The emergency department is one of the most high stress environments in healthcare facilities. This is due to the variety and numerous acute stressful activities and events (Ahwal & Arora, 2015). Nurses are not excluded from the stressful environment in the emergency departments. Some of the challenges within the emergency department that tend to increase the stress on nurses include aggression incidents, being involved in resuscitation, death of patients, the need to make fast and accurate decisions that may be physically and emotionally very challenging (Ahwal & Arora, 2015).
In the case where the stress and stressful environment are not managed appropriately, there may be severe negative effects on the provider, patient and even the facility. Some of these negative consequences include poor patient outcome, compromised patient safety and dissatisfaction for the nurses, burnout, and negative health effect of the nurses and reduced organizational productivity (Yuwanich et al., 2017). There is therefore need for the nurses and other providers to learn how to handle the stressful events and work environments including the emergency departments. From the scenario, communication and collaboration with other providers have been identified as being important aspects and strategies that help nurses cope with the stressful environment at work. These are very important and helpful. Strategies that can help improve coping with the stressful environment include debriefing such as talking and seeking help from other colleagues, positive reframing such as smiling and taking time to rest, sleep, meditate and exercise among others (Yuwanich et al., 2017).
Ahwal, S., & Arora, S. (2015). Workplace stress for nurses in emergency department. IJETN, 1(2), 17-21.
Yuwanich, N., Akhavan, S., Nantsupawat, W., & Martin, L. (2017). Experiences of occupational stress among emergency nurses at private hospitals in Bangkok, Thailand. Open Journal of Nursing, 7(6), 657-670.
I agreed with your post Sunday, Incivility among healthcare workers can thus lead to unsafe working conditions and the safety of a patient. Care providers and organizational leaders must communicate in a way that fosters civility and empowers nurses to speak up. They must strive to create and sustain a healthy work environment where courtesy is evident. Overall, Companies should come up with a no tolerance policy for incivility in the workplace. The procedure could have a penalty resulting in every infringement, verbal caution for the initial offense, written caution for the second mistake, non-payment leave for the third one, and termination. The department of human resources should be included in the policymaking process. If incivility at the workplace is tolerated, destructive behaviors become commonplace and continue in the working environment. Each team member in a company should be educated on the right professional characters with the job code of conduct. Both staff and nurse managers must have the ability to identify it, taking it seriously, and cease the action in its ways.
Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.
I have been through the same type of experience that you have when it comes to nurse compensation. All intensive care units (ICU) nurses in my workplace received a pay incentive for taking care of high acuity patients. The medical surgical nurses made the same argument that they have higher nurse to patient ratios, which made their job more physically demanding. Since our hospital is unionized, this disagreement led to the ICU pay incentive being taken away. Although I am an ICU nurse, I was ok with the decision for the pay incentive to be taken away. I believe that ICU nurses should not be compensated based solely on the acuity of their patients. This can lead to bullying and a toxic work environment between nurses. A toxic work environment can result in loss of motivation, restricted productivity, clinical errors, burnout, and increased turnover (Wei et al., 2018). Ultimately this leads to poor patient care and higher hospital mortality rates. I am frequently floated to the med surge unit when the ICU census is low, so I would never want there to be tension between me and the other nurses. I would rather have a healthy working relationship with the med surge nurses, so they are more receptive to helping me become familiarized with the med surge floor. In return, I can help by offering my ICU skills, such as inserting a peripheral intravenous line on a difficult patient.
When it comes to compensation, I believe pay incentives should be awarded based on education and years of experience instead of patient acuity. This levels the playing field for every nurse no matter where they work. Awarding a pay increase for receiving higher education, passing a national certification, or implementing a patient project pushes a nurse to grow professionally. This puts the focus on nursing education and career development. Continuous education improves the quality of nursing care and increases the effectiveness of patient care, consequently maintaining and enhancing patient safety (Mlambo et al., 2021).
