Path to civility

By Nancyruth Leibold | 12/08/2016

She was grumpy and mean, so they honored her with love. That took courage!

Picture of unhappy nurse
My first teaching position was as a clinical instructor in medical-surgical nursing. I had taught one clinical rotation, was about to start my second, and was thinking about what had gone well and what could be better. 

The first rotation was a success, except for one situation I didn’t learn about until the end. The students told me that a nurse named Alice had been rude to them, said mean things, made fun of them, and put them down. She was very nice to me, and I did not witness what the students described. But, after a previous instructor informed me that Alice had a long history of picking on students, I knew it was important to come up with a strategy my students could use to work with her. 

Nancyruth LeiboldGiving love a chance
My first thought was to suggest that they show her loving kindness. After all, love is foundational to nursing (Wright & Sayre-Adams, 2006), so showing kindness seemed a good place to start. When the next cohort of students came for orientation, I told them about Alice. A few said they had already heard about her from other students and were nervous about working with her. That’s when I suggested we try kindness, and they agreed. No matter how Alice behaved, we would honor her many years of clinical nursing experience by showing her love. 

To develop our loving strategy, we turned to the nursing process—assessment, plan, intervention, and evaluation—a framework that would help the students respond to Alice objectively rather than emotionally. We even rehearsed a few things they could say to keep interactions professional. 

As that clinical rotation got underway and the students interacted with Alice, I observed they were, indeed, following the plan. They showed respect and esteem for Alice by asking for her ideas about patient care, and they asked her about her career. At first, according to the students, Alice was grumpy and sometimes mean, and it struck me that they were courageous to interact with a person who was not always pleasant. 

Love, courage, and honor
Courage can be developed (Hawkins & Morse, 2014), and I recognized I was witnessing that development in those students. By the end of that clinical experience, they had made great strides in relating to Alice. She even organized a potluck luncheon for them on the last day of their clinical rotation—something that had never happened before—and at the luncheon, she announced she loved this group of students! 

During the clinical rotation that followed, which was shortly before graduation, two full-time nursing positions opened up in the medical-surgical unit where Alice worked. She told the head nurse to hire two of my students as they were exceptional and she wanted to work with them! After graduating and becoming licensed, both students were hired for that unit and became close colleagues of Alice, and they worked well as a team. 

Several years passed. I taught the same clinical course repeatedly on the same medical-surgical unit, and Alice was always a delight to work with! Never again was there a clash between her and the students. In fact, she took them under her wing and became one of their favorite nurses. And she continued her practice of organizing a last-day-of-rotation potluck for each clinical group that followed. When I reflected on those years, I was proud of that first group of students for showing love, courage, and honor to Alice. Their actions made such a difference!

One more year passed, and Alice became ill with cancer—a very rapidly growing cancer—and, in a short time, was unable to work. One Friday evening, Alice’s physician admitted her to the hospital, and she was assigned to the same medical-surgical unit where she had worked. I was working as a staff nurse in the intensive care unit at the time and was on duty when she came in. She asked for me, so I went to see her. She also asked for another nurse, one of the students from that first cohort that had won her over. After battling cancer with courage, Alice died that weekend with that nurse caring for her. 

Smooth and rough pathway

The right thing to do

In looking back on those years, it became clear to me that using loving kindness to honor Alice by acknowledging her years of nursing practice was the right thing to do. As we became better acquainted with Alice, we learned that her husband had passed away and that her children had grown up and moved away shortly before my students and I came along. The students who befriended her became a highlight of her life, and she focused on helping them by passing on her nursing knowledge and skills. 

The experience I’ve recounted validates the importance of love, courage, and honor—storgé, tharsos, and timé—the three core values of the Honor Society of Nursing, Sigma Theta Tau International. Those values were present in the pathway that the nursing students, Alice, and I walked. Sometimes a pathway can be smooth, other times bumpy. Kindness will not always work every time there is workplace incivility, but it did in this case. We came upon Alice during a challenging time in her life, and, with love, courage, and honor, a group of nursing students in a medical-surgical clinical rotation smoothed out the bumps in her path as well as ours.

Editor’s note: Want to learn more ways to reduce workplace incivility? The Creating Healthy Work Environments conference is slated for 17-19 March 2017 at the JW Marriott in Indianapolis, Indiana, USA. The theme of the conference is “Building a Healthy Workplace: Best Practices in Clinical and Academic Settings.” The early registration deadline is 25 January! To learn more and to register.

Nancyruth Leibold, EdD, MSN, RN, PHN, CNE, assistant professor of nursing at Southwest Minnesota State University, Department of Nursing, Marshall, Minnesota, USA, is a Virginia Henderson Fellow.

References:
Hawkins, S. F., & Morse, J. (2014). The praxis of courage as a foundation for care. Journal of Nursing Scholarship, 46(4), 263-270. doi:10.1111/jnu.12077
Wright, S., & Sayre-Adams, J. (2006). Love me tender. Nursing Standard, 21(2), 20-22. 
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