NR 500 Week 7 Graded Assignment: Cultivating Healthful Environments
Version 1
Cultivating Healthful Environments
Creating a trusting and caring
... [Show More] relationship between healthcare providers and the people who receive care is important, but healthful working environment for those healthcare providers are equally important. The quality of care that patients and families receive during their stay in hospitals or other healthcare facilities is directly influenced by the well-being of the people who care for them (Warren, 2017). Currently, incivility in healthcare setting continues to arise (American Nurses Association, 2015). Incivility is a damaging and an ongoing issue in healthcare setting that not only hinders the quality of the care being provided, but also the well beings of the employees. Unfortunately, many nurses have either experienced or witnessed incivility in the work place, regardless of setting (CCN, lesson 7, 2017). To cultivate a healthful environment for healthcare workers and the patients, it is important for leaders to recognize the issue and implement changes to improve the culture of the workplaces.
Issue of Incivility
Horizontal violence, nurse-to-nurse bullying, and lateral violence are all collectively known as hostility in workplaces or workplace incivility (CCN, lesson 7, 2017). Incivility is a prevalent phenomenon and it is on the rise. The growing trend horizontal bullying and incivility seems an endemic issue in nursing profession (Mikaelian & Stanley, 2016). Study shows that incivility in workplace has negative impact on recruitment and retention of qualified nurses. It diminishes the nurse’s motivation, performance, productivity and commitment to the job (Abdollahzadeh, Asghari, Doshmangir, Hasankhani & Vahidi, 2017).
There are mainly three factors that results incivility in workplaces. They are workplace systematical failure of stopping incivility, which is administrative not punishing the perpetrators; employees working under the shadow of fear; and certain categories of employees being scapegoats. (Abdollahzadeh et al., 2017). Evidence demonstrates that workplace incivility lead to higher turnover rate, low job satisfaction and decreased patient satisfaction due to proper communication among healthcare workers (Khadjehturian, 2012).
Importance of Nursing
Nurses should be aware that it is our obligation to create an environment where nurses can grow and patients can heal. Work place bullying impedes nursing unity and the health of the profession (Clark & Ahten, 2012). Incivility in nursing diminishes the quality of care that is provided in the nursing units. Patients will have less confidence with the care they receive when they have to witness nurse to nurse violence. Bullying has been recognized as a prevalent phenomenon in healthcare setting internationally. Unfortunately, institutions either deny its existence or minimize its impact to make it difficult for the victims of incivility to report the incidents. It makes employees to have less confidence in report the perpetrators. Ultimately, it creates culture of silence within the institution that masking the existing problems. Workplace incivility in many settings still tolerated (Lachman, 2015). Nursing educators have responsibilities to ensure all nurses are prepared for their professional roles. Nursing educators should integrate education to deter unprofessional behaviors and promote on healthy ways to cope with stress and ways to deal with incivility in workplaces (Evans, 2017).
Storytelling
There was once, a nephrologist saw an acute dialysis nurse who was dialyzing a patient in ICU. The nephrologist was telling the nurse how another dialysis nurse was incompetent in assessing the patients. The nephrologist was loud in the middle of the nursing station where other patients and family members can see and hear. The dialysis nurse was trying to re-direct the conversation, but the physician kept talking loud and use unprofessional language with the nurse. Finally, a secretary paged the dialysis nurse for a phone call to end the situation. In this scenario, though the physician was not complaining against the nurse, but he created an unprofessional scene in the unit. After the physician left, other nurses and patient’s family approached the nurse and questioned if he did anything wrong. When the dialysis nurse was preparing dialysis for another patient in the unit, the patient and the family was concerned with the nurses competent due to what they had seen. The impact from this situation was that the physician made other patients and families uncomfortable and doubted the nurse’s competent in providing proper care. That physician may have created workplace incivility unintentionally, but the impact was that the patients and the family loosing trust with the care they were receiving.
Creating a healthful Environment
There are strategies to create a healthful working environment. Employees should be encouraged systematically to report any workplace incivility and the perpetrator should face consequences. According to Kvas & Seljak (2014), only a small numbers of nurses who are victims of workplace incivility reported violence in written form. Many victims believe that reporting the incidence would not change anything. This indicates that workplace administrative should ensure that lateral violence is not tolerated and the perpetrator will be punished regardless of their seniority. According to McNamara (2012), it is important to enforce zero tolerance policy in all circumstances to promote healthy work environment.
