Description
Please see the attached files one is the questions that I had to do and I got 70 to 79, mildly healthy and the second file is the whole file to get the citation from there I did the test and I got 70 to 79, mildly healthy To Prepare: Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).Review and complete the Work Environment Assessment Template in the Resources. Post – a brief description of the results of your Work Environment Assessment. – Based on the results, how civil is your workplace? Explain why your workplace is or is not civil. – Then, describe a situation where you have experienced incivility in the workplace. – How was this addressed? Be specific and provide examples. Please use this course reference and 3 more outside references that have DOI for the last 5 years and highlight each required question also add conclusion Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf
Unformatted Attachment Preview
Conversations
to inspire and promote a
more civil workplace
Let’s end the silence that surrounds incivility.
By Cynthia M. Clark,
PhD, RN, ANEF, FAAN
“I believe we can
change the world if we
start listening to one
another again. Simple,
honest, human conversation…a chance to
speak, feel heard, and
[where] we each listen
well…may ultimately
save the world.”
Margaret J. Wheatley,
EdD
GIVEN the stressful healthcare
workplace, it’s no wonder nurses
and other healthcare professionals
sometimes fall short of communicating in respectful, considerate
ways. Nonetheless, safe patient care
hinges on our ability to cope with
stress effectively, manage our emotions, and communicate respectfully. Interactions among employees
can affect their ability to do their
jobs, their loyalty to the organization, and most important, the delivery of safe, high-quality patient
care.
The American Nurses Association (ANA) Code of Ethics for
Nurses with Interpretive Statements
clearly articulates the nurse’s obligation to foster safe, ethical, civil
workplaces. It requires nurses “to
create an ethical environment and
culture of civility and kindness,
treating colleagues, coworkers, employees, students, and others with
18
American Nurse Today
dignity and respect” and states that
“any form of bullying, harassment,
intimidation, manipulation, threats,
or violence will not be tolerated.”
However, while nurses need to
learn and practice skills to address
CNE
1.0 contact
hours
L EARNING O BJECTIVES
1. Identify components of a healthy
workplace.
2. Discuss how to prepare for a challenging conversation.
3. Describe models for conducting a
challenging conversation.
The planners of this CNE activity have disclosed no
relevant financial relationships with any commercial
companies pertaining to this activity. See the last page
of the article to learn how to earn CNE credit. The
author has disclosed that she receives royalties and
consulting fees pertaining to this topic. The article
was peer reviewed and determined to be free of bias.
Expiration: 11/1/18
Volume 10, Number 11
uncivil encounters, organization leaders and
managers must create
an environment where
nurses feel free and
empowered to speak
up, especially regarding patient safety
issues.
All of us must strive
to create and sustain
civil, healthy work environments where we
communicate clearly and effectively
and manage conflict in a respectful,
responsible way. The alternative—
incivility—can have serious and
lasting repercussions. An organization’s culture is linked closely with
employee recruitment, retention,
and job satisfaction. Engaging in
clear, courteous communication fosters a civil work environment, improves teamwork, and ultimately
enhances patient care.
In many cases, addressing incivility by speaking up when it happens can be the most effective
way to stop it. Of course, meaningful dialogue and effective communication require practice. Like
bowel sound auscultation and nasogastric tube insertion, communication skills can’t be mastered
overnight. Gaining competence in
civil communication takes time,
training, experience, practice, and
feedback.
www.AmericanNurseToday.com
What makes for a healthy
workplace?
The American Association of Critical-Care Nurses has identified six
standards for establishing and sustaining healthy work environments—skilled communication, true
collaboration, effective decisionmaking, appropriate staffing, meaningful recognition, and authentic
leadership.
In my own research, I’ve found
that healthy work environments also require:
• a shared organizational vision,
values, and team norms
• creation and sustenance of a
high level of individual, team,
and organizational civility
• emphasis on leadership, both
formal and informal
• civility conversations at all organizational levels.
I have developed a workplace
inventory that individuals and
groups within organizations can use
as an evidence-based tool to raise
awareness, assess the perceived
health of an organization, and determine strengths and areas for improvement. The inventory may be
completed either individually or by
all team members, who can then
compare notes to determine areas
for improvement and celebrate and
reinforce areas of strength. (See
Clark Healthy Workplace Inventory.)
