Workplace Environment Assessment in Healthcare

Workplace Environment Assessment in Healthcare

The Work Environment Assessment is an “evidence-based tool to raise awareness, assess the perceived health of an organization, and determine strengths and areas for improvement” (Clark, 2015, p. 19). After completing the assessment tool, my current workplace scored a 68 which places our work environment in the “barely healthy” category. For example, one statement on the assessment asks if there is a clear level of trust between formal leadership and staff in the workplace. I rated this completely untrue. There are many nurses in our clinic that don’t feel like they can trust our nursing supervisor. He will tell you what you want to hear to your face and do the complete opposite just to get you out of his office. He will also talk to one nurse about another nurse negatively. This is not a good example of a leader. This is why I believe that my workplace is not civil because of our poor leadership. The common theme is that leadership is addressed with issues and then nothing happens. According to Marshall and Broome, “doing nothing and not making decisions when one is in a position of responsibility is simply unconscionable” (2017, p. 139).

Incivility can be defined as “a low-intensity behavior, or uncivil behavior, with the intent to harm the target” (Kisner, 2018, p. 36). Here is an example of incivility between a nurse, fellow collegeaus, and leadership. This is a Department of Defense facility so there are always formal leaders, providers, and nurses coming and going. Almost everyone in the facility is directly linked to the military system. When I first started working here, the clinic was developing a new team or clinic for the 65 and older community. My preceptor and several others were being moved to the new team due to colleagues not being civil to each other. My preceptor took me with her to the new team, stating that based on my personality it would be better for me. Our team worked so incredibly well together. Everyone knew what their duties and responsibilities were every day. Our team was growing in patients, providers, and nurses. A new RN was added to our team and conflict immediately started. She came in on the first day acting like she was above everyone else. In orientation, she would always say well where I came from we did it like this and her preceptor would always reply with that is okay, but this is how we do it here. There were several conflicts and arguments between providers, nurses, and formal leaders with this nurse which lead to conflict between our team. She would pull up provider’s notes and critique them, tell them what they were doing wrong, and take it to our chief nursing officer. She would also take pictures with her phone about other nurse’s work and state that she was going to save them for when she needed them. At one point, she called our chief nursing officer incompetent and our Chief Department Officer a curse word to their face. Nothing happened to this nurse and leadership overlooked this situation. There were several comments made among staff that it must be okay to call your supervisor profound words because nothing will happen to you. Our work environment went from civil to not civil over the short three months that this nurse was there. “Lack of action frustrates others who are looking to you to decide so that they can move on and implement plans aligned with that decision” (Marshall & Broom, 2017, p. 139).

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When issues develop, mediation has been a key component to resolve the issue at a lower level. “Mediation is described by legal scholars as a facilitated process designed to resolve conflict between two parties in a voluntary and mutually acceptable way through neutral third-party assistance as an alternative to proceedings that are more coercive” (Knickle, McNaughton, and Downar, 2012, p. 1). In this situation there were several levels of mediations that started at the lower level first (person to person), then lead RN to individual, then as a team, and then to our chief nursing officer. This issue went all the way to our chief of department officer, because our chief nursing officer didn’t do anything to help solve the issue. For example, this new nurse requested many times to change teams because personalities were clashing and she stated that she was being bullied. Our supervisor would continue to say that conflicts needed to be addressed within the team. This clinic is huge and there was a need for this individual on several teams. Eventually, this nurse found another job and left.

References

Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American

Nurse Today, 10(11), 18-23. Retrieved from

https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Knickle, K., McNaughton, N., & Downar, J. (2012). Beyond winning: mediation, conflict

resolution, and non-rational sources of conflict in the ICU. Critical care (London, England), 16(3), 308. doi:10.1186/CC11141

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

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Nurse to nurse incivility is “associated with high rates of employee turnover and decreased quality of care” (Clark, 2015). In the clinical setting that I am currently in, I have not seen this type of behavior. On one hand, senior nurses may be leaving due to incivility from less experienced nurses. On the other hand, the older generation nurses are not technology savvy and nursing has changed to be more computer based. This could be another reason why senior nurses are leaving. Senior nurses could also be leaving the workforce because the patient load has become too intense and they are burnout.

Senior nurses “may feel threatened by novice faculty and their attempts to retain their power and territory may contribute to the lack of professionalism leading to incivility” (Peters, 2014, p. 223). For example, in my clinic we have a nurse practitioner that has been there for over 10 years. We have recently added three new, but more experienced, nurse practitioners to the clinic. Leadership will go to them for advice first. This has caused a lot of incivility between providers because the senior providers that have been there longer, feel like their opinion is more valuable. Some providers have left the clinic or are looking for new jobs because of the lack of worth they feel from leadership.

References

Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American

Nurse Today, 10(11), 18-23. Retrieved from

https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Peters, A. B., (2014). Faculty to faculty incivility: Experiences of novice nurse faculty in

academia. Journal of Professional Nursing, 30(3), 213-227. Doi:10.1016/j.profnurs.2013.09.007

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