Next strategy is to address the issue directly to the perpetrator. If the issue continues, report the issue following chain of command till the problem improves. Violence reduction will create a better work environment for nurses (Park, 2015)
Strategy that will help in supporting a healthy work environment is when employees at feeling trusted, supported and respected by their co-workers and leaders (Porath, 2017). Education is needed for the employee regarding the importance of nurturing healthy working environment. Recognizing the form of incivility, increasing opportunities for lateral collaboration and buddy systems can increase the perception of teamwork, ultimately contributing to healthy working environment.
Practice Application
I chose family nurse practitioner tract for my future career goal. As a master’s prepared advanced practice nurse, my strategies to cultivate a healthy working environment are zero tolerance policy and lateral collaboration. Lachman (2015) suggests the necessity for written standard zero-tolerance policies on incivility in the workplace. It stressed the importance of enforcing this policy in all circumstances to be effective in promoting healthy work environment.
It is important for nurses to have empathy to their colleagues as much as their patients. Periodic education is necessary to create scenario of workplace incivility to make everyone aware the severity of the consequence of workplace incivility. Individuals can hold themselves and each other accountable for unprofessional behaviors and participate in teamwork. Nurses need to hold each other accountable and report through proper channels when nurses witness or experience in horizontal bullying or incivility in their workplace (Lachman, 2014).
Conclusion
Horizontal violence in nursing hinders the healthcare outcomes for the patient we care. When patients witnesses horizontal bullying among nurses, they will lose confidences of the nurses’ competence. They will doubt the quality care they are receiving by the nurses. It is important to create working environment that provides opportunities for lateral collaboration for nurses to nurture a healthy working environment. As a master’s prepared advanced practice nurse, I will promote healthy working environment by participating policy making system regarding zero tolerance in every level of the organization. I will work with nurse leader to systematically make it easy for anyone to report incivility. I will step in whenever I witness bullying or incivility. As healthcare providers, regardless of the scope of our practice, we work as a team to provide care to our patients. Our patients deserve to stay in a friendly and caring hospital environment. It is our moral responsibility to stop the violence and report it promptly to cultivate healthy, caring and trusting working environment for all.
References
Abdollahzadeh, F., Asghari, E., Doshmangir, L., Hasankhani, H., & Vahidi, M. (2017). Workplace Incivility as an Extensively Used, But Seldom Defined Concept in Nursing. Nursing & Midwifery Studies, 6(2), 1-4. doi:10.5812/nmsjournal.41029
American Nurses Association (2015). Incivility, bullying, and workplace violence Position Statement. Retrieved from file:///C:/Users/User/Downloads/PosStat-Endorsed-ANA-Incivility-Bullying-Violence.pdf
Chamberlain College of Nursing (2017). Chamberlain College of nursing masters of Science in Healthful Working Environment. Retrieved from https://chamberlain.instructure.com/courses/9672/pages/week-7-lesson?module_item_id=984981
Clark, C.M., & Ahten, S. (2012) Beginning the conversation: The nurse educator’s role in preventing incivility in the workplace. Georgia Nursing, 16-17.
Evans, Gary (2017) Training for Toxic Work Culture Should Start in Nursing School, Hospital employee health. 36(5).
Khadjehturian, R. E. (2012). Stopping the Culture of Workplace Incivility in Nursing. Clinical Journal of Oncology Nursing, 16(6), 638-639. doi:10.1188/12.CJON.638-639
Kvas, A., & Seljak, J. (2014). Unreported workplace violence in nursing. International Nursing Review, 61(3), 344-351. doi:10.1111/inr.12106
Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. Urologic Nursing, 35(1), 39–42.
Mikaelian, B., & Stanley, D. (2016). Incivility in nursing: from roots to repair. Journal of Nursing Management, 24(7), 962-969. doi:10.1111/jonm.12403
Park, M., Cho, S., & Hong, H. (2015). Prevalence and Perpetrators of Workplace Violence by Nursing Unit and the Relationship Between Violence and the Perceived Work Environment. Journal of Nursing Scholarship, 47(1), 87-95. doi:10.1111/jnu.12112
Pinckney, M. Y. (2015). Increasing Civility in the Workplace. JOCEPS: The Journal of Chi Eta Phi Sorority, 59(1), 11-16.
