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Incivility: Beyond the Nurse

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Jkaiservi Jkaiservi (New)

Previous explanations of nursing incivility blame the nurse and/or the culture of the nursing profession. Organizational and leadership impact are factors yet to be explored in this enigma.

Incivility: Beyond the Nurse

Nursing Incivility and Leadership: A Missing Link?

The American Nurses Association Code of Ethics implores nurses to maintain caring and professional relationships with colleagues as well as with patients and their families. Provision 1.5 of this code specifically states that the nurse must "create a culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect" (American Nurses Association, 2015, p. 4). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the primary authority in healthcare regulation. The Joint Commission has issued a mandate for institutions to address uncivil behaviors in healthcare as they create a threat to patient safety.

Despite these directives, nurse-to-nurse hostility is a known problem according to the past 25 years of professional literature (Embree & White, 2010). Inter-collegial hostility, or incivility, is particularly prevalent in the nursing profession versus non-nursing vocations. This is an enigma, as the nursing profession is based upon interpersonal relationships and the care of others.

Civility is defined as the display of polite and courteous acts and expressions that show regard for others (Clark & Carnosso, 2008). Clark & Carnosso, in a concept analysis of civility, find that civil behavior includes tolerance, listening, accepting other viewpoints without negativity, respecting differences, treating one another with dignity and honor, and engaging in social discourse (2008). Civility not only denotes particular behaviors but also describes an attitude of respect for other persons. The word civility has Latin roots in the word 'civilitas' meaning community or city. Civility is more than just polite behavior; it is a prerequisite for humans to live together and function as a community. Thus, civility has been described as active engagement in creating and participating in a group or community (Clark & Carnosso, 2008).

Conversely, incivility can then be understood to delineate impolite, discourteous, rude conduct that shows a disregard or disrespect for others. Common forms of incivility in nursing are non-verbal innuendos, verbal affronts, condescending language, impatience, reluctance or refusal to answer questions, disrespect, and undermining (Embree & White, 2010; Weinand, 2011). Unlike civility, uncivil behavior purposely keeps others out of the in-group, e.g. the community.

Nursing has been considered the primary occupation at risk for horizontal violence and workplace bullying. Studies estimate that approximately 85 percent of nurses are victims of incivility and up to 93 percent of nurses' report witnessing incivility in the workplace (Christie & Jones, 2014; Lachman, 2014). Studies comparing nursing versus non-nursing work environments find a rate of incivility at 85 percent in nursing work environments, compared to 75 percent in non-nursing occupations (Hunt & Marini, 2012). Additionally, non-nursing occupations generally report managers as the perpetrators of bullying in a top-down relationship of power (Hoel et al., 2010). Unique to nursing is the prevalence of incivility between workers with equivocal levels of power. Patient care environments may be particularly susceptible to incivility due to high-emotions, stressful conditions, challenging and difficult work, and diverse roles and interactions. Nonetheless, nurses as a distinct sector of the healthcare team have a particular propensity toward uncivil treatment of each other.

Causes of Incivility in Nursing

A perceived power imbalance is most often a requisite to bullying. Bullying appears to be particularly prevalent in institutions where hierarchy and power imbalances are strongly emphasized (Salin, 2003). Nursing was founded as a predominantly female profession in a patriarchal society with a cultural standard of gender oppression (Bartholomew, 2006). Additionally, in Western healthcare, nursing is practiced in a medically-dominant environment, where work structures are traditionally hierarchal in nature. Patients are admitted under the treating physician's name and nameless nurses will execute physician's orders. Furthermore, the organizational model of nursing is derived from historical roots in the military. This hierarchal system is thought to place nurses in a position of inferiority of rank and subordination. Literature supports the subordinate role of nurses, finding that nurses lack autonomy, control, and self-esteem (Freshwater, 2000). As a result, nursing has been described as a culture characterized by obedience, servitude, dedication, and adherence to hierarchy (Hutchinson, Vickers, Jackson, and Wilkes, 2010).

