NR 500 Week 7: Cultivating Healthful Environments

NR 500 Week 7: Cultivating Healthful Environments

NR 500 Week 7: Cultivating Healthful Environments

Incivility in the workplace is a prevalent concern in nursing and healthcare settings. The knowledge of incivility and lateral violence in nursing is not an uncommon issue. It has been around for decades and remains a strong presence in nursing today. This causes me great sadness for the profession I hold dear. Uncivil workplace behaviors can be characterized as rude and discourteous, with no regard for others (Phillips, Smith, MacKusick, & Whichello, 2018). This repeated act that is essentially bullying, whether verbally or silently, can lead to absenteeism, low job satisfaction and morale, burnout, poor productivity, mental, and physical health problems for the recipient of this poor treatment (Phillips, et al., 2018). The nursing profession must take a continual stand against incivility to assure the safety and well-being of our nurses and ultimately our patients whose care can be affected by work incivility.

As a nurse of many years, I have been witness to and also the target of workplace incivility. As a novice NICU nurse many years ago, I remember the leadership in my department setting an intimidating tone for new employees. There were cliques and gossiping that ultimately led to low morale and fear. This is truly a sad and dangerous place to be when caring for the precious lives of others. In an ICU setting, nurses need to be able to work as a team to deliver effective care. The ability to discuss care situations with colleagues and receive their input in a supportive, non-judgmental way is how nurses grow in their knowledge and expertise, ultimately fine tuning their trade. When intimidation and condescending attitudes are present, nurses will question their ability to provide good care and may eventually leave the department or the profession.

I am currently serving my fourth year as an assistant nurse manager in the pediatric operating room where I am employed. Upon immediate receipt of this promotion, I felt that the staff who were once my colleagues, but now my direct reports started to treat me differently. Suddenly, I became the enemy in some employee’s perspectives as I became responsible for scheduling, assignments, time and attendance tracking, and evaluations. My determination from the start to was model kindness and compassion towards others despite often times not receiving it in return. At the end of the day, I like to reflect upon the questions: Did I do my best? Was I fair to everyone? Was there anything I could have done better? Unfortunately, even with putting my best efforts forward in communication, organization, and compassion towards others, there are those few in the department that intend on holding grudges and forming untrue opinions about me. We live in a world where very little grace is extended towards others and that is something I intend to provide more of the older I get. Presently, I am dealing with a situation with a particular surgical technologist that refuses to speak to me unless she has too. She talks to everyone around me and is generally well liked by all. She has never taken the time to get to know me personally but became very irritated with me on a few occasions when I assigned her to surgical cases. Instead of immediately coming to me with her frustrations, she would complain to her co-workers. It would be weeks of the silent treatment before I would figure out that she was upset with me. I have tried repeatedly to rectify the situation, exemplify kindness by asking how she and her family were doing, and have unfortunately gotten nowhere. She complained to our manager that I speak to her like a child and give her unfair assignments. We sat down with our manager to discuss the situation further which led to 30 minutes of her telling me how she has never liked me and does not want me to speak to her and even threatened human resources involvement. During this interaction, I wish that I handled it differently but I did let anger and defensive mechanisms take over, taking the opportunity to call her out on the poor behavior she exhibits towards me on a daily basis. In the end, not much was resolved, my leader advised us to start anew and try to leave negative feelings towards each other in the past. I go to work each day with a desire to provide exemplary care to my patients and support to my team. Unfortunately, not much has changed with my interactions with this surgical technologist as she refuses to speak to me still unless it is a work-related matter, and then she does it begrudgingly. In a recent attempt to improve this situation, I reached out to my manager and fellow leadership group to let them know that despite efforts, this employee continues to display negativity to me in and out of my presence as has been told me to by other employees. My fellow leadership team did not provide the clarification and support I was seeking, but instead responded that I was just one person and this individual is a ray of sunshine to others. One fellow leader responded that she expects staff to talk negatively about us and not agree with everything we do. This response has ultimately left me feeling more isolated and alone in this situation. I am currently at a loss as to how to proceed. I have worked many years to reach my current position. Through hard work and dedication, I have been able to advance my nursing practice and hold my professionalism to a high standard. Phillips, Stalter, Winegardner, Wiggs, & Jauch (2018), describe workplace incivility and its consequences such as nursing resignations, mental anguish, and potential patient safety concerns. Personally, I have felt mental anguish over this situation and have indeed considered other positions. As present, I have decided to stick with it and continue to strive for excellence and maintain dignity despite the discomfort I feel when I am around this individual.

Having known earlier how this employee felt about me and addressing the issue upfront could have potentially led to a different outcome. Over time, tension and frustrations tend to build up in individuals which can lead to grudges and long-lasting opinions. Knowing this, I intend to address concerns and disagreements immediately from now on. I also feel that pursuing my MSN and addressing concepts such as incivility through scholarly review is empowering me to look past personal matters and seek out the root cause of incivility, better equipping me with a deeper knowledge base towards the subject. This in turn will help me develop better leadership skills in my current and future positions as a master’s prepared nurse. 

