Discussion: Workplace Environment Assessment

NURS 6053 Discussion: Workplace Environment Assessment

Post a brief description of the results of your Work Environment Assessment. Based on the results, how civil is your workplace? Based on my workplace assessment, my facility received a score of mildly healthy.

Explain why your workplace is or is not civil. As a nurse it is my responsibility to create a safe, ethical, civil workplace comprising of dignity and respect (Clark, C. M., 2015). My past workplace is considered mildly healthy. I would consider my workplace in between civility and incivility. Based on policies, procedures, promoting safe environment. Hiring some of the best physicians and support staff, as well as continuing education requirements and support, my workplace is healthy. However, the level of stress, patient overload, acuity and staff concerns, my workplace is not healthy. I strive daily to do what is right because it is right. Everyone that I work with know that if you ask me, I am going to tell the truth and always treat patients with respect and dignity even though the patient may not be treating staff that way. My manager would give me difficult patients and my co-workers knew that and some would even ask me to “swap” a patient with them. The prevailing system of superiority and work overload was evident at my past job. Working in surgery there are different elements to pre-operative environment. Within the peri-operative environment, multi-faceted, are assessment nurses, lab, and chart room nurse.

There was never a clear understanding of the role of the chart-room nurse which posed many problems and challenges. If that nurse did not want to confirm a critical lab, ekg, or issue to the surgeon, it would be brought back to the assessment nurse and at times would be reported to the supervisor. There was a unhealthy relationship established before I began working there. I had no idea. According to Clark et al., (2011), “disruptive behaviors” are common and are often due to unclear roles and expectations, professional and personal value differences, as well as power struggles. I tried to bridge this culture even though I was not in management by engaging with all sides to try to bridge the gap. However, it was to no avail because feelings were deeper than I realized.

Our manager seem to favor the chart nurse as they were very close friends. In lieu of this, I felt optimistic. I attempted to come up with resolutions such as team talks but the chart room nurse did not want to engage. The foundation of good team building must be trust (Laureate Education, 20009u). In the end, I am no longer there and from some of the nurses, these issues exist now. It is so sad, because this could be an idea job for many nurses. Clark et al, 2011, states that these types of issues can be resolved by leaders who model role professionalism and effective communication skills. In the end, I have learned, teams must have shared goals, shared knowledge, and mutual respect -TEDx. (2017).

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References:

Clark, C.M., Olender, L.,Cardoni, C,C., Kenski, D. (2011). Fostering civility in nursing education and practice. The journal of Nursing Administration, 41(7/). 324-330

Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23. https://www.americannursetoday.com/wp-content/uyploads/2015/11/ant11-CE-Civility-1023.pdf

Laureate Education (Producer)(2009u). Working with Groups & Teams

. Baltimore, MD: Author

TEDx. (2017, April). Jody Hoffer Gittell: The power of a simple idea [Video file]. https://www.youtube.com/watch?v=X7hL5RC5kdE.

RE: Main Post-Workplace Assessment Analysis

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The work environment assessment has been an important opportunity to conceptualize the intricate element of the workplace. It has been especially relevant for understanding the mutual connection between different categories of workers and departments that have to actualize the same objectives. Despite the differences that might exist between workers, it is worthwhile to note that the commitment to facilitate the treatment and care for patients is the driving force for enhancing productivity and passion. So far, I have considered different aspects of my workplace and arrived at a fair score on how civil the workplace is, especially in respect of the conditions of the workforce. I align with the fair score given my concern in advocating for essential improvements. Despite the limited impact, my colleagues are also involved in addressing the underlying issues and pushing for better service delivery.

My facility attains a score of mildly healthy. The score is based on the tendency to have extremes of favorable and unfavorable conditions. My workplace has failed to have a balance in considering the interests of the workers. Nurses are indeed at the center of facilitating safety, ethics, and the dignity of the patients (Seyedfatemi et al., 2020). It has performed excellently regarding key areas such as ensuring a safe working environment. It is also noteworthy that the management has succeeded in having the best physicians in place, coupled with the support staff to ensure effective treatment and service delivery. There are further incentives for continuing education, which is often meant to align with the changing dynamics in the health profession (McCloughen & Foster, 2018). However, there are essential concerns regarding a high level of stress, patient overload, and workforce complaints. Such issues need to be addressed to arrive at the desired organizational standards.

References

McCloughen, A., & Foster, K. (2018). Nursing and pharmacy students’ use of emotionally intelligent behaviours to manage challenging interpersonal situations with staff during clinical placement: A qualitative study. Journal of Clinical Nursing, 27(13-14), 2699-2709.

