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25_Weisbrot_D_Assessment7_CultivatingHealthfulEnvironments..docxHEALTHFUL ENVIRONMENTS 1
Cultivating Healthful Environments
Dana Weisbrot
Chamberlain College of Nursing
NR500: Foundational Concepts and Applications
October 2018
Running head: HEALTHFUL ENVIRONMENTS 1
HEALTHFUL ENVIRONMENTS 1
Cultivating Healthful Environment
Incivility is an important issue that affects everyone in the healthcare environment. Nurses are affected which contributes to negative feelings and increased turn over. Patients are negatively affected because of poor communication within the healthcare team leads to poor patient outcomes. Finally, the organization is being affected because of increased nurse turn over and poor patients’ outcomes. According to the American Nurses Association (2015) incivility, violence and bullying are detrimental to the nursing profession due to many leaving the profession with financial ramifications that affect organization and healthcare at a national level. It also explains that all of these factors combined decrease patient outcomes contributing to increased financial ramifications as described above. This paper will discuss the following sections: the issue of incivility, importance to nursing, storytelling, creating a healthful environment, practice application, and a conclusion.
The Issue of Incivility
Incivility in the workplace is defined as actions taken or not taken such as bullying and/or violence perpetrated by the individual that work there or even by the clients. As Saltzberg explains (2011), incivility, workplace violence and bullying are part of a large number of harmful actions which include physical or verbal aggression from actions taken or not taken by those individuals. Examples of these actions are coworkers making derogatory comments about another coworker or trying to undermine a coworker in order to jeopardize their job or legal implications. Therefore, we can infer that incivility in the workplace will bring negative outcomes in the work environment. According to the World Health Organization (2015), not taking action in the form of failing to intervene or vital information is being held letting incivility take its course make the issue of incivility in the workplace a complex phenomenon.
Importance to Nursing
Incivility in the workplace is of great importance to nursing because it has been shown that it directly leads to medical errors, personnel turnover, preventable adverse events, and poor patient outcomes. Violence, incivility, bullying, rudeness, and disruptive actions in the workplace are opposite to the professional nursing model (Meires, 2018). Bullying in the nursing profession will alter the so needed teamwork in a hospital environment for instance, which is of vital importance for nurses to accomplish their numerous tasks throughout the day.
The impact of incivility in the nursing environment can be detrimental to individuals. A recent disturbing research study shows that 48% of nurses report being victims of bullying behavior at work within 6 months of the study, 12% being bullied weekly, and 4% report being bullied daily. Even though “being excluded or ignored” was the most common type of behavior reported, 16% of them report having experience physical threats or actual abuse (Etienne, 2014). The consequences of incivility at a microsystem level can systematically affect the whole work organization. As Mennella and Woten point out (2018), bullying in a hospital environment is a significant source of nurse increased turnover, isolation, burn out, decreased job satisfaction and psychological distress for the bullied nurse. In the overall scenario, it contributes to the current nursing shortage being experienced in the United States.
Storytelling
The following event took place at my previous Hospital where I worked on a med/surge-telemetry floor as a Registered Nurse. One morning Dr. G did her rounds and quickly left the floor. Later on, one of my patient’s family members said to me that Dr G said his daughter was ready to start receiving bolus feedings to her newly inserted Peg tube. I checked for orders or notes to confirm what the family was telling me, but there were none. I then put out a total of 3 calls throughout the day, but the doctor never called back. The level of this family’s frustration was increasingly getting worse and mine as well. When night shift came in I let the night nurse know what was going on. Unfortunately, when I came back the next morning I found out that nothing had changed. At 10 Dr G came to do her rounds and this time I went in the room with her. Family and patient were upset and before I knew the doctor blamed me for not following her orders who she claimed to have placed the day before. I kept silent and just put all my energy in trying not to cry or yell or slap her right there in front of everyone. I left the room and went to the nurses’ lounge for a few minutes to calm down. When I got back saw the feeding orders were just placed on my patient’s file a few moments before. This situation caused a negative impact on patient outcomes since, it caused the patient to mistrust the doctor and nurse which brings its own cascade of negative effects such as mistrust and ineffective communication. In addition to this, it decreased my job satisfaction. Lastly, destroyed our ability as healthcare team to work as an actual team. It turned my work environment into a harsh unfriendly place, affected several aspects of the patient care continuum from patient health outcomes to nurse job satisfaction, increased nurse turn over, and decreased customer service.
Creating a Healthful Environment
As explained above, nurses have to deal with incivility in the workplace perpetrated by clients, coworkers, or even other nurses. Strategies can be used to successfully manage and prevent incivility in the nursing environment.