How to engage in challenging
conversations
One could argue that to attain a
high score on nearly every inventory item, healthy communication
must exist in the organization. So
leaders need to encourage open
discussion and ongoing dialogue
about the elements of a healthy
workplace. Sharing similarities as
well as differences and spending
time in conversation to identify
strategies to enhance the workplace
environment can prove valuable.
But in many cases, having such
conversations is easier said than
done. For some people, engaging
www.AmericanNurseToday.com
directly in difficult conversations
causes stress. Many nurses report
they lack the essential skills for having candid conversations where
emotions run high and conflictnegotiation skills are limited. Many
refrain from speaking with uncivil
individuals even when a candid
conversation clearly is needed, because they don’t know how to or
because it feels emotionally unsafe.
Some nurses lack the experience
and preparation to directly address
incivility from someone in a higher
position because of the clear power
differential or a belief that it won’t
change anything. The guidelines below can help you prepare for and
engage in challenging conversations.
Reflecting, probing, and
committing
Reflecting on the workplace culture
and our relationships and interactions with others is an important
step toward improving individual,
team, and organizational success.
When faced with the prospect of
having a challenging conversation,
we need to ask ourselves key questions, such as:
• What will happen if I engage in
this conversation, and what will
happen if I don’t?
• What will happen to the patient
if I stay silent?
In the 2005 report “Silence Kills:
The Seven Crucial Conversations
for Healthcare,” the authors identified failing to speak up in disrespectful situations as a serious communication breakdown among
healthcare professionals, and they
asserted that such a failure can
have serious patient-care consequences. In a subsequent report,
“The Silent Treatment: Why Safety
Tools and Checklists Aren’t Enough
to Save Lives,” the authors suggested a multifaceted organizational approach to creating a culture where
people speak up effectively when
they have concerns. This approach
includes several recommendations
and sources of influence, including
improving each person’s ability to
be sure all healthcare team members have the skills to be “200% accountable for safe practices.” Ways
to acquire safe practice skills include education and training, script
development, role-playing, and
practicing effective communication
skills for high-stakes situations.
Creating a safe zone
If you’ve decided to engage in a
challenging conversation with a
coworker who has been uncivil,
choose the time and place carefully. Planning wisely can help you
create a safe zone. For example,
avoid having this conversation in
the presence of patients, family,
and other observers. Choose a setting where both parties will have as
much emotional and physical safety
as possible.
Both should agree on a mutually beneficial time and place to
meet. Ideally, the place should be
quiet, private, away from others
(especially patients), and conducive to conversation and problem-solving. Select a time when
both parties will be free of interruptions, off shift, and well-rested.
If a real or perceived power differential exists between you and the
other person, try to have a third
party present.
You may need to initiate the
conversation by asking the other
person for a meeting. Suppose
you and your colleague Sam disagree over the best way to perform a patient care procedure.
You might say something like,
“Sam, I realize we have different
approaches to patient care. Since
we both agree patient safety is our
top concern, I’m confident that if
we sit down and discuss possible
solutions, we can work this out.
When would you like to get together to discuss this?”
Before the meeting, think about
how you might have contributed to
the situation or conflict; this can
help you understand the other per-
November 2015
American Nurse Today
19
Clark Healthy Workplace Inventory
You can use the inventory below to help determine the health of your workplace. To complete it, carefully read the 20 statements
below. Using a scale of 1 to 5, check the response that most accurately represents your perception of your workplace. Check 5 if
the statement is completely true, 4 if it’s somewhat true, 3 if it’s neutral, 2 if it’s somewhat untrue, and 1 if it’s completely untrue.
Then total the number values of your responses to determine the overall civility score. Scores range from 20 to 100. A score of 90
to 100 indicates a very healthy workplace; 80 to 89, moderately healthy; 70 to 79, mildly healthy; 60 to 69, barely healthy; 50 to 59,
unhealthy; and less than 50, very unhealthy.
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□
Completely Somewhat
true (5)
true (4)
Statement
Members of the organization “live” by a shared vision
and mission based on trust, respect, and collegiality.
There is a clear and discernible level of trust
between and among formal leadership and
other members of the workplace.
