BULLYING AND INCIVILITY IN NURSING PRACTICE

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Thoughts on incivility: Student and faculty perceptions of uncivil behavior in

nursing education

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Cynthia M Clark

Boise State University

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T H O U G H T S o n I N C I V I L I T Y: S t u d e n t a n d Fa c u l t y Pe r c e p t i o n s

of U N C I V I L B E H AV I O R in Nursing Education C Y N T H I A M . C L A R K A N D PA M E L A J . S P R I N G E R

CONNIE SEEMS TO CHALLENGE EVERYTHING HER NURSING PROFESSOR SAYS.

During small-group work, Connie text messages her friends and rarely pays attention. The professor is impatient and uses harsh language with Connie in front of other students.

T H I S S C E N A R I O, a common one in many of today’s nursing programs, is typical of sit- uations that are at best disparaging and, under the worst circumstance, potentially violent. Evidence suggests that incivility on American college campuses is a serious and growing concern (1-8).

Fostering an atmosphere of civility on college campuses presents a challenge. To be “civil” is to be polite,

respectful, and decent. Conversely, “incivility ” is defined as speech or action that is disrespectful or rude and

ranges from insulting remarks and verbal abuse to explosive, violent behavior (9). Academic incivility is any

speech or action that disrupts the harmony of the teaching-learning environment. Some uncivil behaviors

can be quite disruptive and affect the academic environment so radically that learning is effectively termi-

nated (10). T H I S A R T I C L E reports on a study of perceptions of nurse faculty and nursing students in one school of

nursing regarding incivility in nursing education, its possible causes, and potential remedies.

ABSTRACT Faculty members complain about the rise of uncivil behavior in their students, and students voice similar complaints about faculty. Using

an interpretive qualitative method for research, this study examined student and faculty perceptions of incivility in nursing education, possible causes

of incivility, and potential remedies. Narrative analysis yielded the following categories: in-class disruption by students, out-of-class disruption by stu-

dents, uncivil faculty behaviors, and possible causes of incivility in nursing education. The authors argue that further research is needed to increase

awareness and understanding about academic incivility, its impact, and its psychological and social consequences.

9 4 N u r s i n g E d u c a t i o n P e r s p e c t i v e s

Review of the Literature I N C I V I L I T Y I N H I G H E R E D U C AT I O N

To create a more civil society, Eberly urges Americans to elevate common good over self-interest, to encourage wider civic partici- pation, and to renew social values (11). Carter believes that rude- ness and disrespect are “the merest scratch of the surface of [our societal] crisis” (12, p. 16) and evidence of our nation’s growing incivility. According to Carter, selfishness and getting one’s own needs met are crowding into the social life of America, including our nation’s classrooms.

While academic incivility is not a new phenomenon, Braxton and Bayer (2,3) suggest that it is on the rise, and that courtesy and civility among faculty and students are fracturing and dissolving on college campuses across the country. Faculty members complain about the rise of uncivil behavior in their students (5,8,13,14), and students voice similar complaints about faculty (1,2,15-17).

Education plays an important role in developing a civil soci- ety, and higher education plays a special role in helping students develop a sense of civic and social responsibility and learn ways to contribute to the common good (18). In the United States, where public education is integral to preparing citizens for employment and socioeconomic mobility, education also accepts social responsibility for well-being in civil society (19).

Many explanations for academic incivility have been suggested, including exposure to violence, poor secondary school preparation, changing student demographics, and inadequate parenting (2). Levine and Cureton describe contemporary college students as dis- trustful of leadership, lacking confidence in social institutions, and being ill prepared for the rigors of academe (20). Braxton and Bayer indicate that it is important to consider the changing demo- graphics of students as well as the impact of faculty behaviors (2,3).

Clearly, a safe teaching and learning environment is needed and deserved. Incivility within the academic community is too damaging to ignore, and even though acts of disrespect and harassment may be reflective of a changing nation, such behav- iors must be immediately and effectively addressed (1,7,21).