Mlambo, M., Silen, C., & McGrath, C. (2021). Lifelong learning and nurses’ continuing professional development, a metasynthesis of literature. BioMed Central Nursing, 20(62). https://doi.org/10.1186/s12912-021-00579-2
Wei, H., Sewell, K. A., Woody, G., & Rose, M. A. (2018). The state of science of nurse work environments in the United States: A systemic review. PubMed Central, 5(3), 287-300. https://doi:10.1016/j.ijnss.2018.04.010
Sample Answer 9 for NURS 6053 Discussion: Workplace Environment Assessment
Working in a peaceful environment is all that every individual needs to perform their work to the best of their ability. The Clark healthy workplace inventory is a tool use to assess the health of workplace (Clark 2015). When an individual is in a workplace and the environment is very toxic, the productive is less, motivation is less and morals of the staff are at all time low which can affect the consumers which in this case the patient. Before this assessment, i was aware of some of the negative aspect of the workplace incivility but did not release that my workplace can be very toxic and uncomfortable for some staff to work peacefully. There are various issues that happens in every floors (units) in different days, times and shifts which can greatly affect the patience, staffs and family members.
There are various incivility among workplace not to exclude gossiping, belittling, disrespect among staffs, inappropriate jokes, bullying and lack of communications. Based on my results of 72 of the civility test, my workplace happens to be in the range of mildly civil which most of the common incivil issues that most workplace do encounter doesn’t happen at my facility. There are are lot of reason why any environment can be considered civil or not. At my workplace which is a nursing rehab facility with a psych unit included, there are lower retention rate among staff both regular nurses and managerial positions staffs. There are instances where there will be staff meeting only on how respectful and courteous we the old staffs are to be towards new staff to make the environment very welcoming to boost the retention rate in the facility.
The major issue at the facility i worked for is lack of communications among staff during change of shifts, rounds, improper break time and cleanliness at the work stations. The are many instances that i experienced incivility at the job but the one that happens a lot at the nursing home among new and old nurses is bullying. The workplace bullying has been on the raise but majority of individuals refuse to report such incivility to the management due to fear of retaliations from others staff members. There are various ways individuals are encourage to report such behavior to the appropriate department which in some cases, little or nothing will be done of such behavior. There was a particular season nurse on the psych unit who always bully, belittle and disrespect new staff nurses on that unit. She will refuses to work behind new nurses. She was receiving nursing report from a new nurse who happened not to complete a new admission that arrived at the facility at 2:10pm. She began calling the new nurse “lazy ass nurse who can’t seems to complete anything to the fullest.” This incident was witnessed by a family member who was leaving the facility and happened to be at the elevator.
The season nurse was so loud that another patient who room was close to the nursing station also heard her rude comment towards the new nurse. Since she refuses to take the admission report from the new nurse, this particular nurse stayed over after punching out from the system and completed the admission. Before leaving the facility , the new nurse wrote a very detail experienced that she encountered from the season nurse and inform the DON that she won’t be returning back to the place again. Also both the family member and the patient who witnessed this incivity both wrote a letter to the DON. The next day a meeting was held which the rude incivility listed above was made aware to all staffs in the meeting. The season nurse was then suspended for a whole week which upon her returned back to the job, she repeated a similar behavior again towards another season nurse and was eventually fired. To solve such problem, there was a policy place for zero tolerance of bullying, use of inappropriate languages and disrespect among staffs which the ultimate results include suspension not to exclude termination of employment. The civility of an organization is crucial as it influences the health of a workplace, which significantly affects employee job satisfaction, performance, and productivity (Broome & Marshall, 2021).
Conclusion.
Incivility can lead to shortages of staffs, lack of motivation and stress among employees. This is very unfortunate for anyone to work in such unpleasant environment. When the Clark healthy assessment tool are used in the workplace, the environment becomes pleasant for the workers, less errors are made due to the less stress that are among the workers.
Reference
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practiceLinks to an external site.. The Journal of Nursing Administration, 41(7/8), 324–330.
Sample Answer for NURS 6053 Discussion: Workplace Environment Assessment
Nurses work in diverse work environments with varying features, including role expectations, support systems, and resources. Despite the differences in these features, nurses must strive to provide the best care possible to patients. Workplace incivility continues to be a significant barrier to achieving high-quality outcomes. According to Zhang et al. (2018), workplace incivility involves discourteous, deviant behaviors intending to harm the target and violating workplace norms. It is pervasive in healthcare settings, and leaders and healthcare staff experience incivility in different magnitudes. Statistics show that more than two-thirds of nurses and three-quarters of physicians have experienced some form of incivility (Keller et al., 2020). Because of its detrimental impacts on patient care, workplace incivility should be identified and addressed accordingly. Nurses should assess their work environment for incivility and work with leaders to de-escalate it using evidence-based interventions. The purpose of this paper is to evaluate the results of the Work Environment Assessment, review literature on incivility, and describe strategies for creating high-performance interprofessional teams.
