Incivility in Nursing: Causes and Intervention Strategies

Review of related literature

a. Definition of incivility

Incivility is defined as an uncivil behavior towards a person whether physical or verbal. Incivility is often seen in different environment and venue such as inside the classroom, clinical setting, community, and workplace. Incivility is always a major issue that affects the relationship between a student and a teacher. According to Clark (2008) she defined incivility as an “interactive and dynamic process that both parties are responsible”. She also stated that it creates a barrier between the teaching-learning environment. The most common issues about incivility between a student and a teacher are that teachers treat students unfairly and teachers pressure students to meet faculty demands. Faculty incivility is unprofessional and unethical, it is a behavior that compromises a students learning ability and decision making in the classroom or clinical setting. Incivility lowers one’s self esteem and self confidence that hinders the student’s ability to perform in the classroom or clinical setting. Faculty incivility leaves a mark to a student, it makes a student feel bad of themselves. According to Clark (2008) students are helpless, powerless, and traumatized. Students’ performance will suffer drastically, she stated that students will have a harder time finishing the nursing program.

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According to Marchiondo (2010), she stated that faculty incivility will result into extreme cases like depression and violence. A student that feels depressed might have a hard time coping inside the classroom. The students’ safety is a main priority for faculty members, a result to violence may affect the environment in school and in the clinical setting. The American Nurses’ Association’s (2004) Nursing: Scope and Standards of Practice stated that professionalism is important in interactions with others, it also stated that the art of nursing is based on caring and respect for others. Marchiondo (2010), she also stated that long term faculty incivility may result in program dissatisfaction and withdrawal. She also stated that faculty incivility ignored is also an act of incivility as well. Ignoring a negative behavior is an act of negative behavior as well. She also stated that there is a high chance of incivility in an educational setting if there are no rules or regulations regarding faculty incivility. Perpetrators of supervision fail to detect incivility or uncivil behavior and will be held responsible for their actions.

According to Bautista (2013) posted journal, student behaviors most commonly reported as discourteous by faculty included making negative groans, making ironic comments or gestures, not interested in class, dominating class discussions, using gadgets in class, and cheating on tests and exams. The greater part of faculty reported that unethical or uncivil student behaviors occurred rarely or sometimes. Samples of faculty behaviors considered unethical or uncivil by students incorporated suspension of classes without warnings, being not ready for class, disallowing open discussions, being not interested or cold in class, mocking or provoking students, conducting fast-paced discussions and lectures, and being unavailable or unreachable outside class. Students think faculty incivility as a reasonable problem in the nursing education environment. Therefore, it is very important that nurse educators and administrators assist students and faculty handle efficiently with these behaviors. (Bautista, 2013).

According to Davis, Karen (2005) she confirmed that the notion of faculty incivility in nursing education is old. However, it has generated much conversation at nationwide conferences, faculty meetings and in the press. What’s disturbing the most is nurse educators are the frequency of faculty incivility being witnessed in every day encounters by teachers who teach students in the clinical setting and the class room. If these actions are not mentioned during the academic process, they can simply go beyond to health care environments.An incorporated assessment of the literature from five years ago, which included nursing students and faculty from programs conferring associate to doctoral degrees, recognized general unethical or uncivil behaviors from students: late in class, being noisy and inattentive in class, dominating class, shouting at professors, threatening and provoking, physical abuse, and threatening or blackmailing to give bad teacher evaluations. Behaviors of the teachers most often measured unethical or uncivil by students were mocking or provoking students, being distant or unreachable, and being unavailable outside the class room. No wonder nursing education is now being considered by a society of incivility.(Davis, 2005).

According to Marchiondo et. al. (2010) he stated that the unethical or uncivil behaviors can have many harmful effects on both faculty and students. Sufferers of incivility may feel symptoms such as pressure, stress and anxiety, fatigue, insomnia, sadness, annoyance and humiliation. One study found a strong connection between a student’s fulfillment and incivilitywith his or her nursing education. Incivility correlates strongly with program dissatisfaction. As the incivility goes up, a student’s fulfillment with the course some students finally leave their nursing course for another course; and some students decide not to enter the nursing career. (Marchiondo, & Lasiter, 2010).

