Assignment: Work Environment Assessment.

According to the Workplace Environment Assessment, I work in a moderately healthy workplace, at times the patients and family can demonstrate incivility towards the staff but, we recognize that these are highly stressful times and help them cope with the difficult times. Staff is very cordial and civil toward one another but, we do have our share of incidences where there has been a breakdown in the art of effective, polite communication. Communication at all levels of the organization is transparent, direct, and respectful and the organization attracts and retains the “best and the brightest” were the only two questions that received a neutral or a negative score.

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The transparency part of the communication is something that I believe the administration could improve upon when talking to their nurse leaders and their staff. When an organization is not transparent, it leads to rumors and speculation; it also leads to distrust. Smith (2019) acknowledges that transparency and open communication translates to learning; learning from mistakes and near misses means fewer errors and better outcomes for future patients. Retaining the best and brightest nurses scored a somewhat untrue because I believe as an organization, we do not ensure that retaining the best and brightest is a high priority. Despite knowing that experienced nurses decrease mortality and increase patient outcomes. I have seen too many excellent nurses leave due to politics with management when an open conversation could have led to a better resolution.

Incivility Incident in the Workplace

In the patient care environment, uncivil encounters can provoke uncertainty and self-doubt, weaken self-confidence, and compromise critical thinking and clinical judgment skills (Clark, 2019). Nurses take an oath to do no harm and sometimes not addressing acts of incivility can breed a culture that accepts rather than deals with incivility. An incident that occurred on my unit involved a nurse who was getting a fifth patient in adolescent mental health unit that has a ratio of 4:1 and an assistant manager who was discussing the assignment in front of a patient and their family. Understaffing is a big problem. However, taking a fifth patient has become common practice within our unit; it has increased the nurse’s workload and stress levels. In this instance, the nurse, when confronted by the assistant manager after the charge nurse, explained that the nurse was not happy about accepting a fifth patient. The nurse then complained that the other patients would suffer because they would be neglected; this was stated in front of a patient and their family. This increased the patient’s and family’s anxiety level, was completely unprofessional from both team members and allowed the unit to explore an opportunity for improvement. Clark (2019) acknowledges that nurses must be well equipped to effectively address incivility in a variety of situations to promote teamwork and collaboration and to protect patient safety. The ability to effectively communicate uncivil situations is critical because the delivery of safe patient care depends on these vital skills. (Marshall, & Broome, 2017). A meeting was held between the four charge nurses, manager, assistant manager, chief nursing officer (CNO), risk management, and the adolescent psychiatrist. Within the meeting, the event was discussed, and each participant was able to speak to their account of the story. All sides agreed that the nurse should not have been confronted in front of a patient and family but, should not have made those comments in front of the patient and family. The additional patient could lead to neglect and decreased patient outcomes, options were explored for the charge nurse to take the patient to alleviate pressure on the staff, as this was the fifth assignment happening that day and the assistant manager assume the charge nurse role. The open dialogue was very civilized, and now we have a protocol in place that ensures that over ratio assignments are a rarity versus common practice. An attempt to call all nonscheduled staff must be performed, the manager must reach out to other units to see how their census is, the charge nurse can take patients if the assistant manager can assume the charge nurse role, the staffing pool must be contacted to see if there is any availability, and physician must be informed that admitting this patient will cause an over ratio assignment. I can say that since instituting this protocol, the number of over ratio assignments has decreased, and civility within the unit has been restored.

Conclusion

Incidents of incivility are bound to happen in high-stress workplaces, but, the key is to address them and have an open dialogue with the involved team members to rectify the situation. Complaining about an additional patient may appear to management as disrespectful when in actuality, it is the nurse concerned for how all the patients will suffer when the workload is increased. A simple conversation can lead to improving practices to avoid these situations, but, these conversations must be heard. The opportunity for both sides to see the one another’s opinion and understand that the goal is not punishment but, rather learning from our mistakes. A great team dynamic is based on communication and civility towards each other and the patients that foundation can be undermined if ant act of incivility goes unacknowledged. Recognizing and putting a plan in place to discuss and improves upon the situations gives each team member the opportunity to grow by learning from the past mistakes made, enhancing the team bond and making the workplace a healthy workplace.

References

Clark, C. M. (2019). Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility. Nurse Educator, 44(2), 64–68. https://doi-org.ezp.waldenulibrary.org/10.1097/NNE.0000000000000563

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

Smith, A. (2019). Beyond Denial and Defense. Physician Leadership Journal, 6(3), 20–25. https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=bth&AN=135860193&site=eds-live&scope=site