Incivility experiences of racially minoritised hospital staff, consequences for them and implications for patient care: An international scoping review.

Workplace incivility is a pervasive complex problem within health care. Incivility manifests as subtle disrespectful behaviours, which seem inconsequential. However, evidence demonstrates that incivility can be harmful to targets and witnesses through negative emotions, poorer mental health, reduced job satisfaction, diminished performance and compromised patient care. It is unclear to what extent existing research critically explores how ethnicity, culture and racism influence how hospital staff experience incivility. This global scoping review systematically analysed existing research exploring the specific ways incivility manifests and impacts racially minoritised hospital workers. Of 2636 academic and 101 grey literature articles, 32 were included. Incivility experiences were categorised into four themes: (1) Cultural control, (2) Rejection of work contributions, (3) Disempowerment at work and (4) Managerial indifference. The included articles highlighted detrimental consequences, such as negative emotions, silencing, withdrawal and reduced support-seeking behaviours. Few studies presented evidence regarding the negative impacts of incivility on patient care. Racialisation and racial dynamics are a significant factor for hospital-based incivility. Currently we do not know the extent to which racialised incivility is associated directly or, perhaps either via burnout or disengagement, indirectly with poorer care. This knowledge can inform the creation of comprehensive, evidence-based interventions to address this important issue.

The effect of nurses' perceived workplace incivility on their presenteeism and turnover intention: The mediating role of work stress and psychological resilience.

AIM: This study aims to determine the effects of nurses' perceived workplace incivility on nurses' presenteeism and turnover intention and to reveal the mediating role of work stress and psychological resilience in the possible impact. BACKGROUND: Nurses directly contribute to the treatment of patients. The problems nurses encounter in the workplace can negatively affect nurses' attitudes towards work. Therefore, the problems faced by nurses should be determined. METHODS: This study complies with the STROBE checklist. This cross-sectional survey was conducted with 302 nurses working in a university hospital in the Konya province of Turkey. Data were collected in May-July 2021. The questionnaire consisted of six parts: sociodemographic characteristics form, workplace incivility scale, psychological resilience scale, work stress scale, turnover intention scale and presenteeism scale. The data were analysed using descriptive statistical methods and partial least-squares path analysis. RESULTS: It was determined that workplace incivility positively and significantly affected turnover intention, presenteeism and work stress. In contrast, it negatively and significantly affected psychological resilience. In addition, psychological resilience played a mediating role in the effect of workplace incivility on presenteeism. CONCLUSION: The results reveal that the behaviours of incivility encountered by nurses in the workplace increase their presenteeism and turnover intention, and work stress further strengthens these effects. The psychological resilience of nurses is a factor that can help them eliminate their negative emotions and attitudes. Therefore, it is recommended that nursing and health managers first identify the stress factors in the workplace and be determined to fight them. In addition, organizing training and providing psychological support to increase nurses' psychological resilience may enable nurses to develop more positive feelings about their jobs and workplaces. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health managers must determine workplace incivility behaviours and inform all employees about these behaviours, their consequences and how to deal with such incivility. In addition, nursing and health managers must determine the stress factors in the workplace and be adamant about combating these factors. In addition, nursing and health managers must give importance to training that will increase the psychological resilience of nurses.

Workplace incivility and the professional quality of life in nurses.