Communication at all levels of the organization
is transparent, direct, and respectful.
Employees are viewed as assets and valued
partners within the organization.
Individual and collective achievements are celebrated
and publicized in an equitable manner.
There is a high level of employee satisfaction,
engagement, and morale.
The organizational culture is assessed on an ongoing
basis, and measures are taken to improve it based on
results of that assessment.
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There is a comprehensive mentoring program for
□
all employees.
There is an emphasis on employee wellness and self-care. □
There are sufficient resources for professional growth
□
and development.
Employees are treated in a fair and respectful manner.
□
The workload is reasonable, manageable, and fairly
□
distributed.
Members of the organization use effective conflict□
resolution skills and address disagreements in a
Members of the organization are actively engaged in
shared governance, joint decision-making, and policy
development, review, and revision.
Teamwork and collaboration are promoted and evident.
□
The organization provides competitive salaries, benefits, □
compensations, and other rewards.
There are sufficient opportunities for promotion and
□
career advancement.
The organization attracts and retains the
□
“best and the brightest.”
The majority of employees would recommend the
□
organization as a good or great place to work to
respectful and responsible manner.
The organization encourages free expression of diverse
and/or opposing ideas and perspectives.
their family and friends.
© 2014 Cynthia M. Clark
20
American Nurse Today
Volume 10, Number 11
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Neutral
(3)
Somewhat
untrue (2)
Completely
untrue (1)
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www.AmericanNurseToday.com
son’s perspective. The clearer you
are about your possible role in the
situation, the better equipped you’ll
be to act in a positive way. Rehearsing what you intend to say also can help.
Preparing for the conversation
Critical conversations can be stressful. While taking a direct approach
to resolving a conflict usually is the
best strategy, it takes fortitude,
know-how—and practice, practice,
practice. Prepare as much as possible. Before the meeting, make sure
you’re adequately hydrated and
perform deep-breathing exercises
or yoga stretches.
On the scene
When the meeting starts, the two
of you should set ground rules,
such as:
• speaking one at a time
• using a calm, respectful tone
• avoiding personal attacks
• sticking to objective information.
Each person should take turns
describing his or her perspective in
objective language, speaking directly and respectfully. Listen actively and show genuine interest in
the other person. To listen actively,
focus on his or her message instead of thinking about how you’ll
respond. If you have difficulty listening and concentrating, silently
repeat the other person’s words to
yourself to help you stay focused.
Stay centered, poised, and focused on patient safety. Avoid being defensive. You may not agree
with the other person’s message,
but seek to understand it. Don’t interrupt or act as though you can’t
wait to respond so you can state
your own position or impression.
Be aware of your nonverbal
messages. Maintain eye contact and
an open posture. Avoid arm crossing, turning away, and eye rolling.
The overall goal is to find an
interest-based solution to the situation. The intention to seek common ground and pursue a comwww.AmericanNurseToday.com
promise is more likely to yield a
win-win solution and ultimately improve your working relationship.
Once you and the other person
reach a resolution, make a plan for
a follow-up meeting to evaluate
your progress on efforts at resolving the issue.
Framework for engaging in
challenging conversations
Cognitive rehearsal is an evidencebased framework you can use to
address incivility during a challenging conversation. This three-step
process includes:
• didactic and interactive learning
and instruction
• rehearsing specific phrases to
use during uncivil encounters
• practice sessions to reinforce instruction and rehearsal.
Using cognitive rehearsal can
lead to improved communication, a
more conflict-capable workforce,
greater nurse satisfaction, and improved patient care.
DESC model
Various models can be used to
structure a civility conversation.
One of my favorites is the DESC
model, which is part of TeamSTEPPS—an evidence-based teamwork system to improve communication and teamwork skills and, in
turn, improve safety and quality
care. Using the DESC model in
conjunction with cognitive rehearsal is an effective way to address
specific incivility incidents. (See
DESC in action: Three scenarios.)
Other acceptable models exist
for teaching and learning effective
communication skills and becoming conflict-capable. In each model, the required skills are learned,
practiced, and reinforced until responses become second nature.
Another key feature is to have the
learner make it his or her own; although a script can be provided, it
should be used only to guide development of the learner’s personal
response.
