Introduction
In order to be able to care for patients and provide a safe environment for positive health outcomes, nurses need to keep their well-being in good shape. While nurses provide a safe and welcoming environment with the patients, they are frequently exposed to workplace incivility and bullying either from colleagues or from patients. Acts of aggression like incivility and bullying should be stopped and prevented in any workplace, not only in the nursing sphere. However, in the nursing sphere, the negativity could be crucial for a nurse’s ability to care for the patients and result in a negative health outcome. This paper will identify outcomes of workplace incivility in nurses’ ability to use high-level critical judgment, analyze the issues that occur in the workplace with incivility, and identify current initiatives to decrease incivility in nursing.
Main body
American Nurses Association differentiates four common types of violence that might occur in the nursing process. In order to understand the use of the term violence, one should understand that both incivility and bullying could be characterized as verbal and psychological abuse that could harm the nurse’s mental health and wellbeing. The most common four types of violence, according to ANA, are criminal intents, customer/client disputes, worker-on-worker issues, and situations that include personal relationships. ANA points that the most met healthcare environment-based assault is the one that involves both customer and client, and in these situations, the perpetrator is usually a member of the public. Although the most common type of violence in the healthcare environment could be a result of a misunderstanding from people that do not know each other well, the next most common is bullying among colleagues. Even if some of the nurses are not exposed to interactions with customers on a daily basis, the bullying involves each and every layer of the healthcare environment and should be prevented at all costs.
Workplace incivility in the nursing sphere could result in consequences like emotional factors, stress and could be a direct or indirect threat to patient’s safety. Workplace incivility could be connected to professional burnout by linear correlation; other outcomes of workplace incivility may include emotive exhaustion, reduction of productivity, stress, burnout, low job commitment, and absenteeism at work (Bambi et al., 2018). The most prevalent answer to the surveys centered around workplace incivility notes the workplace incivility as a predictive factor for turnover intentions. This could be explained as when nurses are faced with workplace incivility, and the initial reaction is to avoid further negative interactions and quit the job at some point. Judging by that fact, one could think that there are no direct connections to the patient’s safety.
However, adding all the possible outcomes of workplace incivility to one list, one could estimate that workplace incivility highly interferes with the nurse’s overall wellbeing. It could be possible that once nurses face workplace incivility, they resort to the thought of quitting the job, which results in a reduction of productivity, low job commitment, and absenteeism. Even if nurses manage to keep the grasp for the work despite the workplace incivility issues, the determination could be resulted in denial of nurse’s own wellbeing and lead to professional burnout. Moreover, on average, from 60 to 90 percent of nurses experience workplace incivility from peers or supervisors (Bambi et al., 2018). Combining the numbers with the emotional outcomes results in a tragic sign of the current situation in the healthcare environment. The numbers multiply the threat for the patients’ care as more than half of the nurses could possibly be affected by issues of workplace incivility.
Two of the most common issues that occur with the workplace or clinical site incivility are lateral violence and bullying. Lateral violence is usually referred to as “open or covert hostility, criticism, sabotage, damage, internal conflicts, looking for a scapegoat” (Bambi et al., 2017). Although lateral violence could occur between colleagues that do not have a gradation in power, bullying generally involves unbalanced power. In both cases, a possible reason for issues could be connected to a hostile environment. Moreover, both issues seem to appear from two main factors: the market’s fluctuation and the overall social environment where people behave in a hostile manner. The first factor comes from the constant turnover of the workforce on the clinical site; the second could be explained by limited resources and inability to follow certain protocols, which results in conflicts and aggression (Bambi et al., 2017). It also must be noted that nursing workers are usually highly loaded with work and constantly face a lack of sleep and rest.
