Cultivating Healthful Environments
The work culture and interpersonal relationship among health professionals are significant factors that influence patient care. With the growth of the current health systems, positive work environment mainly, cooperation among nurses determined quality outcomes to patients. On the contrary, the workplace environment, especially for nurses, can be quite challenging as evidenced by frustrations and an overwhelming workload. Besides, no one would expect nurses to experience challenges related to professionalism with specific encounters identified to be violence, intimidation or gossip from colleagues or physicians. Verbal abuse, as well as harsh workplace environment, has a negative effect on the emotional and mental states of nurse which in overall, affects the quality of health outcomes for patients (Simpson, 2016). In my duties as a Family Nurse Practitioner (FNP), it is important for me to assess the nature of the environment for nurses to evaluate challenging elements in order to establish a safe and supportive work setting. To this effect, the present article piece delves into the concept of work incivility in a bi
d to cultivate healthful environments for nurses. I will focus on the issue of incivility as well as the importance of the same to nursing practice. Storytelling will be initiated to provide a narrative outlook of incivility. Finally, creating a healthful environment and practical application will precede the conclusion of the article.
Issue of Incivility
Several factors compromise the quality of care services administered to patients by nurses. Workplace incivility is one of the major factors apart from the ordinary nursing workloads. According to Simpson (2016), incivility can be described as a low-intensity aberrant behavioral practice deliberately instigated to cause harm to a fellow worker and can be related to a violation of professional ethics. The behaviors violate the norms within the work setting that define mutual respect among colleagues. Incivility in a healthcare setting can manifest through rudeness as well as discourteousness among workers. Further, it can also be identified in terms of bullying, and this has emerged to be one of the significant problems that affect health facilities in the contemporary practice (Suh & Lee, 2013). The deviant behavior manifests in the form of lateral as well as horizontal violence together with harassment directed towards junior nurse staff, new practitioners and students on clinical placements.
Markedly, incivility in the workplace setting of a given hospital may result from oversight activities of leaders, personality conflicts among nurses, and ignorance, especially from colleagues (Williams & Lauerer, 2013). Often, incivility may occur accidentally without the knowledge of the perpetrator comprehending its overall impact on the targets. Further, workplace incivility may result from behaviors such as verbal attacks, inability to collaborate or coordinate activities and worst of all, public criticism of a nurse in the presence of patients. Moreover, condescending language, rude as well as sexual comments comprise of elements of workplace incivility. In certain cases, incivility occurs when FNPs withhold pertinent information on patient care, disregard interdisciplinary aspect of care and blame others instead of offering a solution (Lazear, Shaw & Stanton, 2015). Evidently, there is a major challenge in establishing the incidences together with the prevalence rates of incivility in hospitals since many cases may not be recognized or reported. Studies in the healthcare environment affirm that nurses experience about 27% to 85% workplace incivility (Simpson, 2016).
Importance to Nursing
Incivility in the workplace setting can result from an assertion of authority from the senior supervisors and other nurse leaders to junior staffs. However, frequent exposure to incivility in hospitals is associated with increased psychological distress, decreased job satisfaction and increased nurse turnover intentions (Williams & Lauerer, 2013). Ideally, uncivil workplace environment disrupts the mental and physical health of FNPs. In turn, the experience may cause mental health symptoms, which include but are not limited to anxiety, stress, depression, and workplace frustrations among family nurse practitioners. Besides, workplace incivility can result in an experience of burnouts primarily due to frustrations and stress from uncooperative co-workers. The negative impacts of uncivil work environment among nurses is amplified in quality outcomes for patients. A study by Suh and Lee (2013) indicate that disruptive behaviors among nurses comprise patient safety risks among others and can lead to adverse events of negligence due to lack of adequate coordination of shift hours. In addition, according to a study by Lachman (2015), lateral violence among care workers has made health sector incur more than $4 million annually mainly due to lost time, staff turnover and decreased level of productivity amongst workers. Thus, incivility plays an important role in nursing as it affects the delivery of services to patients.
