53/7 Dis R1

Reply to colleague: Post 2 paragraphs with 2 sources sharing ideas for how shortcomings discovered in their evaluations and/or their examples of incivility could have been managed more effectively.

POST:

Incivility in the healthcare setting can be a major disruptor to clinical care and the promotion of a teamwork environment. An uncivil atmosphere may lead to higher nursing turnover (Berry et al., 2016). Also, a lack of respect, bad manners, and discourteous behavior may hasten the development of mental health issues for nurses such as post-traumatic stress disorder (Spence Laschinger & Nosko, 2015). This discussion will highlight the results of the Clark Healthy Workplace Inventory assessment and the level of civility at the writer’s employment. Also, the post will address the issues of civility at the writer’s clinical organization, describe an uncivil incident in the writer’s career, and how the behavior was addressed.

In 2015, the American Nurse Today journal published the Clark Healthy Workplace Inventory assessment tool to help nurses determine the level of emotional health in the workplace setting. Dr. Cynthia Clark has been writing about incivility in the healthcare field since 2006 when she published her doctoral dissertation about student perceptions of uncivil behavior from nursing instructors (Assessment Technologies Institute, n.d.). In completing the assessment, the writer tallied a score of 29, meaning the current workplace setting at the writer’s employment is considered very unhealthy. To ensure whether the writer’s score was reflective of the current environment, the writer recruited two nurses to take part in the assessment. Scores from both nurses were similar and reflect an unhealthy setting.

The reasons for the level of incivility at the writer’s employment are multifold. First, there is a clear lack of communication regarding policy and procedures. Management will introduce new forms for nursing documentation, consistently revise policies regarding patients, and amend schedules of patient activities without prior notice to the nursing staff. Hospital-wide meetings are non-existent, except for the recent events involving COVID-19. Shared governance and decision-making do not occur. Professional growth and development opportunities do not exist. The perception by employees is of an organization not valuing its staff. Given recent developments of the coronavirus, the mental health hospital for which the writer is employed does not supply masks to employees. Also, the hospital, in great need of nurses and behavioral health staff due to the influx of call-offs, instituted monetary bonuses for agreeing to additional shifts, then cut the bonuses in half and made the dollar reductions retroactive.

A prime example of incivility in the writer’s nursing career occurred at his first job in psychiatric nursing. Working the second shift, the writer received a late doctor’s order to start an IV and introduce fluids due to a patient’s high creatine kinase levels. Knowing the overnight shift was short of staff, the writer agreed to extend his shift and sit with the patient to ensure the administration of all of the prescribed fluid. Less than an hour into the third shift, the overnight nurse came into the patient’s room and turned off the IV pump and instructed me to go home. The next day, several staff members questioned me about the patient. According to the shift report given by the overnight charge nurse, the writer was accused of not wanting to wait until the full fluid amount had been administered to the patient, and that the writer turned off the pump, discontinued the IV, and went home. Flummoxed, the writer met with the unit manager to discuss the information being presented to staff, addressed the falsehoods of the report, and asked for a meeting between the unit manager, the overnight charge nurse, and the writer. As the meeting between us ended, the overnight charge nurse denied making the alleged statements – though multiple people from the first shift meeting confirmed the nurse’s report – but vowed to work together to ensure a similar incident does not repeat itself. The unit manager asked for my cooperation in promoting a teamwork atmosphere and report to her if another occurrence of a comparable nature occurs.

The memory of the writer’s first experience with incivility in the healthcare workplace will always be fresh. Yet, the incident serves a valuable lesson. Never be quiet when patient care is involved. Patient safety is of utmost importance. By not speaking up, danger to a patient and unnecessary problems can happen (Clark, 2019).

References (CharBra)

Assessment Technologies Institute. (n.d.). Research by Cynthia M. Clark, Ph.D., RN, ANEF, FAAN: Strategic nursing advisor, ATI. Retrieved from https://www.atitesting.com/docs/default-source/default-document-library/research-by-cynthia-clark.pdf?sfvrsn=d87e07e9_0

Berry, P.A., Gillespie, G.L., Fisher, B.S., Gormley, D., & Haynes, J.T. (2016). Psychological distress and workplace bullying among registered nurses. OJIN: The Online Journal of Issues in Nursing, 21(3). https://doi.org/10.3912/OJIN.Vol21No03PPT41

Clark, C.M. (2019). Ending the silence: Antidote to incivility. Reflections on Nursing Leadership. Retrieved from https://www.reflectionsonnursingleadership.org/

features/more-features/ending-the-silence-antidote-to-incivility

Spence Laschinger, H.K., & Nosko, A. (2015). Exposure to workplace bullying and post-traumatic stress disorder symptomology: The role of protective psychological resources. Journal of Nursing Management, 23(2), 252-262. https://doi.org/10.1111.jonm.12122