BACKGROUND: Workplace Incivility is a common issue in the nursing profession. Nurses who are affected by such behaviors may experience distress. OBJECTIVES: This study aimed to assess the relationship between workplace incivility and nurses' professional quality of life. RESEARCH DESIGN: This cross-sectional correlational study was conducted in 2021 in "Tehran". Data were collected using a demographic questionnaire, the Nursing Incivility Scale (NIS), and the Professional Quality Of Life scale (ProQOL). Data analysis was performed through the Pearson correlation and multiple linear regression, using the SPSS v.16. PARTICIPANTS AND RESEARCH CONTEXT: Participants were 200 nurses randomly recruited from selected hospitals of "TUMS". ETHICAL CONSIDERATIONS: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. FINDINGS: The mean age of participants was 32.30 ± 7.22, and 76.5% were female. There was a significant correlation between the professional quality of life and workplace incivility (r = -0.23, p = .001). Multiple regression analysis between the subscales of workplace incivility and professional quality of life demonstrated that the incivility from the supervisor (ß = -0.29, p = .001) and incivility from patients (ß = -0.27, p < .001) can predict the compassion satisfaction dimension. The incivility from the supervisor (ß = 0.24, p = .001) and incivility from patients (ß = 0.26, p < .001) can explain burnout. The incivility of the patients can explain secondary traumatic stress (ß = 0.14, p = .02). CONCLUSION: This study showed that workplace incivility is significantly related to professional quality of life. Therefore, the reduction of behaviors of incivility can lead to the improvement of the professional quality of life.

Effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses: a randomized controlled trial.

BACKGROUND: Witnessing or experiencing of incivility affected the nurses' perception of the ethical climate and quality of their work life. The aim of this study was to investigate the effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses. METHOD: This study was conducted as a randomized controlled parallel group clinical trial. Eighty emergency nurses participated in this study and were randomly assigned to intervention and control groups during December 2019-March 2020. Cognitive rehearsal program (include of definitions of incivility, ten common incivilities and appropriate practice methods for responding to each and role-plays) was delivered in five two-hour sessions over three weeks on different working days and shifts. The control group received only written information about what incivility is and how to deal with it before the implementation of intervention and one month after the completion of the training sessions, the demographic information form and the incivility scale were completed by the nurses. RESULTS: The results showed that there was a significant effect on overall incivility, general incivility, and supervisor incivility between the intervention and control groups. However, these significant reductions were seen in control group who received only written education. There were no significant differences in nurse's incivility towards other nurses, physician incivility, and patient/visitor incivility between the two groups. CONCLUSION: The cognitive rehearsal program did not decrease perceived incivility among emergency department nurses in the short term. TRIAL REGISTRATION: Our research was registered on clinicaltrials.gov. REGISTRATION NUMBER: IRCT20200714048104N1 , first registration 16/07/2020.

About Face: Toward a Culture of Innovation.

Intellectual curiosity is the gateway to an innovative mindset. Success is contingent upon what we do with that knowledge to solve problems in our everyday professional practices. However, merely 13 to 25 percent of college graduates enter the workforce with the desirable innovative mindset. Rather, a culture of mediocrity persists within facets of academia as well as the professional workforce. Given that the youngest ranks of nurses emerge from institutes of higher learning and are the future of the nursing workforce, it is appropriate for academia to begin the charge toward change. This article presents a pragmatic discussion of key antagonists to the adoption of a culture of innovation, namely factors that comprise a culture of mediocrity. Strategies that promote creative problem-solving and a shift toward a collaborative culture of innovation will be presented for nurses practicing within academia and the health care system.

Nurses Need Not Be Guilty Bystanders: Caring for Vulnerable Immigrant Populations

Nurses face many dilemmas when providing healthcare to immigrants, a vulnerable population. Racist, rancorous dialogue can create a hostile care environment that may place patients at risk for substandard care. This article presents a two part case study about a Hispanic patient to illustrate both examples of inappropriate dialogue (Part I) and potential nursing actions (Part 2). The authors review myths versus facts about Hispanic immigrants and introduce activist Thomas Merton's concept of the guilty bystander, the nursing professional code of ethics, and Professor Joseph Badaracco's concepts of quiet leadership as practical tools and approaches that nurses can use to advocate for safe, quality, ethical care of immigrant populations.

Acts of xenophobia among nurse educators: A qualitative study.

