Incivility: Nursing's Dirty Little Secret and Cognitive Rehearsal as an Intervention

Monday, 9 November 2015

Laura Marie Schwarz, DNP, RN, CNE
School of Nursing, Minnesota State University, Mankato, Blaine, MN, USA
Nancyruth Leibold, EdD, MSN, RN, PHN, LSN, CNE
Nursing, Minnesota State University, Apple Valley, MN, USA

The American public has consistently rated nursing as the most honest and ethical profession every year for the past decade (Riffkin, 2014).  Yet nursing has a dirty little secret; incivility. Incivility is rampant in the nursing workplace with 82% of nurses witnessing it daily or weekly (Dumont, Meisinger, Whitacre & Corbin, 2012).  It causes nurses psychological and physical trauma, and frequently to leave their jobs and sometimes nursing altogether.  The consequences are severe and destructive not only to nurses, but also to patients who suffer decreased safety, and healthcare facilities which experience lost money and time orienting new nurses.  Cognitive Rehearsal is one method nurses can use to combat incivility. According to Griffin and Clark (2014) “cognitive rehearsal is an evidence-based strategy to effectively communicate and deliver a message to uncivil or laterally violent colleagues that it is not okay for them to behave in an uncivil manner” (p. 539-540).  Addressing uncivil behavior when it occurs may be the most successful in getting it to cease. Cognitive rehearsal is a method used to immediately address the uncivil behavior when confronted with it.  It typically entails three parts: 1) instruction on the method; 2) learning and repeating verbal responses that can be used when encountering incivility; and 3) practicing to reinforce the instruction and rehearsal. Several studies conducted over the past 10 years have confirmed that cognitive rehearsal is an effective method for addressing incivility and lateral violence in the nursing environment (Griffin & Clark, 2014).  The authors of a mixed-methods study on incivility in nursing (N=27) will present background information on incivility and disseminate study findings.  Findings include nurses’ ability to recognize incivility in nursing pre versus post education, and the effectiveness of education on ability to deal with it.  Further, the presenters aim to teach learners the basics of the cognitive rehearsal method for dealing with incivility.