COMMENTARY

Nurses: Resetting the Civility Conversation

Cynthia M. Clark, PhD, RN; Sara M. Ahten, MSN, RN

Disclosures

August 19, 2011

In This Article

Nurse Civility in Action

Civility: Starting With Nursing Students

We are passionate about promoting civility in nursing education -- the very beginning of the nurse's career. Students walking into clinical settings should understand what is expected of their professional behavior and what they can expect from everyone they encounter. In time, today's graduating students will become charge nurses, nurse managers, and valuable bedside nurses who may not have a title but are recognized as leaders among their peers. Students and new nurses will benefit most directly by education and policies in school and the workplace that clearly define expected professional workplace behaviors, the process for addressing violations of those policies, and the consequences of those violations.

Our hope is that we all become a voice for respectful, responsible, professional nursing practice and education. It will take all of us standing up and saying, "No more, this is unacceptable," and then taking action to make positive changes not only at the bedside but also in the classroom. It will take managers and leaders who believe in their own worth and that of their staff and faculty.

Nurse Civility: Stories and Examples

Dr. Yox called for nurses to reset the civility conversation through stories and examples of civility in action. (See Incivility in Nursing -- Is That All There Is to Talk About?) We would like to encourage that trend and leave you with some examples of positive initiatives in our own backyard as well as suggestions for creating your own civil workplace.

Cindy: the Cosmic Connection. More than 5 years ago, Susan Luparell, Kathleen Heinrich, and I forged a unique and powerful group to support one another in our ongoing work to foster civility in the nursing profession. We called it the "Cosmic Connection." We met for the first time in October 2005 as a result of our shared commitment to fostering civility and initiating change. Using Kathy's process for cultivating mutually beneficial partnerships,[3] we formalized our relationship by crafting a contract and a covenant, which culminated into a shared vision for our Cosmic Connection. One of our goals is to take what we have learned about fostering civility and positive relationships to the greater nursing community, to provide a safe place for stories to be told and a place for healing to occur.

This group has provided each of us with a "soft place to land" while speaking out against the consequences and devastating effects associated with incivility and bullying. At least every month, we meet to discuss the issues and to consider best practices to cultivate civility. Being a member of the Cosmic Connection is one of the most invigorating experiences that I have ever had.

The same can be said of the Leadership and Management teaching team in the School of Nursing at Boise State University. We collaborate and share the joys of a high-performing team based on respect and the enjoyment of teaching and student learning. We intentionally role model the importance of civility with our students; encouraging them and teaching them how to recognize, address, and foster civility in workplaces and academic settings.

Civility teams. Nurses can create similar relationships in their workplaces. One way is to reach out to coworkers who share your interests and establish a circle of civility. For example, a large hospital in the east formed a "Civility Team" composed of interested nurses who were empowered by the hospital leadership to increase civility and reduce incivility among staff nurses and other healthcare workers. The team partnered with outside researchers[4] to conduct a comprehensive institutional assessment using the Organizational Civility Scale to measure civility, incivility, stress, coping, and job satisfaction among their staff.

Using the findings of the survey, the Civility Team put in place interventions to improve relationships among colleagues and to continue the practices that promote civility. The team held forums for healthcare workers to review the survey results, openly express their concerns and ideas, and work together to formulate clear, confidential procedures and reporting systems for uncivil behaviors. They also instituted an "incivility and bullying hotline" to report uncivil behavior as well as a reward system for civil and ethical behavior.

A group like this can have a major impact on recruitment and retention, as well as employee grievances and lawsuits, which can mean significant cost savings for the institution. If you plan to create a Civility Team in your organization, emphasize this point to management.

Many of our graduates have entered practice settings where civility reigns. At the Boise Veterans Affairs Medical Center, new graduate nurses are encouraged to ask questions, collaborate as valued members of the healthcare team, and pursue clinical excellence and career advancement. One of our recent graduates works in an orthopedic surgical clinic where new nurses are treated with respect and are given ample opportunities to hone their nursing skills while becoming integral members of the perioperative team. The nurse manager of the clinic is a dynamic leader whose managerial style encourages dialogue, collegiality, and teamwork -- all essential elements in fostering a civil workplace that result in safe, quality patient care.

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