NURS 6053 WORKPLACE ENVIRONMENT ASSESSMENT PAPER

NURS 6053 WORKPLACE ENVIRONMENT ASSESSMENT PAPER

NURS 6053 WORKPLACE ENVIRONMENT ASSESSMENT PAPER

NURS 6053 WORKPLACE ENVIRONMENT ASSESSMENT SAMPLE PAPER

Template

Use this document to complete the Module 4 Workplace Environment Assessment.

Summary of Results – Clark Healthy Workplace Inventory	On the workplace inventory, scores range from 0 to 100. These scores were obtained from nurses’ responses regarding their perception of the workplace. A score of less than 50 indicates a very unhealthy workplace, 50 to 59 indicates an unhealthy workplace, 60 to 69 represents a barely healthy, 70 to 79 indicates a mildly healthy, 80 to 89 indicates a moderately healthy, and 90 to 100 indicates a very healthy workplace. From the responses, our workplace is moderately healthy with a score of 80 to 89.
Identify two things that surprised you about the results. Also identify one idea that you believed prior to conducting the Assessment that was confirmed.	There is a high level of employee satisfaction, engagement, and morale. There are sufficient resources for professional growth and development. There is an emphasis on employees’ wellness and self-care
What do the results of the Assessment suggest about the health and civility of your workplace?	The responses used to generate the results demonstrate that there is civility in our workplace. However, various factors hinder the management’s desire to achieve high level civility in my workplace. For this reason, there is a need for advanced medical training to ensure general respect and courtesy in speech and behavior
Briefly describe the theory or concept presented in the article(s) you selected. Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.	According to Clark et al. (2011) civility is the general respect and courtesy in speech or behavior. The article discusses various strategies that can be put in place at a healthcare setting to ensure civility and create good working conditions.  On the other hand, incivility is a low –intensity deviant behavior that is capable of causing harm to the people around. Impolite behavior, or attitude among peers displays a lack of regard to colleagues. In the nursing practice, incivility can be dangerous to care givers and patients since it creates an unsafe working environment.  Also it leads to poor patient outcomes and high medical costs. Civility in my organization require various review to reach a maximum to ensure a healthy working environment.
Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.	Civility is an important virtue that my organization can employ to create a good working condition and improve organizational health. Strategies such as stress management programs to healthcare worker, adding civility to the requirements for hiring, assessing the organization to measure civility, and holding people accountable for acceptable behaviors (Griffin & Clark, 2014) . Through these methods the organization will be able to create stronger work teams that can easily achieve the targeted goal.
General Notes/Comments	A very healthy workplace promotes evidence based practice, care coordination, and innovation. Sense of humor, civility, flexibility, positive values, commitment to excellence, and open communication are among the main factors that improves the health of a workplace

References

Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice: Nurse leader perspectives. JONA: The Journal of Nursing Administration, 41(7/8), 324-330. DOI: 10.1097/NNA.0b013e31822509c4

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542. Doi.org/10.3928/00220124-20141122-02

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Incivility in healthcare can lead to unsafe working conditions, poor patient care, and increased medical costs. The authors discuss a study that examined factors that contribute to adverse working relation- ships between nursing education and practice, effective strategies to foster civility, essential skills to be taught in nursing education, and how education and practice can work together to foster civility in the profession.

The work of nursing is 4 times more dangerous than most other occupations,¹ and nurses experience work- related crime at least 2 times more often than any other healthcare provider.² Root causes for workplace violence are multifaceted and include work-related stress due in part to an increasingly complex patient population and workload and deteriorating interper- sonal relationships at the bedside.¹ When normalized or left unaddressed, these uncivil and disruptive

Review of the Literature

Incivility and disruptive behavior in nursing educa- tion and practice are common,^4,9 on the rise,¹¹ and frequently ignored.¹² Two decades ago, Boyer¹³ noted several challenges facing institutions of higher education, including academic incivility. Although incivility in the academic setting is not a new phe- nomenon, the types and frequency of misbehavior are increasing and have become a significant prob- lem in higher education, including nursing educa- tion. Clark and Springer^14,15 explored faculty and student perceptions of incivility in nursing education and found negative behaviors to be commonplace and exhibited by students and faculty alike. The ma- jority of respondents (71%) perceived incivility as a moderate to serious problem and reported that stress, high-stake testing, faculty arrogance, and student en-

titlement contributed to incivility.¹⁴ More than half

haviors may emerge into an incivility spiral, depicted

along a continuum from an unintentional act leading to intentional retaliation, escalating to workplace bul-

4

of the respondents reported experiencing or know-

ing about threatening student encounters between students or faculty.¹⁴

lying and even violence. Incivility and disruptive behaviors have been identified both in the academic^5-7 and clinical settings^8-10; however, no direct study of incivility between the 2 environments has been made.