Uncivil behavior among nurses is posited to result from this culture of oppression and subordination. Horizontal violence and incivility was originally described as an internal manifestation of conflict that resulted from oppression of one group by a more powerful entity (Freire, 2000). An oppressed group is one in which members lack power or control except within the group itself (Peters, in press). Internalized beliefs about their own inferiority prevents the oppressed group from controlling their own destiny, maintaining the status quo and allowing power structures to remain unchallenged. Frustration with these feelings results in aggression toward colleagues within the oppressed group (Hutchinson, Vickers, Jackson, & Wilkes, 2005). Members of the oppressed group direct their frustrations toward each other as they cannot act out directly to those who create the oppression (Freshwater, 2000). From this perspective, incivility in nursing is the reaction to the oppression and subordination experienced by nurses as a collective profession.

Besides a culture of oppression, the socialization of nurses into the profession is said to propagate a culture of incivility. Foundational paramilitary influences are said to have fostered a culture in which insult, humiliation, and hazing are considered part of the on-the-job training (Hutchinson et al., 2005). In fact, the metaphors frequently used in nursing orientation include "earning one's stripes" and "boot camp". A common narrative is to intentionally subject a novice nurse to the same experience seasoned nurses had when they entered practice, with the mentality of "if I had to do it, (s)he can too" (Bartholomew, 2006). Compounding the problem is that most females have been socialized not to react to conflict, to avoid it, and to keep the peace. Nurses too have been socialized not to assert themselves individually or collectively. The result is that nurses often are silent as either targets or witnesses of incivility (Croft & Cash, 2012).

Students and new graduates are particularly at risk to be targets of incivility. In Freire's theory of oppression, any member introduced into a powerless group is at high risk for horizontal violence (Freire, 2000). Additionally, Kanter's Structural Theory of Empowerment finds that when subordinates try to assert their power and authority, only to have it blocked, they usually will seek power over those whom they can dominate. Usually that power is directed downward in the hierarchy (Twale & De Luca, 2008). Incivility is used to acculturate new members into the oppressed group; it is how the unspoken rules are taught (Bartholomew, 2006). Targets of incivility are usually individuals who are different or threaten the status quo (Salin, 2003; Twale & De Luca, 2008). If the status quo is disrupted, fear escalates within the group and is expressed as hostility. Until the newcomer is acculturated as a subordinate group member he or she is considered a threat and treated as such (Bartholomew, 2006). Victims often have done something unknowingly to disrupt the status quo that results in hostility. These acts may range from simply being hired to questioning a philosophy or process of a seasoned organizational member. If someone is introduced to the culture who does not adhere to the group expectations, or worse, challenges the dominant members or cultural norms, they are eliminated, treated uncivilly, bullied, taken advantage of, or marginalized (Twale & De Luca, 2008). As is often heard, the notion of "nurses eating their young" continues to prevail in contemporary nursing.

More recent literature has considered contextual factors such as job conditions, levels of empowerment and the presence of in-groups as explanations for incivility. While some organizational factors have been explored, no studies in any setting involving nurses are found that explore the relationship of the leadership style of a nurse leader with perceived levels of incivility. It is well established that leaders have a profound impact on the culture and interpersonal relationships of a group. A potential explanation for uncivil behaviors that has been little explored is the impact of leadership style on nurse-to-nurse incivility.

Organizational Culture

In the nursing literature, incivility has been predominantly understood as the reactions of an individual agent within a subordinate group exhibiting oppressed group behavior. Oppressed group explanation of incivility provides one consideration, but is not the only factor that impacts incivility in nursing (Hutchinson et al., 2005). Organizational issues contribute to an environment in which incivility is normalized and acceptable. The assumption that incivility is simply a result of the unique socialization of nurses as a subordinate group fails to consider the organizational contexts in which nurses work, as well as the organizational factors that impact incivility (Hutchinson et al., 2005). "Organizations and management structures have been able to remain immune from any further consideration as to their role in perpetuating bullying" (Hutchinson et al., 2005, p. 120).