Part 1: Work Environment Assessment
Understanding the civility of an organization can help healthcare staff and leaders to implement strategies for achieving a healthy work climate. The Work Environment Assessment tool quantifies the organization’s civility status by rating defining aspects like communication, employee satisfaction, shared governance, and teamwork. After completing the Clark Healthy Workplace Inventory, my organization scored 65%, implying that it is barely healthy, but some job aspects help employees empower employees to continue with their everyday roles. Various work-related factors contribute to this score in varying degrees. The first factor is a shared vision between the organizational leaders and employees. A shared vision is a key element of transformational leadership, where leaders create visions and goals and inspire employees to achieve them (Khan et al., 2020). The other contributing factor is employees’ perception of the job; they feel that the management fairly treats them and provide input where necessary. The opportunity to provide input is among the strategies leaders utilize to make employees feel valued and appreciate their contribution to the organization’s success.
The last element critical in attaining an average score is communication. According to Kwame and Petrucka (2020), clear communication allows employees to understand their roles and the organization’s goals. Forward-thinking leaders also understand the importance of communication in preventing workplace conflicts. In the organization, communication is always transparent, respectful, and targeted. As a result, there is no role confusion, and employees can focus on their tasks and achieve the set objectives. Besides improving civility, effective communication is fundamental to high-quality patient care since patients can be treated as nurses tailor care based on patients’ backgrounds and needs.
The workplace inventory helps healthcare professionals to understand their work environment in more detail. However, there are some job characteristics they know and expect to be confirmed before conducting the assessment. One of the things that surprised me about the results is that the civility scores depend mainly on employee-related factors. In this case, the organization must focus more on workplace elements that motivate employees, make them feel valuable, and include them in decision-making as crucial team members. Such elements include promoting teamwork and collaboration, a reasonable workload, and high employee satisfaction (Clark, 2015). Actively involving employees in shared governance and policy development is also important.
The other thing that surprised me about the results was the performance in some areas, such as talent attraction and retention, promotion and career advancement opportunities, and workload. These areas should be addressed to improve performance and contribute more to higher workplace civility. On the things that were confirmed, I expected the organization to score highly on communication and related aspects due to the respectful and transparent nature of communication. To improve performance, employees should be continually trained on effective communication and other areas, such as teamwork, employee wellness strategies, and expressing ideas in a civil manner.
The results (65%) suggest that the organization is vulnerable to workplace incivility and should intensify its efforts to prevent the damaging effects of incivility. According to the Clark Healthy Workplace Inventory, a very healthy workplace has a score of 90-100, while moderately healthy workplaces’ scores range from 80-89 (Clark, 2015). These should be the targets of functional workplaces seeking to achieve the best for their leaders, employees, and stakeholders. The organization can improve performance through employee development, continuous assessment and improvement of organizational culture, employee motivation, and ensuring adequate opportunities for employee wellness and self-care. Such efforts will improve civility and avert the dangers of workplace incivility, such as a decline in performance, anxiety/worries about the incident, and turnover (Wohlever, 2019). These interventions will further help the organization to improve nurse retention and reduce costs associated with skills loss and employee replacement.
Part 2: Reviewing the Literature
Current and past literature has explored workplace incivility and provides numerous concepts useful in addressing the problem. Clark (2015) discussed how workplace incivility could be addressed by holding conversations to inspire and promote a more civil workplace. The article is founded on the principle that a high score could be achieved in nearly every inventory item if healthy communication exists in the organization. However, communication amid incivility is challenging, and healthcare practitioners must understand when to initiate a conversation about incivility and how to sustain it to prevent further conflicts. According to Clark (2015), nurses should first create a safe zone if they decide to engage in a challenging conversation with an uncivil coworker. In this case, both parties should choose an emotionally and physically safe setting to hold the conversation. Such a place should be away from patients, family, and other potential observers.
The concept (crucial conversations) presented in Clark’s article relates to my Work Environment Assessment since it stresses the importance of effective communication. Whether civil or uncivil, healthcare organizations should embrace communication and empower employees to communicate effectively (Clark, 2015). Barriers to communication, such as lack of resources, medical jargon, and the halo effect, should be addressed effectively. Indeed, high performance in the communication aspect improved my organization’s overall score. As a result, it is a critical aspect of civil workplaces, sustained employee productivity, and healthy relationships between employees and other organizational members.
