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. 

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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.”

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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.