Fourth in a series of articles on civility in nursing education and practice—why it matters and what can be done to foster it.
Over the years, I have received several e-mail messages and have listened to—and recorded—hundreds of stories from students describing their experiences with academic incivility. I have also collected numerous ideas and strategies from students to address this problem.
In the previous installment
of this series, I suggested several ways faculty members could foster civility in nursing education. In this article, Cari Cardoni, president of the Boise State University chapter of the Student Nurses Association, and I highlight ways students can play a pivotal role in fostering civility.
I recently had the delightful experience of facilitating an all-day civility workshop with a group of nursing students from a large state in the western part of the United States. Students shared their experiences with regard to incivility, discussed specific ways to cope with stressors related to incivility and generated several individual and group strategies to foster civility in nursing education. The following quotes come from nursing students commenting on incivility in U.S. nursing education.
One student commented: “I think the general trend in our culture is one of incivility, and the same is true for education. Some faculty set a low bar, and students respond accordingly. Others show respect and receive it in return. I think faculty need training in how to deal with student behaviors, and some students need to be taught how to respect themselves and one another.”
Another commented: “First, the problem needs to be named. If we don’t call it [incivility] what it is, then we can’t really address it. Academic incivility needs to be widely addressed, perhaps during orientation or at regular trainings. Every individual needs to take accountability for [his or her] actions and refuse to perpetuate the cycle, no matter how rude others are. Students need to share their thoughts and concerns calmly, politely, at the appropriate time using the appropriate forum. Faculty need to create a safe forum for students to express concerns and a fair way of judging their opinions without getting defensive.”
The stressors of nursing school
Students—and faculty—often comment on the stress associated with pursuing a nursing degree. My own empirical studies support this claim. Nursing students often report being stressed by competing demands of school, work and family; struggling to achieve in a competitive, high-stakes academic environment; and financial worries. These stressors can lead to cheating, exhaustion and burnout. Therefore, it is very important to provide resources for students to prevent and deal with these stressors.
During the workshop, we generated several strategies for reducing stress, including spending time with family, friends, other supportive people and pets; exercising; getting fresh air and sunshine; engaging in hobbies; eating healthy food; drinking plenty of water; getting adequate sleep; and engaging in faculty-student social activities away from the stress of the classroom and clinical setting.
I asked the students to identify the most important factor in helping them deal with incivility, and their reponses fell into four main categories: 1) family and friends, 2) classmates, 3) caring faculty and nursing staff, and 4) faith and inner strength. To me, their responses are very encouraging, as they should be for other nurse educators and nurses in practice who are called upon to provide support and encouragement to stressed-out students. These findings underscore the importance of role modeling and positive mentoring.
Student-driven strategies for fostering civility
In addition to preventing and alleviating stress, there are several other strategies students can use. First, they need to reflect on their own behaviors and assume personal responsibility for their actions. When a student encounters incivility, he or she should thoughtfully consider the intent and context of the event and his or her individual contribution to it. If, after careful reflection, the student still believes that he or she has been treated disrespectfully, he or she needs to clarify the interaction with the offender. If a student is apprehensive about a face-to-face meeting, sending a polite e-mail asking for clarification can be helpful. While an e-mail message can help get the conversation started, having an in-person meeting can be empowering. As Margaret Wheatley so beautifully reminds us, “We can change the world if we start listening to one another again, [since] it is the simple art of conversation that may ultimately save the world.”
Nursing students have a responsibility to model civility and encourage respectful social discourse. Collaborating with faculty and taking a leadership role in co-creating classroom and clinical norms have a significant and positive impact on providing a safe, open environment to express diverse views.
In the second installment of this series, I discussed the importance of co-creating class norms. On the first day of class and clinicals, my students and I work together to establish behavioral norms based on the vision and mission of the university, the college and the department of nursing. This is a lively and spirited exchange and takes about 30 minutes of class time. The following were among our norms for this semester: assume good will, listen carefully, respect one another, communicate respectfully, use computers in class for class-related content only, keep cell phones on vibrate, make every effort to minimize distractions and have fun! We revisit our norms often and use them to guide class discussions and activities.
