04 April 2016

When people behave badly: How to recover if you're the target

For well over a decade, I have studied and contributed to the body of science on fostering civility, and creating and sustaining healthy workplaces. The utter cruelty of certain individuals never ceases to amaze me. Fortunately, the vast majority of people are respectful and civil. Yet, sadly, others treat people with disdain and contempt. I am often asked what motivates people to behave badly. It’s not a simple question to answer. Although there are reasons behind negative and harmful acts, some of which make sense, others simply fail to explain disrespectful human interaction.

For example, do you consider yourself a reasonably respectful or civil person? Most of us would say yes. If this is true for you, here’s another question: Have you ever been rude or disrespectful to someone? If you are like every other human being, the answer to the second question is also yes. So then the question becomes, why would an otherwise civil or respectful person behave rudely or badly?

Stressed out
Very often, the answer is, “Because I’m stressed out.” I agree; heightened levels of stress brought on by any number of life’s demands often account for much incivility. Stress may be caused by the challenges of managing the myriad roles and responsibilities associated with family, work, and life in general. Being overworked, underpaid, and sometimes unappreciated also may contribute to increased stress. While not acceptable, responding rudely in highly stressful situations is more easily understood than other forms of incivility.

–  People Images
In the workplace, incivility can add tension to an already highly stressed environment, and its potential impact cannot be overestimated. Being treated badly or in an uncivil manner, particularly over time, can have devastating results. In a practice-based discipline, such as nursing, this is especially troubling, because incivility can weaken confidence and moral courage, impair clinical judgment and reasoning, create vulnerability and self-doubt, and cause anxiety, resentment, and anger. Ultimately, it can negatively impact patient care.

Stress is not the only contributor to incivility. I’m reminded of a story told to me by a nursing instructor in her mid-50s. She was so excited because she had finally, after much soul-searching and research, decided to pursue a doctoral degree. She could hardly wait to share her excitement and ideas with her program director. When she had an opportunity to meet with the director and disclose her scholarly intentions, the director laughed and said: ‘‘Are you kidding, at your age? You can’t be serious. By the time you finish your degree, you’ll be ready to retire. We prefer to invest in younger faculty.”

The exchange left the instructor feeling demoralized and diminished, and she decided to forgo pursuing the doctoral degree. Whether the director’s comments were intentionally or unintentionally delivered, the result was the same. A talented and energetic faculty member was left to feel devalued and unimportant.

Rank rankism
This example illustrates the negative impact that low emotional intelligence, ineffective communication skills, and an attitude of superiority—a sense of power over—can have. The instructor in this story is the target of rankism, a term coined by Robert W. Fuller, PhD, former president of Oberlin University. In his book, Somebodies and Nobodies: Overcoming the Abuse of Rank, Fuller tells us that "rankism" lies at the heart of discriminatory behavior, is evident in nearly every institution in society, and occurs when people abuse their power to demean and disadvantage those they outrank.

Intended or not, disrespectful and rude behavior toward others may indicate prejudice and rise to the level of discrimination—in some cases, outright abuse. The antidote to rankism is to foster work environments based on human dignity for all. It is abuse of power and rank—not power and rank per se—that damages relationships and puts people at a disadvantage.

Those who are targets of rankism and other forms of incivility often describe their experiences in vividly emotional ways. Many are still negatively impacted by their uncivil experiences, even when the encounters occurred years before. Some people describe intense psychological symptoms, such as feeling traumatized, helpless, and powerless. Many feel caught in a no-win situation, with little possibility of successful resolution. The lingering effects of incivility can cause serious and sometimes lasting psychological and physiological effects.

Although each of us deserves to be treated with dignity and respect, people report varying degrees of discomfort when addressing conflict and incivility. For further discussion of this topic, read my two-part series on conflict negotiation.

If you have been the target of repeated incivility or bullying, attending to your physical, emotional, and spiritual health is a critical first step. It may be necessary to see your healthcare provider or seek counsel from a mental health expert. Getting yourself physically and emotionally prepared to deal with the problem will require you to be in a healthy state. When reporting a problem, it’s important to follow confidential policies, procedures, and guidelines (assuming they exist). In any case, inform your employer or supervisor about the problem, and request institutional support. Be sure that human resource and employee-assistance program personnel have your best interest in mind and are poised to assist you in following healthy workplace policies and procedures.