Nursing individuals who have faced continuous bullying and lateral violence report that the issues resulted in several physical and psychological consequences. The physical consequences of workspace incivility may include insomnia, tremors, loss of appetite and weight, back pains, diabetes, fatigue, asthma, arterial hypertension, osteoarthritis, and rheumatoid arthritis (Bambi et al., 2018). The psychological consequences include loss of self-confidence, anxiety, panic attacks, depression, and Post-Traumatic Stress Disorders (Bambi et al., 2018). The most endangered group in this situation are young junior staff representatives, who, due to lack of experience and power, could be positioned to the bottom of the bullying scheme.
Summing up, the issues that occur with workplace incivility are bullying and lateral violence. The bullying usually occurs from an individual’s unbalanced power and could lead to a constant turnover of the workforce. On the other hand, the turnover implies a lack of experience among the nursing staff and could end up in negative outcomes for patients’ care. Lateral violence does not necessarily mean violence as it is; it could be unauthorized use of victim’s personal belongings, a withholding of important information, or a jammed paper purposely left unfixed in the printer (Bambi et al., 2018). Lateral violence issues could make nursing staff obsessed with double-checking, aggressive, nervous, and impatient, resulting in worsening care for the patients.
In any workplace, not just the clinical sites, effective communication is a crucial factor for work effectiveness. Incivility in the clinical site could lead to possible issues among the personnel and the patients, and customers. Nurses affected by the consequences of workplace incivility may lack the attention required to ensure an individual approach for each patient. The addition of excessive workload could worsen the process of patients’ examinations, resulting in communication issues with the patient and overlooking important information.
Incivility and its’ consequences could profoundly affect communication in the workplace or clinical site. Effective communication skills required for productive work could be weakened by lateral violence or bullying. The example made by Bambi et al. (2018) illustrated how communication could be affected in a negative way by the withholding of important information. Incivility provokes distrust and ill feelings among the personnel that could lead to disagreements in the process of patients’ treatments.
Several organizations are currently working on developing programs and initiatives implemented to decrease incivility within the workplace or clinical sites. The American Association of Critical Care (AACN) has introduced the concept of ‘healthy work environment’, pointed towards team strengthening and higher levels of effectiveness (Bambi et al., 2017). The policies of the concept imply creating of adequate work climate and maintaining operative and organizational flexibility. The concept includes four general aspects: minimizing the barriers to delivery of care to the patients, designing and implementing technologies of effective communication, focusing mainly on patients’ care, and support for the newly hired nurses.
The scientific community was affected by workplace incivility more than any other working field. The matter resulted in various associational and professional position statements, for example, the Joint Commission statement (Bambi et al., 2017). The document defines the negativity and workplace incivility, analyzes the consequences of the matter, and suggests several potential solutions to the problem. The document implies the use of educational interventions to the staff and promotes concepts of professionally appropriate behavior like the culture of respect and empowerment.
Several international organizations also covered the problem of workplace incivility. The Royal College of Nursing, for example, covered the problem of workplace incivility in a separately published booklet (Bambi et al., 2017). The booklet features a list of behaviors one might implement to manage workplace conflicts. The booklet also introduces some actions one could follow in case of being a victim of workplace violence, harassment, or bullying.
Conclusion
In conclusion, the problem of workplace incivility is highly expansive in clinical sites. The nursing staff is frequently laterally violated or bullied by colleagues, patients, and superior staff. The consequences of workplace incivility include worsening of the mental health of nursing staff that could potentially affect the patient’s care in a negative way. To stop workplace incivility, the staff needs to be educated on the topics of professional behavior and mutual professional respect among the staff of all layers in the organization.
References
Bambi, S., Guazzini, A., De Felippis, C., Lucchini, A., & Rasero, L. (2017). Preventing workplace incivility, lateral violence and bullying between nurses: A narrative literature review. Acta bio-medica: Atenei Parmensis, 88(5S), 39–47. Web.
Bambi, S., Foà, C., De Felippis, C., Lucchini, A., Guazzini, A., & Rasero, L. (2018). Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors. Acta bio-medica : Atenei Parmensis, 89(6-S), 51–79. Web.