Civility and incivility between nurses and administrators: A model to drive successful health care outcomes in the Department of Veterans Affairs

Through an evidence-based synthesis, this research explores civility and incivility in the nurse-administrator relationship using the social ecology and symbolic interactionism theories to create a model that explains the concepts and provides a method for addressing incivility and instilling civility in the nursing units of VA.Civility and incivility between nurses and administrators: A model to drive successful health care outcomes in the Department of Veterans Affairs Lisette Montalvo Advisors: Professors Dr. Dennis Winter and Dr. Sharon Hadary Fall 2012 Purpose and Scope of Research Purpose: 1) To develop a comprehensive understanding of the concepts of civility and incivility as applied to nursing practice in the Veteran’s Administration to improve health care outcomes; and 2) To create a model to address incivility and instill civility in the nursing units of VA. Scope: Through an evidence-based synthesis, this research explores civility and incivility in the nurse-administrator relationship using the social ecology and symbolic interactionism theories to create a model that explains the concepts and provides a method for addressing incivility and instilling civility in the nursing units of VA. 2 Personal Reasons for Research Topic During a flight from DC to Texas, I read the book “The Cost of Bad Behavior” by Andersson and Porath about incivility in the workplace. This topic resonated to me since I have witnessed and experienced incivility in the workplace. While in Texas, Dr. Hadary called me and asked which topic I wanted to pursue. She advised me to select something about which I am passionate. I stated ,“incivility”. The topic was new to me. With Dr. Hadary’s and Dr. Winters’ guidance, I started a fascinating path of knowledge and self discovery that led to my dissertation. 3 Importance to Management Practice Incivility has been linked to: • Increase in EEO claims . (2,010 cases with a cost of $14,269 in 2010) • Increase nurses’ turnover during a severe nurse shortage . (Average cost of $99,000 per nurse) • Non compliance with Join Commission of Hospital Accreditation Standards . • Decreased quality of patient care. Civility leads to: • Increased productivity. (Estimated at $6,677 per nurse) • Employee retention. • Increased satisfaction with care received. • Reduction in EEO cases workload. 4 Line of Argument Civility and incivility model Civility and incivility effects Framework to address incivility and instill civility Concept, definitions, and behaviors Interpersonal and intrapersonal factors Environmental factors 5 Most Important Theoretical Frameworks 1) Socioecological theory – Elton (1927) defined ecology as “the study of animals and plants in relation to their habits and their habitats” (Colinax, 1986) Levels of influence Intrapersonal factors 6 2) Symbolic interaction- developed by Mead (1934), Blummer (1986), and interpreted by Charon (2007), where communications are treated as a medium through which determinants of behavior pass to produce the desired behavior (Blumer, 1969) Research Questions 1) How does civility and incivility in the relationship between nurses and administrators affect the health care outcomes and productivity in the nursing units of VA? 2) What is the model that leaders can use to create a workplace characterized by civility, thereby improving health care outcomes and productivity? 7 Research Propositions Proposition number 1: There are the definitions of civility and incivility specifically related to nursing practice with specific behavioral components associated to them. Proposition number 2: Civility and incivility affect administrators, nurses, and patients. Proposition number 3: The prevalence, reporting, and effect of incivility in the nurse-administrator relationship are directly connected to the power and close proximity of their work relationship. 8 Primary Practitioner Scenario (Scenario paraphrased from Vickers, 2006, p.10) Claudia (Administrator) – “Where is Leanne?… I told her to move everyone down this end 20 minutes ago. Where is she? What is she doing?” Spectator (patient) – The instigator of the ruckus pulls off her latex gloves with considerable vigor and throws them impatiently in the bin provided. Her hands move promptly to her hips. The junior nurse she has addressed looks rather nervous and scurries off to the “other end.” Claudia in front of all the patients, starts to go on and on to a third nurse about “that Leanne…I told her to move the patient down… I am sick and tired of Leanne’s behavior… Leanne is hopeless,” etc. A third nurse trying to engage Claudia was ignored. Claudia – “I don’t care!” (Her body language depicted her increasing anger.) 9 Main Literature Themes & Authors Incivility definitions and effects – Andersson, Porath, and Pearson Civility definitions and effects – Hughes, Jenkins, and Forni VA specific literature and data on civility and incivility – Laschinger, Oore, Furst-Holloway, and Carameli Aggression learning theory – Bandura Social-Cognitive Information Processing – Husseman 10 Warrant 11 Unaddressed incivility Increase turnover Increase EEO cases Decreases mental health Decreases physical health Decreases quality of patient care Increases stress Decreases job satisfaction Undermines self efficacy Conceptual Framework 12 Conclusions • Incivility concept is more mature among researchers than civility, which remains in its paradigmatic infancy. • Uncivil behaviors specific for nursing: Acting in an impatient manner; being unable or unwilling to empathize with others; critical of students or other staff; displays of temper; tantrums; making unreasonable demands; rumor mongering and gossiping; staff splitting and polarizing some staff members against others; and talking negatively about others. •Civil behaviors: Expressing appreciation; trust; integrity; respect; transparency; honesty; responsibility; respecting one another and honoring differences; listening and seeking common ground; engaging in social discourse and appreciating its relevance. •Literature does not have evidence of a program to report and address incivility. Targets avoid reporting incivility incidents for fear of retaliation. •Civility is not the lack of incivility; the constructs have a weak statistical relationship. •Nurses’ civility has an effect on patients’ perception of care received; changes in administrators’ civility over time have a strong statistical significance with nurses’ perception of patient care provided. •The model created demonstrates how to create a civil workplace. 1