design considers threats to validity such as construct underrepresentation and factors exerting nonrandom influence on scores. This study consists of two primary steps: (1) train the raters in the use of the new tool and (2) pilot-test a simulation using an Objective Structured Clinical Examination. We aim to obtain a total of 90 independent assessments based on the performance of 30 trainees rated by 15 trained raters for analysis. A comparison of raters’ responses will allow us to compute a measure of interrater reliability. We will additionally compare the results of ACT4Ethics with another existing instrument.

Results

This study will take approximately 18 months to complete and the results should be available by September 2019.

Conclusions

ACT4Ethics should allow clinician-teachers to assess and monitor the development of competency of trainees’ judgments and communication skills when facing ethically sensitive clinical situations. The instrument will also guide the provision of meaningful feedback to ensure that trainees develop specific communication, empathy, decision-making, and ethical competencies.

International Registered Report Identifier (IRRID)

PRR1-10.2196/12039

Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors

BACKGROUND

Negative interactions among nurses are well recognized and reported in scientific literature, even because the issues may have major consequences on professional and private lives of the victims. The aim of this paper is to detect specifically the prevalence of workplace incivility (WI), lateral violence (LV) and bullying among nurses. Furthermore, it addresses the potential related factors and their impact on the psychological and professional spheres of the victims.

METHODS

A review of the literature was performed through the research of papers on three databases: Medline, CINAHL, and Embase.

RESULTS

Seventy-nine original papers were included. WI has a range between 67.5% and 90.4% (if WI among peers, above 75%). LV has a prevalence ranging from 1% to 87.4%, while bullying prevalence varies between 2.4% and 81%. Physical and mental sequelae can affect up to 75% of the victims. The 10% of bullied nurses develop Post-Traumatic Stress Disorder Symptoms. Bullying is a predictive factor for burnout (β=0.37 p<0.001) and shows a negative correlation with job efficiency (r=-0 322, p<0.01). Victims of bullying recorded absenteeism 1.5 times higher in comparison to non-victimized peers (95% CI: 1.3-1.7). 78.5% of bullied nurses with length of service lower than 5 years has resigned to move to other jobs.

CONCLUSIONS

There is lack of evidence about policies and programmes to eradicate workplace incivility, lateral violence and bullying among nurses. Prevention of these matters should start from spreading information inside continue educational settings and university nursing courses.

Rudeness and Medical Team Performance

OBJECTIVES

Rudeness is routinely experienced by medical teams. We sought to explore the impact of rudeness on medical teams' performance and test interventions that might mitigate its negative consequences.

METHODS

Thirty-nine NICU teams participated in a training workshop including simulations of acute care of term and preterm newborns. In each workshop, 2 teams were randomly assigned to either an exposure to rudeness (in which the comments of the patient's mother included rude statements completely unrelated to the teams' performance) or control (neutral comments) condition, and 2 additional teams were assigned to rudeness with either a preventative (cognitive bias modification [CBM]) or therapeutic (narrative) intervention. Simulation sessions were evaluated by 2 independent judges, blind to team exposure, who used structured questionnaires to assess team performance.

RESULTS

Rudeness had adverse consequences not only on diagnostic and intervention parameters (mean therapeutic score 3.81 ± 0.36 vs 4.31 ± 0.35 in controls, P < .01), but also on team processes (such as information and workload sharing, helping and communication) central to patient care (mean teamwork score 4.04 ± 0.34 vs 4.43 ± 0.37, P < .05). CBM mitigated most of these adverse effects of rudeness, but the postexposure narrative intervention had no significant effect.

CONCLUSIONS

Rudeness has robust, deleterious effects on the performance of medical teams. Moreover, exposure to rudeness debilitated the very collaborative mechanisms recognized as essential for patient care and safety. Interventions focusing on teaching medical professionals to implicitly avoid cognitive distraction such as CBM may offer a means to mitigate the adverse consequences of behaviors that, unfortunately, cannot be prevented.

How to Prevent Workplace Incivility?: Nurses' Perspective

Background:

Many articles have studied workplace incivility and its influence on outcomes, but very few have been conducted to assess how to prevent this issue. In this study, we aimed to determine how to prevent workplace incivility from the nurses' perspective.

Materials and Methods:

This was a qualitative study which was based on a conventional content analysis approach. Thirty four nurses (25 to 52 years old) from seven training hospitals in Tabriz, Iran were selected through purposive sampling. Thirty six semi-structured interviews and eight field notes were analyzed.

Results:

The data analysis revealed 417 codes, ten categories, three subthemes and one theme, that is, A Need for a Comprehensive Attempt. Attempt of organization, nurses, and public as subthemes are needed to prevent workplace incivility.

Conclusions:

The findings of the study indicated that a comprehensive and systematic attempt was needed to prevent incivility. Nurses should try to improve their skills; officials should try to show the real image and position of nurses and hospitals to the community.