Nurturing a civil and
collaborative culture
Addressing uncivil behavior can be
difficult, but staying silent can increase stress, impair your job performance and, ultimately, jeopardize patient care. Of course, it’s
easier to be civil when we’re relaxed, well-nourished, well-hydrated, and not overworked. But over
the course of a busy workday,
stress can cause anyone to behave
disrespectfully.
When an uncivil encounter occurs, we may need to address it by
having a critical conversation with
the uncivil colleague. We need to
be well-prepared for this conversation, speak with confidence, and
use respectful expressions. In this
way, we can end the silence that
surrounds incivility. These encounters will be more effective when
we’re well-equipped with such
tools as the DESC model—and
when we’ve practiced the required
skills over and over until we’ve
perfected them.
Effective communication, conflict negotiation, and problem-solving are more important than ever.
For the sake of patient safety,
healthcare professionals need to
focus on our higher purpose—providing safe, effective patient care—
and communicate respectfully with
each other. Differences in socialization and educational experiences, as well as a perceived power differential, can put physicians
and nurses at odds with one another. When we nurture a culture
of collaboration, we can synthesize
the unique strengths that healthcare workers of all disciplines
bring to the workplace. In this
way, we can make the workplace
✯
a civil place.
Cynthia M. Clark is a nurse consultant with ATI
Nursing Education and professor emeritus at Boise
State University in Boise, Idaho. Names in scenarios
are fictitious.
For a list of selected references, visit American
NurseToday.com/?p=21641.
November 2015
American Nurse Today
21
DESC in action: Three scenarios
The DESC model for addressing incivility has four elements:
D: Describe the specific situation.
E: Express your concerns.
S: State other alternatives.
C: Consequences stated.
I’d like to talk about alternatives because I’m unable to work an
additional shift today.”
Consequence: “Let’s work together to discuss alternatives for
covering Nicole’s shift. It’s important for me to have a voice in
decisions that affect me.”
The scenarios below give examples of how to use the DESC
model to address uncivil workplace encounters.
For a staff nurse, addressing a manager can be daunting. To
have a critical conversation with an uncivil superior in an effort
to put an end to the problem, you need the courage to be assertive. Engaging in stress-reducing and self-care activities and
practicing mindfulness can boost your courage so you’ll be
prepared. Most of all, you need to practice and rehearse effective communication skills until you feel comfortable using
them.
A 2014 study by Laschinger et al. found a compelling relationship between meaningful leadership and nurse empowerment and their impact on creating civility and decreasing
nurse burnout. This study underscores the need for leadership
development to enable nurse managers to foster civil work environments. To create and sustain a healthy environment, all
members of the organization need to receive intentional and
ongoing education focused on raising awareness about incivility; its impact on individuals, teams, and organizations; and
most important, its consequences on patient care and safety.
Nurses Sandy and Claire
At the beginning of her shift, Sandy receives a handoff report
from Claire, who has just finished her shift.
“Geez, Sandy, where have you been? You’re late as usual. I can’t
wait to get out of here. See if you can manage to get this information straight for once. You should know Mary Smith by now. You
took care of her yesterday. She was on 4S forever; now she’s our
problem. You need to check her vital signs. I’ve been way too busy
to do them. So, that’s it—I’m out of here. If I forgot something, it’s
not my problem. Just check the chart.”
Not only is Claire rude and disrespectful, but she also is putting the patient at risk by providing an incomplete report.
Here’s how Sandy might address the situation.
Describe: “Claire, I can see you’re in a hurry, and I understand
you’re upset because I’m late. We can talk about that when we
have more time. For now, I don’t feel like I’m getting enough
information to do my job effectively.”
Explain: “Talking about Mrs. Smith in a disrespectful way and
rushing through report can have a serious impact on her care.”
State: “I know we’re both concerned about Mrs. Smith, so
please give me a more detailed report so I can provide the
best care possible.”
Consequence: “Without a full report, I may miss an important
piece of information, and this could compromise Mrs. Smith’s
care.”
Nurse manager Alice and staff nurse Kathy
The anxiety level may rise for a nurse who experiences incivility from a higher-up. The following scenario illustrates an uncivil encounter between Alice, a nurse manager, and Kathy, a staff
nurse.