1. Training nurse managers on supporting nurses when they need help dealing with incivility at the workplace. Nurses need to feel that support is available from their immediate superior manager in order to deal with violence or bullying behavior. This implies that nurse managers need to be properly trained to be able to intervene between the nurse and client, doctors or other nurses. A recent research study shows that if nurses are strongly supported by their nurse manager incivility rarely happens because none dares to behave impolitely. When a nurse manager provides effective support to a bullied nurse, others can see this, and it drastically prevents this behavior from re-occurring (Abdollahzadeh, Asghari, Hossei, Rahmani, & Vahidi, 2017)
2. Ensure the organization maintains nurses’ workload at manageable levels. Incivility in the workplace appears mostly when nurses’ workload is excessive. With an increase workload comes stress, inability to accomplish all daily tasks, as well as feelings of dissatisfaction and frustration. As Viotti, Converso, Hamblin, Guidetti, & Arnetz, point out (2018) organizational efficiency is essential to understanding both coworker incivility because workers may not be able to control themselves as well as they would if the organization provided them with a number of tasks that can be accomplished realistically in a nursing shift.
3. Educating nurses on how to manage difficult situations can help them better deal with incivility in the workplace. By nature, the profession of nursing can be stressful. Nurses normally have to be able to manage their own stress as well as their patients’ and families’. Educating nurses on problem solving strategies and what the psychological effects of bullying are on nurses can reduce incivility in the workplace. In order to curve or eradicate bullying in the workplace nurses need to be trained on empowerment and conflict resolution safeguarding the collaboration of all members of the healthcare team (Ettiene, 2014).
Practice Application
As a Family Nurse Practitioner (FNP) I plan on implementing strategies to cultivate a healthful work environment. I will target two sectors which are the nurses and the organization’s administrators.
1. I will design collaboratively with other professionals a presentation for nurses presenting the idea that incivility is a real problem that affects us all at different levels and transmit the idea that they’re not alone. Educating nurses to know that they need to seek help if unable to deal with violent or bullying situations is key to preventing bullying at the workplace. Incivility can be stopped when staff members are empowered to stop it. A project unit change has already begun to inverse its culture, fixing its environment, and improving patient’s outcome (Balevre, Balevre & Chesire, 2018).
2. With the help of a good presentation backed with scholarly data sources from the latest research I will prove to the organization’s administrators that incivility in the workplace greatly affects the organization at so many different levels such as decreased job satisfaction, miscommunication within the healthcare team, poor patient outcomes, increased nurse turnover which contributes to the current nursing shortage being experienced in the United States. “Sustainable change can spread, mitigating the organization’s nursing shortage threats, budgetary challenges, and employee dissatisfaction” (Balevre, Balevre & Chesire, 2018). I will also suggest that the need to take this issue seriously and come up with disciplinary action for those who commit acts of incivility in the workplace to include the whole healthcare team no matter their position.
Conclusion
Provide a conclusion. Include a summary on incivility and the issues this creates; strategies to create healthful environments, specialty track, and how you will contribute to cultivating healthful environments in your future professional practice. Include a self-reflection. Self-reflection is written in first person.
After learning about incivility in the workplace I concluded that this is an important issue that affect all of us and that requires a collaborative effort from both nurses and the organization’s administration in order to find an effective solution. Nurses need to be supported, educated, empowered to keep this problem under control. Organization administrators have to be made aware of the enormous ramifications of this issue and provide tools for the effective education and disciplinary action to manage the issue effectively. If we all come together we will be able to find a solution to the issue of incivility which affects us all as individuals and as members of our society.
References
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
Balevre, S. M., Balevre, P. S., & Chesire, D. J. (2018). Nursing Professional Development Anti-Bullying Project. Journal for Nurses in Professional Development, 34(5), 277. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=131897356&site=eds-live&scope=site
Etienne, E. (2014). Exploring workplace bullying in nursing. Workplace Health & Safety, 62(1), 6-11. doi:10.3928/21650799-20131220-02
Meires, J. (2018). Workplace Incivility. The Essentials: Here’s What You Need to Know about Bullying In Nursing. Urologic Nursing, 38(2), 95–98. https://doi-org.chamberlainuniversity.idm.oclc.org/10.7257/1053-816X.2018.38.2.95
Mennella, H., & Woten, M. (2018). Bullying in Nursing CINAHL Nursing Guide. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T903018&site=eds-live&scope=site
Saltzberg, C. W. (2011.) Balancing in moments of vulnerability while dancing the dialectic. Advances in Nursing Science, 34(3), 229–242.
Viotti, S., Converso, D., Hamblin, L. E., Guidetti, G., & Arnetz, J. E. (2018). Organisational efficiency and co-worker incivility: A cross-national study of nurses in the USA and Italy. JOURNAL OF NURSING MANAGEMENT, 26(5), 597–604. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1111/jonm.12587
World Health Organization. (2015). Violence. Retrieved from http://www.who.int/topics/violence/en/.