I N C I V I L I T Y I N N U R S I N G E D U C AT I O N Further research in the area of incivility in nursing education is needed. A qualita- tive study by Luparell used a critical incident technique to con- duct extensive interviews with 21 nursing professors representing nine different nursing programs in six states (5). Faculty described aggressive and severe incidents of student incivility and reported being verbally abused by students. As a conse- quence of significant and sustained negative effects of these encounters, faculty reported losing sleep, having interrupted sleep patterns, and experiencing a number of other negative reac- tions to these encounters. Some faculty changed their pedagogy and modified grading criteria to avoid further conflict with stu-

dents, and many harbored self-doubt about their teaching abili- ties and assumed much of the blame for what occurred.

Thomas conducted extensive interviews with nursing students from a variety of nursing programs across the country (14). These students offered the opinion that faculty play a significant role in academic incivility and provided examples of uncivil faculty behaviors. They described themselves as being angry about unex- pected changes in clinical schedules, changes to the syllabus, and nurse faculty who “seem to make up the rules as they go” (14, p. 19). Several common triggers of their anger were identified, includ-

ing perceptions of faculty unfairness, rigidity, being overly critical of students, insistence on conformity, and discrimination against nursing students based on gender, race, and ethnicity.

Lashley and deMeneses surveyed 409 nursing programs in the United States regarding the frequency of uncivil student behaviors (22). Inattentiveness, absence from class, and tardiness were the most frequently reported uncivil behaviors. Fewer than 50 percent of respondents reported verbal abuse of faculty and student peers as a problem. Forty-three percent indicated that disruptive behav- iors had increased over the last five years.

A plenary session panel at the National League for Nursing Education Summit 2005 focused its attention on incivility in nurs- ing education, and a report on the panel discussion was published in Nursing Education Perspectives (23). Clark, a panelist, reported on the use of the Incivility in Nursing Education (INE) survey, which includes both quantifiable and open-ended items (24). Clark and Springer used the INE survey to investigate incivility in nurs- ing education from both faculty and student perspectives in a nurs- ing program in the northwest United States (17).

Findings from the pilot study revealed that both nursing faculty and students viewed academic incivility as a moderate to serious problem. Both groups reported similar behaviors as uncivil, and both indicated a desire to learn more about the problem. The qualitative comments were illuminating and form the basis for this article.

The Qualitative Study This study was conducted using quan- titative and qualitative methodologies to investigate the problem

U N C I V I L B E H A V I O R

Clearly, a safe teaching and learning Incivility within the

and even though acts of disrespect and a changing nation,

immediately

U N C I V I L B E H A V I O R

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U N C I V I L B E H A V I O R

of incivility in nursing education in a university environment from both student and faculty perspectives. Its purpose was to con- sider possible causes of incivility and to recommend potential remedies. The qualitative portion of this study was developed to examine three research questions: • How do nursing students and nurse faculty contribute to inci- vility in nursing education? • What are some of the causes of incivility in nursing education? • What remedies might be effective in preventing or reducing incivility in nursing education?

All faculty (n = 36) and students (n = 467) in the associate and baccalaureate degree nursing programs of a metropolitan public university received information about the study and were asked to participate (17). Approval to conduct the study was obtained by the university Institutional Review Board.

S U RV E Y I N S T R U M E N T All participants completed the Inci- vility in Nursing Education survey, which included demographic questions, quantitative items designed to measure faculty and student perceptions of incivility in nursing education, and four open-ended questions used to gather perceptions of faculty and students. This survey was developed by modifying items from two instruments designed to measure faculty and student incivility in higher education: 1) the Defining Classroom Incivility survey designed by the Center for Survey Research at the University of Indiana (25), and 2) the Student Classroom Incivility Measure (known as the SCIM-Part C), where students are asked to rate uncivil faculty behaviors in the classroom (4). After obtaining permission, Clark developed the INE by modifying items from these instruments to be more applicable to nursing education.