Incivility among intensive care nurses: the effects of an educational intervention

BACKGROUND

Incivility is a significant problem in nurse satisfaction and nurse retention and can be detrimental to a patient's outcome; therefore, it would be beneficial to educate nurses on ways to improve incivility in clinical practice.

OBJECTIVES

To determine if a nursing education program, utilizing case studies and discussion of the nurses' experiences would increase awareness of incivility and impact the number of perceived incidences by (1) assessing nurses' experience of incivility along with discerning the perceived source of the incivility and (2) educating the nurses, thus determining if the in-service education decreases the incidence of incivility in the adult intensive care unit.

METHODS

This is a quantitative pilot study that utilized a 1-group preintervention and postintervention test design. The intervention was a 60-minute educational program. Twenty-one nurses completed the survey that assesses prevalence of incivility by specific sources, such as nurses, physicians, supervisors, general (other hospital employees), and patients before and after participation in the education intervention. Descriptive statistics of the 5 dimensions of civility and a total dimension score of civility were used.

RESULTS

A total of 21 nurses completed all parts of this study. The postintervention score had a higher mean than the preintervention score in each of the dimensions. Higher scores indicate incivility; thus, lower scores indicate civility. Therefore, more instances of incivility were identified after intervention to increase awareness of incivility. In addition, nurses perceived greater amounts of incivility from patients and families, whereas the direct supervisor (team leaders) showed the greatest amount of civility. A hierarchical regression revealed that race had the largest negative impact, followed by nurses practicing for more than 5 years, part-time status, and younger age, respectively.

DISCUSSION

The outcomes in this pilot study contradict much of the research on incivility in nursing, which previously found that supervisors are more uncivil toward their staff nurses than the rest of the staff. The results of the current study found that incivility perceptions were higher in the postintervention survey; these findings suggest that the education was effective, thus creating more awareness of incivility. This could be a positive cultural turning point in nursing as it decreases incivility, which in turn will help to decrease medical errors, attrition rates, and the financial burden on hospitals.

Social Justice as a Lens for Understanding Workplace Mistreatment

Workplace mistreatment can be viewed as a social injustice that prohibits one from achieving optimal well-being. Cognitive and interpersonal skills required of nurses can be impacted by workplace mistreatment, thus extending injustices by violating the rights of patients to optimal care. The purpose of this article is to view workplace mistreatment through the lens of Powers and Faden's theory of social justice. Workplace mistreatment is explored through the 6 dimensions of well-being, including health, personal security, reasoning, respect, attachment, and self-determination, identified in the theory. The implications for practice and policy are discussed and recommendations for research made.

Can incivility impair team’s creative performance through paralyzing employee’s knowledge sharing? A multi-level approach

Purpose

– The purpose of this paper is to examine how a supervisor’s incivility in teams impact team’s creative performance through the mediating factor of knowledge sharing intention among team members. Moreover, the moderating role of collaborative climate was investigated as protector against leaders’ incivility.

Design/methodology/approach

– The proposed multi-level model was tested by surveying 312 health care providers nested within 42 work units at eight large hospitals in Iran. Multi-level regression analysis was used to analyze the data.

Findings

– The findings revealed that those team members experiencing incivility from their supervisors are more likely to show reluctance to share knowledge with team members and as a consequence this response further decreases team’s creative performance. However, the climate of collaboration inside hospitals can buffer the negative impact of incivility on their readiness to share knowledge.

Practical implications

– In team-based organizations, a supervisor’s incivility can stifle the creative performance of his/her team through blocking the knowledge sharing of members. First, human resource department should have some plans to curtail incivility of supervisors. Second, establishing a climate of collaboration and trust among team members can mitigate the insidious effects of supervisors’ incivility.

Originality/value

– In prior research studies, the role of incivility on individual outcomes has been highlighted. This paper, according to the best knowledge of the author, is the first considering the negative impact of incivility on team’s performance. Moreover, collaborative climate is a novel moderator considered in this study.

Perceived incivility during emergency department phone consultations

OBJECTIVE

Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations.

METHODS

We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties.

RESULTS

Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P < 0.01), consultations with specialist trainees postgraduate year > 4 (9.1% vs 3.8%, P < 0.01) and those involving radiology specialty (18% vs 5.32%, P < 0.01). The risk was lower when the consulted professional was a specialist medical practitioner as compared to specialist trainee (4.1% vs 9.4%, P = 0.02). Multiple logistical modelling suggests that female (adjusted OR 2.4, 95% CI 1.1-5.2) medical staff are more likely to report perceived incivility during ED phone consultations.

CONCLUSIONS

Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture.

A cross-hospital exploration of nurses' experiences with horizontal violence

AIM

To explore nurses' experiences of horizontal violence (HV) in three diverse non-affiliated organisations within a single city in the USA.

BACKGROUND

Horizontal violence, also called workplace bullying or lateral violence, is a long-standing nursing issue.

METHOD

Content analysis was used to analyse open-format textual responses from 126 registered nurses.