My organization could apply the concept of crucial conversations to improve health and create stronger work teams. According to Clark (2015), addressing uncivil behaviors through open communication can be challenging, but silence increases workplace stress, impairs job performance, and risks patient care. Therefore, my organization should establish a framework for engaging in challenging conversations and ensure employees understand they should address an uncivil encounter when it occurs. To succeed in challenging conversations, nurses should be well prepared for the conversation, speak confidently, and use respectful expressions. Leaders should train nurses to hold such conversations to empower them to face uncivil colleagues. Wohlever (2019) also stressed the importance of organizations and employees having a plan for handling incivility in today’s practice. To optimize safety, organizations should have de-escalations strategies for incivility and teach employees how to implement them. Employees should also know the type of help available to them in the organization so that they can engage in what is permissible and manageable.
Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams
Addressing Shortcomings in the Work Environment Assessment
A score of 65% implies that intensive efforts are needed to maximize civility in the organization. To improve communication, decision-making, and teamwork, the organization can implement routine huddles to address incivility-related safety risks and other issues. In the context of healthcare, huddles are brief interdisciplinary meetings for improving team communication and coordination by addressing issues affecting patients, staff, and the environment (Pimentel et al., 2021). Nurses and leaders can use huddles to share their experiences of incivility and how it should be addressed. The other area that requires massive improvement is employee retention through attracting and retaining the best talent. High employee retention could be achieved by increased motivation and assigning manageable workloads to prevent nurse turnover. Always, the guiding principle should be higher patient outcomes.
Bolstering Successful Practices
Teamwork is crucial for sustained performance and interprofessional collaboration. An effective way of improving teamwork and communication is by creating diverse healthcare teams. Such teams include members of different races, cultures, and ages who work together for a common goal. Stanford (2020) stressed the importance of diverse, inclusive teams in healthcare for high coordination and a shared perspective. Team members learn from each other and learn effective communication skills such as emotional intelligence, tolerance, and attentive listening. The other important practice for bolstering performance is wellness and self-care since they help to create nursing teams that are optimally healthy (Hofmeyer et al., 2020). Prioritizing wellness and self-care helps nurses to be mentally, physically, and emotionally healthy. Such wellness is crucial for sustained performance and low incivility in the workplace.
Conclusion
Healthcare organizations should be highly civil for employees’ optimal performance. Issues contributing to workplace incivilities, such as poor communication, a lack of employee engagement, and a high workload, should be prevented as much as possible. My organization’s score of 65/100 shows that multiple interventions should be implemented to improve the civility score. Focus areas include communication, teamwork, shared decision-making, wellness, and self-care. It is also crucial to empower employees to engage in challenging conversations with uncivil colleagues.
References
Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23.
Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse Education Today, 94, 104503. https://doi.org/10.1016/j.nedt.2020.104503
Keller, S., Yule, S., Zagarese, V., & Parker, S. H. (2020). Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open, 10(6), e035471. http://dx.doi.org/10.1136/bmjopen-2019-035471
Khan, H., Rehmat, M., Butt, T. H., Farooqi, S., & Asim, J. (2020). Impact of transformational leadership on work performance, burnout and social loafing: A mediation model. Future Business Journal, 6, 1-13. https://doi.org/10.1186/s43093-020-00043-8
Kwame, A., & Petrucka, P. M. (2020). Communication in nurse-patient interaction in healthcare settings in sub-Saharan Africa: a scoping review. International journal of Africa nursing sciences, 12, 100198. https://doi.org/10.1016/j.ijans.2020.100198
Pimentel, C. B., Snow, A. L., Carnes, S. L., Shah, N. R., Loup, J. R., Vallejo-Luces, T. M., Madrigal, C., & Hartmann, C. W. (2021). Huddles and their effectiveness at the frontlines of clinical care: a scoping review. Journal of General Internal Medicine, 36(9), 2772–2783. https://doi.org/10.1007/s11606-021-06632-9
Stanford, F. C. (2020). The importance of diversity and inclusion in the healthcare workforce. Journal of the National Medical Association, 112(3), 247–249. https://doi.org/10.1016/j.jnma.2020.03.014
Wohlever, A. S. (2019). Incivility in health care: Strategies for de-escalating troubling encounters. Family Practice Management, 26(5), 8-12. https://www.aafp.org/pubs/fpm/issues/2019/0900/p8.html
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. https://doi.org/10.1136/bmjopen-2018-021874
