INCIVILITY IN THE WORKPLACE Patricia Obulaney, MSN, RN, ANP-C

Define workplace incivility in nursing profession- in both clinical and academic settings. Describe civil and uncivil behaviors. List strategies and interventions to create a civil environment   Objectives

Is Incivility A Real problem? Incivility has increased in the workplace Occurs between manager and employee or employee to employee Also seen in higher education settings: between or among disciplines in higher education, faculty to faculty, faculty to student, and student to student. Is Incivility A Real problem?

Dr. Cindy Clark, faculty at Boise State University- consultant to nursing for workplace or learning institutions to foster an environment of civility. Clark (2009, 2012): Rude or disruptive behaviors which often result in psychological or physiological distress for people involved-and if left unaddressed, may progress to threatening situations or result in temporary or permanent injury or illness. Incivility in Nursing

Uncivil Behaviors Definitions of workplace uncivil behaviors: Low-intensity, deviant behavior with ambiguous intent to harm the target Rude and discourteous behaviors Lack of regard for others Causes atmosphere of conflict, disrespect, and STRESS Workplace uncivil behaviors: Low-intensity, deviant behavior with ambiguous intent to harm the target Rude and discourteous behaviors Lack of regard for others Causes atmosphere of conflict, disrespect, and STRESS Here’s the best: some people don’t even know they are bullying. They just think they are “faster, smarter, or better skilled” than their workplace peers. They have an exaggerated sense of self-worth and importance. Some folks don’t realize excluding others from their elite circle of friends or their unwelcoming attitude to another is actually a form of bullying.

Those of us who are over 40 can remember when you would become upset by occasional, rude behavior and it was unexpected and almost a rare occurrence. Over the past ten years, we have seen an increase in rude behavior-on the highway, in super markets, in a classroom setting and on our TVs (reality shows where they vote individuals out of their “world” or little inner circle) and in movies. More recently, the “mean girls” behavior has become more commonplace. People are texting, face-booking and emailing nasty things to others or about others on this public forum. It’s kind of gossip on steroids! It has become quite problematic in businesses, schools, and now even in the patient care setting. We are on a decline and few experts see a quick resolve for this rising issue. Uncivil Behavior

Uncivil Behaviors Insulting comments Denigration of the target's work Spreading false rumors Social isolation Bad manners Mean girls mentality Develop feelings of unfairness and anger; can lead to hostility & violence Some examples of uncivil behavior Uncivil Behaviors

Clark’s Continuum of Incivility Begins with low risk or disruptive behaviors (eye- rolling, sarcastic comments, which eventually progresses to bullying & racial/ethnic slurs) Progresses to high risk or threatening behaviors (intimidation, physical violence, even tragedy) Clark’s Continuum of Incivility

This is Clark’s Continuum of Incivility model

Lateral violence Nonverbal innuendo (eyebrow raising, make faces) Undermining activities (not be available) Verbal affront (snide remarks, abrupt responses) Withhold information Sabotage (set up negative situation) Back stabbing (complain about individual to others) Failure to respect privacy Broken confidence Griffin, 2004 Lateral violence

Incivility in the U.S. American acts of goodwill are declining Repeated public opinion polls indicate concern of Americans over the attrition of civility KRC Research survey (2011) of Americans: 86% report being victims of incivility when driving and 72% while shopping Six in 10 Americans surveyed admit they have acted in an uncivil manner Incivility in the U.S.

In movies, television shows Via phone (texting & speaking) Where is Incivility? In the Workplace In our Schools On our Roads In Politics On the Web In movies, television shows Via phone (texting & speaking) Our highways and parking lots have been slowly increasing with people exhibiting rude behaviors. It is now uncommon for someone to let another person go before them…when it was a common occurrence when I was a child. Some of the workplace conflicts have also been attributed to people losing basic communication skills due to electronic communications, abbreviated conversations on texts. Frustrations at home (finances, children, relationships, chronic illnesses) carry over to the workplace, roadways, shopping centers.

Causes of Incivility Forni (2008) feels individuals are Vulnerable Stressed Unhappy Rushed Forni eloquently stated, "Incivility often occurs when people are stressed, unhappy, and rushed. When these coincide, anything can happen. Incivility erodes self-esteem, damages relationships, increases stress, contaminates the work environment, and may escalate into violence. Some stressors include lack of control, long work hours, heavy workloads, poor reward system, inadequate structure of communication flow within the institution-be it a hospital, medical office, same day surgery center. Lastly, in a compassion industry such as healthcare, compassion burnout is a problem. EMOTIONAL EXHAUSTION opens the door to depersonalization at the workplace-start giving impersonal responses, and become unaffected with a flattened affect…or become a short fuse under the pressure. Causes of Incivility

Instigators of Workplace Incivility Mismatched Team Members Low Employee Morale Workplace Stress Bad Employees/ Rude Behavior -Kate McFarlin (2012) Age, skill level, personalities can cause conflict. Managers’ attitudes also contribute Low morale d/t feeling unappreciated, unfair treatment (real or perceived), being treated as incompetent by a peer or manager Workplace stress: 12 hour shifts are being studied & evidence is leaning towards long shifts as contributing,. ALSO poor time management skills, lack of teamwork, high acuity patient loads Poor behavior-young adults may not be learning coping skills or are not being taught how to cope in workplace. Kate McFarland wrote a piece in Chronicle about Instigators of Workplace Incivility

Causes of employee conflict Poor communication Different values Difference in personalities Competition Varied educational backgrounds Causes of employee conflict

Negative work environment which can cause medical mistakes Medical complications Violence in workplace Even death Incivility Breeds

What is the Impact? Lower job satisfaction Feelings of self-doubt, low self-esteem Absenteeism, tardiness, Unfavorable perception of work environment Greater intent to leave job Decreased communication, teamwork, collaboration Deterioration of morale Anxiety, helplessness, dejection and emotional pain What is the Impact?

