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Development of an Instrument to Measure Civil and Uncivil Behaviors in the Hospital Clinical Environment

Implications for Nurse Leaders

Tecza, Bonnie M. MSN, RN, CPN; Boots, Brenda K. MSN, RN, CPN; Clay, Patricia M. MSN, RN, CPN; Kirkman, Kendra S. MSN, RN, CPN; Mains, Brandi C. MSN, RN, CPN; Newton, Erin E. MSN, RN; Olney, Adrienne MS; Bartlett, Jacqueline A. PhD, RN

JONA: The Journal of Nursing Administration: July/August 2015 - Volume 45 - Issue 7/8 - p 391–397
doi: 10.1097/NNA.0000000000000220

OBJECTIVE: The purpose of this study is to develop a valid and reliable instrument to measure nursing students’ (NSs’) perceptions of civil and uncivil behaviors displayed by direct care nurses in the hospital clinical environment.

BACKGROUND: Incivility in nursing has been well documented. However, little is known about perceptions of incivility by NSs in the hospital clinical environment and its effects on NSs’ transition to professional practice.

METHODS: A 13-item instrument was developed using literature, faculty feedback, and a semistructured focus group. The instrument was administered to convenience samples of NSs at a Midwest, Magnet®-designated pediatric hospital (N = 496).

RESULTS: Findings indicated high reliability and validity of the instrument, with a Cronbach’s α of .930.

CONCLUSIONS: This study has produced a valid and reliable survey instrument to measure the perception of civil and noncivil behaviors on the part of clinical nurses as rated by NSs in hospital clinical settings. The use of this instrument will be beneficial to nurse executives in measuring these perceptions in their clinical settings.

Author Affiliations: Nursing School Clinical Manager (Ms Tecza), Clinical Instructor (Mss Boots, Clay, and Mains), Research Advisor/Data Analyst (Ms Olney), Children’s Mercy Hospital, Kansas City, Missouri; Clinical Nurse Educator (Ms Kirkman), Baton Rouge General Health System, Louisiana; Assistant Professor (Ms Newton), Undergraduate Faculty, Research College of Nursing, Kansas City; Director of Evidence Based Practice (Dr Bartlett), Children’s Mercy Hospital, Kansas City, Missouri.

The authors declare no conflicts of interest.

Correspondence: Ms Tecza, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108 (

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