Incivility: A Case Study

Conflict is an unfortunate part of life and it is truly inevitable, however in the field of nursing it can be detrimental. “Conflict is defined as the discord that results when two or more parties have opposing or incompatible ideas, beliefs, or goals.” (Schub & Schub, 2015). Within healthcare settings there are an outstanding number of differences in opinions that could potentially lead to conflict throughout a number of different levels of the employees. Focusing in on one of those areas would be the nurse to nurse, or horizontal/lateral violence.

Excellent discussion on workplace violence in the health care setting. When this writer finished nursing school approximately nine years ago, the thought of being assaulted or abused by the patient or family member did not cross this writer mind. Most people think of nurses as being the most nurturing, caring indivdiual, whom assist the patient with restoring their health. Society has shifted in a direction within the current health care industry and there is not a level of respect being demonstrated towards the health care professional. This can create a barrier with building a therapeutic and effective nurse to patient relationship. When this wall has been established due to workplace violence resulting from the patient and family,

The QSEN competences which are affected are the focus on patient safety and teamwork and collaboration. QSEN defines teamwork and collaboration as the “ability to function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.” (Pre-Licensure KSA 's). QSEN defines patient safety as “Minimizes risk of harm to patients and providers through both system effectiveness and individual performance” (Pre-Licensure KSA’s). Failure to work with and collaborate with each other can break down morale and communication which in turn can negatively affect the patient. It is important to continue research and studying this topic, because the lasting effects of lateral violence can affect the health of the nurse and the patient long term and affect the revenue and budget of the hospital.

Because A&E often has difficult and violent patients, your manager has asked you to give these new nurses some guidance on how to deal with challenging behaviour that they may encounter.

The nurse as a leader looks to achieve a workable unity. (Gardner, 2007) In an interdisciplinary format this is vitally important. There will be many factors that will prevent group cohesion and mutual tolerance in any environment. In an emotionally charged setting this is especially true. The nurse can help to manage conflict and promote a positive environment. This can

Incivility is an umbrella term used to describe any type of negative behavior directed towards another individual that may impact the way that they behave and/or feel. While incidences of incivility may be visible in most professional careers, it’s significance in nursing has prompted a provisional statement from the American Nurses Association. “The nurse creates an ethical environment and culture of civility and kindness. Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors” (American Nurses Association, 2015, p. 4). Dumont, Meisinger, Whitacre, & Corbin (2012)

It may surprise many student nurses that most horizontal violence in school and the workplace does not entail physical violence. New graduate nurses need an understanding of what horizontal violence is and have the skills to prepare them for the likelihood of being not just a victim of, but the perpetrator of this behavior. Intimidating behavior distracts from patient care and can ultimately place the patient at risk for harm. Recognizing the behaviors that are considered horizontal violence, showing respect for peers, and having the tools to intervene will foster positive working relationships and a safer patient environment.

The QSEN competencies’ that are of primary importance to me are teamwork and collaboration. QSEN in 2013 defined teamwork and collaboration competencies as the effective functioning of, communication, working together, respect, professionalism and quality of care in nursing environment. As a traveling nurse in the field, my overall experience was quite the contrary. Various nurse’s in the assigned facilities exhibited deliberate and harmful behaviors for example, bullying, indifferent, demeaning, and similar to lateral violence (LV). This often occurred from one employee to another; and was/is a significant problem in the nursing profession (Christie 2014 et al and QSEN in 2013).

Furthermore, there has been increasing correlation of lateral violence to poor leadership or management. In response to this, the Joint Commission on Accreditation of Healthcare Organization created a new standard in the “Leadership” chapter that tackle disruptive and inappropriate behaviors (American Nurses Association, 2012). This “Leadership” chapter, will further aid in seeking and preventing lateral violence.

Within the interactive presentation of Riverbend City: Team Dynamics and Conflict resolution (Capella University, 2017), there were many forms of aggression displayed by the staff within the hospital. The first type of aggression that will be discussed is instrumental aggression. This type of aggression is brought on by the desire to achieve a goal (Bordens &Horowitz, 2002). Nurse Alan Warnack, was acting very aggressive while helping a different unit of the hospital due to the emergency of the chemical spill. He was very vocal about completing his assignment and was aggressive towards those who began to derail him from accomplishing his goals. Within this group of nurses, Alan was not displaying himself as an interdependent member, which means that he was not depending on the others to help him complete his goals (Bordens & Horowitz, 2002). This made him and other nurses fall apart

The code emphasizes a standard of conduct that prohibits nurses from harassment or intimidating behavior with the expectation that nurses value the unique contributions to care that their coworkers provide. Second, nurses are expected to collaborate with their fellow coworkers due to the complexity of the health care delivery system (ANA, 2001). Disruptive behaviors interfere significantly with nurses’ intra-professional cooperation and multidisciplinary partnership.

I was particularly impressed by way this meeting dissected critical issues. The participants of this gathering welcomed openness and honesty from all. This meeting investigated ethical issues regarding patient care, and scenarios in which one’s discretion licensed him/her to question a patient’s judgments. This gathering also addressed the issue of productivity, in terms of sustaining it and enhancing it amid a taxing and demanding environment. The participants then proceeded to address common relational issues, which involved disagreements among nurses, and conflict mitigation. After witnessing the dynamics of this meeting, it became readily apparent that conflict

Incivility and bullying differ in that bullying is often an individual or a group of person that is the object of ridicule. This individuals or groups are often targeted by another person or group. For example, LBTG groups are targets for being who they are or people of different faction/ethnicities can face bullying. Bullying is not limited to personal issue as bullying can be seen in the workplace. For example, derogatory comment toward an individual about their work/ability to perform his or her job is seen as workplace bullying (Walker, 2017). Bullying is considered doing psychological and physical harm; it creates a suffocating and unfriendly environment to be in (Gomez-Mejia, Balkin & Cardy, 2016). The hostile actions are seen as aggressive, manipulative and humiliating. Bullying in the workplace stunts creativity, lower productivity, creates a toxic culture and puts the company at legal risk if the bullying is not dealt with (Walker, 2017).

Incivility, bullying, and workplace violence are part of a larger complex phenomenon, which includes a “constellation of harmful actions taken and those not taken” in the workplace (Saltzberg, 2011, p. 229). The term “actions taken and not taken” provides an overarching framework that includes using explicit displays of uncivil or threatening acts, as well as failing to take action when action is warranted or required to address incivility, bullying, or violence in the workplace.

During my practicum in the emergency department, I utilised my interpersonal, negotiation and conflict resolution skills to de-escalate a situation during a busy shift. When asking the patient how I could help her, the patient became verbally aggressive. Expressing displeasure with her nursing care, a lack of communication, the long wait time for medical treatment and not being offered food and drink.