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Incivility: Disclosing and Disarming the Incivility Elephant in Academic and Practice Nursing
 

Incivility: Disclosing and Disarming the Incivility Elephant in Academic and Practice Nursing

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    Incivility: Disclosing and Disarming the Incivility Elephant in Academic and Practice Nursing Incivility: Disclosing and Disarming the Incivility Elephant in Academic and Practice Nursing Presentation Transcript

    • Incivility: Disclosing and Disarming the Incivility Elephant in Academic and Practice Nursing
      The University of Southern Mississippi
      PhD Program of Nursing
    • Participants
      Sheila P. Davis, PhD, RN, FAAN
      Mary Friend – PhD Student
      Charlotte Gore- PhD Student
      Danny Tige Lantrip- PhD Student
      Melissa Martin- PhD Student
      Sharon McDonald- PhD Student
      Melinda Sills – PhD Student
    • Incivility – Dr. Davis
    • Objectives
    • Incivility – the Elephant
      Definition – any action that is offensive,
      Intimidating, or hostile that interferes with the
      Learning and/or practice environment (CRLT).
      Such behavior may be increasing, thus jeopardizing the welfare of the educational and/or practice setting of nurses.
    • A Student’s Account
      “I was typing my patient assignment on the computer and began humming to myself. The instructor approached me angrily and told me that if I hummed again, she would kick me out of clinical. .. She really let me have it in front of other students……inside, I was ready to burst.” (Clark, 2008)
    • Faculty Experiences
      “ Faculty who realize that they will likely face inappropriate behavior during lectures may begin devoting time and energy to planning coping ( survival) strategies rather than focusing on lecture material. Further, faculty who dread going to a particular class and having to deal with particular students can become demoralized and disillusioned with the overall teaching process.” (Morrissette,
    • How Bad is the Problem in Nursing ?Luparel( 2008)
      Moderate problem in nursing ( Clark & Spring, 2007)
      Tardiness, talking in class, and other inattentiveness was experienced by 100% of faculty
      One half of faculty reported being yelled at in the classroom
      43% of faculty reported being yelled at in clinical setting
      Faculty report having serious emotional and physical consequences
    • Incivility in the WorkplaceJane Legacy
      Incivility appears to be an increasing dilemma for organizations.
      Incivility is getting worse and more exaggerated
      Incivility is a business issue – expensive $$
      Victims suffer from increased stress, anxiety, exhaustion, sleeplessness, depression, anger and embarrassment. Lost of work time, sickness, extreme reactionary actions, and lawsuits can result from incivility.
    • Bullying
    • Incivility – Workplace Bullying
      According to Gary and Ruth Namie, authors of The Bully at Work, bulling is ‘the repeated malicious, health-endangering mistreatment of one employee (the target) by one or more employees (the bully, bullies).  The mistreatment is psychological violence, a mix of verbal and strategic assaults to prevent the target from performing well.  It is illegitimate conduct in that it prevents work getting done.  Thus an employer’s legitimate business interests are not met.
    • End Result of Extreme IncivilityWorkplace Violence
      Almost 38% of shootings in the workplace happened in "white collar" situations. This makes up over 30% of all fatal shootings at work.
      Florida and California were the most dangerous states involving shootings on the job.
      24% of workplace shooters were laid off or fired.
      about 9% of those shooting showed warning signs beforehand that were commonly ignored when others noticed them.
      There were about 13% of shootings in the workplace that involved a former or current intimate relationship.
      Over 13% of cases revealed the workplace shooter had a history of mental health issues
    • Melissa Martin, MSN
    • What do you think of ?
      Patients yelling, using vulgarities at the nurse and throwing things?
      Physicians being discourteous and obnoxious?
      Experienced nurses leaving new nurses to fend for themselves?
      Anger, jealousy and strife between nurses or units?
      School/College /University shootings/ most recently faculty on faculty- February 2010
    • YES
      The previous are all blatant acts of Horizontal Incivility and Violence!