Organizational culture influences how members perceive their interpersonal interactions and how they manage and respond to such interactions (Keashly & Neuman, 2010). An organization that encourages genuine friendships will have a more positive atmosphere. An organization that promotes boundaries and professional distance may have respectful interactions, but may fall more easily into incivility in times of stress or conflict. Lateral violence has been described as an emotion-based response triggered by factors such as rapid change, pressures for increased productivity, and chaotic work environments (Hutchinson et al., 2010).

Workplace demands are thought to create pressures and opportunity for incivility. Hutchinson et al. notes that contemporary "healthcare organizations are now characterized as transactional climates, strongly focused on productivity and its reward" (2010, p. 27). The central pressure within healthcare organizations is cost containment, with organizational goals described in terms of efficiency and quality. Nurses are under constant surveillance and are challenged daily with providing care in a corporate context (Hutchinson et al., 2005). This added pressure and scrutiny compounds the already complex environments in which nurses work, including a frantic pace, high-stake decisions, and heavy workloads. This type of environment induces frustration and high emotions (Croft & Cash, 2012). The effects of stress contribute to the use of incivility as a reaction to the environment.

In some organizations, incivility is more or less permitted as the way things are done. There exist organizations in which bullying is actually considered acceptable and creates advantages to the perpetrators (Salin, 2003). Furthermore, it is suggested that uncivil behavior amongst nurses is 'accepted' within the profession as part of the metanarrative (Hutchinson et al., 2005), i.e. "nurses eat their young." Often in nursing units, cliques with nursing management and select staff are formed, and this group dictates the norms of the unit. Self-assured of their position in the alliance, these nurses act to enforce the 'rules of work' (Hutchinson et al., 2010). It has been found that bullies within the nursing workforce in particular are often protected by those in power (Croft & Cash, 2012).

The Corollary Role of Leadership

The leader of an organization has a powerful influence on organizational culture. The important role of leadership and organizational structures in influencing a positive workplace is well-documented. In a workplace with a strong sense of team membership and community, incivility is much less likely (Clark & Springer, 2010; Weaver Moore et al., 2013). Leaders are powerful role models, and their actions communicate messages as to what is considered acceptable behavior (Clark, Olender, Kenski, & Cardoni, 2013). Leaders play a key role in establishing the climate and culture of the organization. Ultimately, people are more likely to follow the performance cues of those with social power or social status within an organization (Twale & De Luca, 2008). Organizational culture includes the norms, values, and rituals that characterize an organization, and "serves as a social control mechanism that sets expectations about appropriate attitudes and behaviors of group members, thus guiding and constraining their behaviors" (Bally, 2007, p. 144.). It is vital to identify the effect of leadership and organizational culture on uncivil behaviors among nurse coworkers.

Summary

Incivility in the workplace has far-reaching, damaging effects to both the individual and the organization. Incivility is a particular problem in the nursing profession, which, paradoxically, is founded on caring. Leaders can play a key role in attenuating or contributing to levels of incivility. Hence, it is important to first understand what particular leadership styles or behaviors are more or less associated with worker incivility. From this information, actions by the leader to prevent workplace hostility can be better implemented.

References

American Nurses Association (2015). Code of Ethics for Nurses with Interpretive Statements.

Nursebooks.org publishing program of the American Nurses Association: Silver Springs, MD.

Bartholomew, K. (2006). Ending nurse-to-nurse hostility: Why nurses eat their young and each other. Marblehead, MA: HCPro, Inc.

Clark, C. M. & Carnosso, J. (2008). Civility: a concept analysis. The Journal of Theory Construction & Testing, 12 (1), pp. 11-15.

Croft, R. K. & Cash, P. A. (2012). Deconstructing contributing factors to bullying and lateral violence in nursing using a postcolonial feminist lens. Contemporary Nurse, 42 (2), pp. 226. Retrieved from Contemporary Nurse - Contemporary Nurse: Healthcare Across the Lifespan.

Embree, J. L. & White, A. H. (2010). Concept analysis: nurse-to-nurse lateral violence. Nursing Forum, 45 (3), pp. 166-173.

Freire, P. (2000). Pedagogy of the oppressed (30th anniversary ed.). New York: Continuum publishers.