RESULTS

A powerful collective story emerged from nurses' shared experiences with HV, describing the characters and the setting in which HV and its consequences exist. Nurses' depictions of HV were consistent despite the different organisational structures of their workplaces suggesting that hospital type is not the explanation for HV, rather the culture of acute care nursing. Nurses want change and asked for tactics to resolve HV within their institutions; some provided specific solutions.

CONCLUSION

Nurse managers must continue to address HV by using a variety of known tactics, as well as adopting new evidence-based interventions as they are identified. The anti-bullying message should be disseminated through professional nursing organisations as well as in local health-care establishments.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to be the culture champions who hold individuals accountable for HV and foster professionalism through their leadership.

[Nurses' experience of incivility in general hospitals]

PURPOSE

This study was done to describe nurses' experience of incivility in hospitals and to consider nurses' work environment.

METHODS

Data were collected through in-depth interviews and analyzed using Colaizzi' phenomenological analysis methodology. Participants were seven experienced clinical nurses working on a general ward (2 nurses), or in an intensive care unit (2 nurses), emergency room (2 nurses), or operating room (1 nurse).

RESULTS

The incivility that nurses experienced was categorized as follows: 'being afflicted as a weak person', 'being treated as less than a professional', 'being overwhelmed by shock and anger', 'experiencing an untenable situation', 'struggling to survive', and 'pursuing professional growth'.

CONCLUSION

Behavior guidelines should be developed to reduce incivility, and incivility cases should be continuously monitored by the nursing department. Also, to handle incivility problems in clinical nursing areas, a reporting and counseling system and education programs are needed.

Exploring workplace bullying in nursing

Bullying in the nursing workplace has been identified as a factor that affects patient outcomes and increases occupational stress and staff turnover. The purpose of this project was to assess registered nurses' perceived exposure to workplace bullying. A convenience sample of a Pacific Northwest state professional nurses' association membership was solicited for this descriptive study using the Negative Acts Questionnaire-Revised (NAQ-R). Forty-eight percent of respondents admitted to being bullied in the workplace during the previous 6 months, with respondents choosing "being ignored or excluded" as the most common negative experience in the workplace. The results of this study suggest that workplace bullying remains a problem for which reduction strategies must be devised as a means of retaining nurses and preventing adverse outcomes. One strategy shown to be effective in curbing bullying is assertiveness and aggression training for nurses.

The degree of horizontal violence in RNs practicing in New York State

This study examined the degree of horizontal violence (HV) among RNs practicing in New York State (NYS). The objective was to determine the knowledge of HV and the degree of being a victim among practicing RNs. A descriptive survey using Briles' Sabotage Savvy Questionnaire, measuring occurrences of HV and nurses' knowledge of HV, was conducted among 2659 RNs in NYS hospitals. Findings demonstrate a significantly greater (P < .05) degree of HV in union versus nonunion cultures and less HV in Magnet® organizations. Gender and RN education significantly impacted HV. Developing organizational, leadership, and individual interventions to address HV helps create a culture of safety.

Strengthening communication to overcome lateral violence

AIM

This quality improvement project aims to reduce nurse-to-nurse lateral violence and create a more respectful workplace culture through a series of workshops.

BACKGROUND

Lateral violence is common and pervasive in nursing, with detrimental physical, psychological and organizational consequences.

METHODS

This project describes the organization-wide pre- and post-intervention survey of registered nurses' perception of lateral violence and turnover.

RESULTS

After the workshop series, nurses who reported experiencing verbal abuse fell from 90 to 76%. A greater percentage of nurses perceived a workplace that was respectful to others and in which it was safe to express opinions. After the workshop series, a greater percentage of nurses felt determined to solve the problem after an incident of lateral violence, while a smaller percentage felt powerless. Nursing turnover and vacancy rates dropped.

CONCLUSIONS

Educational workshops that enhanced awareness of lateral violence and improved assertive communication resulted in a better working environment, reduction in turnover and vacancy rates, and reduced incidence of lateral violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers must raise awareness of lateral violence with individual and organizational consequences. Nursing leadership can effect organizational change to lesson lateral violence and enhance a healthy workplace culture by replicating our intervention or components of our workshops.

Registered nurses' perspectives on the new graduate working in the emergency department or critical care unit

BACKGROUND

This qualitative study describes registered nurses' perspectives on work relationships with new graduates in emergency and critical care settings.

METHODS

Six focus groups of registered nurses (N = 31) were interviewed in open and informal discussions lasting approximately 45 to 90 minutes.

RESULTS

Two themes extracted from the data were lacking confidence and gaining acceptance into the unit's culture. Registered nurses were disillusioned by the lack of confidence, organization, and skill performance of the new graduate. They agreed that nurses "eat their young."

CONCLUSION

Suggestions are offered for preceptors, mentors, and staff. Recommendations for supporting the new graduate in an uncivil environment are also given.

Systems approach to address incivility and disruptive behaviors in health-care organizations

In response to the growing evidence that disruptive behaviors within health-care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health-care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model--Toxic Organization Change System--that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.