To establish initial content validity, faculty with experience in student and faculty incivility reviewed the newly developed sur- vey and compared the content to themes found in the literature. Faculty and students pilot tested the survey for readability, and revisions were then made to the wording of questions.

P R O C E D U R E The researchers emailed faculty in the depart- ment of nursing to invite them to participate in the study and request permission to distribute surveys to their nursing students.

Faculty response was favorable; all agreed to assist in the distri- bution of the survey to nursing students.

Clearly written instructions were provided with the surveys. During a two-week period in October 2004, faculty self-adminis- tered their own surveys and provided time during classes and clinicals for students to complete their surveys. All participation was voluntary. All responses were collected and placed in a large envelope, which was then given to a research assistant to compile.

Fifteen of 36 nurse faculty (41.6 percent) and 168 of 467 nurs- ing students (35.9 percent) completed the qualitative parts of the survey. An interpretive qualitative method was used to analyze the data from narrative responses (26). Each researcher indepen- dently reviewed the student and faculty comments to identify recurring responses and organize them into themes. Areas of agreement and disagreement were discussed and verbatim com- ments reviewed until both researchers were comfortable that the analysis was a valid representation of the comments.

Findings The first research question asked students and faculty how each group contributes to incivility. Findings were grouped into two themes: in-class disruption and out-of-class disruption. Table 1 lists uncivil in-class student behaviors as identified by faculty; response frequencies are provided in descending order.

With regard to in-class student disruption, respondents wrote about disruptions in class, negative remarks, and other forms of student incivility. Cited behaviors included challenging profes- sors regarding test scores in class, dominating class discussion, carrying on side conversations that disturb other students, and sighing to express displeasure with assignments. Students com- mented as follows: • “Students are disruptive when they do not listen to faculty and other students, text message their friends, and use cell phones during class.” • “It is most frustrating when students challenge professors, especially during class.”

With regard to out-of-class disruption, respondents wrote about discrediting faculty, complaining about faculty, and failing to use appropriate communication channels. (See Table 2.) Uncivil behavior in this category included students discrediting faculty knowledge, publicly bad-mouthing professors, and turning in assignments late, without making prior arrangements. Students commented as follows: • “I hear students bad-mouthing professors between classes. I don’t think it’s helpful to prejudice another student against a pro- fessor in that way.” • “Students send inappropriate emails, are negative toward fac- ulty and other students, and sigh because they think that an

environment is needed and deserved. academic community is too damaging to ignore, harassment may be reflective of such behaviors must be and effectively addressed.

9 6 N u r s i n g E d u c a t i o n P e r s p e c t i v e s

assignment is stupid.” The students identified six themes of uncivil faculty behaviors

as shown in Table 3. Comments referred to faculty condescension, poor communication skills, and superior attitudes toward stu- dents. Uncivil behavior included challenging students’ knowledge or credibility in front of others, demeaning the profession of nurs- ing, and failure to provide a respectful forum for discussing con- cerns. Students commented as follows: • “Some faculty make belittling comments and try to weed out students. They are arrogant and show superiority over students.” • “Some faculty treat students like they are stupid and make condescending, rude remarks.”

The second research question asked students and faculty to suggest possible causes for uncivil behavior in nursing education. Their responses are presented in descending order in Table 4. Themes included the high-stress environment of nursing educa- tion, faculty arrogance, and a lack of immediacy in addressing incivility when it occurs. Students commented as follows: • “Faculty lose their patience and take out their personal stress on students. They either do not deal with uncivil behaviors or are overly harsh and demeaning.” • “Incompetent, rude professors encourage the same rude behav- ior from students. If you can’t teach, don’t! Students are frustrated by the lack of resources to report a rude, incompetent professor, and fear retaliation if they go to the top to report it. We’ve been told that it can cost us our degrees and that we’ll be flunked out if we speak up. This simply encourages incompetence and incivility to continue.” • “Many students believe they can be as rude as they want because they are paying customers.”

The third research question asked students and faculty to sug- gest possible remedies for incivility in nursing education. In many cases, the respondents called for a swift, immediate response to incivility, and some suggested a “zero tolerance” approach to the problem.