Students can also conduct solution-focused open forums, which include faculty, where action plans are developed to prevent and address incivility. Both groups—students and faculty—can thus discuss civility issues in a safe, nonthreatening environment.
Students can also actively participate in governance teams and contribute to effective running of the nursing program. Opportunities for student involvement abound in nursing education, including team and committee membership, campus and community service, student government, and student organizations. By openly addressing incivility, student organizations and campus coalitions can help break the taboo on discussing the topic. Students can take a leadership role in identifying incivility, discussing its consequences and seeking solutions to diminish it. This may include developing policies to prevent and deal with incivility in nursing education.
It’s the simple things
When I ask students to name the most essential strategies for fostering civility, they often respond with the following: showing respect to one another, taking civility reminders into the clinical setting, co-creating norms for classroom and clinical settings, discouraging gossip, speaking openly about the need for change, holding one another accountable and dealing with issues before they become insurmountable. Ultimately, however, it’s the simple things that matter most—attending class, being prepared and paying attention to class content.
Students need to be on time. If a student has a legitimate reason for being late, he or she should enter quietly and unobtrusively. Likewise, if a student needs to leave early, it is a good idea to inform the professor about the need to leave before class ends and sit near the door. They should avoid side conversations and, if they have questions, raise their hand. Students should stay on topic and avoid monopolizing class discussion, because other students’ ideas are important and valuable, too. They should focus on the class and avoid sleeping, talking, reading materials unrelated to class, checking e-mail or their Facebook page, or working on assignments for another class.
Other civility-promoting measures include greeting one another, listening with intention, sharing positive comments, engaging in meaningful dialogue, offering solutions and treating one another with dignity and respect. Perhaps most important, we must assume good will. If we expect best intentions, we are more likely to receive them.
In other words, if someone tells you another person is saying something negative about you, you have at least two options: 1) Assume good will about the person and say, “Interesting. That doesn’t sound like something so-and-so would say.” 2) If you suspect it might be true, check it out by going to that person and asking if the report is accurate. If so, discuss the issues and, if possible, come to a mutual understanding. Taking a direct and honest route is clearly the best strategy. Constructive dialogue improves the quality of human interaction and thus enhances civility.
The power of a student’s voice
As a nursing student, I have witnessed and used much of the advice Professor Clark has provided above. Tips that have helped me navigate through school include getting involved, being patient with others, addressing concerns directly with the individual and finding a mentor or professor you can trust.
Early in my nursing student journey, I encountered a situation where a faculty member was openly speaking negatively about me. It was both hurtful and intimidating. I decided to confront the professor—respectfully and in a nonaggressive manner. Explaining what I had heard, I asked that, in the future, concerns regarding me be brought to my attention directly. The professor apologized and, for the remainder of my nursing education, our relationship has been positive. I believe this situation could have ended much differently and am proud of our addressing the issue head-on and moving forward. It prepared me for similar problems that may occur in the future as I transition to the practice environment.
As president of our Student Nurses Association (SNA) chapter, I have the privilege of being a member of the student advisory panel. In these meetings, my voice matters and my suggestions are seriously considered. I have also served as a communication bridge between the faculty and other nursing students with regard to current activities and changes within our department.
As students, we must remember that we have a valuable role in fostering civility. Joining organizations such as SNA can create a unified and powerful student voice. Students should also find ways to interact with faculty outside of the classroom. We must strive to be an example of the behavior we wish to see. By communicating openly, treating each other with respect and addressing concerns before they escalate, students can play a key role in fostering a healthy learning environment for themselves and those who follow. RNL
Cynthia Clark, PhD, RN, ANEF, FAAN, nurse consultant for ATI Nursing Education, founder of Civility Matters, and author of Creating and Sustaining Civility in Nursing Education, Second Edition, is a psychiatric nurse/therapist and an expert in fostering civility and healthy workplaces.
Cari Cardoni, a nursing student at Boise State University (BSU), is president of the BSU chapter of the Student Nurses Association.
Other articles in Cynthia Clark’s series on civility in nursing education and practice:
The sweet spot of civility: My story
Why civility matters
What educators can do to promote civility
From incivility to civility: Transforming the culture