B. Student incivility

According to the book of Lower J. (2007) usually “bullies” don’t know their own attitude and behavior as being immoral or uncivil. They may depart one position, only to cause disorder anywhere else. Their insight truly becomes their reality. Incivility can become the standard for a class room, clinical setting, and workplace, which makes it harder to modify. Dealing with the negative behavior in a sensible way, will stop incivility from becoming the standard. Once incivility is permitted to become the standard, it takes time to get the place of work back to an optimistic, healthy atmosphere. Experts concur that it takes about 2-5 years for a group to change its customs. Policies are a must to stop and/ or progress incivility. A policy of behavior is essential to describe the behaviors that are considered troublesome. The system needs to deal with all employees in a group such as non employees such as providers, and nurses. In order for a policy of behavior to be efficient, it must be applied in all situations. Leadership needs to be not only implicated in the process, but dedicated to reinforcing its significance. With no enforcement, the policy is useless. All members of the team, including leadership, need to be responsible for enforcing and modeling the policy of behavior. Similarly important is assessing incidents and complaints in an appropriate method, and taking counteractive action so workers see it is not tolerated or condoned. Nurse leaders need to set the nature and outlook for the type of proficient communications that will occur in the workplace. Words can be typed in a mission statement, but the truth is that nurses and students will copy the behaviors they view and practice from the faculty and nurse leaders. If my nurse leader does not “walk the talk,” I am going to disregard the policy and act what I know I can get away with. We all float irregularly and that is human nature. However as nurses, we are responsible for our own behaviors and actions. Education is the key to serving others. Some health settings are looking for to teach nurses on how to get better at social communications, proper etiquette, and promote optimistic skills in the place of work. People may not understand they show unethical or uncivil behavior. People consider this is “not about me.” Many times people need insight or self-awareness, and have no idea how to modify behavior that may be embedded. Teaching everyone on the new code of conduct will assist produce an accepting, friendly, and an open atmosphere. It may be needed to offer guiding and coaching as desired to help develop the attitudes and behaviors of others. There should be a no acceptance for incivility. It’s significant for all of us to educate respect and teach others to know and react to incivility. Nurse leaders must get complaints critically and not let off the messenger. It takes great effort to tell incivility. Don’t make excuses such as “that’s just the way she is, but you will get used to it” or “the unit cannot afford to lose him even though he makes worry on the unit.” As a nurse leader it’s vital to collect information swiftly, shake-up the facts, and act upon when needed. It’s important to carry out post-departure interviews, not at the time a student leaves, but weeks after leaving. This will give you an improved image as to what other essentials may have been concerned in the worker exit his or her situation. It’s significant to maintain the latest traditions by obliging open communication so that civility becomes the custom. Nurse leaders require showing dependably and making a safe atmosphere so nurses are not afraid when giving out complaints and concerns or telling reports. Nurse leaders also need to endorse positive and open response so nurses learn how to show common courtesy and respect. It’s significant to be tolerant of each other’s opinions and ideas. Nursing academic programs need to contain incivility issues and topics in the program. It’s also supportive to have students’ role play specific situations. It has been found that former students are able to feel unethical or uncivil behaviors in a more suitable approach, with the use of play-acting.

C. Faculty incivility

Regarding to the definition of Clark, et.al. “Incivility in the nursing education is perceived as impolite or troublesome behaviors which often effects in psychological or physiological suffering for people concerned and if left with no action, may develop into a provoking condition” (Clark, Farnsworth & Landrom, 2008).

Regarding to the “US National Library of Medicine National Institutes of Health” the incivility in the nursing education is a developing crisis and one that gravely affects the learning-teaching atmosphere and frequently outcomes in problematic and stressful faculty-student relationships. Nursing professors, who show constructive, ethical behaviors, support similar attitudes and behaviors from their students. Furthermore, professors who are unfriendly, not interested, and humiliating may call upon resentment. The document that was written by Cynthia M. Clark (2008) made a phenomenological research to observe nursing students’ view of faculty incivility and its effect on the students. Students recognized 3 major themes of faculty incivility:

1. Professors behaving in humiliating and mocking ways,
2. Treating students unjustly and personally, and
3. Obliging and pressuring students to conform to difficult school demands.