10 tips for recovery
For anyone who experiences incivility, either inside or outside the workplace, it is imperative to reverse the negative effects it can have on his or her physical, emotional, and spiritual well-being. If you have been the target of bad behavior, here are 10 tips for successful recovery.

1. Share your story with a good friend, family member, mentor, counselor, or member of the clergy. Avoid sharing your experience with co-workers. Instead, seek support from those who can offer a more objective perspective, such as an ombudsperson, conflict negotiator, or civility coach. Relating the experience and sharing it with others can provide healing. However, avoid dwelling on it too long. Tell your story, validate that it occurred, and make a plan to move forward.

2. Journal about your experience. For many people, writing their story and reflecting on it can be therapeutic and may help provide insight.

3. Engage in activities you enjoy, and don’t retreat from relationships that matter to you. Continue to make time for exercise, friends, family, pets, and social activities.

4. Enjoy a massage, meditation, yoga, deep breathing exercises, and other relaxation techniques.

5. Get plenty of sleep, stay hydrated, and eat a well-balanced diet.

6. Get (or stay) involved by helping a friend, neighbor, or co-worker. Volunteer in the community, or champion one of your favorite causes.

7. Focus on building resiliency. No one size fits all, so find the plan that works for you. Surround yourself with positive people and with those who bring you joy.

8. Try to find meaning in stressful or traumatic events and experiences, and incorporate this meaning into moving forward.

9. Recognize what makes you uniquely strong, and own it! Don’t let others define you. Memorize and practice reciting a positive script, such as: “I am poised, balanced, and in control of my life. I am talented, courageous, and confident in my ability to succeed.”

10. Remember, symptoms of distress can last from a few days to many months, and recovery takes time and progresses at varying paces and degrees. If symptoms are persistent, you may need to talk with an expert. Don’t hesitate to reach out for support if you need it.

Clark, C.M. (2008). Student perspectives on incivility in nursing education: An application of the concept of rankism. Nursing Outlook, 56(1), 4-8.

Fuller, R.W. (2003). Somebodies and nobodies: Overcoming the abuse of rank. British Columbia, Canada: New Society Publishers.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

11 February 2016

Conflict negotiation, Part 2

Most people recognize that direct communication may be the most effective approach to resolving conflict, but are reluctant to address issues head-on. If you do decide to address a conflict, be sure to plan wisely. Create emotional and physical safety by selecting a proper setting for your conversation. Both parties need to agree on a mutually beneficial time and place to meet. Select a quiet venue conducive to conversation and problem-solving. You should be well rested, and the encounter should take place in a private area away from other people, where you’ll be free of interruptions. If desired, a third person can be invited by either side to listen in or mediate.

Goals and ground rules
Be sure to co-create goals and ground rules (i.e., speaking one at a time; addressing one another directly; using a calm, respectful voice; avoiding personal attacks; sticking to objective information, etc.). Also, be sure to test your assumptions since they may be wrong. This can be accomplished by asking clarifying questions, such as: “I’m gathering from our conversation that you’re concerned about my performance. Is that the case?” Or, “I’m inferring from this exchange that you question my intention. Is that correct?” Asking clarifying questions helps clear the air and establish mutual understanding.

Conversations that involve criticism can be stressful, so prepare by being well-hydrated, rested, and as stress-free as possible. Do some deep breathing exercises or yoga stretches before the meeting. When the meeting starts, listen carefully, and show compassion and genuine interest in the other person. Stay focused on your purpose, maintain eye contact, and avoid being judgmental.

I also suggest using evidence-based models for framing conversations that address conflict. Below, I have provided two common workplace scenarios using two different approaches to conflict negotiation. The first scenario, based on a framework suggested by Casperson (2014), demonstrates addressing conflict “in the moment.” The second scenario, which uses the DESC model offered by TeamSTEPPS, demonstrates a more planned approach.