Background: Xenophobia has been in existence for centuries, though subtle and not too pronounced as of recent years. It has now pervaded all spheres including businesses, academia and industries. Previous studies have found it to be disruptive both to organizations and employees. Purpose: To explore acts of xenophobia among nurse educators, underpinned by the frustration and aggression theory. Method: A qualitative study involving twenty-five nurse educators in Botswana was carried out between July 2019 and August 2020. Open-ended semi-structured questions were used to collect face to face in-depth interviews from participants. Findings: Dehumanizing comments, labelling and discrimination were the three themes that emerged from interpretative analysis. Affected persons were mostly foreign nationals and people of different ethnic groupings. Conclusion: The study concluded that there is need for a policy that addresses acts of xenophobia and an intervention to mitigate acts of xenophobia.

Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being.

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

Experience of Workplace Incivility and Its Impact on Stress and Turnover Intention among the Nurses Working at a Hospital: Cross-Sectional Survey Approach.

BACKGROUND: Incivility in the workplace drowns the mental health of the nurses and hampers the daily routine. The majority of the nurses working at hospitals were experiencing incivility. It affects the physical and psychological health of the nurses. Experience of workplace incivility and its impact on stress and turnover among nurses was discussed in this study. MATERIALS AND METHODS: Cross-sectional survey approach was used to select 50 nurses by simple random sampling technique. Standard scales for incivility, stress, and pre-tested scale for the turnover intention was used to collect the data. RESULT: Nurses experience incivility in their workplace almost from all the sources. The majority (64%) of the staff nurses had a moderate level of stress and 30% had average intention to leave the present job. There was a positive relationship found between the experience of incivility and stress (r = 0.43, p < 0.002), stress, and turnover intention (r = 0.40, p < 0.004). CONCLUSIONS: Experience of incivility provokes stress among the nurses, and this may influence turnover intention.

Incivility toward nurses: a systematic review and meta-analysis.

One important part of a nurse's job is to create and help maintain a safe work environment. Evidence shows that negative behaviors such as incivility are not uncommon in the nursing profession. This systematic review and meta-analysis aimed to examine the prevalence of incivility toward nurses. For this purpose, all observational studies that primarily investigated the rate of incivility toward nurses were selected. The electronic databases PubMed, Embase, Web of Sciences, Magiran, IranDoc, and Scopus were searched for studies published during the period of January 1, 1996 to December 31, 2019. The quality of studies was assessed using Hoy's Critical Assessment Checklist. The study was undertaken using the random effects model, and data were analyzed using STATA14. Data on 60 articles, including data on 30801 individuals, published between 1997 and 2019, entered the study. The findings showed the prevalence of incivility to be 55.10% (95%, CI: 48.05, 62.06). Due to the high prevalence of uncivil behavior, especially of the verbal type, nursing managers should identify risk factors in the workplace. Planners should develop programs to increase workplace safety, especially in centers that are most exposed to these behaviors. It is also recommended that future studies focus on implementation of effective evidence-based interventions based on organizational culture.

Association Between Workplace Bullying Occurrence and Trauma Symptoms Among Healthcare Professionals in Cyprus.

Workplace bullying/mobbing is an extreme work-related stressor, but also a severe hazard for physical, mental and psychological health in healthcare employees, including nurses. A range of trauma-related symptoms has been linked with bullying victimization. The aim of the study was the investigation of workplace bullying/mobbing-related trauma symptoms in Greek-Cypriot nurses working in emergency and critical care settings, as well as of potential correlations with demographic and occupational variables. A descriptive, cross-sectional correlational study was performed in a convenience sample of 113 nurses. A modified version of the Part B.CII of The Workplace Violence in the Health Sector-Country Case Studies Research Instrument (WVHS-CCSRI Part C.II-M) and the modified Secondary Traumatic Stress Scale (STSS-M) were used for the assessment of bullying/mobbing frequency and workplace bullying/mobbing-related trauma symptoms, respectively. A total of 46.9% of the sample reported experiences of both bullying/mobbing victimization and witnessing of bullying/mobbing to others (VWB subgroup), 21.2% reported solely bullying/mobbing victimization (SVB subgroup) and 10.6% reported witnessing of bullying/mobbing to others (SWB subgroup). A total of 22.3% did not experience or witness any bullying/mobbing at the workplace. Trauma symptoms intensity (STSS-M total score) was more severe in the participants a) with a high frequency of workplace bullying/mobbing experiences compared to those with a moderate frequency of such experiences (p = 0.018), b) of the VWB subgroup compared to those of the SWB subgroup (p = 0.019), c) employed in Emergency Departments compared to those employed in ICUs (p = 0.03), d) who had considered resigning due to bullying/mobbing experiences compared to those who had never considered resigning (p = 0.008), e) who had been punished for reporting a bullying/mobbing incident compared to those who had not (p = 0.001), and f) who considered the incident unimportant to be reported compared to those who avoided reporting due to other causes (p = 0.048). This data highlights the need to establish effective and safe procedures for bullying/mobbing reporting, aiming to support bulling/mobbing victims and witnesses, and further to protect their legal rights. Both victims and witnesses of workplace bullying/mobbing need to be assessed by mental health professionals for PTSD symptoms in order to have access to effective treatment.

