18 American Nurse Today Volume 10, Number 11 www.AmericanNurseToday.com
“I believe we can change the world if we start listening to one another again. Simple, honest, human con- versation…a chance to speak, feel heard, and [where] we each listen well…may ultimately save the world.” Margaret J. Wheatley,
GIVEN the stressful healthcare workplace, it’s no wonder nurses and other healthcare professionals sometimes fall short of communi- cating in respectful, considerate ways. Nonetheless, safe patient care hinges on our ability to cope with stress effectively, manage our emo- tions, and communicate respectful- ly. Interactions among employees can affect their ability to do their jobs, their loyalty to the organiza- tion, and most important, the deliv- ery of safe, high-quality patient care.
The American Nurses Associa- tion (ANA) Code of Ethics for Nurses with Interpretive Statements clearly articulates the nurse’s obli- gation to foster safe, ethical, civil workplaces. It requires nurses “to create an ethical environment and culture of civility and kindness, treating colleagues, coworkers, em- ployees, students, and others with
dignity and respect” and states that “any form of bullying, harassment, intimidation, manipulation, threats, or violence will not be tolerated.” However, while nurses need to learn and practice skills to address
uncivil encounters, or- ganization leaders and managers must create an environment where nurses feel free and empowered to speak up, especially regard- ing patient safety issues.
All of us must strive to create and sustain civil, healthy work en- vironments where we
communicate clearly and effectively and manage conflict in a respectful, responsible way. The alternative— incivility—can have serious and lasting repercussions. An organiza- tion’s culture is linked closely with employee recruitment, retention, and job satisfaction. Engaging in clear, courteous communication fos- ters a civil work environment, im- proves teamwork, and ultimately enhances patient care.
In many cases, addressing inci- vility by speaking up when it hap- pens can be the most effective way to stop it. Of course, mean- ingful dialogue and effective com- munication require practice. Like bowel sound auscultation and na- sogastric tube insertion, communi- cation skills can’t be mastered overnight. Gaining competence in civil communication takes time, training, experience, practice, and feedback.
LEARNING OBJECTIVES 1. Identify components of a healthy
workplace. 2. Discuss how to prepare for a chal-
lenging conversation. 3. Describe models for conducting a
The planners of this CNE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity. See the last page of the article to learn how to earn CNE credit. The author has disclosed that she receives royalties and consulting fees pertaining to this topic. The article was peer reviewed and determined to be free of bias.
CNE 1.0 contact hours
Conversations to inspire and promote a
more civil workplace Let’s end the silence that surrounds incivility.
By Cynthia M. Clark, PhD, RN, ANEF, FAAN
www.AmericanNurseToday.com November 2015 American Nurse Today 19
What makes for a healthy workplace? The American Association of Criti- cal-Care Nurses has identified six standards for establishing and sus- taining healthy work environ- ments—skilled communication, true collaboration, effective decision- making, appropriate staffing, mean- ingful recognition, and authentic leadership.
In my own research, I’ve found that healthy work environments al- so require: • a shared organizational vision,
values, and team norms • creation and sustenance of a
high level of individual, team, and organizational civility
• emphasis on leadership, both formal and informal
• civility conversations at all orga- nizational levels. I have developed a workplace
inventory that individuals and groups within organizations can use as an evidence-based tool to raise awareness, assess the perceived health of an organization, and de- termine strengths and areas for im- provement. The inventory may be completed either individually or by all team members, who can then compare notes to determine areas for improvement and celebrate and reinforce areas of strength. (See Clark Healthy Workplace Inventory.)
How to engage in challenging conversations One could argue that to attain a high score on nearly every invento- ry item, healthy communication must exist in the organization. So leaders need to encourage open discussion and ongoing dialogue about the elements of a healthy workplace. Sharing similarities as well as differences and spending time in conversation to identify strategies to enhance the workplace environment can prove valuable.
But in many cases, having such conversations is easier said than done. For some people, engaging
directly in difficult conversations causes stress. Many nurses report they lack the essential skills for hav- ing candid conversations where emotions run high and conflict- negotiation skills are limited. Many refrain from speaking with uncivil individuals even when a candid conversation clearly is needed, be- cause they don’t know how to or because it feels emotionally unsafe. Some nurses lack the experience and preparation to directly address incivility from someone in a higher position bec