Casperson’s framework
Dana Casperson suggests the following approach for opening a conversation in which you address conflict: When (identify the triggering event) happened, I felt (identify the negative emotion you experienced) because my (identify your specific need or interest) is really important to me.

Workplace scenario: You are a member of a work team in a health care organization. Some team members engage in negative gossip and spreading rumors. You believe you have been the target of these behaviors and, one day, when you approach the lounge, you hear your name mentioned in a derogatory way. As you enter, the room falls silent. You decide to address the situation.

A Casperson response: When I approached the lounge, I heard my name mentioned in a negative light. It concerns me because being accepted as a valued member of the team is important to me. In the future, please speak with me directly if you have something to say about me.

The DESC model
DESC stands for: 1) Describe the specific situation. 2) Express your concerns. 3) Suggest other alternatives. 4) Consequences stated.

Workplace scenario: You and a colleague, Professor Grey (referred to as Terri in the response below), are team-teaching a nursing course. The two of you become engaged in passionate disagreement over specific content to include in or exclude from the course. As a result, working together has become very stressful. You are actively avoiding Terri, and you notice she does not reach out to you as often as before. To make matters worse, students are beginning to suffer the consequences of this alienation and are becoming confused and frustrated. You realize something needs to be done to resolve the situation.

A DESC response: Describe: Terri, thank you for meeting with me. I’d like to share an observation with you about the course we are co-teaching. Explain: I realize we have differences about our course content, and I’m concerned that this disagreement has begun to impact our relationship as well as our students’ ability to learn. Suggest: Because we both genuinely care about our students, it’s best if we can work out our differences. Consequence: Let’s use our course outcomes and objectives as criteria to address the situation. That way, we’re more likely to be successful in reaching agreement.

These conversations are not for the faint of heart. They require courage, preparation, and follow-through. If you feel that taking a direct approach with your co-worker is just too difficult, enlist the support of a trained expert or your supervisor in reconciling the problem. After discussing it, ask him or her to practice addressing the situation with you.

Either way—the Casperson approach or the DESC approach—taking action to address a conflict is not an easy or stress-free decision to make.

Caspersen, D. (2014). Changing the conversation: The 17 principles of conflict resolution, New York: Penguin Books.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

25 January 2016

Conflict negotiation, Part 1

Twenty years ago, I read an excellent book authored by scholars from the Higher Education Research Institute (HERI, 1996) at UCLA. In describing a social change model of leadership development, they identified ability to engage in “controversy with civility” as an essential element. Conflict, they suggested, often implies competition or disagreement that involves potential aggression, and the term frequently conjures up the notion of winners and losers. Controversy, on the other hand, implies disagreement that has potential for positive outcome resulting in a solution that is beneficial to all.

For controversy with civility to occur, observed the scholars, parties to the disagreement must accept two fundamental premises: 1) Differences of viewpoint are inevitable, and 2) resolution of opposing points of view requires that both positions be aired honestly but with civility and openness. Whether one uses “conflict” or “controversy with civility” when referring to disagreement, both terms, it should be noted, describe natural and normal processes which, when managed well, can lead to creative problem solving. This is particularly true when problem solving occurs in an atmosphere of civility, collaboration, and with intent to achieve common purpose. Successful negotiation of either conflict or controversy requires listening well and setting ground rules—rules of engagement—that provide a platform for acceptable conduct and interaction.

You don’t have to be mean to be a leader!
The relevance of the HERI publication I refer to above resonates even more for me today as I consider the political rhetoric surrounding the 2016 U.S. presidential campaign. I passionately believe that positive and effective leadership only occurs in a context of civility, ethical conduct, and professionalism. Some years ago, I developed the acronym PEAK—Principled, Ethical, Authentic, and Kind—to describe that kind of leadership.

Leading with civility and kindness is not a sign of weakness, nor is it a philosophical abstraction. Rather, it is living and leading by a durable code of moral and principled behavior that is applied in everyday life. True leadership calls for strong commitment to ethical conduct and ability to empathize with others. As I reflect on some of the comments made during the current campaign season, I am reminded of a quote by Eric Hoffer, who said, “Rudeness is the weak man’s imitation of strength,” and another quote by Tennessee Williams, who quipped, “All cruel people describe themselves as paragons of frankness.”