Story Telling
In the line of duty as a family nurse practitioner, I encounter incivility most often within the facility. My latest experience in what I consider lateral violence occurred at the antenatal care unit in the outpatient department of the facility. In the course of providing services at the outpatient department, I recall an incident when a fellow FNP acknowledged a decline in the iron levels in an expectant woman seeking prenatal care. The nurse asked her why she had not been taking iron supplements because her levels were alarming and could cause damage to the unborn child. She informed the nurse that in previous two weeks ago at the same facility, one of the nurse informed her that her iron status was at the marginal levels and that she should watch on her diet to boost the volumes in the blood. Actually, this is contrary to protocol since all pregnant women are entitled to iron supplementation where a standard dose of 60 mg iron is administered as per the World Health Organization’s recommendation. I also had a perception that the nurse made a mistake not to administer the supplement to the mother.
However, my concern was on how the nurse providing current care reacted to the advice of the previous nurse who had attended to the expectant mother. The nurse mentioned that the previous care provider was a quack who lacked adequate knowledge on aspects of prenatal care. She went ahead to inform the patient that the nurse had a history of misdiagnosis and wrong administration of prescription drugs to the patient. To the nurse’s surprise, the care provider she negatively talked about was in the next room and apparently heard all the conversations including a mention that the provider was a quack. The nurse being discussed waited for the patient to leave and later came in to ask the current provider about public criticism in the presence of a patient and misguided information about her professional qualification. All the provider could mention was that she was sorry and it would never happen again. I sympathized with the nurse because the derogatory remarks were enough to affect the morale of the previous provider in her future practice. I also went and cautioned the current provider against public criticism of colleagues in the presence of a patient because it alters the confidence of the patient with the nurse practitioner. Since I did not want such an incident to occur within the care setting, I reported the matter to the nurse leader in the out-patient department.
Creating a Healthful Environment
Establishment of a healthful environment commences with effective communication. As an FNP leader, it is imperative to implement a communication strategy that offers an avenue for the channeling of concerns regarding care practices. According to Lazear, Shaw, and Stanton (2015), the communication approach should also lay a foundation for the resolution of disputes and misunderstanding in the workplace setting. The other method to create a healthful environment relates to teamwork and coordination of activities. Nurses need to work as a team to offer coordinated care. In other words, the work environment should be conducive for nurses to consult about various aspects of care. Organizations can also achieve coordination of workers by providing education and capacity building forums for FNP nurses (Lachman, 2015). Finally, as an FNP leader, I will use personal self-reflection to engage nurses and inquire about their experience at work. The approach enables nurses to raise awareness about lateral violence from co-workers or stress-related encounters that might comprise the quality of their service to patients.
Practice Application
In my duties as an FNP, I will enhance teamwork and collaboration by delegating work schedule accordingly. This ensures no conflicts arises from overburdening other employees. I will also extend respect and kindness to co-workers to ensure team support during the provision of care (Williams & Lauerer, 2013). In order to implement personal self-reflection by engaging the nurse workers, I will enforce policies that address violence in the healthcare setting. This entails enlightening nurses about the aspects of work incivility, how to identify incidences and the approaches to take in the event of an occurrence. As an FNP, I will also model change realities by acknowledging lateral violence in a health care setting and challenge nurses to report such incidences of uncivil work environment for an appropriate action to be taken.
Cultivating Healthful Environments Conclusion
Incivility in the healthcare setting has garnered a lot of concern since it is one of the most complex problems in professional nursing practice. The intimidating behaviors undermine the quality of care administered by nurses. In my role as an FNP leader, I will implement change that steers the nursing team for future practice. Therefore, it is integral to establish strategies that address the uncivil work environment in a care setting. As such, it is important to promote an environment that fosters mutual respect and enhances the implementation of professional codes of practice to cultivate healthful work setting for nurses.
Cultivating Healthful Environments References
Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. Urologic nursing, 35(1), 39.
