Incivility has become a topical issue in healthcare organizations around the world. Incivility within the healthcare metaparadigm is defined as behaviors that infringe the workplace norms of respect but have an ambiguous intent to harm (Zhang et al., 2018). It may include such actions as being rude, yelling, expressing gender or racial bias, reprimands, gossip, swearing, and others (Keller et al., 2020). Although these behaviors are unprofessional and hurt the target, they usually do not fall within the scope of legal sanctions (Keller et al., 2020). As a result, hospitals may not pay enough attention to dealing with this issue.
Workplace incivility stems from the stressful environment that is characteristic of healthcare professions, especially nursing. Keller et al. (2020) discovered that the predictors of incivility in clinical sites were high workload, a lack of teamwork and little familiarity among the team members, poor communication, heavy responsibilities, and organizational constraints. Workplace violence can take four major forms: committed during criminal activity, performed by the customer, used by the worker against the colleague, and done to the employee at home, for example, by a member of the family (Enos, 2020). Healthcare organizations have the power to address workplace violence coming from customers and healthcare workers’ colleagues because these types of incivilities often stem from poor organizational culture.
The Impact of Incivility on Nurses’ Clinical Judgment
Workplace incivility negatively affects nurses’ ability to exercise high-level clinical judgment. According to Zhang et al. (2018), victims of incivility experience continuous stress, which may lead to severe psychological problems, depression, and anxiety. McPherson and Buxton (2019) also state that the uncivil work environment causes nurses to have poor sleep quality, withdrawal from others, burnout, and increased sickness and absenteeism rates. All these adverse effects make nurses feel distressed and shift their focus from providing the best possible patient care to coping with the influence of workplace incivility.
New nurses are the most susceptible to uncivil behaviors coming from colleagues and supervisors. The study conducted by Zhang et al. (2018) showed that novice nurses experience a lack of self-confidence due to workplace incivility. This is because they are assuming a new professional role and are faced with a gap between their career expectations and clinical competence. Thus, they need peer support to adapt to the workplace environment. However, when they see that their colleagues treat them unfairly or ignore their requests for help, they may lose their self-confidence and start doubting their career choice. A lack of trust in one’s clinical competence can have adverse consequences in the healthcare setting. For example, a nurse may perform an assessment several times or wait for the other nurse to do it, thus wasting the precious time to provide the necessary patient care.
Issues That Occur with Workplace Incivility
One problem that healthcare organizations encounter due to workplace incivility is reduced patient safety. The study conducted by Riskin et al. (2019) shows that healthcare teams exposed to uncivil behaviors have decreased compliance with medication protocols and hand hygiene. This issue negatively affects the organization because non-adherence to medication protocols may lead to medication errors, and not following hand hygiene may cause infections. Non-compliance with the organization’s protocols compromises patient safety and can result in preventable adverse events.
Another issue that stems from workplace incivility is worsened patient outcomes due to decreased nurses’ job performance. According to Riskin et al. (2019), victims and witnesses of uncivil conduct have reduced cognitive ability, flexibility, creativity, and prosocial behavior. It means that healthcare workers subject to workplace incivility may be distracted from delivering care or exercise not the best clinical judgment when assigning treatment. Zhang et al. (2018) also state that workplace incivility reduces nurses’ work efficiency and the quality of nursing care. All these effects negatively influence the clinical site because fewer patients can get the necessary care in the facility, and the delivered care may result in suboptimal patient outcomes.
The Impact of Incivility on Workplace Communication
Workplace incivility damages communication between the members of healthcare teams. The research conducted by Riskin et al. (2019) revealed that uncivil behaviors in healthcare settings led to problems with information sharing. It means that team members experiencing incivility do not freely share information about key decisions and treatment issues with others and do not keep their colleagues up to date on what they do. This problem may result in missed treatments and patients’ suffering because the necessary information about medication regimens or changes in the treatment plan are not shared with all team members on time.
