Interprofessional courses prepare nursing and medical students for future teamwork.
A positive relationship between healthcare workers is crucial to high-quality care, but incivility and bullying in the workplace are increasing. It doesn’t have to be that way.
Teamwork is an essential component of organizational success. Because of the complexity of the healthcare system and increasing demand for its services, effective teamwork is essential to patient safety and delivery of quality care—and nurses play a fundamental role. Stress can negatively impact that role. One significant stressor is uncivil behavior from co-workers, including physicians. In healthcare, a positive relationship between nurses and physicians is crucial to providing high-quality patient care.
When physicians disrespect nurses, treat them aggressively, pay no attention to their communication by ignoring their phone calls or refusing to listen to their opinions—even though nurses are very familiar with their patients’ conditions—they are exhibiting uncivil behavior. Such behavior can negatively impact nurses’ self-esteem and morale and make them feel powerless and frustrated. Bullying occurs when a person uses abusive or intimidating behavior to make the victim feel humiliated, vulnerable, or assaulted (Eagar, Cowin, Gregory, & Firtko, 2010). Incivility, in general, and bullying, in particular, are increasing in the nursing environment and have received greater attention in the past decade.
Impact and a primary cause of incivility
Working together as a team requires understanding and valuing each other’s roles. When nurses are abused and feel disrespected in their workplaces, their contribution to the team is negatively affected. Disrespectful behavior by co-workers lowers job satisfaction, organizational commitment, and work engagement, all of which are known predictors of nurse burnout and turnover. If nurses remain in their positions, the stress they experience may cause them to react aggressively to situations.
Incivility among team members can negatively impact patient safety. Evidence shows that bullying has been associated with increased incidence of treatment errors and adverse events (Houck & Colbert, 2017), so reducing the incidence of employee incivility in healthcare settings is crucial. The first step in halting workplace incivility is to identify potential causes.
A primary cause of incivility is failure to understand each other’s roles and contributions. Physicians and administrators may regard themselves as being at the top of a team’s hierarchy and nurses at the bottom. If they underestimate the role of nurses, they may disrespect their opinions about patient care and otherwise mistreat them.
Value differences across generations also contribute to incivility. For example, an older nurse may feel disrespected if a younger physician who is preoccupied with a smartphone fails to maintain eye contact during a conversation.
Strategies for change
Reducing incivility in the workplace should begin in academia when nursing and medical students are preparing for their future roles. Curricula should include interprofessional courses and activities designed to enhance knowledge, foster positive attitudes, and develop effective communication and teamwork skills.
Within healthcare systems, organizations should emphasize the importance of creating cultures of respect and incorporate the guiding principles of those cultures in their core values and strategic planning initiatives. Establishing a code of conduct that articulates desired collegiality among nurses and physicians is very important.
To enhance patient safety, healthcare organizations have called for establishing blame-free work environments. It is time to also provide similar environments that enhance workplace safety for nurses. Nurses need to have the opportunity to be open about negative nurse-nurse and nurse-physician relationships and to report issues related to incivility and workplace violence. Clear policies should be established on how incidences are reported and how they should be handled to achieve the ultimate goal of promoting a healthy work environment. RNL
Sulaiman Dawood Al-Sabei, PhD, RN, is an assistant professor at Sultan Qaboos University College of Nursing, Department of Fundamentals and Nursing Administration, in Al-Khoud, Muscat, Sultanate of Oman.
Sulaiman Dawood Al-Sabei will present The Impact of Nurse-Physician Interprofessional Relationship on Nurses' Willingness to Engage in Leadership Roles on Saturday, 23 February 2019, at Sigma’s Creating Healthy Work Environments conference in New Orleans, Louisiana, USA.
Eagar, S. C., Cowin, L. S., Gregory, L., & Firtko, A. (2010). Scope of practice conflict in nursing: A new war or just the same battle? Contemporary Nurse, 36(1-2), 86-95. doi:10.5172/conu.2010.36.1-2.086
Houck, N. M., & Colbert, A. M. (2017). Patient safety and workplace bullying: An integrative review. Journal of Nursing Care Quality, 32(2), 164-171.