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Cowboy Up: Cultivating Civility

in Healthcare

Montana Perinatal Association Annual Conference

Susan LuparellMontana State University

Defining Incivility

� Use of words and/or behaviors to demonstrate defiance, disrespect, or aggression� Associated with a lack of regard for another

� Intentional or unintentional

� In academic setting, can completely disrupt teaching and learning

Is Incivility a Problem in Health Care?

• N=4530 in 102 hospitals

• 77% witnessed disruptive behavior in physicians

• 65% witnessed disruptive behavior in nurses

(Rosenstein & O’Daniel, 2008)

Surprise! (Or not?)

� Horizontal violence and interprofessional nastiness abound

� Nursing students are subjected to incivility by faculty and agency staff

(Clark, 2008; Lasiter et al., 2012; Thomas, 2009)

� Faculty are subjected to incivility by students

(Clark, 2008; Luparell, 2004; Lashley & deMeneses, 2001)

What We

Used to

Think…..

Potential Impact on Staff

� Decreased job satisfaction

� Psychological and physical symptoms

� Decreased productivity

� Even non-victims of workplace incivility or bullying are significantly affected

(Johnson, 2010)

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Joy-stealing

Experiences with students, colleagues, staff and administrators that rob… [nurses] of their zest, clarity, productivity, feelings of worth, and desire for more connection.

(Heinrich, 2007)

Potential Impact on Bottom Line

� Increased sick calls

� Decreased productivity

� Turnover

What is the impact on

our newest

nurses?

• Less compassion

and tolerance for

patients

• Less likely to ask

questions

• Errors as a

consequence of

aggression and

bullying

(Johnson, 2010)

What About the Patients?

• 1 in 5 nurses personally aware

of an adverse event occurring

as result of disruptive behavior

(VHA Study: Rosenstein & O’Daniel, 2005; 2008)

Patient Harm

�Patient safety is jeopardized when health care team does not communicate effectively

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Points for Consideration

� Historically, incivility has led to important societal change

� From the genetic point of view, diversity of the gene pool serves to make a species stronger

� There are aberrant genes that will cause harm and destruction

An All Too Common Theme in Some

Organizations?

Why Should We Address It?

� Nursing values

�Altruism

�Respect for human dignity

(AACN Baccalaureate Essentials, 2008)

More Specifically

� “…inherent in accountability is responsibility for individual actions and behaviors, including civility. In order to

demonstrate professionalism, civility

must be present.”

(AACN Baccalaureate Essentials, 2008)

Why Should We Address It?

Behaviors belie values(Bruhn, 2001)

How Can We Reconcile Caring

and Taking Action?

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ANA Code of Ethics

� #1: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual….” (p.4)

� 1.5: Principles of respect extend to all encounters,

including colleagues. “This standard of conduct

precludes any and all prejudicial actions, any form

of harassment or threatening behavior, or disregard

for the effect of one’s actions on others” (p.9)

STOP

Ignore the Urge to Ignore

Seeking Congruency

� What is the collective expectation concerning conduct?

Selling the Idea

Engage the Evidence…

Consider couching incivility and

negative environmental issues in the context of a shared desire for

patient safety

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Get Ready for Game Day

(Practice, Practice, Practice)

� Proactively train to address inappropriate behavior

� Simulation as a tool for instructors?

Determine Who “Us” Is

(or at the very least….WHO YOU ARE)

� Examples might include:

�We don’t roll our eyes on the unit

�We do not curse at each other

�We assume the other person was trying to do their best

�We refrain from texting during staff meetings

�We do not speak negatively about colleagues in their absence

Creating civility—a journey well

worth the effort!

“With great power comesgreat

responsibility.”

~ Spiderman

I’d Love To Hear From You

Susan Luparell, PhD, CNS-BC, CNEMontana State University College of Nursing400 15th Avenue South, Suite 106Great Falls, MT 59405Phone: 406-771-4459Email: luparell@montana.edu

© Susan Luparell, 2013