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: No Magic Required

Positive working conditions do not occur by accident. If you are a leader or manager in your organization, it is up to you to create and foster a healthy work environment. Here are some suggestions:

  • Start the conversation about civility with your staff. All nurses need to participate in creating and sustaining a culture of civility and respect. However, many nurses are ill-equipped to deal with incivility, so strategies must be taught, practiced, reinforced, and supported. Many nurses who behave in an uncivil manner are unaware of how they come across to others. This may be surprising to some, but it is helpful information and a good place to start in bringing these issues to awareness.

  • Make a civil culture a priority on your unit. Staff meetings are practical venues to discuss acceptable and unacceptable behaviors, to establish norms of behavior, and to practice and role-play civil interactions. Don't fall into the trap of being what we in education call the "sage on the stage" -- the person at the front of the room who talks at the group rather than with the group. Be the "guide on the side" -- present a targeted piece of information, then give your staff the time to discuss, express ideas, and share their suggestions and recommendations. Your role is to clarify and verify information, recognize roadblocks, encourage participation, and create a safe place for people to express their opinions respectfully.

  • Set expectations, incentives, and consequences. Nurse managers must establish and enforce policies and procedures for addressing incivility, following through with sanctions if indicated, and rewarding civility and collegiality. Use simple and direct language in stating your position.

    • Say what you mean and mean what you say. You need to understand very clearly the message you want to send before you speak to your staff. Forget the buzzwords and long explanations. If your presentation is a PowerPoint presentation, it should be limited to 2 blank slides, and your staff can "fill in the blanks" on: (1) the behaviors expected in the department, and (2) the behaviors that will not be accepted. Engage your staff in creating norms and identifying expected behaviors. This process is essential in fostering a civil environment and instills a sense of ownership and commitment to a respectful workplace. When the the staff collectively establishes norms for behavior, they are more likely to approve of and conform to these behaviors. Once the norms are agreed upon, they become the standard for interactions among the healthcare team. The norms must be periodically revisited, revised, and reaffirmed.

    • We have often been asked for a list of effective incentives to use in creating a civil work environment. Although it would make the process much easier, the truth is that there is no "one-size-fits-all" answer. As leadership and management expert Ken Blanchard so wisely stated, "What motivates people is what motivates people." The truth is that a smart manager asks his or her employees what motivates them -- what they would view as a meaningful reward and incentive for high performance. The responses will be as numerous and varied as the individuals involved and are powerful tools for a manager looking to engage his or her staff in making a cultural change.

    • Be clear and fair, but most of all be consistent in what you expect. Although positive motivators are preferred, the consequences for violating the agreed-upon norms must be clearly stated. The reality is that some people only change when their actions begin to have negative results. The reluctance or inability of managers to confront unacceptable behavior hurts an organization as much, if not more, than the incivility itself. This means no special circumstances, no exemptions for favored employees, and no ducking the conversation you need to have with a staff member who doesn't abide by the expectations of the unit.

  • Be the advocate for your staff in management decisions. One of the most frequent criticisms of nurse managers is they forget or are not involved with the realities of day-to-day work in the healthcare setting. It is an appropriate role and responsibility for a nurse manager to evaluate what is required of the staff and create realistic work expectations that don't compromise patient safety. Then take that message into management discussions, and repeat as needed. It may not be a popular message, but it is a necessary one. Creating realistic work environments where nurses feel that they can deliver adequate, appropriate care goes a long way toward creating civil people and civil organizations.

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