Seyedfatemi, N., Mohammadi, N., & Hashemi, S. (2020). Promoting patients health in intensive care units by family members and nurses: A literature review. Journal of Education and Health Promotion, 9.

RE: Discussion – Week 7

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Workplace Environment Assessment

Productivity level and quality of work can be evaluated based on the workplace environment. Nurses must foster a civil and ethical workplace, which involves creating a culture and environment of kindness, civility, respect, and dignity (Clark, 2015). The overall score for my workplace environment assessment indicated that it is unhealthy. Two statements were found to be “completely true”, while the rest had “neutral” or “somewhat true” responses. Such responses could indicate that the environment is unsettling. Responses about overall civility were mostly “neutral”, implying the unhealthiness of the workplace environment. A negative influence on service delivery can be associated with uncivil work atmospheres.

Several aspects were identified that could be attributed to the uncivil workplace environment. The facility could realize an improved workplace atmosphere if these aspects are addressed. Employee engagement, satisfaction, and morale are of low levels resulting in a negative impact on the facility’s workplace. Workplace incivility negatively affects workplace engagement, which increases turnover levels (Tricahyadinata et al., 2020). Most of the facility’s workers are leaving while others are shifting to part-time work status. The nursing team and other frontline staff are not engaged in decision-making about their job. In this case, they feel unvalued, resulting in decreased interest and driving force for the facility’s change and success.

Incivility was experienced with the management in various situations. For instance, the manager failed to recognize and appreciate collaborative work in the facility. Such actions indicated that the manager lacked regard and respect for others. Poor work ethics can be linked to not appreciating others’ efforts or work.

The incivility situation can be addressed using practical communication skills. Private discussions with the manager can be conducted to emphasize the need to appreciate and recognize others’ efforts in projects or jobs. Emotional intelligence methods can be applied to make the message precise and clear. Relationships, problem-solving, and communication in the workplace can be improved using emotional intelligence (Wang et al., 2018). Honest workplace relationships can be created once the incivility situation is addressed.

References

Clark, C.M. (2015). Conversation to inspire and promote a more civil workplace. America Nurse Today, 10(11)18-23. https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Tricahyadinata, I., Hendryadi, Suryani, Zainurossalamia ZA, S., & Riadi, S. S. (2020). Workplace incivility, work engagement, and turnover intentions: Multi-group analysis. Cogent Psychology, 7(1), 1-16.

Wang, L., Tao, H., Bowers, B. J., Brown, R., & Zhang, Y. (2018). When nurse emotional intelligence matters: How transformational leadership influences intent to stay. Journal of Nursing Management, 26(4), 358-365.

RE: Discussion – Week 7

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Workplace Environment Assessment

Working in the emergency department is one of those areas; a healthy work environment is essential. The emergency department is an area with high-stress levels as nurses often experience traumatic events. Maintaining civility in the emergency department is crucial as they provide services to the community that is relied upon (Shakespeare-Finch & Daley, 2017, p. 32). An organization not only has to promote and maintain civility but address incivility when it arises. The use of the cellphone at the workplace is a distraction and interrupts

Work Environment Assessment

Upon completing the Workplace Environment Assessment, I work in a moderately healthy environment. In the emergency room, I work in, and there are a shared vision and mission. We respect and trust one another during high-stress situations such as traumas and code blues. We collectively communicate well with one another, promoting high-quality healthcare and addressing patient needs. When there is a communication breakdown amongst staff, we tend to go to our separate corners take time to collect thoughts, and come back to discuss the issue at hand. Overall the emergency department functions very well, but outside the realm of the emergency room, that is where things seem to fall short. Several neutrals stemmed from shared governance, conflict resolution skills, salaries, benefits, and career advancement.

When there are physician-related issues such as not rounding on patients promptly, being unable to get a hold of physicians, or trying to physicians to comply with standards of care such as the Sepsis bundle, the blame tends to fall back on nursing. This puts nurses and physicians pitted against each other rather than a collaborative effort (Clark, 2015, p. 21). Another hospital in our area gives additional compensation for obtaining certifications such as Certified Emergency Nurse (CEN), but the hospital I work in does not. There is little career advancement as leaders tend to hold positions such as clinical supervisors or directors for many years. Low key points stemmed from a lack of mentorship programs and limited resources for professional growth.