Not all conflicts are created equal.
In my work as a consultant, mastering the skills of conflict negotiation often tops the list of skill-building requests. While many of us recognize that conflict can be a positive experience when it is addressed directly, we often avoid it, especially if a situation has evolved over time and bad feelings have built up, resulting in a breakdown of communication and damaged relationships. In some cases, individuals avoid dealing with conflict because they lack the requisite skills or are unable to create the emotional “safe space” needed for effective dialogue and conflict resolution.

Other reasons for avoiding conflict include believing that mentioning the conflict or attempting to resolve it may put one’s position or job at risk. Not all conflicts are created equal. Some may be resolved with a brief conversation that clears up misunderstandings, but others require work, energy, and willingness to revisit a painful issue. It is important, therefore, to decide which conflicts to address and which ones to let go.

Effective conflict negotiation requires that you carefully analyze your level of interest in the other party, and how important it is to you to resolve the conflict. For example, if the issue is not of high interest to you or you are not deeply vested in the other party, the effort required to resolve the conflict may not be worth it. However, if the issue is of high interest to you and you are also highly vested in your relationship with the other party, it is probably in your best interest to attempt to resolve the problem, especially if both parties care about the results. It’s important to realize that some problems or issues may never be resolved.

Ask yourself these questions.
Before engaging in conflict negotiation, ask yourself the following questions: How important is your relationship with the other person? If you are able to resolve the conflict, how much will it affect your working relationship now and in the future? If you don’t address the conflict, will it negatively affect your ability to work with this person now and in the future? How likely is it that the conflict will be resolved and the relationship improved? What are the potential costs and benefits of addressing the situation?

Once you have carefully considered these questions and have decided to address the conflict, it is important to reflect and consider how you may have contributed to the situation. Many times, people will say, “I had nothing to do with this conflict, and the other person is to blame for the problem.” In most cases, this is not a true assessment. Even when it might be true, it’s still important to consider the other person’s point of view regarding your role. Doing so will help you develop an understanding of that person’s perspective.

Higher Education Research Institute (1996). A social change model of leadership development guidebook. Version III. Los Angeles, CA: Author.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be published.

13 November 2015

Beating the burden of burnout

It’s amazing to me that, not long after the start of a new academic year, many nursing faculty members are overwhelmed by stress with some nearing a state of burnout. During a lunch break at a recent nursing conference, I chatted with nurse educators from around the country. The conversation centered on their myriad work responsibilities and heightened levels of stress. Seated around the table, they described how each minute of every day seems to be filled with an endless list of family, life, and work responsibilities. They lamented the long work hours invested in preparing for classes, grading assignments and exams, meeting with students, engaging in committee work, working on scholarly activities, providing service, teaching—both classroom and clinical—and fulfilling a number of other responsibilities.

Manuel Faba Ortega
One professor commented: “It’s only the first month of classes, and I am completely exhausted. I’m teaching two 12-hour clinical days and an extra class as an overload assignment because we have unfilled faculty positions, and there is no one else to teach the class. I’m also enrolled in a DNP program, because our university requires all faculty members to obtain a doctoral degree. We have a new director, and she has asked me to take on some of the school’s administrative responsibilities, which I have agreed to do. On top of everything, our current cohort of students is more challenging than ever, and I am completely drained.”

Too busy for self-nurturing
Concerned for her, I asked: “What are you doing for yourself? How are you nurturing your body and spirit?” She looked at me with a perplexed expression and said, “To be perfectly honest, I am doing very little, if anything, to nurture myself. I’m just too busy.”

Unfortunately, this story is not uncommon. I often ask nurses, nurse faculty members, and nursing students the same question, “What are you doing to nurture yourself?” Sadly, the vast majority of respondents say they are working so hard and moving in so many directions that self care has taken a back seat to responsibilities that often overwhelm them.

This is deeply concerning, because lack of self care takes a significant toll on personal, physical, emotional, and spiritual well-being, and it can have a potentially negative impact on our ability to care for others, including patients. The pressure created by competing demands from family, work, and life responsibilities can cause stress and maybe even burnout.

