Title:
Incivility in the Clinical Setting: Introducing CRT as an Intervention
Brief description:
High nursing turnover remains a challenge in healthcare, often driven by normalized uncivil behaviors in the workplace (Muharraq, E.H., et al.). Toxic environments contribute to staffing shortages, increased stress, decreased job satisfaction, and heightened risk to patient safety. To address this issue, healthcare organizations must adopt a proactive framework that discourages incivility (King, C., et al.). This project aims to raise awareness about the comprehensive impact of incivility within healthcare settings.
Methods:
A secure online survey, administered using Qualtrics, was conducted before and after a 20-minute virtual civility training module. The Workplace Civility Index (WCI), a validated 20-item Likert-scale tool, measured participants' baseline understanding of civility and assessed changes in their perception following the intervention. No identifying information beyond basic demographics was collected, ensuring confidentiality and minimizing ethical concerns.
Results:
Descriptive statistics revealed no change in mean self-rated civility scores from pre- to post-intervention (M = 84.38), although the median score declined slightly, and variability increased. Ratings of others' civility were notably lower, with an unchanged mean of 65.25 and a drop in median from 68.0 to 64.0. These findings suggest high self-perceived civility, continued lower perceptions of peer civility, and minimal overall impact from the intervention.
Conclusion:
Although the intervention did not yield statistically significant results, it provided insights into perceptions of civility and highlighted the need for more comprehensive, sustained, inclusive strategies. The gap between self and others' ratings underscores the importance of fostering shared accountability and cultural transformation. Continued efforts should prioritize reflection, dialogue, and education to support respectful environments and improve patient outcomes.
Project site:
Eskenazi Health
How did you become interested in this area of research?
I became interested in the topic of incivility after witnessing and experiencing unprofessional behavior over the years and observing its negative effects on morale and patient care. I observed how such behavior was often excused or normalized, even when individuals had the courage to speak up and express their concerns. However, it was seeing my nursing students directly subjected to incivility at clinical sites that truly motivated me to act and advocate for healthier, more respectful work environments.
How has your project been introduced at Eskenazi Health?
My project was introduced through the Patient Care Leadership Council (PCLC), where staff were invited to voluntarily participate in a brief, structured Cognitive Rehearsal Training (CRT) session delivered via PowerPoint, along with pre- and post-intervention surveys to assess perceptions of civility. The project was framed as a proactive, awareness-focused initiative that offered practical strategies for addressing unprofessional behavior while minimizing disruption to daily workflows.
Post-graduation plans?
After graduation, I plan to continue my work in public health, focusing on reducing Indiana's maternal morbidity and mortality rates, which I’m extremely passionate about. I also plan to expand my role in academia, influencing the next generation of nursing professionals. Additionally, I’m interested in potentially publishing my research findings to contribute to meaningful organizational change in healthcare.
Faculty Mentor:
Deb Sipes-Fears, DNP, RN, CCRN
Site Mentor:
Jennifer L. Embree, DNP, RN, NE-BC, CCNS, FAAN