Incivility in nursing. Given by Dr. Sheila Davis and USM Ph.D. students.

1. The University of Southern Mississippi
PhD Program of Nursing

2. • 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

4. Define incivility and state statistics to its manifestation in the academic and practice setting
Be aware of the range of behaviors associated with incivility
Provide input into a conceptual model for recognition and reduction of incivility in nursing.
state at least three precipitating indices related to incivility
State at least three alleviating indices related to incivility
Be aware of resources to aid in formation in policies and procedures related to incivility

5. • 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.

6. • “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)

7. • “ 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,

8. Luparell( 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

9. Jane 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.

11. • According to Gary and Ruth Namie, authors of
The Bully at Work, bullying 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.

12. • 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

14. • 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

15. • The previous are all blatant acts of Horizontal
Incivility and Violence!
• But incivility is not always that easy to identify.

17. • 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.

18. Please don’t answer
Just Think…
Have you ever been guilty of any of
these?

19. • 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.

20. Objective 3
Provide input into a conceptual model for recognition and reduction of
incivility in nursing.

27. ….. 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)

28. • 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)

29. • Requires
– Nurses
– Students
– Faculty
– Administration

30. • Zero-tolerance
• Clear communication
• Non-threatening environment
• Shared involvement
• Self-reflection
• Cooperate
• Collaborate
• Monitor for bullying groups
• Carefully select employees

31. • Zero-tolerance
• Clear communication
• Non-threatening environment
• Shared involvement
• Self-reflection

32. • Zero-tolerance
• Clear communication
• Role-models
• Shared involvement
• Self-reflection
• Criminal background checks
• Act on warning signals

33. • Zero-tolerance
• Clear communication
• Self-reflection
• Cooperate
• Collaborate
• Carefully select faculty
• Refuse to be a victim
• Monitor for bullying groups

34. • Zero-tolerance
• Clear communication
• Self-reflection
• Respect subordinates
• Listen
• Educate subordinates on incivility and civility
• Acknowledge warning signals
• Evaluate organizational structure

36. • 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.

37. Two federal statutes that spell out the affirmative duty of
managers to provide a safe, non-hostile working
environment.
1. Occupational Safety and Health Act of 1970
2. Title VII,Civil Rights Act

38. • 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.

39. • 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.

40. • 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.

41. • 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.

42. • 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.

43. • 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.

44. • 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.

45. • 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.

46. • The American Organization of Nurse
Executives has stated that collaboration and
communication are some of the
characteristics that are needed in a healthy
workplace.

47. Principles and elements of a healthful practice/work environnent. (2008.)
1. Collaborative Practice Culture
2.Communication Rich Culture
3. A Culture of Accountability
4. The Presence of Adequate Numbers of Qualified Nurses

48. The Presence of Expert, Competent, Credible, Visible Leadership
Shared Decision-Making at All Levels
The Encouragement of Professional Practice & Continued
Growth/Development
Recognition of the Value of Nursing’s Contribution
Recognition by Nurses for Their Meaningful Contribution to Practice

49. • 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.

50. • 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

51. • 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.

52. • 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.

53. • 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.

54. • 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).

55. • 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.

56. Provide coaching and mentoring as needed to help
improve behaviors.
Provide mediation services in instances of
unresolved disputes between parties .
If well-documented efforts at changing the
behaviors are not adequate, take disciplinary action.

57. • 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.

58. • 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).

59. • 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_det
ail/225618.cfm

60. • 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/displayco
mmon.cfm?an=1&subarticlenbr=195.

62. • 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

63. • 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

64. • 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/positio
ns/lateralviolence.pdf
• (accessed July 15, 2010).

65. • 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

66. • 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

67. • 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

68. • 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/SentinelEve
nts/SentinelEventAlert/sea_40.htm Accessed
September 22, 2010.

69. • Lazoriz, S., and P. J. Carlson. 2008. Don’t tolerate
disruptive physician behavior. American Nurse Today 3
:http://www.americannursetoday.com/ME2/dirmod.as
p?sid .
• Legacy, J. , Incivility in the workplace. Retrieved July 7,
2010 from
http://www.publicvirtues.com/Incivility_Study.html.
• Luparell, S. (2008). Incivility in nursing education: Let’s
put an end to it. NSNA Imprint, April/May, 42 – 46.

70. References
• 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

72. The University of Southern Mississippi
118 College Drive, #5095
Hattiesburg, MS 39406-0001
601-266-5457
www.nursing.usm.edu