Author Affiliations: Professor (Dr Clark) and Research Assistants (Mss Cardoni and Kenski), School of Nursing, Boise State University, Idaho; Doctoral Candidate (Ms Olender), Seton Hall University, South Orange, New Jersey, and Executive Con- sultant and Nurse Researcher (Ms Olender), James J. Peters VA Medical Center, Bronx, New York.

The authors declare no conflict of interest.

Correspondence: Dr Clark, School of Nursing, Boise State Uni- versity, 1910 University Dr, Boise, ID 83725 (cclark@boisestate.edu).

DOI: 10.1097/NNA.0b013e31822509c4

A small but growing body of research suggests

that incivility and disruptive behaviors are particu- larly commonplace to the new graduate nurse or nursing student within the clinical setting.¹⁰ Paral- leling incivility in the academic setting, staff nurses are also vulnerable to bullying, defined as negative behavior that is systematic in nature and purpose- fully targeted at the victim over a prolonged time frame with the intent to do harm.¹⁶ These findings are also supported by a recent Joint Commission (TJC) survey¹⁷ reporting that more than 50% of nurses are victims of disruptive behaviors including

incivility and bullying, and more than 90% of nurses stated witnessing abusive behaviors of others in the workplace. Likened to the concept of nurses ‘‘eating their young’’,¹⁸ the findings of several studies suggest that these negative behaviors are a learned process, transferred through staff nurses to new nurses and student nurses via interaction within the hierarchi- cal nature of the profession.¹⁰

Incivility and disruptive behaviors may also be normalized or perpetuated by organizational cul- ture,^12,18 particularly during times of restructuring or downsizing. This is suggested to be secondary to unclear roles and expectations, professional and per- sonal value differences, personal vulnerabilities, and power struggles common within organizations dur- ing periods of change.¹⁸ Other consequences of inci- vility include heightened stress levels, physiological and psychological distress,⁵ job dissatisfaction,^10,19 decreased performance,²⁰ and turnover intention.²¹ Bartholomew¹⁸ noted that uncivil behaviors may contribute to the exodus of new graduates leaving their first job within 6 months. If disruptive behav- iors are tolerated, nurses may leave the profession altogether.²¹ Disruptive and bullying behaviors have been identified as a root cause of more than 3,500 sentinel events over a 10-year time frame²² and con- tribute to an annual estimate of 98,000 to 100,000

patients dying secondary to medical errors in hos- pitals.^23,24 Collectively, these findings led TJC¹⁷ to intervene and release a sentinel event alert calling for zero tolerance of intimidating and bullying behaviors.

Conceptual Framework

Clark⁵ developed a conceptual model to illustrate how heightened levels of nursing faculty and student stress, combined with attitudes of student entitle- ment and faculty superiority, work overload, and a lack of knowledge and skills, contribute to incivility in nursing education. This conceptual model has been adapted to reflect the stressors that contribute to incivility in both nursing education and practice (Figure 1). Factors that contribute to stress in nurs- ing practice are similar to the stressors experienced in nursing education including work overload, un- clear roles and expectations, organizational condi- tions, and a lack of knowledge and skills. Moreover, in both practice and academia, stress is mitigated by leaders who role model professionalism and utilize effective communication skills.²⁵ The importance of modeling effective communication and related edu- cation to address incivility cannot be underestimated, can reduce its incidence and effects,²⁶ and can assist in fostering cultures of civility.

Nurse Leaders’ Survey

Mindful of the need to enhance the culture of civility both in the academic and clinical settings, a descrip- tive qualitative study was conducted. The purpose of the study was to gather practice-based nursing lead- ers’ perceptions about factors that contribute to an adverse working relationship between nursing ed- ucation and practice, the most effective strategies needed to foster civility, the skills needed to be taught in nursing education, and how nursing education and practice can work together to foster civility in the nursing workplace.