Predictors of new graduate nurses' health over the first 4 years of practice.

AIM: To examine predictors of Canadian new graduate nurses' health outcomes over 1 year. DESIGN: A time-lagged mail survey was conducted. METHOD: New graduate nurses across Canada (N = 406) responded to a mail survey at two time points: November 2012-March 2013 (Time 1) and May-July 2014 (Time 2). Multiple linear regression (mental and overall health) and logistic regression (post-traumatic stress disorder risk) analyses were conducted to assess the impact of Time 1 predictors on Time 2 health outcomes. RESULTS: Both situational and personal factors were significantly related to mental and overall health and post-traumatic stress disorder risk. Regression analysis identified that cynicism was a significant predictor of all three health outcomes, while occupational coping self-efficacy explained unique variance in mental health and work-life interference explained unique variance in post-traumatic stress disorder risk.

Student-faculty relationships and its impact on academic outcomes.

OBJECTIVE: The aim of this review of the literature is to synthesis the knowledge attained about determinants of student-faculty relationships and its impact on student outcomes. While adding to the body knowledge, the researchers discuss the importance, barriers, and facilitators to student-faculty academic relationships in nursing education. DESIGN: We conducted a narrative literature review using a modified version of the framework of the Population, Intervention, Comparison, and Outcome method to develop the research question for this review. That question was: What determinants of undergraduate nursing students' relationships with faculty affect those students' academic outcomes? DATA SOURCES: To search and review the literature systematically, we entered the specific criteria into the EBSCOhost interface. The following databases were used for data sourcing: Cumulative Index to Nursing and Allied Health Literature Plus with Full Text; Teacher Reference Center; Education Resources Information Center; Medline; and Theses and Dissertations. We selected only full-text, peer-reviewed sources that were written in English for final inclusion. REVIEW METHODS: After the retrieval of 56 reports via an EBSCO host search, abstracts were reviewed and 29 were rejected based on the exclusion/inclusion criteria. The rejected reports met some or no criteria and not others; or showed little to no association with determinants of nursing student-faculty academic relationships or students' academic outcomes. An inductive method of analysis was used to review and extract emerging themes. RESULTS: Findings revealed four core determinants of student-faculty relationships: support, caring, diversity, and incivility. These determinants were interrelated and appeared to have an impact on student academic outcomes. CONCLUSIONS: Nursing institutions should be proactive to ensure that barriers such as incivility are reduced and that diversity is included and appreciated in the teaching and learning environment. Additionally, a caring and supportive climate of learning should be emphasized and enacted by nurse educators.

Certified Registered Nurse Anesthetist Working Conditions and Outcomes: A Review of the Literature.

