The stories are true; the names have been changed.
My professional mission is to create civility in nursing education and practice. In addition to raising awareness of incivility and its consequences and being an ambassador for lasting change (Clark, 2013), I strive to be a role model of civility for my students and others. It’s rewarding work, as the following stories—all true—illustrate. Only the names have been changed.
It began several years ago and involved a nursing student in the final semester of his BSN program. I was Robert’s professor for both the didactic and clinical nursing leadership courses. One of the objectives of the latter course was for students—through collaboration with classmates, faculty members, and community partners in completing a clinical project—to develop skills in negotiating conflict. Another was for students to demonstrate professional and ethical behavior. Robert’s ability to achieve either objective was lacking. It became apparent early in the semester that he had difficulty dealing with conflict, behaving in a professional manner, and interacting effectively as a team member.
As part of the course, all students completed a conflict style assessment. Robert’s revealed a tendency toward aggression and unwillingness to compromise. His quick temper and impolite comments negatively affected group interaction and interrupted project completion. By Week 4, after seeing little to no improvement, I met with Robert to discuss my observations.
In that first meeting, Robert and I reviewed his conflict style assessment. I suggested some specific ways for him to improve his conflict negotiation and collaboration skills and asked him for his suggestions. Robert reacted angrily, claimed I was wrong, and accused me of singling him out. Working through the anger, we ultimately developed a student success plan for Robert that included meeting with me over the course of the semester.
The objectives for these meetings included strengthening professionalism, improving his ability to manage conflict, and becoming a more effective team member. Robert attended all of the meetings but made it clear he was unhappy with the arrangement. Nevertheless, by the end of the semester, I noticed slight but incremental improvement. Robert went on to graduate, and I wished him well with his career.
Some years later, my aunt visited us in Boise. A few days into her stay, she began to complain of chest pain and shortness of breath, and we transported her to a hospital emergency room. As she was being settled into a room, a familiar voice addressed me. It was Robert’s. Once my aunt was comfortable and being attended to by a physician, Robert asked if I would join him in the family waiting room. Upon entering, he looked me in the eye and said: “I want to thank you. When you were my professor, I was so furious with you that one day I arrived home and raged about you to my wife. Once I finished venting, she looked at me and said, ‘I hope you will take your professor’s suggestions to heart. She’s right. Your anger can be very frightening.’”
That encounter changed his life, Robert said. Shortly after the conversation with his wife, he not only attended the meetings scheduled with me, but he also enrolled in anger management sessions provided by the community. Robert expressed excitement and gratification about his achievements and said he and his wife were doing just fine.
Moral of the story: We can never fully predict the outcome of taking the time to mentor and coach a student when the situation calls for it. Not only is it the right thing to do, but it also may result in significant personal and professional growth for everyone involved. In Robert’s case, it was a rousing success, mostly because of his willingness to change.
Bailey openly and defiantly challenged a faculty member’s credibility in class, in front of nearly 60 other students. She made demeaning and hostile remarks that nearly resulted in her dismissal from the nursing program and the university. The instructor, greatly shaken and traumatized, later took early retirement, in large measure because of that incident.
As a condition of remaining at the university, Bailey was placed under supervision and required to sign a “student success contract” for behavior improvement. A representative from the Student Success Office assisted in the supervisory process and made several recommendations to Bailey, including that she issue an apology to the instructor, write a multipage essay on how her behavior negatively impacted the faculty and the class, and agree to participate in a detailed plan for remediation and student success.
Bailey’s nursing program involved enrollment in my senior didactic and clinical courses. After reviewing her file, I decided to meet with her well in advance of the new semester with the goal of developing a mutually agreeable, detailed plan for successfully completing the courses. I was thankful when Bailey agreed.