Obviously, stress will always be a part of our lives, and mild stress levels can actually give us an edge and help us mobilize for action and achievement. However, too much stress, especially if prolonged and coupled with poor coping habits, can cause physical, emotional, and spiritual fatigue as well as ill health. Common signs and symptoms of stress overload include accumulation of belly fat, interrupted sleep, fatigue, irritability and anger, and lack of interest. Mental health problems, such as increased anxiety and depression, may result, and it’s not uncommon for stomachaches, headaches, intestinal problems, and cardiac changes to manifest when stress levels are heightened and prolonged.

A few questions to ask
For some, burnout may also occur. Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. When we are burned out, we feel overwhelmed, depleted, unproductive, unhappy, unappreciated, and too tired to function. To determine if you might be experiencing burnout, ask yourself a few questions:
  • Do you have difficulty getting out of bed and feeling excited about your day?
  • Do you become irritable or impatient with students, coworkers, or patients?
  • Do you lack energy and feel disillusioned about your work?
  • Are you using unhealthy coping strategies, such as spending hours watching TV or browsing the Internet, or using drugs, food, or alcohol to feel better?
If so, you may be experiencing or approaching a state of burnout.

While eliminating stress is impossible, minimizing it and engaging in self-care techniques can be extremely helpful and ultimately important in achieving an overall state of wellness. So, take a minute to jot down your favorite stress busters and most effective stress-reducing techniques. Some of us benefit from physical exercise and activities, such as yoga, meditation, progressive relaxation, deep breathing, and enjoying music or the outdoors. Spending time with family, friends, and pets, eating nutritious foods, and getting enough rest also help reduce stress.

While these stress-management techniques can be helpful—and I certainly recommend them—real and lasting change comes from identifying the sources of our stress and creating an intentional plan to deal with them. It may be helpful to carry a small notebook or make a note using your smartphone to record events or situations that cause you stress. After a week or two, you will likely gain a clear picture of where your stress is coming from and how you might address it.

Putting yourself first essential
After reviewing your personal list of stressors, identify those that you can do something about and those that are out of your control. For example, you may be stressed by your work commute. Is there a way to change the method, timing, or route of your commute to reduce your stress? If so, this is something within your control. If you identify a stressor that you cannot effectively eliminate—caring for a child with a disability, for example—perhaps there are ways to reduce the stress involved. In the case of a child with a disability, are there other people or community resources available that can share your care responsibilities and thereby lessen your stress?

Regardless of the sources of your stress—whether you can change them or not change them—putting yourself first is essential. This is not a selfish endeavor. By taking care of yourself, you can better attend to the needs of others. Enter “me time” into your calendar and regard that time as important as any other work meeting or event. Resist the urge to cancel “me time,” because the healthiest way to cope with stress and burnout is to take excellent care of yourself.

Managing your time well and staying organized can also be stress-reducing. Start each day with a “to-do” list and arrange them by priority—from high to low. Consider dropping low priority tasks altogether by rescheduling them for completion sometime in the future, or better yet, when possible, delegate those tasks to someone else. Resist multitasking and the urge to immediately respond to every text or email message you receive. Prioritize the messages, and, if possible, save them to a folder to be addressed when you have more time.

“Unplug” from your phone, television, computer, and other distractions to enjoy a moment of peace and quiet. Take a deep breath, and clear your mind. When life is busy, we often get distracted and lose connection with those we care about most. Schedule a date night with your partner, enjoy lunch or a power walk with a friend, or spend time with your furry friends. Avoid negative people as much as possible, and surround yourself with those who bring fun and laughter into your life. Take time off, or schedule a mini-vacation. Whatever you decide to do to de-stress, remember, you deserve it!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not b posted.

28 August 2015

Civility, an ethical imperative

Everyone should choose to practice civility. For nurses and the nursing profession, however, it is imperative, an ethical requirement. According to the American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements (2015), all nurses regardless of setting or position have an ethical responsibility to create and sustain healthy work places and to foster an atmosphere of dignity and regard for all. The code is clear: “The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect. … Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors” (p. 4).