      But incivility is not always that easy to identify.
    • So what really constitutes incivility?
    • Incivility can be ‘discreet’
      Arriving late to a meeting or leaving early.
      Sending an e-mail without a greeting.
      Not using uncivil words- but using accompanying harsh tones or body language.
      Dismissing or ignoring co-workers concerns, thoughts, or input.
    • Please don’t answer
      Just Think…
      Have you ever been guilty of any of these?
    • Then….
      Perhaps incivility is more common than we think.
      Perhaps incivility exist in places we are afraid to consider.
      In fact, incivility has permeated all areas of society and nurses are no exception.
    • Charlotte Gore RN, MSN
      Objective 3
      Provide input into a conceptual model for recognition and reduction of incivility in nursing.
    • Lindy Sills, MSN
    • ‘Dance of Incivility’
      ….. A dynamic interaction between faculty and students. When viewed as a ‘dance’ rather than a struggle for power and control, the potential for healing is enhanced. (Clark 2008)
    • Facilitating Factors
      Crowded working conditions
      Overworking conditions
      Too many demands
      Fundamental mistrust between students and faculty that faculty are trying to “weed them out”
      Fundamental mistrust between subordinate and supervisor
      Ineffective classroom and/or practice management skills ( Luparell, 2008)
    • Civil Workplace
      Requires
      Nurses
      Students
      Faculty
      Administration
    • Measures to Address Nurse to Nurse Incivility
      • Zero-tolerance
      • Clear communication
      • Non-threatening environment
      • Shared involvement
      • Self-reflection
      • Cooperate
      • Collaborate
      • Monitor for bullying groups
      • Carefully select employees
    • Measures to Address Faculty to Student Incivility
      Zero-tolerance
      Clear communication
      Non-threatening environment
      Shared involvement
      Self-reflection
    • Measures to Address Student to Faculty Incivility
      Zero-tolerance
      Clear communication
      Role-models
      Shared involvement
      Self-reflection
      Criminal background checks
      Act on warning signals
    • Measures to Address Faculty to Faculty Incivility
      Zero-tolerance
      Clear communication
      Self-reflection
      Cooperate
      Collaborate
      Carefully select faculty
      Refuse to be a victim
      Monitor for bullying groups
    • Measures to Address Administration to Subordinate Incivility
      Zero-tolerance
      Clear communication
      Self-reflection
      Respect subordinates
      Listen
      Educate subordinates on incivility and civility
      Acknowledge warning signals
      Evaluate organizational structure
    • Resources for Addressing Incivility in the Workplace
      Louanne Friend, MN,RN
      University of Southern Mississippi
    • Legal Protection
      Anti-bullying legislation was enacted in Sweden in 1993, Great Britain in 1997, Belgium in 2002 and Australia in the mid- to late-1990’s (Leymann & Gustafsson 1996; Namie 2004).
      Targets in the U.S. find few avenues of legal redress available.
    • Federal Statutes
    • Title VII Civil Rights Act
      Case law associated with Title VII of the U. S. Civil Rights Act of 1964 has established employer liability for the consequences of a hostile work environment. Title VII prohibits discrimination on the basis of “race, color, religion, sex, and national origin” which renders it inadequate to protect against generalized workplace bullying.
    • OSHA
      The U. S. Occupational Safety and Health Act of 1970 (OSHA) was primarily designed to respond to physical hazards in the workplace (Yamada 2000). OSHA’s protections do not generally extend to psychological or stress-related hazards in the workplace.
    • Workers Compensation
      Few, if any, States recognize psychological or stress-related claims as compensable under their Workers’ Compensation programs. Because the vast majority of workplace bullying is verbal in nature, there is often no direct physical injury to the target.
    • Healthy Workplace Bill
      New York is the only state that forbids abusive conduct in the workplace.