Freshwater, D. (2000). Crosscurrents: against cultural narration in nursing. Journal of Advanced Nursing, 32 (2), 481-484.

Hutchinson, M., Vickers, M., Jackson, D., & Wilkes, L. (2005). Workplace bullying in nursing: Towards a more critical organizational perspective. Nursing Inquiry, 13 (2), 118-126.

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19 Comment(s)

Yes! For my Nursing Leadership & Management class, we had to write a Sentinel Event paper using incivility in nursing as the subject. It was a very challenging, yet eye-opening assignment.

Edited by Cali_Nurse_209
Typo

I have been nursing for over 40 years, have worked in several different countries, was a commissioned officer in the military and more recently a civilian nurse. I would like to think that it was the oppressive, patriarchal system which turns nurses into uncivil, unsupportive work colleagues and many years ago when I did Sociology I would have enthusiastically supported this theory. These days, I am much more cynical and simply believe it's because most nurses are women. Get a group of women together, whether it be nurses, mummy groups etc and the knives will be out. When I worked in male dominated environments, I very rarely experienced the same level of rudeness and ********** as when working with all women. I don't think nursing and nurses attitudes towards one another will ever change.

Jkaiservi,

This is one of the best written posts that I have seen on AN. I saved a copy of this because it is so well written and because I fear that it might get deleted because you mention NETY, and there is a taboo about this here on AN.

You have cited some excellent sources that I had not previously been aware of.

I have researched the issue of how patients are (dare I say) abused in the healthcare setting due to the balance of power. This has been long accepted as paternalism, and healthcare is having a hard time letting it go. (See: Forbes, Dinosaur Doctors And The Death Of Paternalistic Medicine)

Despite the obvious problems with paternalism healthcare still tries to defend it. (NIH, Autonomy, Paternalism, and Justice: Ethical Priorities in Public Health)

Note: I have been ridiculed on other threads for providing citations to my comments.

Additionally, Kanter's Structural Theory of Empowerment finds that when subordinates try to assert their power and authority, only to have it blocked, they usually will seek power over those whom they can dominate. Usually that power is directed downward in the hierarchy (Twale & De Luca, 2008).

I have cited this situation as a cause of nurses asserting power (almost to, and to the point of abuse) over patients. The best example of nursing justification of and methods of asserting power over patients (and the most disturbing) are the papers written by Joan Emerson. Although my research is patient focused, the same theories also explain nurses' incivility to each other.

A perceived power imbalance is most often a requisite to bullying. Bullying appears to be particularly prevalent in institutions where hierarchy and power imbalances are strongly emphasized (Salin, 2003).

An even better explanation to this is found in Philip Zimbardo's Stanford Prison Experiment. The correlation that applies is that just as prisoners are subordinate to the guards' authority, they develop their own hierarchical structure that violently enforces the norms that that group sets within itself.

Besides a culture of oppression, the socialization of nurses into the profession is said to propagate a culture of incivility. Foundational paramilitary influences are said to have fostered a culture in which insult, humiliation, and hazing are considered part of the on-the-job training (Hutchinson et al., 2005). In fact, the metaphors frequently used in nursing orientation include earning one's stripes” and boot camp”. A common narrative is to intentionally subject a novice nurse to the same experience seasoned nurses had when they entered practice, with the mentality of if I had to do it, (s)he can too” (Bartholomew, 2006).

This is the hidden curriculum, which present the same issues as for physicians. The hidden curriculum is so influential because it is taught by example. (Albert Bandura A: Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice Hall, 1985.)

Dewey stressed that the role an individual is assigned in an environment – what he is permitted to do – is what the individual learns. In other words, the medium itself, i.e., the environment, is the message. ‘Message' here means the perceptions you are allowed to build, the attitudes you are enticed to assume, the sensitivities you are encouraged to develop – almost all of the things you learn to see and feel and value. You learn them because your environment is organized in such a way that it permits or encourages or insists that you learn them.” (Postman N, Weingartner C: Teaching as a Subversive Activity. New York: Dell Publishing, 1969.)