Procedure and Analysis

The survey was developed by the author (C.M.C.) and included 4 open-ended questions designed to garner nurse leaders’ perceptions on ways to foster civility in nursing education and practice. The ques- tions were constructed based on a comprehensive review of the literature on incivility and numerous empirical studies. Two other researchers reviewed the survey for content validity and logical construc- tion. Institutional approval to conduct the study was obtained. The surveys were administered to nurse leaders attending a statewide nursing conference using a paper method for gathering narrative, hand- written responses. Once the study was clearly ex- plained, the respondents provided consent and voluntarily completed the survey. Aside from indi- cating their employment position, no demographic information was gathered about the participants. The survey contained 4 questions:

1. What factors contribute to an adverse working relationship between nursing edu- cation and practice?
2. What are the most effective strategies for fostering civility in the practice setting?
3. What essential skills need to be taught in nurs- ing education to prepare students to foster ci- vility in the practice setting?
4. How can nursing education and practice work together to foster civility in the prac- tice setting?

The sample consisted of 174 nurse leaders: 68 (39.1%) nurse executives and 106 (60.9%) nurse managers who were attending a statewide conference held in a large western state. The respondents were recruited by the researcher (C.M.C.), who explained the purpose of the study during the keynote address. The surveys were collected and prepared for analysis. Textual content analysis was used to manually analyze the respondents’ narrative responses. Key words or phrases were quantified by the researchers;

inferences were made about their meanings and cat- egorized into themes. Two members of the research team reviewed the nurse leaders’ comments indepen- dently to quantify the recurring responses and orga- nize them into themes. Then, 2 other research members reviewed the comments. Areas of theme agreement and disagreement were discussed, and verbatim com- ments were reviewed until all researchers were con- fident that the analysis was a valid representation of the comments.

Findings

Analyses of the narrative responses from the partici- pants were organized into themes, ranked in order of the number of responses, and described according to each research question. The first research ques- tion asked nurse leaders to identify factors that con- tribute to an adverse working relationship between nursing education and practice. Both groups identi- fied a noticeable gap between nurses in education and practice (Table 1). Nurse executives reported nurse educators failing to keep pace with practice changes, lacking familiarity with practice regulations and standards, being slow to respond with curricular changes, and a lack of shared goals between nurses in education and practice. Nurse managers reported similar findings, but suggested that a limited number of nursing faculty, a highly stressed work environ- ment, and lack of adequate resources also contributed to adverse working relationships. These reported defi- cits resulted in the perception that students were not being adequately prepared for practice.

The second research question asked the respon- dents to identify the most effective strategies for fos- tering civility in the practice setting. Nurse executives identified 4 major themes, and nurse managers iden- tified 7 themes, listed in Table 2. Strategies that ren- dered less than 10 responses are not listed in the table. For nurse executives, these themes included holding self and others accountable for acceptable behaviors, addressing incivility in nursing education programs, implementing stress reduction strategies, making ci- vility a requirement for hiring, and conducting in- stitutional assessments to measure incivility. Nurse managers’ responses to this question were similar to those of nurse executives. Notable differences between the 2 groups were nurse executives’ recommendations for civility teaching starting at the education level, civility as a requirement for hiring, and ongoing ci- vility assessment. Nurse managers’ responses differing from executives were establishing a healthy work en- vironment, ongoing practice-preparedness education, and reinforcing positive behavior.

Table 1. Factors Contributing to an Adverse Working Relationship Between Nursing Education and Practice^a

1. Educators not keeping current with practice changes (standards and regulations) (39)
2. Lack of communication, collaboration, and mutual curriculum planning between nursing faculty

and staff (16)

3. Lack of preceptor engagement due to stress and workload (23)
4. Lack of shared vision, mission, and goals between practice and education (11)

1. Limited number of faculty and disconnected from practice (40)
2. Highly stressed work environments plagued by rude, uncivil behaviors among members of the health

care team (32)

3. Faculty and staff workload and being stretched too thin (29)
4. Lack of communication, collaboration, and mutual curriculum planning between nursing faculty and staff (21)
5. Lack of adequate resources (human and financial) (18)

^aFactors identified by less than 10 respondents are not included; please see text.

^bThe number in parentheses following the factors indicates the number of times the factor was identified. The number exceeds the number of respondents because of suggestions of multiple factors.

The third research question asked the respon- dents to identify essential skills that need to be taught in nursing education programs to prepare students to foster civility in the practice setting (Table 3).

Nurse executives identified 4 major themes, and nurse managers identified 8 themes. Strategies that rendered less than 10 responses are not listed in the table. For nurse executives, these themes included re- flective practice and critical thinking, respect for di- versity, and stress reduction strategies. Nurse mangers had similar responses for essential skills and also sug- gested critical-thinking skill sets (time management, decision-making, and problem-solving skills), organi- zational culture of civility, and civility education.