Strategies that support a healthy work environment are education on incivility in the workplace and how to counteract this detrimental behavior. This should be provided upon hire and repeatedly through computer based learning, staff meetings, and educational retreats. If a healthcare system invests in creating a just culture that maintains accountability for behaviors and actions, civil behavior will grow and support a healthy work environment (Phillips, et al., 2018). Leadership should have zero tolerance for incivility and be able to role model appropriate behaviors that promote team cohesiveness and support.


Phillips, G., MacKusick, C., & Whichello, R. (2018). Workplace incivility in nursing: A   literature review through the lens of ethics and spirituality. Journal of Christian Nusing, 35(1), 7-12. doi: 10.1097/CNJ.0000000000000467

Phillips, J., Stalter, A., Winegardner, S., Wiggs, C., & Jauch, A. (2018). Systems thinking and incivility in nursing practice: An integrative review. Nursing Forum, 2018, 1-13. doi: 10.111/nur.12250

Mosadeghrad (2014) suggest that a variety of factors influence the quality of services provided by nurses in their routine practice. The incidents of incivility could be a major reason in this list. Therefore, it is extremely critical to further assess this issue so that adequate policy measures can be drafted to address this issue. According to Brown and Cummings (2013), there could be different names ad terms but incivility, violence, and bullying is often witnessed by practicing nurses. Therefore, the code of conduct for nursing has seen many revisions in light of this issue, as stated by Simpson (2016). The objective of this paper is to examine the incidents and issue of incivility against nurses and how to deal it effectively without braking the decorum. It also helps the healthcare professionals as well as the management to create a better environment for service delivery.

Issue of Incivility

Several academic researchers have defined the cases of incivility in nursing in different ways. According to American Nurses Association (2015), incivility refers to the act of behaving rudely and without curtesy with the hospital staff. For example, if an individual spreads rumors with the intention to create panic in the hospital complex. In another case, a colleague may refuse to support another to create nuisance in the hospital environment. According to Mosadeghrad (2014), since nurses work in an extremely stressful environment where situations swing between life and death, this incivility becomes an integral part of the business. Even with the best of efforts, the incidents cannot be completely eliminated.

Apart from this, there are many risks and hazards associated with the profession of nursing. Therefore, the nurses as well as patients could be extremely tired and frustrated and lead into behaviors that are classified as incivility. Equipped with these assumptions and knowledge, Lachman (2014) suggests that we need both, primary as well as secondary interventions to address this issue. With the help of primary interventions, the incidents can be prevented while secondary interventions are used to bring down the frequency of such incidents.

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Due to incivility, the relationship between nurses and patients, or fellow nurses may get impacted severely. As a result, there could be many conflicts that hamper the day to day work. The seminal paper by Wood (2016) suggests that due to incivility, the performance of nurses could go down significantly. As a result, the overall healthcare services become of low quality. Having learnt these massive impacts of incivility in the healthcare environment, it is extremely importance to find a solution to this problem so that the healthcare professionals may work in a normal manner.

Importance to Nursing

Lachman (2014) argues that the incidents of incivility in the healthcare environment have been increasing in the last few years, and it has brought down the quality of healthcare services.  The nurses as well as patients, both have to bear the brunt of it. As the situation worsens on day by day basis, the sector would find it hard to maintain the quality, allocate resources intelligently, and maintain the desired level of patient outcomes. Due to the bad behavior that nurses see around them, they often end up either leaving their job or the industry altogether. Therefore, the turnover rate of nurses also becomes higher. Incivility makes the healthcare environment extremely stressful and impacts the psychology of nurses (Chamberlain College of Nursing, 2017). When nurses face constant conflicts, stressed environment, sleep deprivation, or embarrassment at workplace, they lack motivation to work at their full efficiency (Wood, 2016). Due to this increased activity, the nurses may also fall sick and remain absent from work. For a family nursing practitioner, such issues could trigger negative emotions. Brown and Cummings (2013) further elaborate on the ways in which negative emotions could impact the performance of family nurse practitioners.

Due to incivility and the associated poor performance, the nurses often receive bad ratings in performance appraisal. Such ratings often discourage them and the performance level and commitment further reduces. The emotional impact due to incivility could come out in the form of anger, isolation, or fear etc. (American Nurses Association, 2015).

Incivility has other effects also, such as causing damage to the staff nurses. Gradually, increase in the incident of mistreatments provokes the people engaged with the matter and makes the situation intense. Simpson (2016) accepts that there are chances that nurses could get physically injured in the environment of violence. Such conditions take place when one person does not trust another person leading to misunderstandings, arguments and self-interest.


