Over the last decade, civility has become a hot topic. I got involved with it in 2000, when more than 700 nurses told the Maryland Commission on the Crisis in Nursing that civility was one of their top three workplace concerns. Since then, studies have linked lack of civility to potentially decreased patient safety, blueprints have been created for establishing a civil work environment, codes of conduct have been developed, and healthcare workers have been educated on the topic.
In 2005, VitalSmarts and the American Association of Critical-Care Nurses (AACN) published the study “Silence Kills: The Seven Crucial Conversations for Healthcare” and launched the Healthy Work Environments initiative. The 2010 follow-up study, “The Silent Treatment,” found more nurses had concerns about incompetence and disrespect, and a higher percentage of intensive care and operating-room nurses were speaking out on the topic.
Sounds good, right? Well, not really. Incivility remains a problem. Where did we go wrong? (Or did we go wrong?) Was it the timing? Have healthcare workers simply grown weary of dealing with yet another “issue”? Should we just accept that incivility and conflict are inevitable—especially with our multigenerational workforce and pressures on caregivers to navigate rapidly multiplying regulations, documentation requirements, resource shortages, and high acuity?
Assessing unit culture
Health systems grapple with the uneasy balance between creating excellent patient experiences and protecting the workforce. Many have started crisis prevention and…
What is civility?
Civility is behavior that shows respect toward another person, makes that person feel valued, and contributes to mutual respect, effective communication, and team collaboration. Author P.M Forni describes civility as a form of benevolent awareness (respect, restraint, and consideration) in his book Choosing Civility: The 25 Rules of Considerate Conduct.
In Civility: Manners, Morals, and the Etiquette of Democracy, author Stephen Carter describes civility as the sum of the many sacrifices we’re called on to make for the sake of living together. He stresses that our duty to be civil to others doesn’t depend on whether we like them. Civility doesn’t require us to mask our differences but to resolve them respectfully—to express ourselves in ways that show we respect others. Civility allows criticism of others, but the criticism should always be civil. Being civil means thinking before you speak.
Why bother being civil?
Who has the time, energy, or resources to focus on being civil? Why should you bother? Because civility can be the foundation for patient safety, a healthy work environment, healthy staff, and increased productivity. Civility affects the quality and quantity of our hard work. Incivility, in contrast, is a short step away from aggressive behavior, which can lead to lateral or horizontal violence.
What if each of us made a commitment to change our behavior? To forgive those who’ve done us an injustice? To choose to revise our assumptions of others? To seek common ground, goals, and purpose? Why not just do it—even if you’re the only one? The goal of being civil is not to have other people reciprocate respect and kindness to you (though that’s usually a natural outcome). The goal is for others to see you as successful when you continue to practice civility, regardless of others’ responses. It’s about you, not them.
What’s holding us back
One of the biggest barriers to civility is the “bitter bag” nearly all of us carry—bags where we stash our grievances. They contain all the slights, rebuffs, injustices, rudeness, embarrassments, and other wrongs that have befallen us. We rarely address individual wrongs when they arise, instead tossing them into the “bitter bag.” We take the bag home and mull over these wrongs, usually distorting the facts. We think the bag’s acrid contents give us permission to be less civil to the perpetrators.
But until you begin to empty your bitter bag, you’ll have trouble moving forward and being committed to civility. If you don’t empty it, it’ll be an albatross around your waist—a barrier to moving forward. (See How to empty your “bitter bag.” by clicking the PDF icon above.)
Strategies to promote civility
Here are some strategies to help you behave in a civil way.
- Know your triggers—the words, actions, and gestures that make you angry. Knowing your triggers helps you monitor and manage your reactions. You can’t control what others do or say, but you can control your response. So think before you speak or act. Always consider what impact your words or actions might have on others.
- Assess your own behavior. What do you do to contribute to civility or incivility? Ask a trusted friend for feedback here.
- Don’t jump to conclusions or assume you know another person’s intent or motive.
- Walk in the other person’s shoes. This can show you the context for his or her words or actions and help you understand what triggered them.
- When rumors or gossip come your way, let them go in one ear and out the other.
- Resist looking for someone to blame. Remember that in many cases, a problem reflects a systemic shortcoming, not an individual’s.
- Take the “temperature” of your milieu often to determine if colleagues could use a little proactive kindness—for instance, a soda run or a quick check of the unit to see who needs a hand.
- Listen more and talk less, to show you respect others’ opinions.
- Seek common ground, even if it’s to agree to disagree.
- Go out of your way to say thank you.
- When you get credit for something, spread it around to those who helped you.
- Take the time to make it safe for the other person to have a dialogue with you.
For more ways to create a more civil workplace, visit www.hweteamtool.org/main/index. This page describes AACN’s free web-based Healthy Work Environment Assessment.
Civility: A mission possible
Many of us see what’s happening in the workplace today as symptomatic of what’s happening in society at large. But dealing with a societal change can be overwhelming, whereas addressing civility on your own unit is manageable. If you work full time, you may spend more time at work than you do at home, so it’s worth the effort to make your workplace more civil.
Is this idea simplistic compared to the big civility programs that have been implemented recently? Will it produce results? Will it be faster than waiting for a larger program of external constraints and consequences to change the culture? Will it have more staying power than previous initiatives that didn’t ask individuals to change? Only time will tell, but in the interests of patient safety and healthier workers and workplaces, it’s worth a try. Great changes often begin with a simple first step. To achieve a civil workplace, choose to be the spark that ignites civility.
Visit www.AmericanNurseToday.com for a complete list of references.
Judith (“Ski”) Lower is an independent lecturer and consultant in Water Valley, Texas.
