Workplace incivility is often referred to as bullying, lateral/horizontal violence, or harassment. It can be defined as repeated offensive, abusive, intimidating, or insulting behavior, abuse of power, or unfair sanctions that make recipients upset and feel humiliated, vulnerable, or threatened, creating stress and undermining their self-confidence (Vessey, DeMarco & DiFazio, 2010). Workplace incivility and prevalence is often unrecognized and underreported therefore determining the actual incidence and prevalence of workplace incivility is difficult. Studies examining workplace incivility assert that the percentage of nurses experiencing some form of incivility ranges from 27% to 85% (Becher & Visovsky 2012; Wilson, Diedrich, Phelps & Choi, 2011). Workplace incivility decreases job satisfaction and morale and increases absenteeism (Chipps & McRury, 2012). The financial consequences are well documented; almost 21% of nursing turnover can be related to bullying and 60% of new RNs who quit their first job in nursing within 6 months report that it is because of uncivil behaviors in the workplace (Johnson & Rea, 2009).
National governing bodies such as the Joint Commission (2008) and American Nurses Association (2015) have strongly encouraged healthcare organizations to address the presence of incivility in the workplace. Disregarding the prevalence of this phenomenon in the workplace culture will continue to drain financial resources, perpetuate a toxic work environment and may adversely affect the safety and quality of patient care. The purpose of the Institutional Review Board (IRB) approved study was to measure the prevalence of nursing-specific workplace incivility. An educational offering was given with the aim of increasing awareness of incivility and also provided cognitive training tactics designed to reduce the incidence of incivility. After the education, the prevalence of incivility was re-measured immediately and at six months to determine if a change occurred. The independent variable in this study was the educational intervention and the dependent variable was the prevalence of incivility in the nursing workplace. The research questions that guided the study were:
- What is the prevalence of source-specific (coworkers [nurses], supervisor, physicians, patients/visitors, and the general environment) incivility within nursing at Harris Health System?
- Is there a change in the prevalence of source-specific (coworkers [nurses], supervisor, physicians, patients/visitors, and the general environment) incivility at the conclusion of content specific education?
- Is there a change in the prevalence of source-specific (coworkers [nurses], supervisor, physicians, patients/visitors, and the general environment) incivility over time?
Methods
Design, Subjects, Instruments, Procedure
A quasi-experimental, interrupted time-series design was used. With the interrupted time-series design, the researchers measured one group repeatedly, before the intervention, after the intervention and 6-months later. The method of data collection chosen was in person, paper and pencil survey questionnaire to produce quantitative data. A convenience sample of registered nurses who participated in the in-person nursing incivility class was eligible; inclusion criteria included registered nurses. No subjects were excluded based on gender, race, ethnic group or religion.
A brief demographic questionnaire obtained participant age, ethnicity, educational degree, nurse tenure and area of specialty and years worked in specialty area. The instrument used to measure the prevalence of nursing incivility was the Nursing Incivility Scale (NIS). The NIS is a reliable tool specifically designed to capture nursing-specific workplace incivility prevalence (Guidroz, Burnfield-Geimer, Clark, Schwetschenau & Jex, 2010). Forty-two items are included in the scale and are rated on a five-point Likert type scale ranging from 1 (strongly disagree) to 5 (strongly agree). In a previous study using a sample of 163 hospital nurses, alpha statistics demonstrated reliability for all subscales, with scores ranging from 0.81 to 0.94 (Guidroz, et al., 2010).
IRB approved research advertisements were e-mailed to potential participants for recruitment purposes and individuals interested in participating contacted members of the research team for study details. All participants signed a written informed consent and were given a copy of the consent. Upon consent endorsement, the participants were given the demographic questionnaire, the paper survey and were given time to complete the first administration of the questionnaire (T1). At the conclusion of the 90-minute class, members of the research team administered the second (T2) survey to all volunteer research participants. The final (T3) survey administration occurred 6 months after the class at a time and location that was convenient to the each participant. Pre-surveys (T1) were taken before the training to assess initial awareness of incivility. The T2 survey was administered immediately after the training to measure changes in awareness of incivility and capture baseline data on the frequency of instances of incivility. The T3 survey was given 6 months after the last training session to determine if the intervention was successful in decreasing perceived instances of incivility.
Results
Data Analysis
A total of 80 participants completed T1 and T2 surveys and 75 participants completed the T3 survey for a 94% retention rate. Participation was higher in the first two surveys because they were administered in conjunction with the in-person training sessions. Demographic data was evaluated using descriptive statistics and revealed a primarily female sample (92.5%) with Bachelor of Science in Nursing education (62.5%) and worked as an RN for an average of 12 years. Statistical analyses were applied to the T1, T2, and T3 administration of the NIS. The NIS was constructed in a manner that equated lower scores with a more civil environment and higher scores with an uncivil environment; thus, the higher the score, the more uncivil the environment. The NIS was scored using Friedman’s ANOVA test, which is the nonparametric alternative to the one-way repeated measure ANOVA. Post hoc analysis revealed statistically significant differences in incivility scores from four of the five source-specific subscales demonstrating a statistically significant decrease in instances of perceived incivility: general incivility (4.10 to 2.44, p < .0001), co-worker (nurse) incivility (2.40 to 2.10, p = .012), patient and/or family incivility (2.80 to 2.10, p = .002) and physician incivility (2.41 to 2.00, p < .007). The supervisor subscale demonstrated a slight increase in the occurrence of incivility, although not statistically significant.
Conclusion
Overall, the results indicate that the use of increasing incivility awareness along with conducting education that contains cognitive training techniques is an effective method to decrease the prevalence of incivility. Due to the low sample size and single-site setting, the results of this study are not generalizable.