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Incivility in Healthcare: Creating Healthy Environments Research shows that incivility has been an increasing problem for nursing staff in health care settings. An act of incivility includes any type of rude or disrupting behavior directed toward another nurse or co-worker. Although this behavior may not have been intended to cause harm, it still intrudes on workplace regulations, creates negative outcomes and lowers morale. In order to fix the problem of incivility, nursing staff must understand what causes this behavior and the effects it can have on nurse and patient welfare. To be proactive and create healthy workplace environments, nurses must educate themselves on what incivility is and how to identify various incivility issues. Unfortunately, in my professional role I have personally been affected by incivility, but can now recognize why this lack of respect has such a strong affect nursing. Creating positive- healthy work environments in trauma hospitals can be achieved by prevention and conflict management of incivility situations; I will offer specific methods on how to address incivility in healthcare workplace settings. Defining Incivility can be defined as (Thompson, 2017) impolite, hostile or disruptive behavior and/or communication. Incivility is usually displayed as disorderly behaviors that most people would identify as offensive, discourteous, ill-mannered, discourteous, and unethical. Incivility can create negative workplace environments and even negatively affect patient care and nurses’ health. According to Brantley, McGuire&Spiri (2016), the performance of health care professionals is negatively impacted by incivility, which then makes the quality of patient care decrease. Incivility generates prospective dangers to patient care and safety. Unfortunately the intensities of incivility in the healthcare work environment are difficult to gauge and not always clear but studies prove that medical staff who have been involved in or witnessed incivility are negatively affected. Negative side effects of incivility may include: emotional trauma, suicidal thoughts, anxiety and drug abuse. Research shows that (Thompson, 2017) sixty percent of nurses who are new to the field resign only a year into their career because they were mistreated by their colleagues. Not only do these nurses quit after one year but most of them quit nursing or the medical field because of how they were treated. According to Brantley, McGuire &Spiri(2016), patronizing verbal exchanges and lack of patience for inquiries, were stated as the most frequently reported issue of incivility in the healthcare workplace environment. Incivility makes the work environment hostile and causes all involved to be on edge and not perform efficiently, which then cause poor communication between colleagues. Nurses must collaborate with leaders to prevent and stop it. Uncivil behavior and rudeness cannot always be blamed on others, and all nurse professionals must self-reflect and see how they are contributing to this problem. Importance to Nursing Relevant literature indicates that incivility is a concern for nurses, the nursing profession, patients, individuals involved and the microsystem work environments. Due to fear or the feeling of not wanting to cause trouble, nurses tend to disregard or accept incivility. Bullying in the healthcare work field is responsible for making hundreds of nurses resign from their field annually. Incivility has many damaging effects on nursing professionals and can even decrease job fulfillment, weaken morale among employees and, dwindle employee health. The ANA has stated bullying can lower a person’s self confidence and self worth which can cause the person to display physical symptoms such as headaches, interrupted sleep, and intestinal problems. Bullying can also result in the person displaying psychological effects such as anxiety, irritability, and depression symptoms. Some reports claim that this intensified state of pressure might impair medical decision-making and affect work performance which can result in patients not being treated correctly. Multiple studies show that when nurses work in these high stress environments that errors increase and more incidents such as patients receiving the wrong medicine or falling, are reported. Work environments are negatively impacted by incivility as well as the nurses’ self-confidence and proficiency which also harmfully affects patient care. In a journal writing by Luparell (2011) it was suggested that nurses that are victims of bullying have expressed the intent to leave the nursing profession or their specific job due to the incivility they have experienced. Luparell expresses the alarming amount of evidence that shows the correlation between poor communication with unprofessional relationships in the workplace has shown to have an effect on poor patient outcomes and patient safety . With this evidence organizations have been vigorously working to address the problem. Sommers, Thornlow, Warrner & Zappa (2016) examine the effects of incivility on nurses, the healthcare organizations and patient protection. Studies show a correlation amongst incivility that is directed at nurses cause drops in patient welfare. With incivility in the workplace some unsafe practice choices were made that would have originally been questioned for example written orders that are unreadable not being clarified and lifting or ambulating heavy patients without help. These are just a few examples of how incivility affects nurses, the nursing profession, individuals involved and the microsystem work environments. A scenario of incivility in which I was directly involved, consisted of a patient who