Background:Favorable nurse staffing and nurse work environments have been linked to better patient and nurse outcomes in multiple large studies using sophisticated quantitative methods (Aiken et al, 2011; Aiken et al, 2014; McHugh et al, 2016; McHugh & Ma, 2014). However, nurse coworker incivility has not previously been studied as an outcome of modifiable features of nurse work environments.
Methods:Donabedian’s (1980) structure-process-outcomes conceptual framework was the theoretical basis for this study. Hospital staff registered nurses at 5 hospitals, 3 of which were Magnet recognized, were surveyed. A cross-sectional, correlational design was employed. Linear regression models were estimated to explain the variance in coworker incivility explained by manager effectiveness and staffing adequacy.
Results: The final analytic sample was N = 212 after data cleaning and multiple imputation. Half of the sample were 35 years of age and under. Most participants (76%) held a bachelor degree in nursing. More positive reports of nurse manager leadership were inversely correlated with lesser scores for coworker incivility (b = -.55). More positive reports of nurse staffing and resource adequacy were correlated with lower scores for coworker incivility (b = -.45). In separate linear regression models, reports of nurse manager leadership predicted 15% of the explained variance in coworker incivility (R2 = .15, p < .01) and reports of nurse staffing adequacy predicted 7.7% of coworker incivility. In a joint regression model, perceptions of nurse manager leadership were inversely correlated (b = -.47) with coworker incivility, while nurse staffing exhibited a weaker but significant effect (b= -.19). All regression results remained stable even while controlling for the nurse’s age, years of experience, and educational level.
Conclusions: Inadequate nurse staffing and ineffective nurse manager leadership undermine civility among nurse coworkers. Measures should be taken to monitor, evaluate, and address nurse manager leadership deficits and nurse staffing and resources as part of an effort to reduce coworker incivility among registered nurses. Evidence-based strategies to improve nurse manager leadership skills are needed and research efforts should address this topic.