Incivility Incident in the Workplace

Several years ago, I had a patient that had gone across to Mexico to get an abdominoplasty or “tummy tuck.” She had normal vital signs, but her abdominal wall incisions were dehisced, and she had white drainage that was oozing from the wounds. She had computerized tomography of the abdomen and pelvis, labs with blood cultures, urine all exams were within normal limits, so the emergency room physician planned to discharge her. I remember when it was time to release her, she looked uncomfortable and still had drainage from the wounds. I spoke with my charge nurse because I felt she was an unsafe discharge. She told me that it was the doctor’s decision and if he thought she could go home, she could be discharged. For the next hour, I argued with the physician that she needed to be admitted to the hospital, but as I questioned his decision, he started to become upset since I was questioning his judgment. The charge nurse also was getting annoyed that I was delaying the discharge, but I stood my ground. At that point, I asked him if he had consulted the surgeon on-call he said “NO” he did not.

When I suggested this, he told me you know since she had her procedure done in Mexico, no surgeon will be willing to operate on her since her procedure was done somewhere else. I told him that I was ready to discharge her home without hesitation if he consulted the surgeon. Also, I pointed out to him that if the patient did get discharged and returned to the emergency department, the decision would not be on him but the surgeon on call. In the end, the surgeon was paged, and he accepted her under his services. Several days later, I ran into the surgeon, and he told me when he took the patient to the Operating Room, he had to lavage large amounts of drainage, and without surgical intervention, her condition would have been far worse.

Conclusion

Working in the high-stress area incivility will happen, the key is to remain calm, address the situation in a respectful manner. In the example given, a conversation between the physician and me led to a solution that both were content with. Working in the emergency department can be challenging regarding teamwork and communication (Weigl & Schneider, 2017, p. 21). When engaging in a challenging conversation, choose a safe zone and not in the presence of family and patient (Clark, 2015, p. 19).

References

Clark, C. M. (2015, November). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10, 18-23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Shakespeare-Finch, J., & Daley, E. (2017). Workplace Belongingness, Distress, and Resilience in EmergencyService Workers. Psychological Trauma: Theory, Research, Practice & Policy, 9, 32-35. http://dx.doi.org/doi:10.1037/tra0000108

Weigl, M., & Schneider, A. (2017, January). Associations of work characteristics, employee strain and self-perceived quality of care in Emergency Departments: A cross-sectional study. International Emergency Nursing, 30, 20-24. http://dx.doi.org/

https://doi.org/10.1016/j.ienj.2016.07.002

RE: Discussion – Week 7

COLLAPSE

Thank you for taking the time to reply to this post. I agree that working in this sector requires a healthy work environment since this is an area with great stress levels since nurses working in this sector tend to experience traumatic events. It is encouraging knowing that you work in a moderately healthy work environment from the Clark Healthy Workplace Inventory results (Clark, 2015). The high stress of traumas in the emergency room requires an environment that will maintain civility. This helps to ensure that the patient’s needs are well catered for, and quality healthcare services are offered. However, there is a need to make changes to maintain a healthy environment. Some of the considerations include encouraging nurses to consider how they treat others (Alshehry et al., 2019). Also, there is a need to ensure open communication between the staff members. This will help to support optimum work performance from every team member. I have experienced an incivility incidence in my workplace and understand how this leads to decreased quality of healthcare offered. The incidence resulted in staff leaving their jobs due to the stress that resulted from incivility. Appropriate measures had to be taken to prevent the significant losses that come with incivility.

By reading your experience concerning incivility incidence in your workplace, I understand that this is an issue that regularly occurs in various healthcare. The incivility incidence mainly resulted from the lack of good communication between the staff members. The incidence shows how the incidence of incivility between the team members or healthcare providers can relate to poor patient outcomes. However, it is encouraging learning that the incidence of this patient was later resolved. Addressing the situation in a respectful manner helped solve the issue. From this incident, I understand that to promote a healthy work environment, and all members must be willing to work as a team. Great post!

References

Alshehry, A. S., Alquwez, N., Almazan, J., Namis, I. M., & Cruz, J. P. (2019). Influence of workplace incivility on the quality of nursing care. Journal of clinical nursing, 28(23-24), 4582-4594.

RE: Discussion – Week 7

COLLAPSE

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).

References

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.

References

Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.

Cimarolli, V. R., Bryant, N. S., Falzarano, F., & Stone, R. (2022). Factors associated with nursing home direct care professionals’ turnover intent during the covid-19 pandemic. Geriatric Nursing, 48, 32–36. https://doi.org/10.1016/j.gerinurse.2022.08.012Links to an external site.

Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44(2), 64–68. https://doi.org/10.1097/nne.0000000000000563Links to an external site.

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

Links to an external site.

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

Links to an external site.

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.