Before going over the plan for success with Bailey, I asked her to tell me in her own words why she behaved the way she did with the previous professor. She became very quiet and thoughtful and then said: “I have had a lot of time to think about this, and the truth is, I was absolutely wrong. I was so stressed about the way my life was going that I completely lost it. I am a single mom with very little support, almost no money, and a slew of really hard classes. I stopped doing all of the activities that worked to reduce my stress, and I just kept getting more and more stressed out. It’s not an excuse; it’s just what happened. I accept full responsibility. I want to be a nurse, and I am truly sorry for my actions. I have started running again, and I have a neighbor who is helping me with my daughter. I feel like I’m back on track and, while I know I have a long way to go to make up for my bad behavior, I’m here to make a plan to be successful in your classes and to finish my degree.”
Wow, this certainly made my job easier! I was encouraged even more when Bailey pulled a notebook out of her backpack and showed me a list of ideas she had developed to help her succeed. She suggested that she sit near the front of the class, ask for regular feedback from a few trusted classmates about the appropriateness of her behavior, and also meet with me at scheduled intervals throughout the semester to discuss her progress. I commended Bailey for her thoughtful suggestions and agreed her ideas had merit. I further proposed that she continue to engage in stress-reducing activities and consider seeking support from the University Counseling Center. She agreed to both suggestions, and the semester progressed satisfactorily.
Moral of the story: There are times when even the most offensive behavior has an explanation. It is important to hold an individual accountable for impertinent and uncivil behavior, but the ultimate goal is to seize the teachable moment and promote civil, professional behavior.
Identifying and implementing specific strategies or interventions to improve areas of concern and to reinforce areas of strength are essential. Each strategy or intervention should include clear goals, objectives, expected timelines, and resources needed to accomplish the goals and objectives, which may include such activities as soliciting peer feedback and visiting, in the case of Boise State University, the University Counseling Center. Using assertive, behavioral terms to address uncivil situations; developing a mutually agreed-upon, interest-based resolution that includes clear expectations; and agreeing on who is going to do what by when can result in a win-win solution.
This took place a couple of years ago, and it was a nerve-wracking experience because it involved a conversation with an entire class of approximately 75 students, shortly before the end of the semester. Because graduation was just around the corner for this group of students, it was tempting to avoid the conversation altogether and to simply chalk up the students’ poor behavior to a bad case of “senioritis,” but I couldn’t see the benefit of avoiding the situation. So, mustering my courage, I took it on.
Before proceeding further, I should note that, during the first class meeting of that semester, the students and I had engaged in co-creating classroom norms that would ensure a civil, safe teaching and learning environment. (I do this with all my classes.) Establishing these norms is foundational to how we conduct ourselves in and out of the classroom. Wediscuss specific standards that promote civility, enhance learning, and foster professionalism and personal responsibility. We emphasize the importance of attending class, being on time, being prepared, avoiding distracting side conversations, and not using media in disruptive ways. Once norms and methods to ensure compliance are agreed upon, we rely on them to shape the way we behave toward one another throughout the semester.
At key times throughout the semester, we evaluate the effectiveness of our strategy to promote appropriate behavior and use it as a touchstone for measuring civility and professionalism. In this case, the standards we had agreed upon were working reasonably well—with two exceptions. Many students were consistently arriving late for class, and disruptive side conversations were becoming commonplace. Both were violations of our norms, and, in spite of my efforts to redirect the students, these incivilities continued. This was surprising to me because, prior to this particular class, classroom norms had been followed and respected. I knew I had to address these violations and, more importantly, use the opportunity to discuss the importance of professional conduct and thereby promote the standards of the nursing profession.
I was tempted to address the issue by detailing for the class specific behaviors I found uncivil and unprofessional. Believe me, I had a healthy list of behaviors that seriously annoyed me, and I wanted to unload my frustrations by reprimanding the entire class. Fortunately, my cooler head prevailed, and I took a different approach.
