Pros And Cons Of Incivility In Nursing

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,

Obvious communication, listening, and understanding the focus of the dispute are the factors for being effective. Nursing managers may often be involved in a conflict as an individual, an administrator, or a unit representative. A manager is expected to confront staff when a discord develops (Sullivan, 2018). It is also imperative a nurse manager abides by her professional responsibilities and executes practical conflict resolution techniques to diminish low morale and stress among her staff (McKibben, 2017). She must modify her conflict management skills to a likely situation (Saeed et al., 2014). In order for the nurse manager to handle the conflict, it is helpful to understand the people involved. Positive management promotes mutual respect, refines working relationship, and restores staff retention (McKibben,

February 2010 This is a companion document to the Codes of Ethics and Professional Conduct for Nurses

Everyone has to deal with conflict: both in the workplace and personal lives. Fresh nurses too have to witness this at their new work setting.

The purpose of this integration paper is to educate about lateral violence in the professional setting, more specifically within the nursing profession. Lateral violence is defined as “profound and pervasive source of occupational stress with physical and psychological and organizational consequences.” (Cervalolo, D). Types of lateral violence include rude comments, verbal attacks, condescending language, sexual misconduct, lack of collaboration, professionally attacking a person integrity and reputation, blaming others for your own mistakes in front of others and family members of the patient, withholding important information and other non-professional behaviors.

Conflict has been an issue for man since the dawn of civilization. In today’s fast paced world conflict, especially in the workplace, is a frequent occurrence. When that workplace is a health care environment where lives are at stake, emotions run high and collaboration with many different disciplines is required conflict often becomes a prevalent part of everyday life. Conflicts in the workplace can lead to reduced morale, lowered productivity resulting in decreased patient care and can cause large scale confrontations (Whitworth 2008). In the field of nursing whether a conflict is with a peer, supervisor, physician, or a patient and their family, conflict management is a necessary skill.

Key words and terminology in the article search included hostility, nursing turnover, nursing attrition, nurse aggression, bullying, and nurse hostility. Specific key words that were used to narrow down the search included incivility, nurse turnover, lateral violence (LV), horizontal violence (HV), disruptive behavior (DB), and horizontal hostility (HH). The publication date range was adjusted to 2012 through 2017. The following literature review probes into the research of incivility to explore the connection with nursing turnover and patient care.

Acts of incivility such as bullying, lateral violence, or harassment in the work place negatively affects nursing performance, mental health, and retention within an organization or even the profession of nursing (Warrner, 2016). A policy in the American Nurses Association (ANA) proclaims that the nursing profession will not tolerate violence of any kind from any source (ANA, 2015b). The Code of Ethics for Nurses by ANA requires nurses to promote an ethical environment and culture of civility with an emphasis on treating all parties with dignity and respect (ANA, 2015a). A study conducted in a rural Kentucky hospital’s medical- surgical units concluded that educational trainings in itself did not reduce the frequency of experiencing incivility in their unit (Armstrong, 2017). Nevertheless, nurses in the study reported that educational trainings increased their ability to recognize and appropriately respond to workplace incivility (Armstrong, 2017).

Nursing is an occupation in which professionalism (or lack thereof) can have a significant effect on not only patients and their health, but the nurse’s relationships with colleagues, patients’ families and even their community. A nurse must exemplify professionalism, especially in an environment that creates increased risk for loss of life or further injury. There are many aspects that are involved with professionalism in nursing, and many expectations set up on the nurse.

Moreover, another type of violence which nurses experience is horizontal violence. Horizontal violence is described as “hostile, aggressive, and harmful behavior by a nurse or group of nurses toward a co-worker or group of nurses via attitudes, actions, words, and behaviors” (Becher & Visovsky, 2012, p. 210). Horizontal violence not only involves nurse-nurse violence but includes nurse-physician and nurse-supervisor violence. The perpetrator displays behaviors associated with horizontal violence which may include refusing to lend assistance, criticizing, intimidation, gossiping, name-calling, and ignoring (Becher & Visovsky, 2012). The American Nurses Association sets the expectations for nursing standards. According to the American Nurses

When nurses faced with such issues in work setting; it can possibly lead them to having a poor self-esteem, disconnectedness and subscribe to submissive-aggressive syndrome to affect change, which leads them to show their frustration towards other nurses specially the new nurses on the unit rather than confronting the issue. Submissive-aggressive

If a nurse purposely does not relay information, the patient can develop a condition that could have been prevented (e.g. pressure ulcers, incontinence, nosocomial infections). Promoting and Implementing Civility in Nurses Promoting civility can be described as showing respect toward another person. However, the problem with bullying, is it cannot be reversed with one simple approach. Healthcare organizations need to be restructured to solve the problems that take place in their facilities (Granstra, 2015).

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.

Incivility in nursing education and on the clinical floor is escalating. Due to the negative effects of incivility in the classroom and clinical setting on the students and faculty the profession of nursing could potentially be at risk of violating its foundation, the American Nurses Association code of ethics. Interventions to renew professionalism and trust amongst faculty and students in the nursing profession must be implemented to continue to produce dedicate nurses who are well educated, can work well with their colleagues, and provide quality care to patients.