First of a three-part series on fostering civility in nursing education and practice.
Some readers may know I am a professor in the School of Nursing at Boise State University and a fellow in both the American Academy of Nursing and the National League for Nursing’s Academy of Nursing Education. I am also the founder of Civility Matters
. For more than a decade, I have studied incivility in academic and practice environments to develop evidence-based strategies to create and sustain cultures of civility. Very often, I am asked how I got involved in this topic. Here’s my story.
Before I accepted my faculty position at the university, I worked for more than a dozen years as a psychiatric nurse, specializing in adolescent and family mental-health issues. I was blessed to be a member of a hotshot crew of adolescent mental-health workers who treated teenagers living with a variety of mental-health and substance-abuse disorders. Many of our patients were gang members, adjudicated youth with a long history of violence and addiction-related problems.
Using a primary prevention approach, we helped teenagers settle disputes and disagreements with words and other nonviolent means, instead of resorting to weapons and physical violence. We also considered protective factors and resilience measures to equip our patients with effective ways to deal with stress and to recover from traumatic life events, including trauma resulting from exposure to violence. My clinical work with aggressive and violent youth has fully informed my program of research on preventing personal and organizational violence and continues to fuel my passion for creating communities of civility, not only on college campuses but everywhere.
After leaving my clinical practice and assuming my role as a university professor, things were fairly status quo—in the beginning. Students seemed to focus on learning, and faculty, for the most part, enjoyed teaching. However, in the early 2000s, I began to witness a shift. I noticed attitudinal and behavioral changes in our nursing students. Some of the changes were subtle, but they set off alarm bells in my “gut,” because they reminded me of my earlier experiences with angry youth. Although my college students weren’t outwardly hostile, I noticed more and more rude and disruptive behaviors, and I wondered, “Is it just me?” I also wondered if my observations were even accurate; perhaps they were colored somewhat by my previous clinical work.
Armed with a probing and curious mind, I began my quest to learn all I could about this troubling phenomenon. I started asking other professors, reminiscent of a man- or woman-on-the-street interview. I engaged in some very provocative conversations, and what I discovered was fascinating. Several professors were witnessing disruptive student behaviors, such as students consistently being late for class, holding distracting side conversations, misusing cellphones, challenging faculty knowledge and credibility, and making harassing and demeaning comments. Some professors told me they were retiring or moving on to other employment opportunities, because the toxic classroom behavior and these uncivil encounters were psychologically and physically impacting their lives.
“I know where you live!”
About the same time, two major events happened that forever changed my life and set the course for my program of study on incivility. One event involved a very angry nursing student who failed a nursing course and, for some reason that still perplexes me, held me responsible for the failure. Another faculty member had issued the failing grade but, because I was the course coordinator, I had to make the final decision about the grading outcome. I upheld the failure, but the student grieved the grade.
Over the course of the student’s attempts to appeal the failing grade, he made personal threats that, to this very day, make my heart race. In his anger and rage, he threatened me with statements such as, “You need to change my grade to a passing grade because I know where you live, I know where you park your car, and I know where your kids go to school.” It was a terrifying experience and, in retrospect, after a decade has passed, I see how far we’ve come in being able to deal with these situations and prevent them from happening in the first place. Fortunately, this situation was safely resolved, but it left me a bit shell-shocked and questioning if I should stay in my faculty role.
The second event, which happened about the same time, was much more chilling. It involved the killing of three university nursing professors, two of whom were shot in cold blood in a large lecture hall while students were taking their midterm exam. A third nursing professor was later found dead in her office. The shooter, a disturbed nursing student, was apparently enraged over being barred from the exam. After killing the three professors, he turned the gun on himself and took his own life. Prior to the killings, the shooter mailed a lengthy manifesto to an area newspaper, detailing his plan to pull the trigger. I knew then that I was on to something, and I began to study this very important issue in earnest. Eventually, my interest extended beyond student behaviors to include faculty incivility and our potential contribution to this incivility problem.
My work encompasses student perceptions of academic incivility and garners student opinions on ways to address and resolve the problem. Incivility is an issue that, to some extent, all of us face in American society. Whether it’s road rage, desk rage or just plain rudeness, we are impacted by these behaviors. Incivility is an affront to human dignity and an assault on a person’s intrinsic sense of self-worth. The effects can be devastating and long-lasting. Exposure to uncivil behaviors can result in physical symptoms, such as headaches, interrupted sleep and intestinal problems. They can also cause psychological conditions, including stress, anxiety, irritability and depressive symptoms. Thus, it is important to raise awareness about the importance of fostering a civil and healthy academic work environment.
A little bit of cancer?
Sometimes, people make statements such as, “You know, Dr. Clark, in our organization, incivility isn’t really a problem because only one or two individuals are uncivil to or bully others.” Here’s my response: “Imagine you are a patient sitting with your primary care provider after undergoing a series of tests, and he or she says to you, ‘No worries. You are one of the lucky ones; you only have one or two malignant cells circulating in your body.’” Yes, of course, this is a ridiculous response, but I suggest to you that the same level of absurdity relates to incivility in the workplace.
It is my fervent belief, and the evidence bears this out, that one or two toxic employees can devastate an organization. For example, Pearson and Porath (2009) report that managers and executives of Fortune 1000 firms spend as much as 13 percent of their total work time—seven full weeks per year—addressing problematic employee relationships or replacing workers who leave the organization because of incivility. The authors cite one example where a hospital spent more than $25,000 dealing with just one uncivil episode.
The costs of incivility are vast. Uncivil behavior adds to employer and employee stress levels, erodes self-esteem, damages relationships and threatens workplace safety and quality of life (Forni, 2008). Incivility also lowers morale, causes illness and leaves workers feeling stressed, vulnerable and devalued. Therefore, creating and sustaining communities of civility is an imperative and a call to action for all of us. It is also my life’s work.
Civility does matter!
My primary thesis is this: If we identify and address lesser acts of incivility before they escalate into aggression or violence, we are far better off and, in the end, quality of life on all levels will be improved. And here’s what I believe to my very core: Civility does matter! It’s worth fighting the good fight to create and sustain healthy academic and practice workplaces where respect is highly regarded and where benevolence carries the day.
Healthy workplaces do not occur by accident. Creating them requires intention, purpose and bold leadership from all levels of an organization. Incivility takes a tremendous physical, emotional, spiritual and financial toll on everyone. We must do better. One of the most-read articles in Reflections on Nursing Leadership
in 2010, the fourth of a five-part series, was one I co-authored with one of my nursing students, titled “What students can do to promote civility
In the next installment of this three-part series, I will readdress what students can do to foster civility in nursing education. Nursing students are our promise and our hope, the Jedi Knights
who will lead our noble profession to a bright future where civility reigns and respect rules the day. I am excited to share their suggestions for a civil tomorrow. RNL
Forni, P.M. (2008). The civility solution: What to do when people are rude. New York, NY: St. Martin’s Press.
Pearson, C., & Porath, C. (2009). The cost of bad behavior: How incivility is damaging your business and what to do about it. New York, NY: Penguin Group.