Porath, C., & Pearson, C. (2013). The Price of Incivility. Retrieved from hbr.org: https://hbr.org/2013/01/the-price-of-incivility
Warren, I. (2017). Creating a Holding Environment for Caregivers. Journal of Perinatal & Neonatal Nursing, 31(1), 51-57. doi:10.1097/JPN.0000000000000227
Version 2
NR 500 Week 7 Graded Assignment; Cultivating Healthful Environments
Cultivating Healthful Environments
Nurses may experience incivility directed towards them or others that creates difficulty to establish a healthy unified working environment. It is of great importance that nurses recognize these inappropriate behaviors. A responsibility of a family nurse practitioner (FNP) is to be self-aware of his or her environment and intervene by using strategies to disengage or prevent potential bullying.
Issue of Incivility
Previous research has defined incivility as a low intensity bold behavior sought out to cause emotional harm without consideration for the other human being (Armstrong, 2017). McNamara (2012) states, “it’s a discourteous behavior or treatment, an uncivil act.” This type of behavior occurs between two persons and can be hierarchical meaning bullying is directed from a higher power to one with less power. It is imperative that incivility is not overlooked in the workplace due to fear and possible punishment. Each nurse needs to remain accountable for his or her actions and maintain a cohesive non-discriminative relationship with each patient and health care team member. The key is to become a role model that mirrors appropriate respectful behavior and fair treatment that promotes safety.
Importance to Nursing
The uncivil act directed at another individual has vast effects and decreases the morale of an environment. The after effects on the environment posed by incivility is of great concern. Armstrong (2017) conducted a study that indicated how workplace bullying resulted in increased medical errors, increased sentinel events, and compromised patient safety. Bullied nurses avoided asking for help from other co-workers when faced with complex medical situations. Over time, the stress caused poor job satisfaction, call-ins, and decreased retention rates. This impacted the microsystem by causing emotional harm to the nurse and patient and in return proved to be costly for the hospital. More of the hospital’s finances are given to fund new nurses’ orientation and training. Another study conducted by Harold and Holtz (2015) showed that an indirect passive leadership style enhanced the probability that health care team members experience incivility in the workplace, and how they are more inclined to behave in an uncivil way towards others. A passive leader isn’t engaging and present which may cause a laissez approach to issues. Team members aren’t held to an acceptable standard because their leader has not established a code of conduct and held team members accountable. This impacts nursing because expectations need to be set forth. Porath and Pearson (2012) state most targets that are victims of incivility experience sadness, anger and fear. Victims want to retaliate indirectly and directly. Results showed that bullies of higher power were more likely to retaliate directly at the victim. While the victim with less power retaliates towards the organization in a passive aggressive manner. The importance related to extinguishing incivility in the workplace reduces emotional harm, rage, and turmoil between team members. A positive change is unable to take place when one’s feelings are distracting them from the job at hand.
Storytelling
Most nurses experience incivility at some point in their career. Sadly, I have had a first-hand experience. At the beginning of my shift, I had received an admission where my patient needed to be emergently intubated and his blood pressure wasn’t cooperating. I swiftly walked to the nurse’s station to find the phone number for the critical care doctor. During this time, the nurse manager rounded the corner and proceeded to pick up the call light and immediately hung up. She didn’t answer the call light and in a very unpleasant tone asked me why I was not answering the call lights, but she left before I could answer. She caused a scene and everyone watched. I didn’t have words because I was in a state of shock. After I took care of the matter at hand, I was furious. I couldn’t forget what had happened. She proceeded to walk by the nursing station muttering hateful words under her breath. I was appalled. I have never been treated in this manner. Other nurses who had witnessed the scene came and apologized for the nurse manager’s reaction. I feel as though they lost respect for the nurse manager that day too. The morale of the ICU that day was destroyed. As much as I wanted to forget about the situation, I stayed in a foul mood for the rest of the day. It probably affected patient care which isn’t fair to them.