Much of the oppression can be traced to the history of nursing. The beginning of professional nursing can be traced to Florence Nightingale's 19th-century England school of nursing. For the first 30 to 40 years in Nightingale's school, nurses were trained by male physicians because there were not enough educated nurses to teach nursing.

The first book on nursing ethics, Nursing Ethics: For Hospital and Private Use, had been written by the American nursing leader Isabel Hampton Robb.

The focus in the nursing codes was on the physician, until the 1960s. (Not surprising, based on the fact that over the years most nurses have been women and most doctors have been men.) The focus on nurses' obedience to physicians remained at the forefront of nursing responsibilities into the 1960s. By 1973, however, the focus of the ICN code reflected a shift in nursing responsibility from the physician to the patient, where it remains to this day.

Still, old habits die hard.

I agree with the description of the problem, which the majority of the article was devoted to. Towards the end of the article, the author drew attention to the responsibility that an organization's leadership has for promoting a culture of civility within the organization. I would like to see the role of leadership in promoting a culture of civility, and solutions at the level of leadership, developed further. I would like to read about organizations that have dealt with these problems successfully and have well defined strategies for dealing with these problems that are successful. I would like to read about the outcomes of such successful strategies, from the perspectives of all involved.

Edited by Susie2310

labordude, BSN, RN

Specializes in L&D, OBED, NICU, Lactation. Has 15 years experience.

This is one of the best written posts that I have seen on AN. I saved a copy of this because it is so well written and because I fear that it might get deleted because you mention NETY, and there is a taboo about this here on AN.

I have cited this situation as a cause of nurses asserting power (almost to, and to the point of abuse) over patients. The best example of nursing justification of and methods of asserting power over patients (and the most disturbing) are the papers written by Joan Emerson. Although my research is patient focused, the same theories also explain nurses' incivility to each other.

Disclaimer (yes at the beginning): While your individual experience may vary, my comments are accurate in the aggregate.

I really want to thank you for making these comments and I agree nearly completely with you and your entire post. One other poster also discussed that nurses are often their own worst enemies which is entirely true. What you have a group of people where the majority remember so strongly the marginalization and hierarchical power struggles that have defined health care for so many years. Where nursing differs is that there is no 'stronger at the end' team building that is present in other industries or areas. Think of the military, a traditionally male profession with a strong hierarchy. At the lower levels, there is a lot of hazing, joking, and what would be defined as incivility by the expanding definition of this word. At the end of the day, the camaraderie built by team member would send them to the end of the earth to save one another. That doesn't exist in nursing as, in the aggregate, it's easier to remain a victim and complain than it is to actually do something about it.

The patients and our fellow nurses suffer because of this attitude. So many times I've been accused of 'being too big for my britches' or being insubordinate because I don't tolerate the status quo of medicine > nursing power. We are a large, educated, and experienced workforce who is consistently ranked as one of the most trusted professions. Let's use that to our advantage and actually get some real respect while we continue to change the outcome and provide the best for our patients.

I don't know what to think. I agree in that there should not be conflict amongst nurses. On the other hand, what did nursing start out as? Sure, we need to move with the times. But in the end, nursing is a serving, caregiving profession.

I kind of think if people object to their position as nurses and want more power, why not go to their highest in nursing, or go to med school? Most of your basic RNs are not trained on the level of a doctor, so I do not quite understand why there is a problem there. Nursing has a different approach to person care; that is what makes it what it is.

If the issue is about being treated equally as a human being and coworker, I totally understand. But for example, it would make no sense for my father who is a computer engineer, to object to the fact that he cannot automatically be CEO of the storage company he works with. He could train for it, and possibly later get a job like that, but that is not his position at the time. In other words, there is not question about his equality as a man, but his job position and training put him on a lower level. And that is perfectly fine.

I guess I need a clearer explanation. I understand where you are coming from, but then it also sounds like everything has to be equal in the medical field, which, pardon me, sort of sounds like communism. I see my place as a nurse; serving, giving care, following protocol and orders, thinking critically, working autonomously as I can. Do I want to be treated badly, no. But I do not see myself on par with doctors, or even nurses who have greater training then I do. Can I excel, succeed, be part of a team, yes! And if I want more freedom, then I can go back and increase my credential.

