I was recently asked to speak to a group of staff nurses who were attending a seminar offered by their employer to prepare them to precept nursing students. The topic they requested was incivility in nursing. I was asked to speak because I have been coinvestigator on two research studies on the topic of incivility by staff nurses toward nursing students in clinical education. This issue has been of interest to me since I attended a conference about 9 years ago. The keynote speaker had conducted many studies on incivility in nursing and nursing education, a relatively new topic at that time. During the course of her presentation she asked those in the audience, which numbered more than 1,000, to describe in writing an experience in which they felt they had been treated in an uncivil manner and to deposit it in a box at the back of the room. I should add that this was a room full of nurse educators, and, if my memory serves me correctly, we were asked specifically about incivility among faculty. I was astonished as I looked around the room. Virtually every person was scribbling furiously on the paper provided. It appeared to be almost therapeutic. Finally, someone had asked! She had most certainly struck a raw nerve.

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I now cover this topic in a bachelor's completion course for registered nurses. The following question is posted on the virtual discussion board: Have you ever witnessed incivility toward yourself or another nurse while at work? If so, describe what happened, and how it was handled. In every class, out of 30 students, at least 28 will have a story to tell. It may have been directed toward them, or they may have witnessed as it occurred to another nurse. Interestingly, it is most often "lateral violence," meaning nurse-to-nurse. I had expected the majority of the stories to be about physicians treating nurses poorly. I was wrong. It appears we do that well enough among ourselves. The stories as described by the nurses involve gossiping, backbiting, eye rolling, ostracizing, and stinging criticism, often delivered in front of patients. Ouch. These incidents are not quickly forgotten.

This phenomenon is thought to be responsible for high turnover rates, particularly among new graduates. Griffin (2004) estimated that up to 60% of new graduates cited lateral violence as the reason they left their first job, both costly and disruptive to the unit or department. Of particular concern is how this behavior may influence patient outcomes. One of the studies I conducted consisted of five focus groups with student nurses, specifically with regard to perceived incivility by staff nurses toward students during clinical rotations. In each of the focus groups, students cited not being given a complete report by the nurse, and the nurses not accepting report from the students at the end of their shift. In one case, the student handed over her written report on the patient at the end of her shift and the nurse crumpled it in a ball and threw it in the trash (Anthony & Yastik, 2011). Who knows what important information is not being communicated? The Institute for Safe Medication Practices reported that when dual assignments are made, meaning a nurse and a student are both assigned to the same patient, common errors that occur involve the patient receiving medication twice, or not at all. Excellent communication is imperative to medication safety (Institute for Safe Medication Practices, 2007). Interestingly, none of the studies I have read have involved home care. Looking back on my years as a home care nurse, I have to say I can't conjure up any examples. (Well, there was the time when I was sent to the house with 25 cats. Or was it 30 cats? I was new, and I always had a sneaking suspicion that it was a hazing. In any event, I found the patient to be an endearing holocaust survivor who understandably derived more comfort from cats than humans.)

Is there lateral violence in home care that simply has not been studied? Or does the independent nature of the work make it less likely? Is it because most home care nurses have had previous work experience, perhaps making them more resilient and resistant? What is your opinion on this interesting topic? What has been your experience? Do you have an experience to share? E-mail me at mailto:[email protected].

Best regards,

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