Moreover, Provision 7.2 of the code states: “Academic educators must also seek to ensure that all their graduates possess the knowledge, skills, and moral dispositions that are essential to nursing” (p. 28). Therefore, it is incumbent upon nurse educators in all levels of nursing programs to model ethical conduct, professionalism, inclusion, and civility. They must take the lead in preventing and addressing acts of incivility, set the tone by incorporating civility as a shared value within their programs, and prepare students to effectively address incivility and foster safe, healthy work environments. The stakes are high. Safe patient care hinges on our ability to self-reflect and accurately assess our own behaviors, effectively manage our emotions, and communicate respectfully.

For several years, I have intentionally integrated professionalism and civility content into my courses. Students and faculty members must engage in deliberate conversation about these topics, identifying and practicing specific strategies to foster civility. One exercise I like to use is having students complete the Clark Workplace Civility Index. During this carefully arranged activity, each student assesses his or her own perceived level of civility as well as the perceived civility level of another student with whom he or she is familiar and has built an adequate level of trust. They then candidly—and privately—share their insights with one another.

The evidence-based, 20-item questionnaire is designed to assess civility, increase self-awareness, generate discussion, and identify ways to enhance individual and collective civility acumen. The index includes assessing behaviors such as treating others with respect, keeping confidences, avoiding gossip and spreading rumors, using respectful communication, taking personal responsibility, and being accountable for one’s actions.

In addition to completing the index and discussing the issues it raises, each individual makes a firm commitment—in writing—to behave in a civil, respectful, and ethical manner. After completing the index, I recently asked a group of approximately 100 nursing students the following question: “What specific individual action can you take to foster a civil, healthy work environment?” The responses were impressive and, in some cases, inspirational.

Here are the top 10 responses:
  • Always focus on the patient; this will keep us centered and respectful.
  • Listen well and welcome other points of view.
  • Offer to help and be supportive of others.
  • Assume good will and exercise patience.
  • Model professionalism, kindness, and respect.
  • Speak up, set the bar high, and be a crusader for civility.
  • Strive to be the very best person possible.
  • Value differences and avoid judgment.
  • Take good care of myself, de-stress, and live well.
  • Practice the Golden Rule; treat others the way we wish to be treated.

Engaging in reflective exercises and candid conversation about ways to foster civility are helpful strategies to prepare students—and others—to address incivility, establish and sustain healthy workplaces, foster positive interpersonal and intrapersonal relationships, and enhance ethical practices that contribute to the ongoing success of top-performing work teams and highly effective organizations. Addressing incivility can be challenging, but remaining silent not only impairs nurse performance, it ultimately jeopardizes patient care.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

16 July 2015

The next great adventure

My next great career adventure has begun! I recently resigned my faculty position after 20 years of teaching and started working full time as a nurse consultant for ATI Nursing Education. Some say the decision to pursue the next leg of my professional journey was swift. But those in the know are keenly aware that I was methodical and purposeful, carefully and strategically considering each aspect of my career change. It was a deeply reflective experience as I sought the wise counsel of family, friends, and numerous mentors who guided me along the way.

I knew I wanted something new, fresh, and different in my work life. My love for nursing and education never wavered, but a strong and convincing force was beckoning me toward a new direction. For decades, my custom has been to strategically plot my short- and long-term goals on a timeline, to share them with my closest mentors, and to implement an action plan to achieve them. I have known for years that, someday, I would leave my faculty position to pursue my passion to become a full-time nurse consultant. This career transition required careful consideration.

I spent a good deal of time thinking about the type of organization with which I desired to be affiliated. It didn’t matter whether the organization was private or public. What mattered most was that members of the organization lived by a shared vision and mission, based on values of mutual respect, collegiality, quality, and excellence—values built on organizational trust and community responsibility. I wanted to be a member of a workplace where employees are viewed as partners, valued as assets, and generously rewarded for their individual and collective contributions to the success of the organization.