Certified Registered Nurse Anesthetists (CRNAs) deliver anesthesia to more than 34 million patients per year in the United States in both inpatient and outpatient settings. Yet CRNA working conditions and workforce outcomes have not been well investigated in the literature. For a deeper understanding of both issues, a review of the literature was conducted. Following specific inclusion criteria, peer-reviewed research articles published from 2001 to 2015 were included. Data were abstracted from 13 studies and were synthesized. Four themes emerged: communication and collaboration; professional identity and autonomy; work relations issues experienced by CRNAs, who practice in a variety of healthcare settings; and CRNA outcomes. Regarding the latter, job dissatisfaction, occupational stress, incivility, burnout, workplace aggression, and intent to leave were prevalent CRNA outcomes. Future rigorous research should focus on CRNA working conditions that could be changed to diminish negative CRNA outcomes. Positive CRNA workforce outcomes in turn could have financial, access-to-care, and quality-of-care implications for organizations where CRNAs practice. Policy makers, organizations, CRNAs, and the patients and families CRNAs serve would benefit from such research.

Understanding and meeting your legal responsibilities as a nurse.

Nurses, midwives and nursing students are legally responsible for their actions. This article discusses the legal standard of care required in relation to nursing and midwifery practice and nurses' professional standards and code of conduct. It examines how courts in the UK determine if nurses have met their duty of care and how nurses must ensure they maintain competence to provide safe care. It examines why organisational knowing - understanding the organisation in which one is employed; its people, values and how it works - is important for all nurses, regardless of their level in the organisation. It also discusses workplace incivility and its adverse effects on nurses, patient care and healthcare organisations. The article explains that if nurses are uncertain why they are doing something, they should investigate this further, because the law expects nurses to be able to justify their actions, or failure to act.

Predictors of moral harassment in nursing work in critical care units / Predictores del acoso moral en el trabajo en enfermería en unidades de cuidados críticos / Preditores do assédio moral no trabalho da enfermagem em unidades de cuidados críticos

ABSTRACT Objectives: to analyze the predictors of moral harassment in nursing work in critical care units. Methods: a cross-sectional study conducted in a public hospital in Fortaleza, Ceará, with 167 nursing professionals in 2016. Sociodemographic/occupational questionnaire and Negative Acts Questionnaire Revised were applied. The analysis included descriptive statistics, measures of central tendency and dispersion, as well as Mann-Whitney, Kruskal-Wallis and Conover Inman U-tests for multiple comparisons. Results: there was a 33% prevalence of self-perception of moral harassment, highlighting personal/professional disqualification and work-related harassment. The predictors of moral harassment included age, time working in the job and time in the unit, employment relationship and sector. Conclusions: young professionals (< 30 years), cooperative, crowded in intensive care or emergency units, with less time working in the job (< 5 years) or greater time in the unit (above 10 years) are the biggest victims of moral harassment in the work of nursing in critical environments.

RESUMEN Objetivos: analizar los predictores de acoso moral en el trabajo en enfermería en unidades de cuidados críticos. Métodos: estudio transversal realizado en hospital público de Fortaleza, Ceará, con 167 profesionales de enfermería, en 2016. Aplicó encuesta sociodemográfica/ocupacional y Encuesta de Actos Negativos-Revisado. Análisis incluyó estadística descriptiva, medidas de tendencia central y dispersión, así como testes U de Mann-Whitney, Kruskal-Wallis y ConoverInman para comparaciones múltiples. Resultados: encontró prevalencia de 33% para autopercepción de acoso moral, destacándose descalificación personal/profesional y acoso relacionado al trabajo. Los predictores del acoso moral incluyeron edad, tiempo de formación y de actuación, vínculo laboral y sector. Conclusiones: profesionales jóvenes (< 30 años), cooperados, destinados en unidades de terapia intensiva o emergencia, con menor tiempo de formación (< 5 años) o mayor tiempo de actuación de la unidad (arriba de 10 años) son las mayores víctimas de acoso moral en el trabajo de la enfermería en ambientes críticos.

