You have been designated as a team leader to address the issue of incivility. A survey was completed and it showed that very few individuals felt sure of what constituted incivility. The intervention will be an educational program required of all staff and medical providers. 

Complete a SWOT analysis with a 2x2 matrix looking at the strengths, weaknesses, opportunities, and threats that would affect this being successful. Develop a risk management table to reflect impact for threats and weaknesses.   Should the SWOT analyze the facility in which incivility is occurring or the team addressing the problem or both? Should the risk management table address only items identified as threats or weakness in the SWOT?

 

This article looks at the perception of incivility among emergency department nurses and the leadership required to implement evidencebased strategies to address this growing problem. The prevalence of incivility in the nursing profession has been widely researched and shown to have a negative impact on patient safety. Incivility impairs communication resulting in increased medication errors, reduced quality of care, and poor patient outcomes.1 Incivility leads to decreased nursing satisfaction and has been linked to posttraumatic stress disorder including symptoms such as low self-esteem, anxiety, sleep disturbance, recurrent nightmares, and depression.2 Incivility contributes to increased employee turnover, creating a financial burden for the institution.3-5 Addressing incivility in the workplace is essential not only for the benefit of the nursing profession, but also for quality healthcare outcomes including safety. The American Association of CriticalCare Nurses (AACN) has prioritized a healthy work environment as a major advocacy initiative. It identified 6 standards for developing and sustaining healthy work environments. These include skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership.6 While developed for the critical care setting, these standards are applicable across many areas including the emergency department (ED). Authentic leadership is a key to eliminating incivility in the healthcare arena. Nurse leaders must serve as role models, mentoring staff in appropriate behavior in the workplace and upholding the standards of the institution.7,8 Nurse leaders must address uncivil situations and behaviors in the workplace and foster healthy communication among staff.7 The Nursing Incivility Scale developed by Guidroz et al9 was used with the authors_ permission to evaluate ED nurses experiences with incivility in the workplace. The tool was developed and validated in a study with hospital nurses and was found to be psychometrically sound.9 Questions were added to collect demographic data. The aims of the project were to (1) determine the incidence and impact of workplace incivility experienced by nurses working in the ED and (2) describe the nurse_s perception of workplace incivility in the ED. Following approval by a university institutional review board, the survey was distributed to ED nurses in a Southeastern state via e-mail through a state hospital association Listserv and was available for approximately 60 days. The final sampling number was 129 ED nurses; 83.5% were female. Nurses responding to the survey had a wide 8 JONA Vol. 48, No. 1 January 2018 Spotlight on Leadership Author Affiliations: Associate Professor (Dr Garth) and Professors (Drs Todd and Byers), Murray State University; Nursing and InstitutionalResearchCoordinator(MsKuiper), Baptist Health-Paducah, Kentucky. The authors declare no conflicts of interest. Correspondence: Dr Todd, Murray State University, 120 Mason Hall, Murray, KY 42071 (..7@murraystate.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jonajournal.com). DOI: 10.1097/NNA.0000000000000563 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. range of experience working in the ED from less than 1 year to more than 20 years. The majority of nurses (43.3%) had between 1 and 5 years experience, with distribution evenly spread between ranges (see Document, Supplemental Digital Content 1, http://links.lww.com/JONA/A590). Results Results revealed that 62.6% (n = 80) of the participating ED nurses agreed or strongly agreed that they had experienced uncivil behavior in the workplace. Looking collectively at ED nurses who somewhat agreed, agreed, or strongly agreed that they had experienced incivility in the workplace, the total was 86.8% (n = 110). The survey found that 21% (n = 27) of the nurses left a job as a consequence of uncivil behavior. More than 30% (n = 50) of those surveyed revealed that they had reported uncivil behavior to a supervisor. A concerning number of participants, 24% (n = 26), responded they felt there was not an effort to facilitate a culture of civility in their workplace. The most commonly reported uncivil behavior displayed by nurses to other nurses was gossiping (85% [n = 100]). Physicians and families were identified as the 2 groups most likely to take their frustrations out on nurses. Of the nurses surveyed, 43% (n = 50) perceived that physicians took their feelings out on nurses and 85% (n = 100) that families took their frustrations out on nurses. Implications for Nurse Leaders Nurse leaders should assess organizational and department presence of incivility and put actions in place to address it (Figure 1). Institutional policies, behavior, and culture regarding incivility appeared to shape the perceptions of participants about their experiences with incivility. Institutional silence leads to a lack of support for individuals attempting to deal with incivility and perpetuates the problem. Skilled communication is essential for effective relationship building with colleagues, patients, and families in preventing incidents of incivility. Nikstaitis and Simko10 suggest that nurses should receive education regarding incivility and techniques for dealing with incivility in the orientation period followed with yearly thereafter. Nurse leaders should consider the inclusion of all healthcare employees in this process because many teams, including the ED, are multidisciplinary. Incivility recognition education along with organizational policies is essential to eliminate incivility.11 True collaboration is important to support and enhance effective decision making in healthcare.6 Collaboration has been identified as a key element in the Code of Ethics for Nurses. 12 Effective collaboration must occur at several levels: nurse-to-nurse, nurse-topatient, nurse-to-family, nurse-tophysician, and nurse-to-organization. This type of collaboration requires strong organizational support. Nursing leaders should establish department-level teams to address incivility and collaboration, supported by trained leadership. Meaningful recognition is a process that improves the atmosphere of the healthcare environment and leads to feelings of empowerment. Research supports that empowerment is inversely correlated with workplace incivility and supervisor incivility.4 Meaningful recognition of appropriate behavior in the workplace can establish a norm that supports healthy work environments. Tools for nurses to address or avoid incivility can include Figure 1. Suggestions for nurse leaders in addressing incivility. JONA Vol. 48, No. 1 January 2018 9 Spotlight on Leadership Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. a code of conduct, organizational policies, a safe system for reporting incidents, and ongoing multidisciplinary education regarding incivility.13 Empowering bystanders to support a colleague when an uncomfortable situation is observed is also an important tool.14 Conclusion Incivility in nursing as a problem for patient care and job satisfaction has been well established in the literature.8,15-17 The findings of this project, specific to ED nurses, identified a continuing prevalence of incivility and perceptions regarding incivility in this demanding area of practice. The AACN standards provide a framework to address incivility in institutions that can be applied to the ED. Leadership at both the organizational and department levels is critical to establish a culture of civility and mutual respect in the workplace. Nurse executives need to be aware of the presence of incivility in their own organizations to appropriately address it. All nurses have a responsibility to support a civil environment to promote high-quality patient outcomes and a healthy workplace.