Initially, I had no idea about Incivility and its effects. It is when I started my career in nursing I came to know about Incivility in detail. I faced certain challenges in the start while dealing with the cases of patient’s family incivility. Though the subject of the topic is similar still the cases differ and so the way to handle them. During my job, I realized that the members of nurse team and physicians’ team can coordinate and work closely with each other. They together made a strong team and delivered a recognizable service to the patients admitted at a hospital provision.

I encountered many instants where everything could turn out as a huge fight. But the physicians and the nurses looking after that matter somehow managed to handle it smoothly. The matter was regarding the family patient who was supposed to move to the general ward from the ward of intense precaution. Whereas the one group was confident about the decision, another group was still in doubt. The physicians were sure that the patient is in a condition where he can have cared but the nurses were not sure and needed the help of physicians to deal with it (McCormack & McCance, 2017).

There are some ethics to be followed in Nursing out of which one is to treat with respects to other professionals working with you. There is a major reason behind it. Take an example, if the patient is in a critical condition and professionals tend to have different opinions during operation can lead to the patient into danger. Therefore, professionals need to understand the sensitivity of the situation and act accordingly in the operation theatre. Admiring of each other’s opinion is required for the patients’ safety.  As such, the respect of the ideas from both parties involves ensuring that the patients were well cared for.

Creating a Healthful Environment

The health organizations are regulated effectively through implementing the certain strategy like a flow of effective communication. The first strategy that should be employed for the creation of a healthful environment is ensuring that there is effective communication. On this, Lachman (2014) states that effective communication can be a key to solve any disputes or misunderstandings in a healthcare center or anywhere. opines that communication will help in the resolution of possible issues that may occur in the healthcare profession. Additionally, it also keeps the members concerned informed on activities taking place.

 Another strategy explained is coordination. The hospitality is all about caring and goes under manpower. Hence, all the people concerned with each other need to coordinate with each other for smooth operations. Understanding its importance, Brown and Cummings (2013) concludes that if organization aims to achieve the success they should know keep the team spirit allow which is always ready to come front to help each other. Such environment is a boom when it comes to providing training to new employees.

The third strategy is employees engagement. Though the leaders are tending to know for effective decision making due to the experience they acquired, they show involve other unit members in decision making. Also, everyone differs and so does their thought, one can never know when the great idea can come from. The practice of engaging everyone in the course motivates everyone making them feel important. Hence, they also feel appreciated and give their best in every work they take into account. Through research, Mosadeghrad (2014), stated that engaging everyone is a stepping stone to achieve company’s vision and mission involvement in decision making. Involving others in the process of decision making is filled with advantages like the transparency of activities, exchange of ideas, and elimination of disputes and so on.

Practice Application

My role is the family nurse and my responsibilities at work include managing the illness of the patient taken admission in the healthcare and carrying out the physical tests as per procedure. I have been also honored with the task of specialty diagnosis which is meant to looking after the family members for their health for their entire life. We often get a call for meetings between employers and employees. During the meeting, we discuss the activities, critical condition and everything related to patients. The meetings bring clarity among everyone about tasks, its goal and etc. Also, the feeling of engagement motivates us to work effectively.


Through this paper, we get to know about the role and responsibilities of a practitioner of the family nurse. They have curtained aligned tasks to be performed for maintaining the standards set by hospitals in regard to caring of patients. Additionally, they have to go through certain situations like among the members of the unit. Incivility refers to an offensive and bad-mannered behavior which often give rise to a corrupt culture. It affects the people working in an organization and indirectly affects their working pattern. Hence, healthy environment is very important for smooth working. It can be achieved through various well-defined strategies mainly employee engagement and effective communication. Communicating with each member and asking for their opinion for decision making brings the number of benefits to an organization.


American Nurses Association. (2015). Incivility, bullying, and workplace violence. American Nurses Association.

 Brown, P., & Cummings, G. (2013). Factors influencing intentions to stay and retention of nurse managers: a systematic review. Journal of Nursing Management, 21(3), 459-472.

Chamberlain College of Nursing. (2017). Mission, philosophy, program outcomes. Retrieved from

Lachman, V. D. (2014). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. Medsurg nursing, 23(1), 56.

McCormack, B. & McCance, T. (2017). Person-centred practice in nursing and health care. Theory and practice (2nd ed.). Oxford: Wiley Blackwell.

Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International journal of health policy and management, 3(2), 77.

Simpson, K. R. (2016). Incivility, bullying, and workplace violence: new recommendations for nurses and their employeeers from the American Nurses Association. MCN: The American Journal of Maternal/Child Nursing, 41(1), 68.

Wood, R. M. W. (2016). Workplace bullying between registered nurses: Occurrence and perceived effects on work productivity (Doctoral dissertation, Villanova University).