Implementation of a model to not only transform care but the work place environment requires the entire interdisciplinary team working together and performing within their role to operationalize concepts of caring. A community hospital in the Midwest sought to implement Relationship Based Care but understood there was an issue of incivility amongst the staff. It was believed establishment of civility was a requirement if all team members were to successfully operation and collaborate their respective professional role. However before individuals can come together in effective partnerships, they must have individual clarity. Felgen (2007) states when individuals are confident they are able to collaborate with others equally committed to creating ideal conditions for patients by challenging the status quo and to make change. Yet, the detrimental effects of incivility among health care workers are well documented. New graduate nurses who experience incivility perceive greater levels of disrespect from physicians, report lower career satisfaction, and greater intent to leave (Laschinger & Read, 2016; Kerber, Woith, Junkins, Shafer, & Astroth, 2015).
Since this study additional articles have been published on the importance of civility and fostering a healthy work place environment. Abid, et al. (2018) has found thriving, work engagement, and civility is related and important in creating a work environment where the staffs' health and wellbeing is important. Howard (2018) conclusion found that the patient experience and employee engagement are connected and depend on organizational support of a culture of respect, autonomy, and recognition.
This study proposed to understand where civility did or did not exist and how civility related to desirable constructs like clarity, work environment, job satisfaction, and caring for patients.
Methods
This descriptive study utilized Kathleen Bartholomew’s theory of civility to develop a 14-item instrument to inquire about the experience in civility in training in school, training on the job, and the experience within the work itself (Batholomew, 2006). Regression equations were used to study the cascading effect of civility on professional clarity, job satisfaction and caring for patients. Nursing staff from five patient care units (n = 414) were invited to participate.
Results
A total of 177 staff responded (43% response rate). Regression analysis revealed education and observation of civility in school and orientation predicted 26.9% of the variance of civility (β = -.46, t(127) = 6.85, p < .001). Civility predicted 25.9% of clarity (β = -.45, t(121) = 6.50, p < .001). A hierarchical regression equation with self, role and system entered as the first, second and third step explained 44.9% of the variance of caring for the patient with clarity of role explaining 36.3 (β = .45, t(135) = 4.69, p < .001) and clarity of system explaining 8.7 (β = .46, t(134) = 5.59, p < .001)%. Finally, job satisfaction predicted 32.9% of the variance of caring for patients (β = .60, t (136) = 8.17, p < .001).
Discussion
Understanding civility is the first step in enacting the professional role socially and technically which predicted connecting to patients. The staff elevated the importance of creating a healthy and civil work environment was instrumental to the success of the implementation of RBC. The literature continues to expand in this area showing direct correlation between work environment, staff engagement, and thriving at work (Abid, et al., 2018; Howard, 2018).