Vice President for Inpatient Services/Nurse Executive, Children's Hospital and Health Center, San Diego, California Marjoanpeck@sbcglobal.net
Because one responsibility of management is to maintain a safe, nonhostile environment, the Hutton_s article highlights a topic of significance for management in healthcare. The author presented a theoretical framework that described incivility as "low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect." Along with the framework, the incivility spiral that pictorially shows the difficulty in stopping the process of incivility once it has started was also presented. The implication of the theory is that it is easier to continue being uncivil than to pull out of the spiral and move to civil interactions.
The research presented indicates that employees hold their supervisors responsible for incivility when the uncivil behavior is not stopped. If one accepts the incivility spiral as a framework, the message to administrators is that only active intervention will stop uncivil and potentially damaging behaviors.
As a nurse and administrator, I have been asked why nurses, individuals who can be so good to patients, can be so unkind to one another. It is possible that the Anderson and Pearson framework explains not the reason why but the pattern we see in the unkind behavior. Perhaps the spiral of incivility that is so hard to stop is at work. Supervisors are expected to address the behavior as it occurs, reinforce the norm of mutual respect and civility, and find a way to address and stop the uncivil behavior. Understanding more about incivility should assist us in developing intervention strategies to stop the behaviors.
As described by the author, the outcome of incivility, at its most extreme, is physical damage, even death. At a less extreme level, it creates a culture of rudeness, an attitude of disregard that permeates the workplace and very likely permeates the quality of care provided to patients as well. So it is a concern for managers not just as it affects employees but for the effect on patients.
As a child of the 60s (as many nurse executives are), I have to comment on the reference to Philips and Smith who indicate that incivility is required to achieve societal change. As I see it, the "incivility" demonstrated during such societal actions as the civil rights or women's movement is different from individual incivility. For one thing, it does not carry intent to harm. The civil rights movement that, by some standards included uncivil behavior compared to the norms of the day, did not have the intent of doing harm to the target. Rather, the intent was to improve life for a group of people. Behaviors considered rude by some were demonstrated, but not carried out with intent to do harm. I see this as an important difference.
The intent to do harm is an important element of the framework described by the author. The concept of "intent to do harm" is counterintuitive to me for nursing. Yet, incivility certainly exists in nursing. Research to further explore intent to harm as a dimension of incivility seems particularly important; we need to verify intent to harm as part of the incivility framework and, more importantly, design ways to identify and intervene in order to keep it out of the workplace.
The Cortina and Magley study described in the article has implications for administrators to intervene appropriately to stop those who are incivil and prevent retaliation against those who would stop them. The descriptions of retaliation, lack of intervention, and development of "toxic" consequences in the workplace speak to the importance for nurse administrators to define acceptable behaviors, have processes to stop unacceptable behaviors, and have systems that enable employees to let administrators know if incivility is occurring. The description of a spiral of incivility and retaliation when the cycle is interrupted highlights the need for thoughtful intervention early in the cycle.
The author point out a variety of methodological problems with the existing research. Definitions are inconsistent and the research foci are varied. Still, consistent themes are that incivility breeds resentment, sometimes retaliation, and probably is caused by or leads to a toxic workplace. We know it is a problem. The research indicates employees are waiting for managers to do something about it.
The author discussed Krebs' research that designed and tested an intervention model to reduce incivility. It is a starting point. Reproducing Krebs' research would add generalizability to the work and potentially assist in defining additional methods for addressing the problem.
Incivility is not a new problem. It has been discussed under a variety of topics: nurses eating their young, the doctor-nurse game, assertive versus aggressive or passive communication, and workplace violence, to name a few. There are interventions used in many workplaces that define appropriate behavior and assist managers in setting boundaries around this behavior and intervening to stop or prevent it from occurring.
However, I think incivility is framed a bit differently in the Anderson and Pearson spiral. As the author looked at incivility, he addressed not just the incivility of a single event but the potential long-term consequences of incivility for both individuals and the environment they work in. That broader look provides a compelling argument for further research to verify the relationships described and define interventions that will stop uncivil behaviors. The element of intent to do harm is worthy of and calls for research to validate it as a component of the framework and provide information that could lead to design of intervention strategies. Incivility is, at the least, unpleasant with potential to damage employees and patients. The article is thought-provoking, providing opportunity to revisit and better understand behaviors that have such negative effect in the workplace.
Marjorie Peck, PhD, RN
Vice President for Inpatient
Children's Hospital and
San Diego, California
© 2006 Lippincott Williams & Wilkins, Inc.