Impact of Uncivil Behavior RNs working day shifts experienced higher levels of verbal abuse than those working evening and weekend shifts. Staffing shortfalls also were correlated with higher levels of abuse. Intent to leave a job highly correlated with the levels of abuse new RNs experienced RNs who reported no verbal abuse were least likely to plan to leave in the next three years. Those who experienced moderate to high levels of abuse were most likely to say they intended to leave their positions in the next 12 months, but planned to stay in nursing. (Budin, Brewer, Chao, & Kovner, 2013) Impact of Uncivil Behavior

Studies have shown students and graduate nurses are the most common victims of uncivil behaviors! Namie, 2005 Years ago, nurses were battling the problem of rude, disrespectful physicians. Now some of these same nurses are treating students and new graduates in a similar manner. I guess nurses still “eat their young”. Unfortunately, this cycle of abuse is a sad fact. The Unfortunate Truth

What Does Civility Look Like?? Stage an interaction to exhibit poor behavior What Does Civility Look Like??

What is Civility?? “An authentic respect for others that requires time, presence, willingness to engage in genuine discourse, and intention to seek common ground that governs both speech and behavior toward others”. Clark, 2011 What is Civility??

What can we do? Healthcare leaders should act as role models Promote and uphold an atmosphere of respect Create an example of harmony and collaboration for staff Foster healthy communication Intervene when witnessing bullying behaviors Nurse Practitioners and Physician Assistants are healthcare leaders & role models and should conduct themselves in that manner. Healthcare leaders should act as role models Promote and uphold an atmosphere of respect. Create an example of harmony and collaboration for staff. Intervene when witnessing bullying behaviors by asking one of the involved to help you in an area away from the person bullying or just stand beside the individual being bullied. It puts a damper on the situation. What can we do?

If you are the recipient of confrontational encounter, take a breath, consider what just happened, take time to chill, and carefully develop your response. After careful reflection, you might choose not to respond at all. Dr. Clark recommends: before you act, ask yourself: "If I do not respond, what is the worst (or best) thing that can happen? If I do respond, what is the worst (or best) thing that can happen?" How to respond

How to respond Admit that you are being treated poorly and take action It is easier to ignore the problem than to deal with the unprofessional behavior Can be an emotional burden Share your experience with a trusted colleague or two and solicit feedback on how they perceive the situation. Start a paper trail and document any encounters How to respond

Recommended strategies A strong sense of community in the workplace, which views each individual as a valuable member of the team, is the best weapon against bullying and uncivil behaviors. Dellasega, 2003 Recommended strategies

What to do Become cognizant of workplace bullying Recommend behavioral health services to victims Increase awareness of negative effect of incivility-loss of sleep, anxiety, eating disorders Develop effective communication skills Become cognizant of workplace bullying-recognize it and acknowledge it. Recommend behavioral health services-being a victim of bullying is extremely overwhelming. What to do

Formal Approaches to prevent incivility Incorporate stress reduction techniques. Initiate training regarding professional behaviors, effective communication, and team building Develop policies to address uncivil behaviors Document unacceptable behavior towards the victim Formal Approaches to prevent incivility

Professional behavior Accept share of workload Respect other’s privacy Be cooperative concerning shared environmental conditions (temperature, lighting) Keep confidences Maintain eye contact during dialogue Avoid criticizing publicly Avoid conversations concerning peers Professional behavior

Be Part of the solution Show respect to all office/hospital staff Employ open and honest communication Keep actions inclusive and collaborative Be non-judgmental and honest Avoid gossip Be a team-builder Foster forgiveness Be Part of the solution

Friend or Foe?

Questions?

Budin, W. , Brewer, C. S. , Chao, Y. Y. , and Kovner, C. (2013) Budin, W., Brewer, C.S., Chao, Y.Y., and Kovner, C. (2013). Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of Nursing Scholarship. DOI: 10.1111/jnu.12033 Clark, Cynthia and Carnosso, Joan. (2008). Civility: A concept analysis. Journal of Theory Construction & Testing, 12(1), 11-15. Dellasega, C. (2003). Girl Wars: 12 strategies that will end female bullying. Forest City, NC: Fireside. Forni PM. The Civility Solution. New York, NY: St. Martin's Press; 2008. Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. Journal of Continuing Education in Nursing. 35(6), 257-263 McFarlin, K. (2013). What causes incivility in the workplace? Chron.com. Retrieved from http://smallbusiness.chron.com/causes-incivility-workplace-10700.html Namie, G. (2005). Workplace bullying: Hazard for healthcare professionals. Clinical New, 9(11), 14- 15 References