I looked for a workplace with high levels of employee satisfaction, engagement, and morale. It was also important to be affiliated with an organization on the rise, one that encourages free expression of diverse ideas, so that all voices might be heard and appreciated to inform the best decision-making processes possible. I wanted to wake up in the morning filled with feelings of excitement and joy for the work I was doing and be rewarded for a job well done. If you are not doing work you love, you might never reach your full potential. It will continue to be just a job and eventually become rote, mundane, and boring. I never really lacked a passion for teaching; it’s just that the tug of something more continued its steady pull. Thus began my odyssey to pursue one of the best jobs ever.

To begin, I set clear goals and carefully detailed what I was looking for in terms of organizational culture, work responsibilities, opportunities for personal and professional growth, ability to express my passion and ideas, membership on a high performing team, making a difference, and most of all, having fun! Once I began to deeply reflect on these and other issues, I spent countless hours talking with coaches and mentors about the best direction to pursue. I wrote down the pros and cons of leaving my current faculty position and taking on a new role in what would essentially be the grand unknown.

I focused on key elements of a healthy work environment and, taking my own advice, I assessed the relative health of my new work environment by completing the Clark Healthy Workplace Inventory. Because I am a firm believer in working for an organization that promotes wellness, as well as physical, emotional, and spiritual good health, I wanted to ensure that I was making the right decision and focusing on important issues related to healthy workplaces.

It’s easy to become content with the status quo and fall victim to the relative comfort and ease of current work conditions, especially if we are paid a fair wage and genuinely like our co-workers. Of course, there is nothing wrong with feeling content or comfortable in your job. It's just that if you yearn for more, this complacency can hold you back from achieving your grandest dreams. Remember, we spend well over 40 hours per week at our jobs, so it’s important to regularly evaluate our career goals and consider opportunities that will take our careers to a whole new level.

Whether you are curious about the health of your current workplace or seeking employment elsewhere, you might want to complete the Clark Healthy Workplace Inventory. I have said it before, and I'll say it again: “Culture trumps everything.” So if you are curious, click here to see how your place of employment stacks up.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

20 May 2015

Uncivil semester: The nursing class that didn't seem to care!

Just before spring semester began—for many of us in the Northern Hemisphere, spring semester begins in January—I received an email message from a nursing professor (I’ll call her Beth) who expressed extreme distress stemming from a series of ongoing uncivil encounters with a class of nursing students. Attempting to resolve her problem, Beth had availed herself of several civility resources before contacting me, but, despite her efforts, had been unsuccessful in managing the disruptive and intimidating student behaviors.

Beth was very concerned about the situation, made worse by the fact that she would be teaching the same class of students during the spring semester. With permission, I share Beth’s story:

Aggressive and abusive
Fall semester was disastrous. From August into December, Beth experienced ongoing incivility in one of her nursing classes that involved multiple students. She described the students as highly stressed, aggressive, and verbally abusive. Exposure to this incivility began the first day of classes while Beth was facilitating discussion on accelerated heart rates. In the middle of Beth’s explanation, a student rudely interrupted her, stating that Beth didn’t know what she was talking about, and that the correct term was tachycardia. 

Jupiter Images/Photos.com/Thinkstock
Beth agreed with the student and attempted to explain that she, indeed, was planning to discuss the medical term. Before she could finish her response, however, the student made a sarcastic remark loud enough to be heard by the entire class. Some students responded by rolling their eyes and grimacing, and one of them glared at Beth for the remainder of the class. These and similar behaviors continued throughout the semester. Not equipped to address the situation, Beth tried to ignore it, which only made things worse.

To rectify the problem, Beth approached an experienced and tenured faculty member to seek her counsel. Sadly, the colleague acknowledged her own inexperience and lack of ability to address student incivility and offered no assistance. Consequently, the problem went unaddressed and, like pebbles rippling in a pond, continued to expand and intensify. 

Other students also became rude and disruptive, muttering under their breath during class and making disrespectful or aggressive comments to Beth and fellow students. One student openly and consistently challenged Beth during class, often snapping at her, shooting hostile glares, and vehemently arguing with her. At one point, Beth snapped back at the student and, after several unproductive back and forth exchanges, informed the student that she refused to argue with her. This interaction was followed by confrontation with another student, who accused Beth of refusing to satisfactorily answer class members' questions.