RESUMO Objetivos: analisar os preditores de assédio moral no trabalho da enfermagem em unidades de cuidados críticos. Métodos: estudo transversal realizado em hospital público de Fortaleza, Ceará, com 167 profissionais de enfermagem, em 2016. Aplicou-se questionário sociodemográfico/ocupacional e Questionário de Atos Negativos-Revisado. A análise incluiu estatística descritiva, medidas de tendência central e dispersão, bem como testes U de Mann-Whitney, Kruskal-Wallis e ConoverInman para comparações múltiplas. Resultados: encontrou-se prevalência de 33% para autopercepção de assédio moral, destacando-se desqualificação pessoal/profissional e assédio relacionado ao trabalho. Os preditores do assédio moral incluíram idade, tempo de formação e de atuação na unidade, vínculo empregatício e setor. Conclusões: profissionais jovens (< 30 anos), cooperados, lotados em unidades de terapia intensiva ou emergência, com menor tempo de formação (< 5 anos) ou maior tempo de atuação da unidade (acima de 10 anos) são as maiores vítimas de assédio moral no trabalho da enfermagem em ambientes críticos.

Predictors of moral harassment in nursing work in critical care units / Predictores del acoso moral en el trabajo en enfermería en unidades de cuidados críticos / Preditores do assédio moral no trabalho da enfermagem em unidades de cuidados críticos

ABSTRACT Objectives: to analyze the predictors of moral harassment in nursing work in critical care units. Methods: a cross-sectional study conducted in a public hospital in Fortaleza, Ceará, with 167 nursing professionals in 2016. Sociodemographic/occupational questionnaire and Negative Acts Questionnaire Revised were applied. The analysis included descriptive statistics, measures of central tendency and dispersion, as well as Mann-Whitney, Kruskal-Wallis and Conover Inman U-tests for multiple comparisons. Results: there was a 33% prevalence of self-perception of moral harassment, highlighting personal/professional disqualification and work-related harassment. The predictors of moral harassment included age, time working in the job and time in the unit, employment relationship and sector. Conclusions: young professionals (< 30 years), cooperative, crowded in intensive care or emergency units, with less time working in the job (< 5 years) or greater time in the unit (above 10 years) are the biggest victims of moral harassment in the work of nursing in critical environments.

RESUMEN Objetivos: analizar los predictores de acoso moral en el trabajo en enfermería en unidades de cuidados críticos. Métodos: estudio transversal realizado en hospital público de Fortaleza, Ceará, con 167 profesionales de enfermería, en 2016. Aplicó encuesta sociodemográfica/ocupacional y Encuesta de Actos Negativos-Revisado. Análisis incluyó estadística descriptiva, medidas de tendencia central y dispersión, así como testes U de Mann-Whitney, Kruskal-Wallis y ConoverInman para comparaciones múltiples. Resultados: encontró prevalencia de 33% para autopercepción de acoso moral, destacándose descalificación personal/profesional y acoso relacionado al trabajo. Los predictores del acoso moral incluyeron edad, tiempo de formación y de actuación, vínculo laboral y sector. Conclusiones: profesionales jóvenes (< 30 años), cooperados, destinados en unidades de terapia intensiva o emergencia, con menor tiempo de formación (< 5 años) o mayor tiempo de actuación de la unidad (arriba de 10 años) son las mayores víctimas de acoso moral en el trabajo de la enfermería en ambientes críticos.

RESUMO Objetivos: analisar os preditores de assédio moral no trabalho da enfermagem em unidades de cuidados críticos. Métodos: estudo transversal realizado em hospital público de Fortaleza, Ceará, com 167 profissionais de enfermagem, em 2016. Aplicou-se questionário sociodemográfico/ocupacional e Questionário de Atos Negativos-Revisado. A análise incluiu estatística descritiva, medidas de tendência central e dispersão, bem como testes U de Mann-Whitney, Kruskal-Wallis e ConoverInman para comparações múltiplas. Resultados: encontrou-se prevalência de 33% para autopercepção de assédio moral, destacando-se desqualificação pessoal/profissional e assédio relacionado ao trabalho. Os preditores do assédio moral incluíram idade, tempo de formação e de atuação na unidade, vínculo empregatício e setor. Conclusões: profissionais jovens (< 30 anos), cooperados, lotados em unidades de terapia intensiva ou emergência, com menor tempo de formação (< 5 anos) ou maior tempo de atuação da unidade (acima de 10 anos) são as maiores vítimas de assédio moral no trabalho da enfermagem em ambientes críticos.