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what's covered
In this lesson, you will learn about civility in healthcare. Specifically, this lesson will cover:
  1. Civility
  2. Incivility
  3. Just Culture
  4. Reflect

1. Civility

Civility within the workplace is an essential concept to success in healthcare. Understanding and implementing the concept is imperative, given that civility leads to improved safety of the patients and the staff. Medicine historically has been a male-dominated field, and nursing mostly female. The way we practiced was to serve physicians and take a secondary role; now, nursing is coming to the table as a part of the team.

2. Incivility

The OR has been a backdrop for incivility; as the literature suggests, communication, education, and transparency begin to degrade the antiquated ideals that oppress nurses. These behaviors and inactions may result in psychological or physiological distress for the people involved and, if left unaddressed, may progress into unsafe or threatening situations.

Acts of incivility can take various forms, including:

  • Eye-rolling
  • Making disparaging remarks
  • Excluding and marginalizing others
Incivility can also be demonstrated by a lack of action, such as failing to share important information about a patient’s care, refusing to assist a coworker, or intentionally neglecting to acknowledge a coworker (Clark, Kenski, 2017).

In healthcare, the consequences of incivility can be especially devastating. The constellation of uncivil actions and intentional non-actions (Clark, Kenski, 2017) can result in life-threatening mistakes, preventable complications, and even the death of a patient. Furthermore, incivility can have detrimental effects on nurses’ health, well-being, and job satisfaction and can create a heavy financial burden for healthcare organizations.

The costs of incivility are clear and increase when expenses that are associated with supervising the employee, managing the situation, consulting with attorneys, and interviewing individuals who witnessed the incident are measured. If all parties become invested and, with the use of appropriate tools, uncivil environments can easily be changed into cultures of mutual respect and collegiality. Certainly, incumbent on all nurses and nursing organizations is the need to answer the call to action for promoting civility. By responding to this call to action, nurses will be practicing ethically and adhering to standards of practice. This response will result in the development of effective communication skills. This is important as poor communication can negatively affect the delivery of safe, quality patient care. (Clark& Kenski, 2019).

3. Just Culture

A shared and sustained commitment to promoting civility and respect is necessary to prevent uncivil actions from escalating into threatening behaviors and to foster a culture of health and safety that translates into safe, civil work environments for nurses (Clarke, 2018).

think about it
Review the following diagram as civility and safety are symbiotic entities living off each other. Is your organization’s culture moving toward maturity?
<b>Safe & Reliable Culture Maturity Model</b>Source: HealthCatalyst, 2019,
Safe & Reliable Culture Maturity Model
Source: HealthCatalyst, 2019,

A commitment to a healthy, sustainable environment lies within nurses to have the confidence to speak and express the necessary changes for improvement. When nurses speak up and resolve issues, they report better patient outcomes, greater satisfaction in their workplace, and heightened organizational commitment (Clark, 2019). They can also take the lead in establishing team charters, instituting a commitment to coworkers and co-creating norms, or ground rules, of desired behavior. Nurses must also ensure that the organizational philosophy and shared values are predicated on a culture of respect, professionalism, and safety.

4. Reflect

What are your professional principles and values and how can you ensure they are upheld?

Authored by Christina Carsello, DNP, MS, ARNP, NNP-BC


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