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Art of NursingBlog

Why Incivility Continues to Be a Problem in the Nursing Profession

By April 7, 2016 February 1st, 2019 4 Comments

Incivility and bullying is a well documented problem in the nursing profession and was the topic of last week’s blog.

Unfortunately, it is not contained to the nursing profession but is also endemic in nursing education.

In a recent national study, 68% of nursing faculty reported moderate to severe levels of faculty to faculty incivility. But when mild levels of faculty to faculty incivility are included, the prevalence of incivility in nursing academia rises to 96% (Clark, Olender, Kenski, & Cardoni, 2013)!

Chris Tanner addressed the relationship between the “hidden curriculum” that embodies the unspoken culture and health of the department compared to what is in the syllabus and written. It is the “hidden curriculum” that is more likely to be caught and role modeled to students (Tanner, 1990).

Is there a relationship between incivility in the profession and its prevalence in nursing education? Using Tanner’s research and my own observations, I believe there is, and it is time to recognize one of many reasons why incivility continues to be a problem in the nursing profession.

It is role modeled by some faculty in nursing education and “caught” by students as being acceptable.


Faculty to Faculty Incivility

In a recent study (Goldberg, Beitz, Wieland, & Levine, 2013) researchers identified the following unique traits of incivility in academia.

Just a heads up, if you are one of those who recognize the need to challenge the status quo and bring needed change by following my example, you may wind up with a target on your back!

Most likely targets

  • Promoters of change. Anyone who dares to do things differently. If you want to be part of the needed change, be willing to count the cost.
  • Those who speak up/question status quo.

Bullying tactics

  • Withholding information
  • Setting up to fail
  • Gossip/ personal slander
  • Intentionally marginalizing or isolating targets of incivility

Bullying culture

  • Lack of teamwork and inability to work together.
  • Well-established cliques among faculty. Most common clique is the old guard of senior faculty vs. new faculty who often see the need to do things differently.

The Personal Cost/Consequences

Just as in practice, the lived experience of incivility is devastating and leads to the following emotions:

  • Humiliation
  • Depression
  • Feeling distracted, loss of concentration, diminished capacity for clinical judgment, anxiety, and physical sequelae such as G.I. disturbance, headaches, loss of appetite, lack of sleep.
  • Fearful/feelings of defenselessness because of isolation and lack of advocacy in the department
  • Self-blame. What is wrong with me?

My Story

Like many nurse educators, I have witnessed and personally experienced this painful reality and it almost derailed my purpose and passion to teach. I share my story in depth for the first time to help others make sense of your story through my story. This was painful, but healing to share.

Though I was an expert nurse after over twenty years of clinical practice, I realized that teaching was my greater passion and pursued that path to obtain my masters in nursing education in 2007.

As a passionate, but novice nurse educator, I was exhilarated to have been chosen to be an assistant professor at a local state university as a temporary replacement for the school year, and the chance to stay on and obtain tenure.

The friendly veneer of faculty from the interview, soon wore off and as I became acclimated to day-to-day realities in the department. I recognized quickly that something was very wrong.

At the first department meeting, it was painful to observe the obvious dislike that some faculty had for one another and overt disrespectful eye rolling and sighing that took place as each shared their respective position regarding items on the agenda.

Faculty in this department were divided into two factions, those who supported the department chair and the status quo, and those who did not. I was intentionally pulled by each respective faction to support their perspective in what was an obvious toxic environment.

I just wanted to teach and pursue my passion! Let’s focus on the reason we are here, to educate the next generation to the best of our ability and to do so together!

Easier said then done.

In one meeting, the department chair was clearly being disrespectful and bullying another faculty in a departmental meeting. I stood up for this person and supported the bullied faculty openly.

I did not let the dynamics of this department culture keep me from enjoying the reason I was there, to prepare student’s the best I could for professional practice. I revised prior lecture content to include case based scenarios, incorporated active learning to my classroom, and brought needed change!

Though there were the inevitable speed bumps and rookie mistakes, it was overall an experience I thought had gone well.

At the end of the school year, I had numerous examples of excellent feedback from my students, other colleagues, and the personal satisfaction that I had given 110% as a new educator to the program.

All to no avail. Though I interviewed for my position at the end of the year, it was offered to another with less experience and I was shown the door.

When I asked to see the records from my interview with the team of three faculty (one who I co-taught with) to see what happened, I was shocked. My record had been knowingly misrepresented.

I was inferred to be racially prejudiced because students that had required clinical remediation during my clinical instruction were foreign born. This had never been brought up while I was teaching during the entire year, but it had been saved and documented before I had a chance to respond to its implications.

I have since read more about incivility in nursing and nursing education and the nursing literature has put my experience into context that has helped me process what happened in my past.

Intentional sabotage. Information was withheld. I was set up to fail.

Unfortunately, my experience is not unique and I am not alone.

The Rest of the Story

It was a chance encounter with a nationally known and prominent nurse educator that brought me full circle to experience the healing I needed. There is not time to share it here, but please click here for the rest of my story. You won’t want to miss it!

How to Bring Needed Change

As I look back at my time in toxic academic cultures, the one thing that they had in common was a lack of faculty support and teamwork. There was little encouragement or validation for a job well done.

Make it a priority today to change culture by encouraging and validating your colleagues whenever it is warranted.