The final research question asked nurse leaders for strategies about how nursing education and prac- tice can work together to foster civility in the prac- tice setting (Table 4). Both groups identified 5 major

themes. Once again, strategies that rendered less than 10 responses are not listed in the table. For nurse executives, these themes included making civility a requirement for hiring, teaching conflict resolution and managing difficult situations, implementing stress reduction strategies, and conducting institutional as- sessments to measure incivility. Teaching civility was identified only by nurse executives, and themes iden- tified only by nurse managers were mentorship, pro- fessionalism, and reinforcing and rewarding civility. Nurse managers also suggested focusing on patient care and safety and implementing stress reduction strategies (G10 responses).

At both the organizational level and unit levels,

nurse leaders in practice noted the importance of having a shared vision of civility and underscored the importance of adopting and implementing codes of conduct and effective policies and procedures. Both

nurse executives and managers expressed the need for effective communication and collaboration, pos- itive role modeling, and the importance of vigilant and purposeful hiring with civility in mind.

Discussion

The applicability of Clark and Olender’s (Figure 1) conceptual model for fostering civility in nursing academic and clinical practice environments is supported by the results of this study. Indeed, results suggest an increased awareness of stressors likely contributing to a culture of incivility by these nurs- ing leaders. As depicted in the model, and as Table 2 denotes, the implementation of strategies to reduce stressors (such as policy and procedure, education, and self-care initiatives) is a key objective for the establishment of a culture of civility. A high percent- age of nursing leaders emphasized the importance of a collaborative vision and partnership between educa- tion and practice to meet this goal. This vision could emerge via joint education and practice meetings

that focus on designing up-to-date and relevant cur- ricula that reflectcurrentpractice standards with em- phasis on civility education and teamwork. Ideally, this would result in the development and implemen- tation of comprehensive, well-defined, nonpunitive policies and procedures that focus on civility, are widely disseminated, and have measurable outcomes. An emphasis on individual accountability at all or- ganizational levels, as well as organizational adop- tion of a culture of civility, would be required for policies to be effective. In addition, leadership mind- fulness and intentionality toward positive role mod- eling, professionalism, collaboration,  teamwork, and ethical conduct would be required. Related com- petencies would be reinforced and practiced through simulation and role playing, in real time, and in- clusion of these skills within competency assessment systems.

Our findings lend support to studies indicating that stress is a major contributor to incivility^1,5,14,15,19; thus, it is important to integrate self-care and stress reduction into daily activities. The American Holistic

Nurses Association²⁷ recommends several stress management techniques including enjoying the com- pany of family, friends, and other supportive people; getting regular exercise and adequate sleep; eating healthy foods; and drinking plenty of water. We also suggest lunchtime walking programs, change of shift aerobic classes, meditation, and 5-minute massages. This may also include implementing caring compe- tencies such as empathy, collaboration, and conflict resolution in the work site. Last, Olender-Russo²⁸ suggests creating forums to share success stories and to communicate evidence-based outcomes such as staff and patient satisfaction, low turnover rates, and patient-related adverse events or avoidances both at the organizational and unit levels to sustain work- place civility and staff motivation.

Conclusion

Recent reports of the increasing prevalence of in- civility and related disruptive behaviors within our nursing academic and clinical settings are alarming, especially when considering the impact on patient and staff safety. The old adage, ‘‘it takes a village,’’ rings true when one considers the complexity of the task of fostering a culture of civility. A comparison study with academic nurse leaders could illuminate shared perceptions or alternative ways to foster ci- vility in nursing education and practice.

The model proposed in this study is newly adapted to practice and requires further empirical testing. For example, evidence-based data obtained through in- stitutional assessments, such as the Organizational Civility Scale,²⁹ are needed to measure the organiza- tional culture so that targeted interventions may be implemented and empirically tested. Case study meth- ods may be beneficial to showcase best practices.

Researchers also suggest that negative behaviors in the workplace may be a learned process and likely exacerbated within stressful academic and clinical set- tings.¹² Conversely, fostering civility in nursing edu- cation and practice may also be a learned process and, as such, amenable to positive interventions. Nurse leaders need to be extremely attentive and supportive toward the success of the nursing practice and nurs- ing education partnership for the cocreation and sus- tainment of a healthy work environment. Indeed, the promotion of a positive organizational culture has been shown to be a successful strategy and is asso- ciated with increased nurse manager engagement in authentic leadership.²⁵ As healthcare providers, we all have an ethical responsibility to care for those who care for others. Specifically, nurse leaders must create and promote a work environment conducive to caring. This includes fostering a culture of civility both within the academy (where nursing learning begins) and within practice environments (where learning of nursing continues).

