Speak Up Culture and the Academic Nursing Environment: The Junior Faculty Perspective

Friday, 22 February 2019: 11:20 AM

Margaret (Betsy) Babb Kennedy, PhD, RN, CNE
School of Nursing, Vanderbilt, nashville, TN, USA
Abigail Parish, DNP, AGPNCP-BC, GNP-BC, FNAP
School of Nursing, Vanderbilt University, Nashville, TN, USA
Cynthia Brame, PhD
Vanderbilt University, Nashville, TN, USA

Focus on improving organizational culture has led to identification of open communication, or “speaking up,” about concerns, from clinical to professional behaviors, as a primary factor affecting patient safety outcomes. As the setting for education of future health care professionals, the culture of open communication related to professionalism is also crucial to a healthy work environment in an academic organization. Academic unprofessionalism and incivility ranges from subtle, perhaps unintentional, negative comments and condescension, to overt, public, purposeful criticism, rudeness, and disrespectful behaviors. These behaviors can be directed at other faculty, staff or students, isolated or constituting a pattern.

There are personal and organizational costs to academic incivility. Incivility among faculty and students can erode communication and teamwork, affect the quality and safety of the learning environment, and ultimately impact student learning outcomes, all of which bears on institutional achievement in the academic mission. Due to perceived threat, individuals can experience decreased satisfaction in their work, diminished emotional and cognitive resources, psychological distress, and a lack of respect for colleagues and administrators who willingly participate, deny, or actively ignore unprofessionalism and incivility in the academic work environment. Further, stress and threat from incivility can impact those who experience it directly or simply as a witness.

Junior faculty may be particularly vulnerable to academic incivility. Those who experience or witness negative and unprofessional encounters with colleagues may feel decreased job satisfaction, threatened in the work environment, and ultimately leave their academic role. If junior faculty opt to stay in an academic role, such observations and experiences can be viewed as the “hidden curriculum” of transitioning to the faculty role. Thus, unprofessional behaviors may not be recognized as disruptive, accepted as the norm, adopted, and even perpetuated by junior faculty, becoming part of an unhealthy organizational culture.

As new members of the organization, junior faculty can be in a better position to recognize incivility, but may be hesitant to speak up in the midst of witnessing the unprofessional behaviors of their colleagues for a number of reasons. A perceived hierarchy, power dynamics, a desire to be part of the group, uncertainty regarding accepted organizational norms, concerns over tenure or promotion review and influence response to incivility. Additionally, uncertainty of when or how to manage behaviors when they witness or experience them can influence the desire and ability to speak up. Speaking up can also be highly dependent upon context with multiple variables such as setting, individuals involved, and perceived severity of the behavior.

The Junior Faculty Teaching Fellowship (JFTF) is a unique immersion program created to facilitate knowledge, attitudes, and skills in the nurse educator role. The fellowship, a collaborative effort between the school of nursing and the university center for teaching, offers guided faculty development and peer mentoring, to promote professional growth across the domains of scholarship, teaching, and leadership and support role transformation. Participants apply for the program and are typically in year 2-6 of their faculty appointments.

As part of the informal discussion sessions in the 9-month JFTF program, participants requested a topic related to working with “challenging” colleagues. The session was facilitated by the fellowship director from the Center for Teaching and the Assistant Dean for Non-Tenure Track Faculty Affairs & Advancement at the school of nursing. During the discussion, the 5 junior faculty participants described their perceptions or experiences of incivility and unprofessional behaviors in the work environment. The session was held confidential, and specific names were not used in any narrative. Rather, the behaviors themselves were generated with no context. The behaviors were written on paper, crumpled, and tossed into the center of the room. Participants pulled papers from the pile and read aloud the behavior, without identification of their own contributions, to generate a list. After reviewing the list, the junior faculty participants then identified the actual and potential impact of incivility and unprofessionalism on themselves, their work as an educator, students, colleagues, the school of nursing, and health care.

Using evidence from the literature, the session was then grounded in developing knowledge and skills for junior faculty. Identification of unprofessionalism and incivility, decision-making and options for speaking up, communication skills, as well as reinforcement of individual responsibility and organizational support and processes, were key topics for inclusion and discussion. Holding the session outside of the school of nursing and ensuring a safe environment for sharing was critical. In addition, the session occurred later in the fellowship so a sense of camaraderie with peers had developed, and the designated facilitators were those with whom trust had been established. Junior faculty discussed freely their challenges and opportunities for speaking up about incivility in the workplace. Upon conclusion of the session, junior faculty participants had practical strategies for managing unprofessionalism, and were supported in speaking up as witnesses or victims of incivility. Facilitators were also made aware of barriers and facilitators to speaking up to inform further development.

To date, former participants in the Junior Faculty Teaching Fellowship have grown into both formal and informal leadership positions at the school of nursing. These faculty are viewed by colleagues as thought leaders and expert nurse educators. Understanding and addressing issues of incivility and unprofessionalism in the workplace as part of junior faculty development can result in significant and positive impact on the organization. Capitalizing on their enthusiasm for the educator role and new lens on organizational culture with intentionally focused sessions represents a unique opportunity.

While all faculty should feel able to speak up about unprofessional behaviors in the academic environment, junior faculty may feel both particularly vulnerable and uncertain of an appropriate response. An unhealthy work environment with lack of collegiality and open communication impedes professional development of junior faculty in an academic role. Healthy work environment norms that nurture the passion of junior faculty for the educator role, stimulate their intellectual desire for growth in the role, and embrace them in a collaborative faculty community are imperative.

As part of new faculty orientation or faculty development programs for junior faculty such as the fellowship, the topic of incivility must be addressed openly. They must understand workplace expectations and individual responsibility for the academic climate, identify positive role models, and be empowered with knowledge and skills to speak up. Further, it is an institutional responsibility to define and uphold behavioral expectations, to provide development opportunities for all faculty on the topic of incivility and communication skills, and to support a speak up academic culture with appropriate mechanisms and processes for doing so.

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