Creating a Healthful Environment
Various strategies can terminate incivility and create a positive workplace environment. Stanton (2015) describes strategies to decrease lateral violence such as developing a code of conduct to define behaviors that are inappropriate in the workplace and if unfollowed warrants punishment. Then educational programs are utilized to teach the staff the difference between appropriate and inappropriate behaviors. Expectations are set to mentor staff and develop unity in the workplace. The team members make a commitment to the code of conduct to create a positive working environment conducive to respect. It is the responsibility of each member to hold one another accountable to the code of conduct. Another strategy is explained by Blake (2016) that it is imperative for the nurse to identify risk factors that predispose a team member or organization to incivility. For example, whenever a unit is short-staffed for a while nurses become short tempered and feel overworked; tempers and inappropriate behaviors will be seen. We can avoid a potential risk factor by making sure enough staff is scheduled for each day, and a back-up plan is in place for call-ins. Lachman (2015) stated that her study consisted of nurses of which 90% had their bachelor’s degree, yet still didn’t feel comfortable to take the initiative to step in and prevent incivility. It is important that a nurse feels comfortable and forgoes being a bystander when witnessing workplace incivility. This can be achieved based on various types of training by involving team members to be hands on demonstrating effective prevention strategies and diffusing situations that lead to incivility. A team member may have heaps of knowledge but if they are never willing to utilize their skills acquired to reduce incivility then change will never happen.
Practice Application
I chose the family nurse practitioner (FNP) program because I enjoy healthcare based on the family aspect of nursing. We can benefit the community through collaboration with other healthcare professionals to diagnosis, treat, prescribe, and manage a patient’s overall care. I personally believe self-reflection is the best strategy to prevent lateral violence in the workplace. Self-reflection allows me to evaluate my own actions and words and the effects they have on others. Stanton stated that self-reflection must be passed on to educate others what lateral violence looks like. This allows each person involved in incivility to explain their side of the story and then peer review allows discussion of alternate outcomes to be employed (2015). Change begins with constructive criticism and identification of inappropriate behaviors. It is imperative for the master’s prepared nurse to develop skills toward effective leadership to further advance the healthcare profession. Bradd, Travaglia, and Hayden (2017) believe leadership cultivates an environment where all employees perform at maximum potential towards the mission of an organization. As a future FNP, I want to be an effective leader. Lachman (2015) stated that the act of incivility is the attempt to take the power away from another. As a leader, it is important to provide nurses with four structures such as information, opportunity, resources, and support will decrease workplace incivility. Proving a structural empowering environment for the team members creates a workplace that works at maximum potential free of incivility.
Conclusion
Incivility is an inappropriate behavior with an intent to harm another person. It has proven to negatively affect the workplace environment by compromising patient safety. Various strategies are utilized such as the code of conduct, identification of uncivil acts, and gaining confidence to step in and prevent the act of incivility. As a future FNP, I want to always be cognizant of my attitude. This allows cultivation of a healthy environment. I will continually empower my team members by a structural empowering environment and allow self-reflection when needed. By learning the negative effects of incivility and applying these strategies to my practice; I feel I will be successful in my future career as an FNP.
References
Armstrong, E. (2017). A quality improvement project measuring the effect of an evidence-based civility training program on nursing workplace incivility in a rural hospital using quantitative methods. Online Journal of Rural Nursing & Health Care, 17(1), 100-137. doi: http://dx.doi.org.proxy.chamberlain.edu:8080/10.14574/ojrnhc.v17i1.438
Blake, N. (2016). Building respect and reducing incivility in the workplace: Professional standards and recommendations to improve the work environment for nurses. AACN Advanced Critical Care, 27(4), 368-371. doi: http://dx.doi.org.proxy.chamerbalin.edu:8080/10.4037/aacnacc2016291
Bradd, P., Travaglia, J., & Hayden, A. (2017). Leadership in allied health: A review of the literature. Asia Pacific Journal of Health Management, 12(1), 11-24. Retrieved from http://eds.a.ebscohost.com.proxy.chamberlain.edu:8080/eds/pdfviewer/pdfviewer?vid=4&sid=36e80b10-8a49-47e9-b3a2-3b69140ac671%40sessionmgr4009
Harold, C., & Holtz, B. (2015). The effects of passive leadership on workplace civility. Journal of Organizational Behavior, 36, 16-38. doi: 10.1002/job.1926
Lachman, V. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/later violence. Urologic Nursing, 35(1), 39-42
McNamara, S. (2012). Incivility in nursing: Unsafe nurse, unsafe patients. AORN Journal, 95(4), 535-540. doi:10.1016/j.aorn.2012.01.020
Porath, C., & Pearson, C. (2012). Emotional and behavioral responses to workplace incivility and the impact of hierarchical status. Journal of Applied Social Psychology, 42(1), 326-357. doi: 10.111/j.1559-1816.2012.0102.x
Stanton, C. (2015). Action needed to stop lateral violence in the perioperative setting. AORN Journal, 101(5), 7–9. doi:10.1016/S0001-2092(15)00320-8 [Show Less]