Beth began to dread going to class. Often, she lay awake at night. Unable to sleep, she worried about the hostility she would likely face the next day. Students who did not display uncivil behavior seemed to be feeling the stress as well. Again, Beth sought assistance from more experienced nurse educators, but none offered helpful advice.

Breaking point
One day, Beth’s stress level and inability to cope hit what seemed to be a breaking point, and she experienced a fairly intense hot flash during class. Some students, finding the event hilarious, responded by ridiculing and mocking her. Beth was humiliated and stunned by their insensitivity.

One student reported to Beth that class members maintained a social media site where students would criticize the class and post negative comments. She was told that some students fanned the flames of discontent, which, in turn, intensified the situation, resulting in a mob-type mentality. Although Beth tried to remain pleasant and respectful in class, her nerves were hanging by a thread, and she was relieved when the semester ended.

Her relief was short-lived. In addition to the brutally cruel student evaluations she received, it was then she learned she was scheduled to teach the same student cohort the very next semester. As I read Beth’s desperate message and plea for help, her dread was palpable.

Suggested solutions
I suggested several interventions, emphasizing the importance of role modeling and setting expectations the first day of class. I encouraged Beth to engage the students in conversation about the need for demonstrating civility and professionalism, displaying ethical behavior, and assuming the role and responsibilities of a professional nurse. 

I also suggested to Beth that she reinforce in class the various provisions contained in the American Nurses Association's Code of Ethics for Nurses (2015), in particular, Provision 1.5 which reads: “The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and patients with dignity and respect; any form of bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable and will not be tolerated,” (p. 4) and Provision 6.3 which reads: “Nurses are responsible for contributing to a moral environment that demands respectful interactions among colleagues” (p. 24).

In addition, I suggested co-creating classroom norms to foster and sustain a safe and civil learning environment. Faculty members need to take the lead in creating safe spaces for students, faculty, and other members of the learning community to express their views and beliefs without insult or other intimidation. Thus, co-creation of class norms is one of the most important activities to accomplish on the first day of class. Establishing, implementing, and reinforcing these norms are foundational to a respectful and civil teaching-learning environment and become living documents that provide a touchstone of civility and professionalism for students and faculty—a framework for working, collaborating, and learning together (Clark, 2013).

Norms need to be reviewed, revised, and reaffirmed on an ongoing basis. Once agreed upon, they can be used to remind students of their commitment to creating a safe teaching-learning environment and can set the stage for future meetings when faculty members may need to address performance or academic issues with students.

Beth’s story, Part 2.
Wearing business attire and striking a professional tone, Beth arrived early on the first day of the new semester. After welcoming the students, she started a dialogue about class expectations, using several foundational documents including the Code of Ethics for Nurses. Next, Beth facilitated co-creation of classroom norms, emphasizing the importance of following the norms and holding one another accountable for their successful implementation. After passing out index cards, she invited students to anonymously pose questions or comments to which she would promptly respond with posts on the students’ online learning platform.

Next, Beth told the class she had reviewed the course feedback she had received from the previous semester and, as a result, would be making several changes to improve the course. She told the students about her background and experience as a professional nurse and encouraged class members to ask questions and share their own experiences.

Welcome, Civility!
An interesting and wonderful thing happened after Beth shared her plans for the course: The class virtually exploded with questions, and students told stories and shared examples from their personal and professional experiences. It was an animated and interactive dialogue. Beth was “pleasantly shocked.”

Lumina Stock/iStock/Thinkstock
In the weeks that followed, Beth addressed some of the questions posed by students on the index cards, and she periodically discussed their compliance with classroom norms and progress toward becoming professional nurses. Overall, the students remained animated, interactive, and respectful. Several made supportive comments on the index cards. In fact, one student apologized for how the class had treated Beth during the previous semester.

Moral of the story 
Preparation, professional role modeling, and open, honest discussion matter and go a long way toward reducing or eliminating uncivil behavior. More importantly, they foster civility and add value to professional growth and development. Beth’s story is an epic success. We can all learn from her courageous response.

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Washington, DC: American Nurses Association.

Clark, C.M. (2013). Creating & sustaining civility in nursing education. Indianapolis, IN: Sigma Theta Tau International.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.