Manager's Soapbox
Changing to a culture of workplace civility
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Judith (Ski) Lower, RN, MSN, CCRN, CNRN Critical Care Nurse Representative Maryland Nursing Workforce Commission |
Research studies documenting the harmful effects of disruptive workplace behaviors should serve as a wake-up call for managers responsible for retaining experienced perioperative nurses and ensuring safe care for surgical patients. After nurses in Maryland told us lack of respect was in their top three workplace dissatisfiers, a committee under the Maryland Commission on the Crisis in Nursing researched the literature to see how that affects the nursing shortage and found a big problem.
Some veteran nurses said they were ready to walk away from their jobs if their work environment didn't change. Even worse, others said they would stay on the job and put up with colleagues' verbal, physical, even sexual abuse, intimidation and other disrespectful behaviors.
We know that intimidated nurses will avoid communicating with surgeons and other physicians. If nurses don't feel able to speak up as the patient's advocate, questioning inappropriate orders, etc., communication—the No.1 failsafe method for ensuring safe patient care—is compromised. Disruptive behavior in the workplace also has a huge impact: nurses calling in sick, decreased productivity, increased medication errors and even malpractice consequences.
We asked the Maryland Hospital Association to obtain copies of existing policies and codes of conduct in use in hospitals in our state. And we found from interviews with nurses that there was a lack of enforcement of such policies.
We decided to work on a blueprint hospitals could use to begin to change a workplace culture of disrespect to one characterized by "civility." We chose the term "civility" over "respect" because "respect" has to be earned, and we felt a civil work environment should be a right. You can't just order people to do it.
How do you define "civility" in the workplace? We chose three key positive characteristics: showing respect for others, causing them to feel valued and contributing to mutual respect and team collaboration.
We found that trying to fix the issue by simply instituting codes of conduct or decreeing from above that it must be done isn't enough. Our blueprint for culture change includes seven challenges that have to be overcome:
- Increasing awareness of the issue of disrespectful workplace behaviors. Survey a multidisciplinary team. The results will give you the data needed to analyze stress factors: staffing, assignments, caseloads, patient acuity, etc. Ask student nurses who come to your facility for practicums; they have a great insight into the civility of your work environment. Hold open forums and dialogues to allow free discussion of related topics, and invite in guest speakers on disruptive behaviors.
- Creating an institutional framework that identifies expected behaviors at all levels. Get this across to new staff when they first enter your workforce. Include a statement about civility in the workplace in your mission statement. Re-examine your code of conduct. It should state that civility is your professional responsibility.
- Defining a program and processes to operationalize your framework. Appoint a multigenerational, multidisciplinary committee to manage your program. Define a clear system for reporting and responding to incidents of disrespect, and create mechanisms for offering support to staff who are involved in such incidents. Identify and work toward breaking down barriers to the process: administrations that won't discipline physicians who bring in a lot of money, RNs who fear confrontation and escalation of disrespectful incidents.
- To build trust in your new system, develop and enforce a policy that doesn't tolerate disruptive behavior. Assure all of confidentiality of information they submit but not necessarily anonymity. You have the right to face an accuser. Limit direct contact between parties while working out solutions.
- Educating everyone on the program, reporting mechanisms and specific programs for teams or individuals. Schedule opportunities for classes on assertiveness, conflict resolution, interpersonal relations in the workforce, customer service, enabling behaviors, etc.
- Maintaining momentum until an actual change in culture occurs. Make use of the "greatest management principle"—"What gets recognized and rewarded gets repeated." Advertise widely outstanding examples and exemplary behavior.
- Marshaling external support for your endeavors. Work with professional organizations, including AORN, state nurse associations and others, to develop friendly hospital work criteria. For instance, a 2006 American Nurses Association paper on workplace abuse and harassment of nurses called for zero tolerance.
Of course, a disrespectful workplace can't be fixed overnight, but managers can't afford to sit on the fence on this issue. You have to take that first step. We baby boomers often tolerated this in the workplace. GenXers didn't tolerate it but didn't really know what to do about it. Be warned: GenYers absolutely won't tolerate it. Civility is not just about being nice; it is about ensuring the safety of our patients and the retention of our staff by creating healthy work environments.
"Ski" Lower, who managed the Neuro Critical Care Unit at Baltimore's Johns Hopkins Hospital for 24 years, was known for creating an environment in which nurses were empowered not to tolerate abusive behavior. A nurse for 43 years, Lower "retired" from her full-time job in August 2005 but served on the Maryland Commission on the Crisis in Nursing from 2000-2005 and continues as a critical care nurse representative on the new Maryland Nursing Workforce Commission. She devotes her time to consulting and lecturing, including at AORN's professional education conferences.
Read more stories in this issue.