Incivility in nursing : From roots to repair

This paper offers a commentary on the topic of incivility, bullying and horizontal violence that is seemingly endemic and growing in prevalence in the nursing profession (Hershcovis 2011, Vessey et al. 2011, Croft & Cash 2012, Farrell & Shafiei 2012, Khadjehturian 2012, McNamara 2012, Porath & Pearson 2013, Reio & Trudel 2103, Daly et al. 2015). This paper suggests an outline of the reasons for the prevalence of incivility and a description of the impact of this negative behaviour on the staff involved, patients or clients, the organisation and the nursing profession as a whole. The importance of the role of clinical leaders and the theory of congruent leadership in changing organisational culture and combating the propogation of incivility are discussed. Also provided are suggestions around the promotion of clinical leadership by focusing on the impact that clinical leaders can have by taking responsibility for role modelling traditional nursing values (courage, compassion and care) and displaying civil and appropriate positive behaviour to their colleagues.

The nursing workforce, both in Australia and globally, is projected to have unprecedented shortfalls in the future (Department of Health 2014). The forces of incivility, bullying and horizontal violence are compounding staff shortfall issues by seemingly pushing nurses out of the profession (Croft & Cash 2012, Daly et al. 2015).

Civil behaviour can be described as being respectful, honouring differences between one another, actively listening and seeking common ground (Gallo 2012). Safe Work Australia define workplace bullying as, ‘repeated and unreasonable behaviour directed towards a worker or a group of workers that create a risk to health and safety’ (2013, p. 4). Workplace bullying may also be referred to as horizontal or lateral violence (Becher & Visovsky 2012), incivility (McNamara 2012) or workplace harassment (Bowling & Beehr 2006). Despite no universal terminology being evident, all of these terms when enacted, are powerful in their destructive or harmful potential (Hershcovis 2011) and these terms are commonly used interchangeably (Szutenbach 2013), although incivility will be used throughout this paper. A shocking 98% of nurses in some studies have reported some form of incivility (Lee et al. 2014) and significantly, workplace incivility affects more than just the direct victim. Overall, it affects patient outcomes, the quality of patient care, organisational finances and organisational culture (Vessey et al. 2011, Croft & Cash 2012, Farrell & Shafiei 2012, Khadjehturian 2012, McNamara 2012, Daly et al. 2015).

In order to change the passive path of incivility there needs to be an understanding of why it exists, the risks of it continuing and how grass root clinical leaders can lead an approach to changing the current situation.