Paradigm Shift of Culture

1. Behavior

In healthcare, the consequences of incivility can result in life-threatening mistakes, preventable complications and harm, or even death of a patient. Therefore, it is of utmost importance that all nurses become champions for civility (Clark, 2018, QSEN, 2018).

While there is strong evidence that organizational support, as well as leadership support, foster civility, and a healthy work environment, the role of individual nurses must not be underestimated. Nurses at all levels of an organization can become catalysts for change by ensuring an unmistakable commitment to patient safety and quality care (Clark, 2018).

The importance of the role of the nurse manager cannot be overstated. Nurse managers set the tone as both a role model and a mentor for the professional interactions expected in the workplace. Bedside nurses expect their managers to set an example of civility as well as respectable behavior. If a manager does not prohibit incivility or does not address uncivil behavior, it can easily be perceived by others as acceptable.

In addition to behaving professionally and ethically, nurse managers can:

• Capitalize on time during staff meetings and other venues to raise awareness about the need for civility
• Discuss acceptable and unacceptable behaviors
• Establish behavioral norms
• Practice and role-play civil interactions (Clarke, 2018)

2. Accountability

All these improvements and process changes are to reduce adverse outcomes for patients; however, it is important to consider the human factor as the variance. The discussion of what constitutes quality and safety in healthcare encompasses a multitude of elements:

• Quality and safety is everyone's responsibility. Healthcare teams and leadership must collaborate to ensure the quality is consistent and accountable.
• It is important to have a shift of an organization to become a High Reliability Organization (HRO). These organizations rely on communication, accountability, process improvement with the urgency and impetus, as noted in Kotter’s Change Theory. The HRO’s leadership crafts the environment for change and tone for staff.
• Transparency and self-reflection of the organization allow for a non-blame, civil culture to become the standard and cultural norm.
• Inter-collaboration among healthcare providers ensures the process sustains quality and safety.
• HROs leverage technology through innovation with a common goal to create a just culture in which safety and quality are synonymous with patient care.

big idea

In this environment, staff are encouraged to engage in crafting a better environment.

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

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