Furthermore, students felt helplessness and hopelessness to speak to the problem and described faculty superiority and misuse of power as main factors to the problem. (Clark, 2008)

Regarding to the piece written by Susan Luparell (2008) “Incivility in Nursing Education: LET’S PUT AN END TO IT” she confirmed that both students and faculty have addressed that incivility is a reasonable problem in the nursing education. Fortunately, faculties will tell that they see incivility by only rare occasions. Yet addressing with these unusual problem students take an uneven number of their time and effort, and frequently ends up depriving diligent students of excellent educational experiences. Impolite behavior to faculty is not partial to being noisy in class, loud voices, and ironic comments. Nursing faculty have also implicated being pressed, having school stuff thrown at them, vandalizing their stuff and being stalked around and outside the classroom, and obtaining threats. Regrettably, the incivility matter isn’t one-sided. Students also indicate that they also feel disrepected. The people involved may be other students, professors, or staff. It’s not astounding to feel that students find mocking comments and provoking by professors to be unethical or uncivil. (Luparell, 2008)

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Regarding to the book of Carter, he confirmed that to make a more civil surroundings, he tells Americans to raise ordinary good over selfishness, to push wider civic contribution, and to renovate social standards. Carter feels that impoliteness and disregard are “the merest graze of the surface of problem” and proof of our nation’s rising incivility. According to Carter, self-interest and stealing one’s own desires met are crowding into the community of America, including our nation’s schools and classrooms.

As Forni (2008) confirmed, “incivility frequently occurs when people are worried, stressed, miserable, or hurried. When these match, something can occur. Incivility affects self-confidence, damages relations, increases anxiety and stress, contaminates the work atmosphere, and may rise into cruelty.” It’s significant to note that many times the faculty showing the unethical or uncivil behavior is ignorant of how his/her behavior, actions or words may be upsetting others. The outcomes of incivility take a toll on us. It affects our self-confidence by affecting our mentality. When we feel susceptible, there is a rise in stress and anxiety, which can develop to anger and violence. It also affects our relations by causing depression, loss and isolation. It also increases anxiety and stress, which lowers the immune system, it greatly affects our body, soul and spirit. Furthermore, the effects can result to despair and post-traumatic stress disorder (PTSD). It also affects the atmosphere of the workplace by lowering confidence.

Nurse leaders can also be in a difficult situation. For nurses in a management and leadership position, to stay still is to ignore the behavior. If leadership allows the behavior, it makes it difficult for others to tell the same kind of attitudes and behavior. The nurse may think his/her leadership accepts of the behavior. Furthermore, leadership may not understand incivility is happening. The behavior wishes to be told to the nurse leader’s notice for more action. Don’t presume the behavior has possibly been reported by a different nurse. Incivility also happens with student nurses. It results in students having lowered self-esteem and confidence, rage, disappointment, insomnia, stress, anxiety and worry. When student nurses are bullied by staff nurses, they are more suitable to imitate the attitudes and behaviors and result in bullying behavior themselves. (Forni, 2008)

Incivility is defined as an uncivil behavior towards a person whether physical or verbal. Incivility is often seen in different environment and venue such as inside the classroom, clinical setting, community, and workplace. Incivility is always a major issue that affects the relationship between a student and a teacher. According to Clark (2008) she defined incivility as an “interactive and dynamic process that both parties are responsible”. She also stated that it creates a barrier between the teaching-learning environment. The most common issues about incivility between a student and a teacher are that teachers treat students unfairly and teachers pressure students to meet faculty demands. Faculty incivility is unprofessional and unethical, it is a behavior that compromises a students learning ability and decision making in the classroom or clinical setting. Incivility lowers one’s self esteem and self confidence that hinders the student’s ability to perform in the classroom or clinical setting. Faculty incivility leaves a mark to a student, it makes a student feel bad of themselves. According to Clark (2008) students are helpless, powerless, and traumatized. Students’ performance will suffer drastically, she stated that students will have a harder time finishing the nursing program. According to Marchiondo (2010), she stated that faculty incivility will result into extreme cases like depression and violence. A student that feels depressed might have a hard time coping inside the classroom. The students’ safety is a main priority for faculty members, a result to violence may affect the environment in school and in the clinical setting. The American Nurses’ Association’s (2004) Nursing: Scope and Standards of Practice stated that professionalism is important in interactions with others, it also stated that the art of nursing is based on caring and respect for others. Marchiondo (2010), she also stated that long term faculty incivility may result in program dissatisfaction and withdrawal. She also stated that faculty incivility ignored is also an act of incivility as well. Ignoring a negative behavior is an act of negative behavior as well. She also stated that there is a high chance of incivility in an educational setting if there are no rules or regulations regarding faculty incivility. Perpetrators of supervision fail to detect incivility or uncivil behavior and will be held responsible for their actions.