Please don't jump on me. I am only saying this from what I know, which isn't much considering my years. I would love to know more of the rationale behind this view. I don't mind constructive criticism, and I am only trying to learn more.

...Please don't jump on me. I am only saying this from what I know, which isn't much considering my years. I would love to know more of the rationale behind this view. I don't mind constructive criticism, and I am only trying to learn more.

Parakeet,

It is simply human nature. Healthcare by its very nature is an oppressive system. If you are not familiar with The Stanford Prison Experiment, then watch this video about the original experiment:

Great topic and very well researched and written-this is a subject I have had direct experience with having ultimately no choice but to resign and forfeit a fabulous state pension. I worked as an RN for about 18 years in the NY state prison system where moving up the ladder requires taking promotional exams and where seniority reigns. A male colleague hungry for power knew I would not back down from wanting a promotion took several female coworkers under his wing to undermine, bully and sabotage my career- this had been occurring a few years before the strategy became obvious. His tactics became ever more vicious when he saw I was not going to back down- we both had the same grade on the promotional test but I had seniority and wanted this opportunity to get ahead. At the end he was even able to bring the warden and higher ups to go along with his deviousness, not to mention most of my other coworkers. Even though a union was involved they basically blew me off (even though they took 22 dollars every paycheck). Basically, I had no one to back me and due to the fact that my nursing license was next on the chopping block, I was forced to resign leaving behind a 3500 dollar per month pension at 25 years. To show how definite this was when I applied for unemployment it was granted by virtue of 'the grievant shows documentation of reporting this to superiors but fell on deaf ears'. To conclude, what your article espouses is absolutely spot-on ; now I can even put words to some of the concepts of organizational culture and the workings of 'incilvility' in general. Many thanks for this.

Gooselady, BSN, RN

Has 23 years experience.

I don't know what to think. I agree in that there should not be conflict amongst nurses. On the other hand, what did nursing start out as? Sure, we need to move with the times. But in the end, nursing is a serving, caregiving profession.

I kind of think if people object to their position as nurses and want more power, why not go to their highest in nursing, or go to med school? Most of your basic RNs are not trained on the level of a doctor, so I do not quite understand why there is a problem there. Nursing has a different approach to person care; that is what makes it what it is.

If the issue is about being treated equally as a human being and coworker, I totally understand. But for example, it would make no sense for my father who is a computer engineer, to object to the fact that he cannot automatically be CEO of the storage company he works with. He could train for it, and possibly later get a job like that, but that is not his position at the time. In other words, there is not question about his equality as a man, but his job position and training put him on a lower level. And that is perfectly fine.

I guess I need a clearer explanation. I understand where you are coming from, but then it also sounds like everything has to be equal in the medical field, which, pardon me, sort of sounds like communism. I see my place as a nurse; serving, giving care, following protocol and orders, thinking critically, working autonomously as I can. Do I want to be treated badly, no. But I do not see myself on par with doctors, or even nurses who have greater training then I do. Can I excel, succeed, be part of a team, yes! And if I want more freedom, then I can go back and increase my credential.

Please don't jump on me. I am only saying this from what I know, which isn't much considering my years. I would love to know more of the rationale behind this view. I don't mind constructive criticism, and I am only trying to learn more.

Hey Parakeet :) What I bolded in your quote is one of the major points. We have to ask ourselves what 'par' means. My nursing abilities and experience may be greater than yours (at least the latter), but I am exactly the same kind of human being you are, and deserve no more respect than you or a nursing student in his/her first day of clinical. I see it that we are people first, which automatically qualifies as worthy of the deliberate effort to be respectful and fair. Life is hardly fair, and people are hardly 'created' equal, much less how we differ in our experience and skills. These come secondary to the inherent value of the person, which is equal to that of the next person and the next.