was a fisherman, that came to our trauma center because he had fallen off the boat dock and hit some sort of metal pipe. Shortly after his arrival we had discovered he was bleeding internally and needed emergent surgery, so a laparotomy was done. As a result of the surgery he needed a temporary colostomy bag, and staples for his incision. I discharged the patient and he went home fine but I came in the next day and the patient was back, his wound ended up dehiscing. The patient was rushed back to the OR and this time a wound vac was placed. The surgeon said that his abdominal wall was so weak the incision just ripped apart. During this admission the wife ended up being rude to the staff and I understand she was probably scared for her husband’s life but we were the people trying to help him. The wife would stay by his hospital bed all day and night and one day she was so rude to all of the nurses and ended up calling one of the nurses an explicit name, which made that nurse cry. When that same nurse called another nurse in the room to help with blood work, the wife yelled at the helping nurse to get out the room. Her actions negatively impacted the individuals involved and at this point the nurse manager was called and the patient’s wife ended up getting more hysterical so security and patient representative were called. At this time the wife was warned that if she were to be rude to any other staff members, she would be banned from being able to visit her husband during the rest of his admission. The wife made the working environment for this patient hostile and made it to where none of the nurses wanted to take the assignment. The wife made it so uncomfortable to where if you were the nurse you felt you were being watched under a microscope and you were questioned about everything you did as if you were incompetent.Creating Healthy Environments Most research has studied how incivility negatively impacts nurses and the workplace, but few studies have focused on how to prevent this issue. Prevention is the best strategy to lower incivility and be proactive in cultivating healthful environments. Abdollahzadeh, Asghari, Ebrahimi, Rahmani&Vahidi(2017) presented strategies that nurses saw as most important that can be used to avoid workplace incivility; improving communication skills, finishing tasks thoroughly and refining knowledge and skills were three main categories for prevention. Findings suggest (ANA, 2015) that in order to promote healthy environments, intervention is needed to fix vulnerabilities, improve interpersonal and professional relationships. This article recommends that nurses take accountability and encourage vigorous personal relations with co-workers and the team. Nursing professionals must be mindful of their exchanges with others, communicate efficiently, and inform themselves on diversity, inclusiveness, conflict resolution training and continuing education courses. Nurses must familiarize themselves with their employer’s policies on incivility and establish clear positive communication such as code words that can be used as signals that can prompt co-workers of potential threats or conflict. Sommers, Thornlow, Warrner& Zappa (2016) believe that “Providing an atmosphere where nurses can perform at their best to provide quality, safe patient care is the responsibility of all healthcare organizations” (pg.29). Prevention, communication and awareness are the best strategies to lower incivility and cultivating healthful environments. Practice Application Currently my selected specialty track is a nurse practitioner and after doing this research I plan on implementing two main strategies into my future position that will create a healthy work environment. Increasing evidence suggests a healthy happy work environment leads to staff satisfaction, retention, improved patient outcomes. In this article six standards are identified as most important to ensuring a positive environment but two strategies that I found to be most crucial and plan on implementing or working with leadership to implement is skilled communication and meaningful recognition. In order for an individual to be strong within an organization the team must be strong itself. Skilled communication is important so everyone is optimistic and on the same page; effective communication ranks just as high as medical services. The second strategy that I feel is important is substantial appreciation. No matter what work field an employee is in they must feel valued and nurses in particular must know the value they provide to patients and the healthcare profession. I feel both of these strategies will cultivate healthy environments and strengthen the team as a whole. Conclusion As a member of the nursing profession I now see the importance of strategies that are key to cultivating cultures of civility. Incivility in a healthcare setting decreases performance and as a result diminishes excellence in patient care. Prevention is the best strategy to lower incivility and be proactive in cultivating healthful environments. Best practices to cultivate healthful environments include but are not limited to: completing tasks, improving knowledge/skill and communicating effectively. My selected specialty track is a trauma nurse practitioner and I plan on creating healthy environments by implementing skilled communication and meaningful recognition. The more time I spend working at the trauma center the more I am able to value good communication and meaningful recognition. At times I find myself not communicating the best that I can and I would like to work on that in the future. This research really opened my eyes to how each nurse impacts the work environment.

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