At the next class meeting, I opened a critical conversation about civility and professionalism. I started by saying: “When we met on the first day of class, and periodically throughout the semester, each of us expressed our desire to be the kind of nurse we admire, respect, and aspire to be. Today, I’d like us to share impressions about how we’re doing in that regard. Who would like to begin?”
You could have heard a pin drop. The silence was deafening. Finally, one of the more outspoken students suggested the class would be better served had I, the professor, been clearer about a recent homework assignment. In fact, she said, “It was so confusing that, when we discussed it on our class Facebook page, none of us could figure it out.”
Wow, who knew? I wasn’t even aware the students had a separate Facebook page about the class—I am no longer that naïve—so this was surprising to me. Keeping my composure, I asked, “When you discussed the lack of clarity regarding the assignment, did anyone suggest asking me to explain it?” My question was met with blank faces. Clearly, no one had considered approaching me, so I followed up with the next question: “Please help me understand why someone didn’t ask me to clarify the assignment. I would have been more than agreeable to do so.”
What transpired next was quite illuminating. Many students stated that past experience in asking for clarification from professors had been met with accusing comments and, in some cases, rude and demeaning remarks. As a result, the students had learned to do as the professor instructed: “Figure it out on your own!” Impressed with the students’ candor and intent on keeping the conversation going, I asked, “Has that been your experience with me?” The overwhelming consensus was a resounding, “No, but hey, you never know, so we gave it our best shot!”
We agreed that, in the future, students would seek clarification. What happened next was pretty remarkable. The students began to take personal and collective responsibility for their tardiness, disruptive conversations, and other similar behaviors. We recommitted ourselves to being the kind of nurse each of us admires, respects, and aspires to be. It was an invigorating and energizing conversation, one I will always appreciate and never forget.
After class, I went back to my office and sent my students the following email message:
I am writing to thank you for your candor and honesty this morning. I firmly believe that meaningful communication, dialogue, and conversation go a very long way in helping all of us become better nurses and better people. I will take your feedback to heart, and I will make a concerted effort to improve the clarity of my assignments. In return, I am asking each of you to let me know when something is unclear or uncertain, to do your best work, and to remain resolute in your professional pursuits. Today's discussion reminded me of a quote from Maya Angelou that I truly believe—“When we know better, we do better.” So now that we know better, we can all do better.
Soon after sending that email, I received the following message from one of my students:
Dear Dr. Clark,
Thank you so much for your words of encouragement and for treating us with respect. I really look up to you, and your response to the onslaught of student frustration today was, in a word, classy. Taking the time to admit your own mistake was a real learning moment for all of us. You really are a role model for the values and principles you are teaching us. In all honesty, I think most students are tired and stressed as the end of the semester nears, and you bore the brunt of that today. But I can definitely say that most students in the class know that you are an advocate for all of us, and today you drove that point home. So thank YOU! Have a great weekend, and I’ll see you Monday, bright and early!
Moral of the story: Perhaps, on the surface, engaging in civil conversation seems like an easy task. Let me assure you, it’s not easy. But then again, if it was easy, everyone would do it. I encourage you to ratchet up your courage, prepare, practice, and then create a safe space for critical conversation about issues that matter—those that shape the profession and undergird what nursing is all about. The goal should be to negotiate a mutually beneficial outcome, avoid focusing on who’s right and, instead, find common purpose and agree to behave in a civil and respectful manner. As I said, pursuing civility and doing the right thing are not always easy. If they were, everyone would do it. RNL
Clark, C.M. (2013). Creating & sustaining civility in nursing education. Indianapolis, IN: Sigma Theta Tau International.
Cynthia “Cindy” Clark, PhD, RN, ANEF, FAAN, professor at Boise State University School of Nursing and founder of Civility Matters, is a psychiatric nurse/therapist with advanced certification in addiction counseling. Nurse educators
: For ideas on ways to promote civility in the classroom and in clinical environments, see Clark’s book, Creating & Sustaining Civility in Nursing Education
, from Sigma Theta Tau International.