“Hey Kathy, I just found out Nicole called in sick, so you’re going to
have to cover her shift. We’re totally shorthanded, so you need to
stay. You may not like the decision, but that’s just the way it is.”
Kathy is unable—and frankly, unwilling—to work a double
shift. Exhausted, she’d planned to spend time with her family
this evening. Also, she has worked three extra shifts this
month. She decides she needs to deal with this situation now
instead of setting up a meeting with Alice later in the week.
Here’s how she might use the DESC model with her manager.
Describe: “Alice, I can appreciate the need to cover the unit
because of Nicole’s illness. We all agree that having adequate
staff is important for patient care.”
Explain: “I’m exhausted, and because I have recently covered
other shifts, I’m less prepared to administer safe, high-quality
care.”
State: “I realize that as manager, it’s your responsibility to
make sure we have adequate staff for the oncoming shift. But
22
American Nurse Today
Volume 10, Number 11
Nurse Tom and Dr. Jones
This scenario depicts an uncivil encounter between a nurse
and a physician.
Tom is concerned about Mr. Brown, a patient who’s 2 days postop
after abdominal surgery for a colon resection. On the second
evening after surgery, Mr. Brown’s blood pressure increases. Tom
watches him closely and continues to monitor his vital signs. As
the night wears on, Mr. Brown’s blood pressure continues to rise,
his breathing seems more labored, and his heart rate increases.
Tom calls Dr. Jones, the attending physician, to report his findings. Dr. Jones chuckles and says, “He’s just anxious. Who wouldn’t
be in his condition?” and hangs up. Undaunted, Tom calls back
and insists Dr. Jones return to the unit to assess Mr. Brown. Reluctantly, Dr. Jones comes to the unit, peeks into Mr. Brown’s room
without assessing him, and chastises Tom in front of his colleagues and other patients about his “ridiculous overreaction.”
Tom politely asks Dr. Jones to meet with him in an empty meeting
room. Here’s how Tom uses DESC to address the situation.
Describe: “Dr. Jones, I’d like to explain something. Please hear
me out before you comment. I am a diligent nurse with extensive patient care experience.”
Explain: “I know that as Mr. Brown’s attending physician,
you’re committed to his safety. I assure you that everyone on
the healthcare team shares your concern, including me. I
called you immediately after determining persistent and notable changes in Mr. Brown’s vital signs.”
State: “Because we are all concerned about Mr. Brown’s care, it
would be best if you conducted an assessment and addressed
me in a respectful manner so we can provide the best care
possible. I will show you the same respect.”
Consequence: “Disregarding important information or allowing your opinion of me to influence your response could compromise Mr. Brown’s care. We need to work together as a team
to provide the best care possible.”
www.AmericanNurseToday.com
POST-TEST • Conversations to inspire and promote a more civil workplace
Earn contact hour credit online at http://www.americannursetoday.com/continuing-education/
CNE
CNE: 1.0 contact hours
Provider accreditation
Post-test passing score is 80%. Expiration: 11/1/18
The American Nurses Association’s Center for Continuing Education and Professional Development is accredited as a
provider of continuing nursing education by the American
Nurses Credentialing Center’s Commission on Accreditation.
ANCC Provider Number 0023.
ANA Center for Continuing Education and Professional Development’s accredited provider status refers only to CNE activities and does not imply that there is real or implied endorsement of any product, service, or company referred to in this
activity nor of any company subsidizing costs related to the
activity. The author and planners of this CNE activity have disclosed no relevant financial relationships with any commercial
companies pertaining to this CNE. See the last page of the
article to learn how to earn CNE credit.
Contact hours: 1.0
ANA’s Center for Continuing Education and Professional Development is approved by the California Board of Registered Nursing, Provider Number CEP6178 for 1.2 contact hours.
Please mark the correct answer online.
1. The American Association of
Critical-Care Nurses does not identify
which of the following as a
characteristic of a healthy workplace?
a. Skilled communication
b. Informal leadership
c. True collaboration
d. Meaningful recognition
2. A healthy work environment
requires:
a. civility conversations at the highest
level of the organization.
b. emphasis on formal rather than
informal leadership.
c. shared organizational vision, values,
and norms.
d. individualized values and norms.
