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Art of NursingBlog

A Practical Strategy to Address Incivility in Nursing Education

By February 20, 2020April 18th, 2020No Comments

Today’s blog was written by Amy Simons, MSN, RN, a nurse with 30 years of experience, who has taught at Austin Community College in Austin Texas the past six years. Amy is a firm believer that nurses must be lifelong learners and that sharing this knowledge is one of the greatest joys of being an educator. 

If you have questions, or would like to learn more about what she shared today, contact Amy at: amy.simons@austincc.edu


I recently performed a literature search of peer-reviewed, full-text articles about incivility in nursing. Over 200 items resulted!

For the 18th year in a row, Gallup reports that nurses rank the highest among a list of professionals for honesty and ethical standards surpassing physicians! Is it just me, or is there something wrong with the most honest and respected profession also being well known for incivility and bullying?

Many of the articles I reviewed describe a variety of reasons for incivility in nursing, the impact of incivility on patient outcomes, and that many nurses are leaving the profession because of a hostile work environment.

Consequences of Incivility

Many nurses are leaving the workforce, and the American Nurses Association projects the need for more than 200,000 additional nurses each year above the projected and approximate 3 million already entering the workforce.

I don’t suppose any of these numbers are shocking to anyone in the profession, but I do believe much of the information in these articles begins at the end of the story and not the beginning. In my opinion, the solution to incivility in nursing starts with utilizing kindness in our nursing education.

I am not talking about a Pollyanna, rose-colored glasses approach. I believe that by integrating kindness throughout the nursing curriculum, with interactions with students, and between faculty, we can confront and eradicate incivility.

Research shows that kindness helps to eliminate bullying in primary schools, as well as improves concentration, alleviates stress, and encourages collaboration. Why is it then, that when students begin college courses, the focus turns to more technical aspects of delivering content and passing exams?

In How Humans Learn: The Science and Stories Behind Effective College Teaching, Josh Eyler describes the damaging effects of chronic stress on the brain and the ability to learn. He also points out that establishing relationships with educators can reverse these effects! Kindness bridges those gaps and helps to build these relationships.

Kindness Defined

Let me begin by sharing my definition of kindness. Kindness is a behavior marked by ethical considerations, a pleasant disposition, and concern for others. It implies that other people matter; it is both energetic and interactive and is implicit in interpersonal relationships.

Kindness is the framework used to enhance student engagement and success, develop interprofessional collaboration, and bridge the gap between educational and professional implementation and can help eradicate incivility.

Integrating kindness in the nursing curriculum can teach students how to interact professionally and in ways that create appreciation and respect instead of hostility.

Three Ways to Integrate Kindness in Your Curriculum

So, how do we translate a noun into a verb? I want to suggest three ways to kindness can become a word of action.

1. Show appreciation for each student.

There is a great deal of research ongoing about creating inclusive classrooms. In my opinion, a lot of this research boils down to recognizing differences and appreciating them. It all begins by answering the question, “Who are you?” for each student.

I teach in a program with over 600 students. Do I know each one? I do not. However, I recognize and appreciate that my students are unique individuals, and I strive to see the best in each of them.

We need to reframe some common thoughts I have heard faculty express. Instead of thinking they only want to know what content is on a test, perhaps they are trying to clarify what information from a 75 slide PowerPoint is critical versus “good to know.”

Instead of asking “why weren’t you in class or why are you late” we can instead say, “I am glad you are here now, I was worried.” I have had students whose significant other hid car keys or physically assaulted them before exams.

Classroom culture and class expectations need to be established, but can we include input from our students? Enforcing rules is easier when you remind students that they suggested them!

2. Role modeling appreciation and professional behavior between faculty.

As educators, we must model the interprofessional behavior we expect from our students. We can’t set expectations for the students that we don’t meet.

In this world, there are bound to be people we don’t care for, or whose ideas are not like our own. Have you been on Facebook lately? Judging from many posts, no one gets along! We must show respect for and appreciation for our co-workers. Have respectful conversations to keep order if need be, but we must model how to respond when there are differences if students are to learn that same expected behavior.

3. Provide opportunities for students to practice responding to incivility.

During a simulation, or using case studies, students can practice the skill of deflecting the impact of incivility. In our program, students must show mastery of skills before implementing them in the hospital.

All the skills have a checklist of items that a student must demonstrate. Developing a checklist for a variety of bullying, incivility, or abusive scenarios sends the message that this is an important skill to develop.

Students who understand that this is not accepted are more likely to speak to faculty when they witness, experience firsthand, or have a question about whether an incident is considered a problem.

The nursing literature calls this “cognitive rehearsal” and is simply having a direct and respectful prepared response when you encounter a disrespectful encounter. The article “Teaching Cognitive Rehearsal as a Shield for Lateral Violence: An Intervention for Newly Licensed Nurses” is a MUST read for every nurse educator to prepare students for what they may experience in academia and clinical practice.

In Closing

When this new generation of nurses learn how to act professionally, see this behavior modeled by faculty, and have opportunities to become proficient at deflecting this behavior, a ripple effect will take place that has the potential to minimize or possibly eradicate incivility in our profession.

Then we will fully earn the right to be considered as the most highly regarded of all professions.

Kindness, pass it on.


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