Several possible remedies were offered, including setting forth standards and norms, strengthening university policies and sup- port for faculty, and enforcing campus codes of conduct. It was recommended that incivility be addressed immediately and that open forums and mediation panels be developed to resolve con- flicts related to incivility. It was also recommended that faculty and students learn conflict negotiation/mediation skills.

Implications for Nursing Education and Research Nurse fac- ulty and students perceive incivility as a problem both in and out of the classroom. Stress, disrespect, faculty arrogance, and a

Table 1. In-Class Disruption by Students as Identified by Faculty

UNCIVIL STUDENT BEHAVIOR FREQUENCY OF RESPONSE

Disrupting others by talking in class 20

Making negative remarks/disrespectful

comments toward faculty 11

Leaving early or arriving late 9

Using cell phones 7

Sleeping/not paying attention 3

Bringing children to class 1

Wearing immodest attire 1

Coming to class unprepared 1

Table 2.

Out-of-Class Disruption by Students as Identified by Faculty

UNCIVIL STUDENT BEHAVIOR FREQUENCY OF RESPONSE

Verbally discrediting faculty 4

Turning in late assignments without proper notification 2

Sending inappropriate emails to faculty 2

Not keeping scheduled appointments 1

Complaining about constructive feedback from faculty 1

Stealing/driving too fast on campus 1

Making veiled threats toward faculty 1

Table 3. Uncivil Faculty Behaviors as Identified by Students

UNCIVIL FACULTY BEHAVIOR FREQUENCY OF RESPONSE

Making condescending remarks 26

Using poor teaching style or method 23

Using poor communication skills 19

Acting superior and arrogant 15

Criticizing students in front of peers 7

Threatening to fail students 7

Table 4. Possible Causes of Incivility in Nursing Education

as Identified by Students and Faculty

POSSIBLE CAUSE FREQUENCY OF RESPONSE

High-stress environment 10

Lack of professional, respectful environment 9

Lack of faculty credibility and responsiveness 8

Faculty arrogance 6

Sense of entitlement among students 3

Students not really interested in nursing 3

Not being clear about expectations 2

Competitiveness 2

Lack of immediacy to address incivility 2

Distance learning (virtual) environment 2

Lack of student preparation 1

U N C I V I L B E H A V I O R

sense of student entitlement contribute to incivility in nursing education. To deal effectively deal with these issues, faculty and students must work together with administrators to develop and implement comprehensive codes of conduct and effective strate- gies to prevent incivility. Further, they must craft remedies for effective intervention when incivility occurs.

Standards and ethical principles that define the profession exist to ensure that qualified, ethical nurses are graduated from nursing programs. Nurse faculty and students must be account- able to these standards and bear a shared responsibility to con- duct themselves in an ethical, professional manner. They must engage as partners in lively dialogue to address these problems.

This study of incivility in nursing education is timely. Most earlier studies on this topic have focused on the problem of stu- dent incivility. These findings shed light on possible causes of incivility, potential remedies, and how faculty, as well as stu- dents, contribute to the problem. From the classroom to the prac- tice setting, further research is needed to address several topics: • The nature of incivility and its impact on the educational process and on the profession as a whole

• The relationships between student and faculty perceptions of incivility and ways to effectively address the problem • Whether there are gender differences in ways that faculty and students experience incivility • How civility experienced by students — or perpetrated by students — affects patients

It is clear that uncivil encounters have a negative effect on the academic environment and have the potential to disrupt the teaching-learning environment. Greater awareness and under- standing about academic incivility, its impact, and its psycho- logical and societal consequences are needed.

About the Authors Cynthia M. Clark, PhD, RN, is associate professor, Department of Nursing, Boise State University, Boise, Idaho. Pamela J. Springer, PhD, RN, is professor and department chair, College of Nursing. Boise State University. For more infor- mation, contact Dr. Clark at [email protected].

Keywords Codes of Conduct – Incivility – Student Behavior – Student-

Faculty Relations

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