3. When considering whether to have
a challenging conversation, which key
question should you ask yourself?
a. Is the person I need to talk to a fulltime employee?
b. Do I have enough experience to
have the conversation?
c. How many years have I worked at
this facility?
d. What will happen to the patient if I
stay silent?
www.AmericanNurseToday.com
4. Which of the following helps to
create a safe zone for a challenging
conversation?
a. Agreeing on a mutually beneficial
time to meet
b. Having the conversation in the
presence of patients
c. Having the conversation in the
presence of family members
d. Choosing a time immediately after
the other person’s shift
8. What is the first element of the
DESC model?
a. Describe the specific situation.
b. Discuss your concerns.
c. Define your solution.
d. Detail the alternatives.
5. If a power differential exists
between you and the other person, an
effective approach is to:
a. keep the matter between the two of
you.
b. have a third party present.
c. have a security officer attend the
meeting.
d. refrain from having the
conversation.
6. Which of the following is an
appropriate action during a challenging
conversation?
a. Interrupt as needed.
b. Talk quickly.
c. Cross your arms.
d. Maintain eye contact.
9. What is the last element of the DESC
model?
a. Coordinate your response.
b. Consider the setting.
c. Consequences stated.
d. Concerns stated.
10. Which statement about challenging
conversations is correct?
a. Nurses have an innate ability to
have these conversations.
b. The person who called the meeting
should dominate the discussion.
c. Agreeing with the other person’s
message is important.
d. After the resolution, the participants
should schedule a follow-up
meeting.
7. The first step of cognitive rehearsal
is:
a. describing your position in objective
terms.
b. rehearsing specific phrases to use
during uncivil encounters.
c. undergoing didactic and interactive
learning and instruction.
d. having a practice session to
reinforce instruction and rehearsal.
November 2015
American Nurse Today
23
Clark Healthy Workplace Inventory
You can use the inventory below to help determine the health of your workplace. To complete it, carefully read the 20 statements
below. Using a scale of 1 to 5, check the response that most accurately represents your perception of your workplace. Check 5 if
the statement is completely true, 4 if it’s somewhat true, 3 if it’s neutral, 2 if it’s somewhat untrue, and 1 if it’s completely untrue.
Then total the number values of your responses to determine the overall civility score. Scores range from 20 to 100. A score of 90
to 100 indicates a very healthy workplace; 80 to 89, moderately healthy; 70 to 79, mildly healthy; 60 to 69, barely healthy; 50 to 59,
unhealthy; and less than 50, very unhealthy.
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□
□
□
Completely Somewhat
true (5)
true (4)
Statement
Members of the organization “live” by a shared vision
and mission based on trust, respect, and collegiality.
There is a clear and discernible level of trust
between and among formal leadership and
other members of the workplace.
Communication at all levels of the organization
is transparent, direct, and respectful.
Employees are viewed as assets and valued
partners within the organization.
Individual and collective achievements are celebrated
and publicized in an equitable manner.
There is a high level of employee satisfaction,
engagement, and morale.
The organizational culture is assessed on an ongoing
basis, and measures are taken to improve it based on
results of that assessment.
□
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□
□
□
□
There is a comprehensive mentoring program for
□
all employees.
There is an emphasis on employee wellness and self-care. □
There are sufficient resources for professional growth
□
and development.
Employees are treated in a fair and respectful manner.
□
The workload is reasonable, manageable, and fairly
□
distributed.
Members of the organization use effective conflict□
resolution skills and address disagreements in a
Members of the organization are actively engaged in
shared governance, joint decision-making, and policy
development, review, and revision.
Teamwork and collaboration are promoted and evident.
□
The organization provides competitive salaries, benefits, □
compensations, and other rewards.
There are sufficient opportunities for promotion and
□
career advancement.
The organization attracts and retains the
□
“best and the brightest.”
The majority of employees would recommend the
□
organization as a good or great place to work to
respectful and responsible manner.
The organization encourages free expression of diverse
and/or opposing ideas and perspectives.
their family and friends.
© 2014 Cynthia M. Clark
20
American Nurse Today
Volume 10, Number 11
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Neutral
(3)
Somewhat
untrue (2)
Completely
untrue (1)
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