1. Student-Novice Nurse, Hospitals & Incivility
A Systems View:
Student-Novice Nurse, Hospitals & Incivility
Academic Acute Care Hospital
Sickest patients seek expertise of top clinicians
Jr docs & nurses are promoted to leadership
Hierarchical Expert based culture
Top clinical experts work in acute care hospitals
Have complex care plans
Specialized skills required for each area
Nurse Manager education
Nurse managers are bullies
Jr. docs and new nurses adopt hierarchical behaviours
Incivility contributes to adverse patient incident
Incivility & harassment begins in Nursing Program
Hospital culture tolerates bullying
Nurse managers are intimidated to address behaviours
Nurse managers don’t address behaviour issues
Mistake results in adverse patient event
Novice nurse adopts uncivil behaviour norm
Students enter Nursing Program
Sr. Physicians bully nurses & jr. docs
Nursing faculty come from academic hospitals
Sr. RNs bully novice nurses & docs
Novice nurses make mistake
Processes to correct behaviours are time consuming
Sr. Nurses become dissatisfied with job
Experienced nurses make a mistakes
Competitive Hierarchical environment
Intact team intervention
New grads are mentored by sr. RNs on the unit
Bullying becomes normalized for students
Grad nurses seek jobs in academic hospitals
Grads are hired to work on unit teams
Senior nurses have less time to mentor novices
Novice nurse hospital orientation
Sr. Nurses intimidate new grad hires
Senior nurses have worked on same unit for long time
Nurse Faculty bully each other
Orientation for 1st clinical placement
Novice nurses don’t feel safe to speak up
Team operates short staff/stressed
Pension discourages experienced nurses from leaving
Students experience bullying on placements in hospitals
Hospitals hire new grad nurses
Novice nurse suffers harm
Faculty bully students
Students bully each other
Collective agreement promotes hierarchy - “Seniority”
Collective agreements discourage job movement
University Nursing Program
Preceptor/Experienced Nurses
Creates need to hire more nurses
Novice nurses call in sick
Novice nurse suffers physical/psychological harm
Novice Nurses
Physicians/Surgeons
Novice nurse transfers out of unit
Hospital Environment
Nurse Managers
Novice nurse experiences incivility in new unit
Novice nurse leaves profession
Potential points of intervention using the Walk in My Shoes exhibit
Figure 12. Systems View and Potential Points for Interventions 78