Incivility also undermines healthcare workers’ ability to support each other in the workplace. The study carried out by Cooke and Baumbusch (2021) showed that nurses were reluctant to ask their coworkers for help if they witnessed them being involved in uncivil behaviors. This was because they lost trust in those colleagues or did not want to seem incompetent (Cooke & Baumbusch, 2021). Furthermore, nurses were faced with their colleagues’ unwillingness to respond to their help requests because of their lower position in the power hierarchy in the workplace (Cooke & Baumbusch, 2021). Because of this communication issue associated with helping peers, patient safety and outcomes are negatively affected. Patients may not receive the necessary care because the nurses assigned to them struggle with their demanding workload, and their colleagues refuse to aid them.
Initiatives to Decrease Incivility
Many organizations have developed initiatives to cope with incivility in the workplace. For example, the American Nurses Association (ANA, 2019) has created the #EndNurseAbuse initiative, the purpose of which is to promote nurses’ and other healthcare workers’ reporting of incidents of workplace incivility. It informs nurses about the barriers to reporting existing in healthcare settings and encourages healthcare workers to adopt a zero-tolerance policy toward workplace violence. Given the ambiguity of uncivil behaviors, ANA motivates nurses to report all incidents.
Another initiative developed to cope with incivility is Hospitals Against Violence, created by the American Hospital Association (AHA). The purpose of AHA’s (2019) initiative regarding workplace violence is to highlight successful healthcare practices and programs that make the workplace safer by preventing violence. A distinct feature of this initiative is #HAVhope National Day of Awareness, which uses digital media to show that various healthcare organizations and professionals are united in a fight against workplace violence.
The third initiative is the Workplace Safety Initiative developed by the Oregon Association of Hospitals and Health Systems (OAHHS). Its goals are to use evidence-based practices to reduce injuries resulting from workplace violence, strengthen partnerships among organizations regarding patient and employee safety, and disseminate the knowledge about workplace safety practices to all hospitals in Oregon (Enos, 2020). OAHHS encourages healthcare facilities to implement best practices to reduce incidents of workplace violence and establish the organizational culture of a safe work environment.
Conclusion
Workplace incivility refers to disrespectful behaviors with an ambiguous intent to harm. Such misconduct leads to various negative consequences on personal and organizational levels. Rudeness causes stress, depression, anxiety, and a lack of self-confidence, undermining nurses’ physical and mental health and their ability to use clinical judgment. It also decreases patient safety and outcomes by reducing compliance to protocols and workers’ cognitive ability. Incivility hinders effective communication in the workplace by causing problems with information sharing and helping colleagues. Some initiatives created to cope with uncivil behaviors are focused on increasing reporting rates, disseminating best practices, and promoting healthcare workers’ unity against the problem.
References
American Hospital Association. (2019). Hospitals against violence. Web.
American Nurses Association. (2019). Reporting incidents of workplace violence. Web.
Cooke, H. A., & Baumbusch, J. (2021). Not just how many but who is on shift: The impact of workplace incivility and bullying on care delivery in nursing homes. The Gerontologist, 61(4), 563-572. Web.
Enos, L. (2020). Stop violence in health care (2nd ed.). Oregon Association of Hospitals Research & Education Foundation. Web.
Keller, S., Yule, S., Zagarese, V., & Henrickson Parker, S. (2020). Predictors and triggers of incivility within healthcare teams: A systematic review of the literature. BMJ Open, 10(6), e035471. Web.
McPherson, P., & Buxton, T. (2019). In their own words: Nurses countering workplace incivility. Nursing Forum, 54(3), 455-460. Web.
Riskin, A., Bamberger, P., Erez, A., Foulk, T., Cooper, B., Peterfreund, I., Sheps, J., Wilhelm-Kafil, M., Riskin, Y., Riskin-Guez, K., & Bamberger, E. (2019). Incivility and patient safety: A longitudinal study of rudeness, protocol compliance, and adverse events. The Joint Commission Journal on Quality and Patient Safety, 45(5), 358-367. Web.
Zhang, S., Ma, C., Meng, D., Shi, Y., Xie, F., Wang, J., Dong, X., Liu, J., Cang, S., & Sun, T. (2018). Impact of workplace incivility in hospitals on the work ability, career expectations and job performance of Chinese nurses: A cross-sectional survey. BMJ Open, 8(12), e021874. Web.