References

1. Gallant-Roman Strategies and tools to reduce workplace violence. AAOHN J. 2008;56(11):449-455.
2. Dunhart National Crime Victimization Survey: Violence

in the Workplace, 1993-1999. Washington, DC: US Depart- ment of Justice; 2001:1-12. Available at http://bjs.ojp.usdoj. gov/index.cfm?ty=pbdetail&iid=693. Accessed June 19, 2011.

3. Anderson LM, Pearson CM. Tit for tat? The spiraling effect of incivility in the Acad Manage Rev. 1999;24(3): 452-471.
4. Hutton S, Gates D. Workplace incivility and productivity losses among direct care AAOHN J. 2008;56(4):168-175.
5. Clark The dance of incivility in nursing education as de- scribed by nursing faculty and students. Adv Nurs Sci. 2008; 31(4):E37-E54.
6. Clark CM. Faculty and student assessment and experience with incivility in nursing education: a  national  J Nurs Educ. 2008;47(10):458-465.
7. Luparell The effects of student incivility on nursing faculty.

J Nurs Educ. 2007;46(1):15-19.

8. Olender-Russo L. Reversing a bullying culture. RN. 2009; 72(8):26-29.
9. Randle  Reducing  bullying  in  healthcare  organisations.

Nurs Stand. 2007;21(22):49-56.

10. Simons Workplace bullying experienced by Massachusetts registered nurses and the relationship to intention to leave the organization. Adv Nurs Sci. 2008;31(2):48-59.
11. Lipley N. Bullying at work on increase, Royal College of Nursing survey Nurs Manage. 2006;12(10):5.
12. Lewis MA. Nurse bullying: organizational considerations in the maintenance and perpetration of health care bullying Nurs Manage. 2006;14(1):52-58.
13. Boyer EL. Campus Life: In Search of Community. San Francisco, CA: The Carnegie Foundation for the Advancement of Teaching;
14. Clark CM, Springer PJ. Incivility in nursing education: descriptive study on definitions and J Nurs Educ. 2007;46(1):7-14.
15. Clark CM, Springer Thoughts on incivility: student and faculty perceptions of uncivil behavior in nursing education. Nurs Educ Perspect. 2007;28(2):93-97.
16. Hutchinson M, Vickers M, Jackson D, Wilkes L. Workplace bullying in nursing: towards a more critical organisational Nurs Inq. 2006;13(2):118-126.
17. The Joint Behaviors that undermine a culture of safety. Sentinel Event Alert. July 9, 2008; issue 40. Available at http://www.jointcommission.org/assets/1/18/SEA_40.pdf. Accessed June 19, 2011.
18. Bartholomew K. Ending Nurse to Nurse Hostility: Why Nurses Eat Their Young and Each Other. Marblehead, MA: HCPro;
19. Vessey JA, DeMarco RF, Gaffney DA, Budin Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. J Prof Nurs. 2009;25(5):299-306.
20. Cortina LM, Magley VJ, Williams JH, Langout Incivility in the workplace: incidence and impact. J Occup Health Psychol. 2001;6(1):64-80.
21. Duffield C, O’Brien-Pallas L, Aitken L. Nurses who work outside of nursing. Nurs Health Care Manage Policy. 2004; 47:664-667.
22. Healthgrades, Healthgrades Seventh Annual Patient Safety in American Hospitals Study. March 2010. Avail- able at http://www.healthgrades.com/media/DMS/pdf/ PatientSafetyinAmericanHospitalsStudy2010.pdf. Accessed June 19, 2011.
23. Institute of To Err Is Human: Building a Safer

Health System. Washington, DC: National Academy Press; 2000.

24. Institute for Safe Medication Practices. Results from ISMP survey on workplace intimidation. Available at http://ismp.org/ Survey/surveyresults/Survey0311.asp. Accessed June 19, 2011.
25. Shirey MR. Authentic leadership, organizational culture, and healthy work environments. Crit Care Nurs Q. 2009;32(3): 189-198.
26. Griffin Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. J Contin Educ Nurs. 2004;35(6):257-263.
27. American Holistic Nurses Holistic stress manage- ment for nurses. Available at http://www.ahna.org/Resources/ StressManagement/tabid/1229/Default.aspx.  Accessed June 19, 2011.
28. Olender-Russo L. creating a culture of regard: an antidote to workplace Creat Nurs. 2009;15(2):75-81.
29. Clark CM, Landrum Organizational Civility Scale. Avail- able at http://nursing.boisestate.edu/civility/research-instr.htm. Accessed June 19, 2011.