Your Words Have Power!

Solomon, the wisest man of ancient history, wrote the following words of wisdom in Proverbs that, if put into practice, will also work to recapture civility in nursing and nursing education.

I have found the following principles of communication life-giving and restorative if they are used consistently in all that we say and do with our students and to one another.

  • “Kind words heal and help, cutting words wound and maim.” Proverbs 15:4
  • “Life and death are in the power of the tongue.” Proverbs 12:18
  • A soft answer turns away wrath, but a harsh word stirs up anger. The ear that listens to life-giving reproof
        will dwell among the wise.
    Proverbs 15:1, 31

Cognitive Rehearsal

In last week’s blog I addressed Griffins article on cognitive rehearsal as a practical strategy to address incivility in the profession as new nurses. The good news, is that this empowering strategy to counter incivility is effective regardless of the setting including academia!

I also just created an INCIVILITY Essentials bundle that has a PowerPoint, practice based scenarios, and faculty guide with numerous resources to strengthen your understanding of this NEED to know topic and empower you to share it with your students!

In Closing

Make a renewed commitment to support and encourage one another whether you are a student, nurse, or nurse educator. Academia is hard enough, and we really do need each other and work together as a team!

It’s also time to reflect, if you have been a sword that has wounded others through your harsh words or uncivil behavior. Be willing to offer forgiveness to those you have wounded to bring restoration to relationships.

It is my hope and prayer that grace and forgiveness would flow freely in our departments to bring needed healing to those we work with, those we teach, as well as our profession.

What do you think?
What has been your experience with civility or incivility in nursing education? How have you overcome this painful experience?

Comment below and let the conversation begin!

NEED to Have Additional Resources on Academic Incivility:

References

  • Clark, C. M., Olender, L., Kenski, D., & Cardoni, C. (2013). Exploring and addressing faculty-to-faculty incivility: A national perspective and literature review. Journal of Nursing Education, 52(4), 211–218.
  • Goldberg, E., Beitz, J., Wieland, D., & Levine, C. (2013). Social bullying in nursing academia. Nurse Educator, 38(5), 191–197.
  • Tanner, C. A. (1990). Caring as a value in nursing education. Nursing Outlook, 38(2), 70–72.

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Join the discussion 4 Comments

  • Cynthia says:

    Amen! As I journeyed through my Master’s and now Doctor of Nursing Practice journey, civility in nursing at all levels has been my passion. It saddens me to see how disrespectful many nurses are to each other, usually in a covert manner, how some nurses resort to such passive aggressive behaviors in an attempt to climb the professional ladder, and how poor communication skills and a lack of accountability at all levels sets the scene for a negative work environment. I, too, have my own story, as many who have experienced bullying to the extreme do, and have vowed to give new nurses entering the organization tools to effectively communicate, to identify and name bullying and incivility when it occurs, and give preceptors the support to communicate effectively with new nurses while being open to provide and accept feedback in a reciprocal fashion, and also attempt to educate managers on encouraging feedback from their staff. I agree that I mostly see acts of incivility occurring at the seasoned nurse level and leadership level and wonder if it is a multifactorial effect of a lack of support. Although I feel the passion for all of the above, I wonder is it worth being the target that Keith discussed in his blog, or at what point do you say the environment just is not conducive to a healthy work environment and move on. Since I have worked only at one organization for 30 years, is this something that occurs within the walls of all organizations, or are there actually organizations that provide a caring environment that encourages positive growth? Please enlighten me, have other readers reached a point where they outgrow their organization and need to move on? Keith, I love your wisdom and thank you for sharing your insights!!

    • Keith Rischer says:

      Thanks for taking the time to share your observations and experience Cynthia! In response to your question and based on Clark’s recent survey of the culture of academic departments in nursing, 96% have a problem with incivility at some level. I think it is safe to extrapolate this to other healthcare related departments. If there is a lack of support among your colleagues and leadership is passive or part of the problem, then it is time to leave. If you have supportive colleagues and leadership is invested to address the problem, you have the ability to let your light shine and leaven your department to bring needed change so hang in there! Leaving should always be a last resort, but may be your only option if your emotional and physical health is being impacted by a toxic culture.

  • Jennifer says:

    So true Keith, thank you for writing about the subject of faculty to faculty incivility because the problem isn’t going away and it is only by throwing it out there constantly that perhaps people will begin to want to change. Sadly I too have experienced this as a new junior faculty member and then when I started writing about this topic for my DNP dissertation, like you mentioned, the target was on me. There is so much more in the mix to incivility, it isn’t as easy as telling people to play nice with each other.
    Eventually, I had to step down to adjunct and even then was a target so ended up leaving the institution all together – and it was the nursing school I went to as a student! It’s just sad that some faculty are not willing to change, or face their own fears and stand up and say no. I think it is only when nurses get brave and stand up, saying no to incivility will we finally begin to put an end to the bullying culture. But even then, it’s going to take support from all involved from nurses to management and beyond.
    But again, thanks for the great work you do and for keeping your head up even against the dragon of incivility.

    • Keith Rischer says:

      You are right Jennifer, human nature and the dynamics of incivility are complex and unfortunately only have so much space to address in a blog. May you continue to take your stand and do what is needed realizing what is at stake!

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