      In May 2010, the New York State Senate passed the Healthy Workplace Bill, a measure that would allow workers to sue for physical, psychological, or economic harm from abusive treatment at work.
    • 17 States since 2003 have introduced the HWB
      There are many ways that you can contribute to the Healthy Workplace Bill Campaign, from a simple letter to the editor or become a state coordinator, everything helps
      Citizen lobbying as opposed to professional lobbying is appreciated by most politicians.
      Gary Namie, PhD
      Director of the Healthy Workplace Bill Legislative Campaign.
    • Joint Commission
      Taking the perspective that bullying is a safety issue, in 2008, the Joint Commission issued a standard on intimidating and disruptive behaviors at work, citing concerns about increased medical errors, poor patient satisfaction, adverse outcomes, higher costs, and loss of qualified staff.
    • American Nurses Association
      The ANA Code of Ethics states nurses have a responsibility to establish, maintain and improve health care environments and conditions of employment conducive to the provision of quality healthcare.
    • AACN
      American Association of Critical Care Nurses’ Healthy Work Environment Initiative (2004).
      AACN’s Healthy Work Environment initiative is a multipronged, multiyear effort to engage nurses, employers and the nursing profession in recognizing the urgency and importance of working collaboratively to improve the environments in which nurses work.
    • AONE
      The American Organization of Nurse Executives has stated that collaboration and communication are some of the characteristics that are needed in a healthy workplace.
    • American Organization of Nurse Executives (AONE)
    • AONE
    • Healthful Work Environment Tool Kit
      The National League for Nursing has focused on work environments in academia and has published the Healthful Work Environment Tool Kit© that can be used by applicants for faculty positions, current faculty members, and nurse administrators to assess an academic work environment.
    • Toolkit
      The tool kit addresses the following nine work-related areas: salaries, benefits, workload, collegial environment, role preparation and professional development, scholarship, institutional support, marketing and recognition, and leadership. These areas are used to frame the discussion of how nursing faculty and administrators can work together to assess and enhance the health of nursing academic workplaces
    • Center for American Nurses
      Center for American Nurses. Lateral violence and bullying in the workplace. 2008.
      It is the position of the CENTER that there is no place in a professional practice environment for lateral violence and bullying among nurses or between healthcare professionals. All healthcare organizations should implement a zero tolerance policy related to disruptive behavior, including a professional code of conduct and educational and behavioral interventions to assist nurses in addressing disruptive behavior.
    • Nurse Educators
      In the NLN/Carnegie Foundation Survey, Nurse Educators: Compensation, Workload and Teaching Practices, nurse educators reported working just over 56 hours per week while school was in session.
    • Nurse Educators
      To maintain a healthy work environment, nurse administrators should ensure that faculty members have options for nine, ten, and twelve month contracts. Another benefit could be joint-appointment contracts allowing faculty to fulfill both education and practice role responsibilities.
    • Policies Are A Must!
      First, it is important to develop a code of conduct describing the types of behavior that are considered disruptive .The code needs to address all workers in an organization, including employees, such as nurses, and nonemployees, such as physicians (Barnsteiner, Madigan, & Spray, 2001).
    • Code of Conduct
      In order for a code of conduct to be effective, it must be applied in all circumstances where there is a possible breach. Without this enforcement, the code is meaningless. All team members, including hospital administrators, chief nursing officers, and other nursing leaders, need to be accountable for modeling and enforcing the code.
    • What to Do?
    • Cognitive Rehearsal Techniques
      Griffin (2004) reported that newly licensed nurses who had been taught about the use of cognitive rehearsal techniques to address disruptive behaviors were better able to confront nurses who displayed lateral violence.
    • Call a Code
      One strategy that has been used by nurses to show support for other nurses is by calling a “Code Bully” or a “Code Pink” (Childers, 2004; Namie & Namie, 2009). If a nurse is being yelled at by another healthcare worker, a code can be called by word of mouth or by a more formal method, and the nurses can unify by physically standing behind the nurse so as to let the disrupter know that the disruptive behavior is unacceptable (Childers, 2004).
