Incivility

Posted: March 27th, 2020

Incivility

Student’s Name

Institutional Affiliation

Incivility

The attainment and maintenance of public health is a critical concern for stakeholders in the health sector. Due to the significance of this issue, there is growing interest in the factors that undermine and bolster the efficacy of care frameworks in tackling emerging threats to care provisions. One of the most significant issues identified by the investigative endeavors fostered by this interest is incivility. The population’s access to quality health services is reliant on the maintenance of civil interactions between healthcare practitioners. Incivility undermines the creation of conducive work environments, hinders care professionals coordination and, subsequently, the effectiveness of transitions of care, and threatens the physical and psychological well-being of care professionals.

The impact that incivility has is a product of the various forms of behavior that fall under the blanket term of “incivility.” According to Murray (2017), incivility exists on a continuum that comprises negative behavior, such as gossip and rude comments, verbal aggression, such as discrimination and intimidation, and physical or sexual aggression. Given the acts included in this continuum, incivility may be defined as repeated offensive, abusive, intimidating, or insulting behavior, abuse of power, or unfair sanctions that make recipients upset and feel humiliated, vulnerable, or threatened, consequently creating stress and undermining their self-confidence (Warrner, Sommers, Zappa, & Thornlow, 2016). As indicated by this definition, uncivil behavior persists for a relatively long-term, and it adversely affects victims and witnesses to this behavior.

Current research on the issue indicates that incivility adversely affects nurse practitioners, patients, and health institutions. The impact of incivility is exacerbated by the prevalence of the phenomenon in the sector. Research estimates that 27% – 85% of nurses have experienced some form of incivility (Warrner et al., 2016). The effects of these acts on nurses are diverse. Incivility is associated with a decline in nurses’ motivation, productivity, and commitment (Murray, 2017). These effects hinder the provision of quality care, the ability of care facilities to retain qualified staff, and patients’ satisfaction levels resulting in the development and maintenance of adverse perceptions regarding health institutions. Furthermore, according to Abdollahzadeh, Asghari, Ebrahimi, Rahmani, and Vahidi, (2017), incivility is associated with an increase in medical errors. Additionally, as noted by Warrner et al. (2016), negative behavior, physical aggression, and verbal aggression adversely affect the mental health of the nurses. This impact illustrates that the effect that incivility has on nurses transcends their professional lives.

The impact that incivility has on the microsystem is tied to the effect that this phenomenon has on nurses. By undermining nurses’ commitment, incivility leads to an increase in the turnover rates. This effect exacerbates the staff shortage experienced by most health facilities further limiting their ability to cater to the health needs of the community. Moreover, high turnover rates are associated with an increase in healthcare expenditure. Warner et al. (2016) estimate that the average hospital spends $379,500 for every percentage point increase in turnover rates. Additionally, the estimated cost per employee due to absenteeism, reduced productivity, and undermined psychological health is estimated at $30,000 – $100,000 (Warner et al., 2016). Given the cost constraints that the care sector faces, these additional expenses further undermine the efficacy of health organizations to meet the increasing demand for health services.

It is notable that the manifestations of incivility are not always explicit. For instance, in a situation where a colleague fails to respond to greetings from a particular individual, though the act does not fall into the categories outlined in the continuum explored above, it can be classified as an implicit form of aggression. This is because the action alienates the ignored person and may adversely affect their self-esteem resulting in low performance and increasing the occurrence of medical errors.

The impact of incivility explored above demonstrates the need for measures necessary in the creation of sustainable civil environments. A possible strategy is increasing awareness of incivility (Warner et al., 2016). The measures’ underpinning assumption is that bolstering awareness of actions that constitute uncivil behavior and the effects of these actions would encourage a change in behavior, consequently fostering the creation of healthy work environments. One of the tools that could be used to bolster self-awareness and subsequently understanding of the impact of incivility is the Clark Workplace Civility Index.

An alternative solution is communication and conflict resolution training. Due to the stress associated with working in the healthcare sector, conflict is inevitable (Murray, 2017). In light of this, there is a need to foster the adoption of communication strategies that facilitate meaningful conversations that maintain civility (Clark, 2017). Possible avenues that may be used to bolster the development of communication skills include regular training and the provision of constructive feedback.

Implementing support structures for nurses may also prevent incivility. In their 2017 study, Abdollahzadeh et al. found that nurses were less likely to experience incivility in instances where the settings they worked in had support networks in place. It was also noted that providing support to nurses might also foster timely resolution of incivility instances and the establishment of appropriate investigation and punishment frameworks to reduce the prevalence of the phenomenon. Furthermore, the efficacy of this measure is reliant on the involvement of nurse leaders and other relevant stakeholders in the healthcare sector.

In addition to these measures, supplementary strategies that may prove instrumental in my future practice, as a family nurse practitioner, include modeling civil behavior and compliance with established norms. As noted by Abdollahzadeh et al. (2017), leaders are instrumental to efforts aimed at preventing incivility. In this regard, modeling civil behavior could foster the creation of a civil work culture. However, identifying other role models and utilizing effective communication skills would bolster the efficacy of this measure. Effective communication would also facilitate civil interactions with patients.

Other approaches that include adhering to and encouraging compliance with the developed code of conduct and norms may promote the development of sustainable, healthful environments. The systems created by various professional bodies, including the American Nurses Association (ANA), require nurses to develop ethical environments and maintain a culture of kindness and civility. Therefore, observing the provisions of these codes, and encouraging other practitioners to do so, through mentoring and coaching, may guard against the occurrence of incivility resulting in the maintenance of healthy work environments. 

In retrospect, incivility threatens the provision of quality and comprehensive care. This phenomenon adversely affects nurses’ engagement, morale, performance, and psychological health. Moreover, it is associated with low levels of patients’ satisfaction, increased the cost of care and high turnover rates. Possible measures that may be used to prevent the occurrence of incivility include the use of practical communication skills, the establishment of support networks, and improved awareness of incivility and its impact. Possible measures that I may employ during my future practice as a family nurse practitioner to foster the development of a healthy work environment include compliance with the developed code of ethics and modeling civil behavior.

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility? Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157. DOI: 10.4103/1735-9066.205966

Clark, C. (2017). Creating & sustaining civility in nursing education (2nd Ed.). Indianapolis, IN: Sigma Theta Tau.

Murray, E. (2017). Nursing leadership and management: For patient safety and quality care. Philadelphia, PA: F. A. Davis Company.

Warrner, J., Sommers, K., Zappa, M., & Thornlow, D. (2016). Decreasing workplace incivility. Nursing Management, 47(1), 22-30. DOI: 10.1097/01.NUMA.0000475622.91398.c3