Lazear, E. P., Shaw, K. L., & Stanton, C. T. (2015). The value of bosses. Journal of Labor Economics, 33(4), 823-861.
Simpson, K. R. (2016). Incivility, bullying, and workplace violence: new recommendations for nurses and their employers from the American Nurses Association. MCN: The American Journal of Maternal/Child Nursing, 41(1), 68.
Suh, Y., & Lee, K. (2013). Lived experiences of new graduate nurses. Journal of Korean Academy of Nursing Administration, 19(2), 227-238.
Williams, S. C., & Lauerer, J. (2013). Implementing a nursing civility code: Implications for education. Journal of Nursing Education, 52(3), 165-170.
Incivility is one of the problems which affect the healthcare environment negatively. While some nurses get involved directly in incivility, others experience it as it happens between other staff members. Even though it is a common phenomenon, it sometimes gets overlooked. Incivility has been shown to lead to toxic working environments and poor working conditions. Incivility may take different forms, such as bullying, disruptive conduct, unfair conduct, subtle harassment, and rudeness (Green, 2019). Therefore, the purpose of this assignment is to reflect on an experience of incivility at the workplace.
Some time ago, I experienced a first-hand act of incivility. We were always encouraged in the facility to inquire from colleagues and the senior staff members if there was anything unclear or when in doubt. Therefore, as a way of avoiding medication errors, I approached one of the senior nursing staff to help confirm the details of a medication of I was supposed to administer to a patient in terms of dosage and route. To my surprise, the nurse reacted angrily and rudely, shouting that it was a show of incompetence. The nurse even criticized me in front of others, shouting that my skills were short and that I could not handle the simplest of tasks.
The situation made me feel bad, disrespected, and demoralized. The comments of incompetence and half-baked skills cut into me and bruised my self-esteem. I thought for a while about my competence and ability concerning the skills. I don’t think I did anything wrong to warrant such a dress-down. I was only trying to be extra careful so that I don’t commit any medication errors which can lead to adverse outcomes.
Even though the situation made me feel bad, I contained my anger and walked away from the scene. I did not want to create any commotion as patients were close by. I spoke with another staff member who helped countercheck the medication details. The nurse also indicated that the reaction by the senior nurse was inappropriate and uncalled for and that I did well not to respond violently. I made efforts to meet the nurse leader to hold further discussions regarding the matter and how best to handle such situations in the future.
The situation had various consequences. One of the consequences was a strained relationship between myself and the senior nurse. Since I didn’t like how the nurse addressed me, the situation made our working relationship to get sour. Again, the nurse leader was also willing to come in and mediate to ensure the working relationship was restored. The situation also had negative impacts on the work environment and the outcomes. For example, other junior nurses were more withdrawn and never willing to inquire and consult the senior nurses. There is also a potential impact on the outcomes since there are higher chances of making mistakes, such as medication-related errors, when there is no consultation.
The situation could have been prevented by constantly reminding the staff to be gentle and avoid rudeness as much as possible. Talking gently to others helps avert conflicts that could have been caused by rudeness. Various strategies can be used to support a healthy work environment. One of the strategies is encouraging open communication. Open communication helps individuals pass across the intended information and message, preventing conflicts and promoting a healthy environment (Kim et al.,2018). The other strategy is offering support for each other in the work environment. Support ensures that everyone feels comfortable in the work environment, creating a healthy environment.
Cultivating Healthful Environments Conclusion
Workplace incivility has various negative impacts on the staff and the work environment. Therefore, appropriate ways should be used to avoid it. This assignment has described a case of workplace incivility and its impacts.
Cultivating Healthful Environments References
Green, C. A. (2019). Workplace incivility: nurse leaders as change agents. Nursing Management, 50(1), 51–53. Doi: 10.1097/01.NUMA.0000550455.99449.6b
Kim, K. J., Yoo, M. S., & Seo, E. J. (2018). Exploring the influence of nursing work environment and patient safety culture on missed nursing care in Korea. Asian Nursing Research, 12(2), 121-126.