    • Online Resources for Developing Code of Conduct
      American Medical Association: www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/organized-medical-staff-section/helpful-resources/disruptive-behavior.shtml
      HC Pro: www.strategiesfornursemanagers.com/ce_detail/225618.cfm
    • Center for American Nurses
      For those nurses wishing to learn more about disruptive behaviors, the Center for American Nurses (CAN) has a free webinar titled 10 Tips for Addressing Disruptive Behavior at Work that can be accessed at www.centerforamericannurses.org/displaycommon.cfm?an=1&subarticlenbr=195.
    • Conclusion
    • Desk Rage: Do you need a policy to deal with workplace Incivility?
      Employers can reduce risks by identifying and controlling workplace incivility before it gets out of hand.
      Have a civility in the workplace policy that requires the exercise of self-control at work and professionalism in dealing with coworkers. Make sure employees are aware of any anti-stress programs you have. Walking paths, exercise rooms and anger management classes are examples
    • Desk Rage
      Provide a quiet area that employees may use to get away when needed.
      Make sure that employees are aware of job related resources
      Keep in mind that ignorance is not bliss where desk rage is concerned and have a good plan for dealing with it.
      http://del.hrtools.com/policies_and_procedures/articles/desk_rage_do_you_need_a
    • References
      American Association of Critical-Care Nurses (2005). AACN Standards for establishing and sustaining healthy work environments. Available: www.aacn.org
      Center for American Nurses. February 2008. Position statement on lateral violence and workplace bullying. http://www.centerforamericannurses.org/positions/lateralviolence.pdf
      (accessed July 15, 2010).
    • References
      American Organization of Nurse Executives (2006). AONE guiding principles for excellence in nurse/physician relationships. Retrieved June 17, 2009, from http://net.acpe.org/services/AONE/Index.htm
    • References
      Center for Research on Learning and Teaching (2010). Teaching strategies: Incivility in the college classroom. Retrieved September 30, 2010, from www.crit.umich.edu/.../Incivity.php
      Childers, L. (2004, April 26). Bullybusters: Nurses in hostile work environments must take action against abusive colleagues. Nurseweek. Retrieved August 19, 2009, from www.nurseweek.com/news/features/04-04/bullies_print.html
    • References
      Clark, C. (2008). Student voices on faculty incivility in nursing education: A conceptual model. Advances in Nursing Science, 31 (4), E37-E54.
      Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal of Continuing Education in Nursing,35, 257-263.
      Grover, S.M. (2005). Shaping effective communication skills and therapeutic relationships at work. AAOHN Journal, 53(4), 177-182
    • References
      Healthy Workplace Bill. Available at: http://www.healthyworkplacebill.org/ Accessed July 20, 2010.
      The Joint Commission. Sentinel Event Alert #40. Behaviors that undermine a culture of safety. July 9, 2008. Available at: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm Accessed September 22, 2010.
    • References
      Lazoriz, S., and P. J. Carlson. 2008. Don’t tolerate disruptive physician behavior. American Nurse Today 3 :http://www.americannursetoday.com/ME2/dirmod.asp?sid .
      Legacy, J. , Incivility in the workplace. Retrieved July 7, 2010 from http://www.publicvirtues.com/Incivility_Study.html.
      Morrissette, P. (2001). Reducing incivility in the university/college classroom. Retrieved, July 7, 2010 from http://www.ucalgary.ca/iejll/morrissette/
      Yamada, David C., Crafting a Legislative Response to Workplace Bullying (2004). Employee Rights and Employment Policy Journal, Vol. 8, p. 475, 2004. Available at SSRN: http://ssrn.com/abstract=1303725
    • Questions?
    • Contacts
      The University of Southern Mississippi
      118 College Drive, #5095
      Hattiesburg, MS 39406-0001
      601-266-5457
      www.nursing.usm.edu