Ever heard of the line: “nurses eat their young?” If you have, that is really scary, don’t you think so? In this world where the likes of us nurses are dwindling in number, complicated by the more complex needs of our patients or clients, lines like these are unwelcome. You may or may not have experienced this firsthand. However, don’t you think that it is about time for us to improve our workplace cultures for our own sake and those of the people we take care of? 

Here is the link to the podcast: https://open.spotify.com/episode/5hDVZRUOMu5cIL6KEx6bQ1?si=3e2abe86b36a480a

What is Workplace Incivility? 

Incivility is 

any rude or disrespectful behavior toward another with or without the intent to harm.

The American Nurses Association states that incivility may include bullying or lateral violence. They define that as  

repeated, unwanted, harmful actions intended to humiliate, offend, & cause distress in the recipient. 

Oftentimes, the recipients of such unprofessional behaviors are those nurses or other healthcare team members who may just be starting in the field or in the unit/department. These deeds may range from very negligible “microaggressions” or downright humiliation.   

Before we figure out what are we to do if and when we find ourselves on the receiving end of such foul behavior, let us first analyze why it exists in the first place. 

Potential Reasons Why Workplace Incivility Persists 

More than the fact that incivility exists, I think it is more important for us to explore why it persists. We have continuously worked hard on bringing it to everyone’s attention. Some organizations offer training classes on how to recognize and prevent it from happening. Others conduct formal investigations if the offender’s behavior warrants a review or a discussion with the human resources department. Several facilities even get to the extent of offering mental health support for those who may have fallen victim to unwarranted and unsanctioned behaviors. 

Some of the contributing factors may include: 

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 Organizational Factors 

• Poor staffing ratios – this situation just gets everyone worked up and irritated. Without meaning to, people may lash out at their coworkers because of the stress they may be experiencing at the moment. 
• Power imbalances – some people (and not just nurses) place too much importance on the hierarchical work structures. This follows, then, that junior nurses or those just starting out may be “placed in their rightfully deserved place” by the senior ones. Some instances may include the younger nurses’ ideas being shot down. Or they may just be told that they don’t really understand the workplace processes well enough because they are still new.  

• Existing departmental cultures – this could be tied to the power imbalance mentioned above. A glaring example of this is the existing cliques in the unit. These are the groups of nurses or colleagues who may be friends both at work and personally. Obviously, there is nothing wrong with work-based friendships. It just becomes sad, though, when others are kind of left out when those parts of the clique start talking or doing activities together.

Personal Factors 

• Inadequate coping skills – just like in normal, everyday life, most of the bullies were bullied at one point or another. Because of the lack of positive coping skills, they exact the same unwelcome behavior done to them before to their subordinates. These are the people who may have so much going on in their respective personal lives. Unable to separate those home life stresses from the demands of work, they tend to take those out to their coworkers. 
• Inherent personality trait – Whether we accept it or not, there are really people who are born as natural leaders. If used in the correct context and situations, that is awesome to be a leader for the team. However, if part of that leadership persona is to reiterate at every single opportunity that only their input matter, then that brings the group morale a few notches down. Working day in and day out with this kind of colleague will definitely make one feel mentally and emotionally drained even before the shift ends. 

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What Can We Do About It? 

Now that we have defined workplace incivility and identified potential causes, it is important for us to set goals. What do we want to happen? Who should we engage to make it a reality? How do we get there from where we currently are?  

Although not that comprehensive, these are some of the steps we may consider if we want to finally cut that proverbial incivility cord in our respective workplaces: 

• Awareness 

I sincerely think that this is the very first foundational step in finding out the details of the issue. Nurses, or any healthcare colleague for that matter, should be educated on how to determine if they are being victimized either overtly or subtly by their team members. This can be facilitated through computer-based training or other avenues. Maybe organizations can make this a mandatory assignment that needs to be complied with. 

• Create a Supportive Environment 

One way that organizations are able to cultivate this is through the identification of dedicated stakeholders who will oversee this culture change. Aside from that, Shared Governance committees can also incorporate this into the discussions regarding improving outcomes. If you ask me, this is one important outcome that desperately needs improvement. 

• Outline Applicable Change Strategies 

Utilizing the nursing process is key to how to carry this out. Change strategies will emanate from fact-finding as there will never be a one size fits all solution to this concern. In a nutshell, what is applicable to one organization may not work as well in another. Just like we want to provide person-centered care, we also want to implement organization-specific resolution steps to mitigate this issue.  

• Implement Initiatives One Step at a Time 

Similar to the third point, intervening one step at a time will allow the stakeholders to gather feedback after each step. This methodology will allow a first-hand evaluation of what went well, what can be improved upon, and how to carefully proceed to the next phase. Since this has been a long-standing issue in healthcare, maybe in other industries too, careful analysis of successes and necessary improvements are paramount to ensure effectiveness. Also considering what the previous approaches were and why were they unsuccessful will greatly factor into this latest implementation. 

• Periodically Review Progress and Identify Opportunities for Improvement 

Need I reiterate more? Feedback is of utmost importance. This is true across all stakeholders: the front-line staff, the middle management, and those in the executive suites. We all have to be in sync with our strategic plan while being flexible on where to bend as necessary to get this going.  

• Communicate. Communicate. Communicate!

We are finally given a platform to initiate something good for our patients as well as our own benefit. If we continue missing this chance, we are just as complicit as our other colleagues in allowing this negative environment to permeate our workplace environment. We are all physically, mentally, emotionally, and spiritually tired just getting through our shift. This kind of unwelcome behavior will just pile upon those stresses we are already having a hard time dealing with should we not do anything about it.

Needless to say, it doesn’t just stop with me or you! These initiatives and strategies should be communicated with our colleagues to gain their buy-in. After all, a “sick” workplace is detrimental to us all. Don’t know where to start? What about during shift huddles in our respective units? Or maybe during a Shared Governance meeting? The opportunities are limitless, we just need to start somewhere and sometime.

• Do Something Fun as a Group

Sometimes, some of these “misunderstandings” occur when we don’t know where each one of us is coming from. Add in a highly stressful work environment and it becomes a recipe for disaster. It may be worth looking into, then, to get to know each other, let loose, and cultivate personal relationships that go beyond the four walls of the unit. I fully understand that this may work for some but not for others, but it is another avenue worth exploring, don’t you think?

Our Peds Playroom parties were legendary in the olden days!

Conclusion 

Workplace incivility, sadly, is deeply rooted in our practice. So many generations before us have tried to mitigate, if not altogether solve, this issue. However, it persists and continues to have detrimental effects on the morale of our staff and our profession.  

Being on the cutting edge of healthcare, I think this generation should really tirelessly work to finally cut those chains of professional bondage. We all cry about diversity, equity, and inclusion, yet we are only all about words. Sure, it is challenging and an uphill battle for all of us, but someone’s got to do it, right?

Don’t you think it is high time to finally place this issue of workplace incivility to rest? 

*Disclaimer: This post is inspired by a Journal Club our organization facilitated recently. This only proves that an old dog like me can still learn new tricks, particularly in terms of being aware and in turn bringing this concern to the forefront. We all have to do our share in disseminating this information, no matter how small a step it may be. I just did mine!