Persons with insecurity issues (of whatever sort) tend to cling to their perceived superior status, perhaps their years on the unit, rather than realize they too will have a better work experience valuing themselves and others equally, regardless of 'status'. Sure, the charge nurse is the boss and the manager is his/her boss and so forth. We follow their lead, and we follow the nursing practice act, infection control guidelines, sterile technique. We submit to a lot of 'authorities', but that submission does not DEFINE the worth of the person. This is what can get confused, we humans are very status conscious by instinct. But we don't have to act out every primitive instinct that burbles up from the depths of our being :D . I've wanted to wrap 3'' tape around the faces of plenty of people but I have refrained (to date). I've wanted to blurt 'what were you thinking??' and I've certainly not felt like saying "Please". Like, a lot. I don't give myself permission, though. I dislike that behavior coming toward me, so it's a Golden Rule kind of thing.

So while your skills and experience are not 'par' with that of docs or many nurses, and you can submit to their direction, you don't have to see that as a definition of your relative value as a person. And those you submit TO are not somehow 'deserving' of servile obeisance nor do they have special dispensation to offer you less than practical respect because they know more.

I think we nurses are worked very hard, to the limits of our physical and emotional strength, and when we're tired, we don't work as hard to maintain civility, the energy doesn't feel like it is there. Or for some uncool reason, it's not deserved. There's still a lot of push-back to even acknowledging nurse-to-nurse incivility, so it is still significantly institutionalized (ie, 'accepted as part of the nature of nursing'). We can change that ourselves, as in 'be the change you want to see', or cultivate a culture of respect and recognition if we are charge nurses or managers. Sometimes a place is too sick, and we have to save ourselves -- there's no reward for martyrs in nursing, either. We owe it to ourselves to take care of ourselves like we take care of patients or family.

wannabecnl

Specializes in PACU, presurgical testing. Has 4 years experience.

I find a lot of these points interesting, especially seeing how top-level management decisions are often being made without consulting nursing or considering how they will affect patient care. However, no one in management holds a gun to our heads and makes us act like we're back in middle school.

If nursing expects to be treated as a profession, we need to act professionally. That means knock off the eye-rolling and sighing, questioning each other in front of patients and families (unless the patient is in danger), taking out our frustrations with management on each other, crabbing about each other in the break room, etc.

And while we're at it, how about if other providers start acting professional, too, and stop with the snarky comments about patients, talking down to nurses and each other, and failing to listen to other members of the team.

We are only human, but we ARE human; let's act like it and treat others accordingly. That's just being polite and mature.

la_chica_suerte85, BSN, RN

Specializes in Pediatric Hematology/Oncology.

I have been nursing for over 40 years, have worked in several different countries, was a commissioned officer in the military and more recently a civilian nurse. I would like to think that it was the oppressive, patriarchal system which turns nurses into uncivil, unsupportive work colleagues and many years ago when I did Sociology I would have enthusiastically supported this theory. These days, I am much more cynical and simply believe it's because most nurses are women. Get a group of women together, whether it be nurses, mummy groups etc and the knives will be out. When I worked in male dominated environments, I very rarely experienced the same level of rudeness and ********** as when working with all women. I don't think nursing and nurses attitudes towards one another will ever change.

Word.

I can be pretty catty at work and nothing shuts me down faster than someone who thinks they know it all, who does not demonstrate interest, and who does not act like they have it in them to be a hard worker. I've worked with a lot of younger females (of the traditional new grad age) and, though I'm not much older than them, I am astounded by the entitled attitudes and complete void of a work ethic they bring with them. It's amazing. I am fearful of NETY just because of my past behaviors -- but I am not terrified of it actually materializing for me. I stay in my lane when I'm new somewhere and learn and respect the culture of the new place and go from there. I keep my head down, work hard and let me achievements over time reveal my intentions and my commitment to teamwork.

I think a lot of people are struggling with this when they get into a new job (and I've seen this with my BSN buddies who do really think they'll be in management by the end of their first year out) and it's really a Facebook-mediated, everyone-gets-a-medal mentality that has poisoned the concept of what it means to work hard without recognition, to simply show up and do your job and support your colleagues the best you can without expectation of reciprocation. Generally, if you can do those things, you actually do end up with help from your colleagues and respect from those who count.

Edited by la_chica_suerte85

NursesRmofun, ASN, RN

Specializes in Registered Nurse.

Great topic and very well researched and written-this is a subject I have had direct experience with having ultimately no choice but to resign and forfeit a fabulous state pension. I worked as an RN for about 18 years in the NY state prison system...

I may know you, but I don't want to know if I do! I saw for myself what an environment that system was..terrible...lots of infighting...and ratting each other out. Some people worked their hours and others sat in offices talking. No one seemed to care about these facts...certainly not the DON.

NursesRmofun, ASN, RN

Specializes in Registered Nurse.

Good article. And it makes me wonder how you can fix a system (I'm talking hospital now that was a place I worked in the past) that seems to be bad from every angle. In this institution, I never once even saw or heard word about the DON, if she existed. But the unit managers were bad, the charge nurses were worse at times, and the shift supervisors were there strictly for the paycheck and to help their cronies. The people in charge were just helping their buddies and passing the harder assignments and work onto the oppressed, so to speak.

Good article. And it makes me wonder how you can fix a system (I'm talking hospital now that was a place I worked in the past) that seems to be bad from every angle. In this institution, I never once even saw or heard word about the DON, if she existed. But the unit managers were bad, the charge nurses were worse at times, and the shift supervisors were there strictly for the paycheck and to help their cronies. The people in charge were just helping their buddies and passing the harder assignments and work onto the oppressed, so to speak.

I think that it is necessary for organizations' leadership to recognize the problem, have the desire to make a concerted effort towards solving the problem, and be willing to commit time and resources to doing so.

GadgetRN71, ASN, RN

Specializes in Operating Room. Has 15 years experience.

What it comes down to is this, someone can do everything "right" on the job. Work hard, be respectful to others, etc. All it takes in some of these places is one bitter, nasty person to ruin a whole work environment. Some hospitals work environments are so small and "inbred"( meaning that there are many cliques and management is often right in there) that any person who doesn't kiss the butt of this ringleader is fair game. Management is often afraid of this person or group and will do nothing unless made to, by a union or outside group. Even then, that isn't a guarantee. In one place I worked, the problem person was the union rep on the floor.

Excellent, well-written article. I do find it ironic however, since I feel this same verbal behavior existed on one of the threads recently. Several of the "older" established posters were condescending, then I felt, nasty. Sure, there was some defensive behavior from the of the baby nurses that was ill advised. However one of those attacked made some very good points, but she was also ridiculed and devalued because she new to the site. Wow, how to make people welcome! I do get the frustration of having to deal with newbies that come in with know it all attitudes, been there done there; but having examined some of my behavior I realize I must take responsibility for not making those same newbies feel valued. I don't know the solution, but perhaps a start would be if we all try to treat each other as we would like to be treated, especially when tired!

Psych-n-Stuff

Specializes in Mental Health, Burn ICU, SICU, Hospice. Has 10 years experience.

From my understanding and experience in the nursing field, civility and lack thereof is not about levels of training, I believe that it has more to do with the ways that humans with varying degrees of training/opportunities treat one another. An MD, RN, LVN, BSN , CNA or whatever title one has achieved does not entitle any individual to be disrespectful, dismissive, rude, or any other behavior or verbal expression one can think of. A degree earned is about skills and scopes of practice, not about the way one may interact with another. It's unfortunate that there is a belief that one cog in any operating system is more important than any other. All the cogs must be in place for the system to operate efficiently...it can limp along awhile without a certain part, but it can never meets its full potential and reason for existence. Training and higher education are to be admired, but are no reason for treating one's fellow man/woman, whether they are a patient or co-worker or a person that passes one on the street, with superiority, disrespect, unkindness and without charity and humility? We all exist on different planes, with different opportunities and abilities to become what we may; the only similarity that everyone possesses is their humanity and its resulting responsibilities. Great article and opportunity to discuss an abnormally normal situation -- incivility, bullying, man's/woman's inhumanity towards man/woman (and every combination thereof).