A bold call to action: Mobilizing nurses and employers to prevent and address incivility, bullying, and workplace violence

As registered nurses (RNs), you probably agree that taking action to promote and sustain a culture of civility, respect, and safety is paramount to advancing the future of the nursing profession, to building a culture of health that honors the profession’s contract with society, and to recruiting new nurses and retaining experienced nurses in the profession. To achieve such a bold agenda, we must first make a commitment to ending the incivility, bullying, and workplace violence challenging the profession. Second, we must demonstrate through professional nurse unity and genuine partnership with employers how to end this public health threat.

To that end, the American Nurses Association (ANA) issued a call in early fall 2014 for members to submit applications to serve on what would eventually become the largest of its professional issues panels assembled. More than 500 ANA members expressed interest in and applied to serve on the panel to address incivility, bullying, and workplace violence in health care. In its application review, ANA considered such things as regional and national representation, membership in an affiliate nursing organization, years in the profession, and diversity in terms of nursing practice, education, research, culture, and experience with the topic. From the full applicant pool, ANA selected and invited 24 steering committee members to lead the development of the new position statement. A group of 441 advisory committee members were also selected to provide guidance and feedback to the association and the steering committee throughout the project, and to contribute to the development of resources.

The overall goal of the panel was to develop a position statement on incivility, bullying, and workplace violence that describes evidence of related issues and provides detailed guidance supported by evidence to help RNs and employers promote and sustain healthy workplaces. Four co-chairs were appointed, including the two authors of this article; Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, Delaware Nurses Association and Emergency Nurses Association 2014 president; and James Cole Edmonson, DNP, RN, FACHE, NEA-BC, Texas Nurses Association. The co-chairs, in collaboration with staff from ANA’s Department of Nursing Practice and Work Environment, convened the activities of the Steering Committee and Advisory Committee in November 2014. After circulating the draft document for public comment in April, a final version is expected by the end of August 2015.

Before embarking on the critical work of developing a position statement on incivility, bullying, and workplace violence, members of the professional issues panel collaborated to establish and adopt a team charter and to create and agree upon a set of functional team norms or ground rules. The panel’s team charter provides a framework for desired individual and collective performance, defines the team’s purpose and goals, describes the team members’ roles and responsibilities, identifies key deliverables and decision-making processes, and includes the panel’s agreed upon team norms or ground rules. Ground rules are essential components for effective team functioning, and once they are established, affirmed, and operationalized, teams have a clearer description of their mission and purpose and are better positioned for success. (See Professional issues panel’s team ground rules.)

Professional issues panel’s team ground rules

The panel members hope that the ground rules below might be used by other teams or groups as a guide to develop their own set of ground rules. While important for any team, the ground rules were especially essential for the professional issues panel, because of the sensitivity of the issues related to incivility, bullying, and workplace violence.

  • Assume goodwill and conduct dialogue in a respectful manner.
  • Listen, be nonjudgmental, and keep an open mind.
  • Actively participate in meetings and discussions.
  • Adhere to deliverables and deadlines established for the project.
  • Strive for balanced discussion of all team members
  • Provide opportunities for input from dissenting and/or minority voices.
  • Encourage respectful dissent as a way to arrive at fully formed ideas.
  • Offer solutions when presenting a problem or disagreeing

In the position statement, a “constellation of harmful actions taken and those not taken” provides an overarching framework, which includes explicit displays of uncivil or threatening acts, as well as failing to take action when action is warranted or required to address incivility, bullying, or violence in the workplace. The background section provides an overview of relevant literature and research evidence, which supports and justifies the position. The position statement defines incivility, bullying, and workplace violence, and provides examples of each; it outlines RNs’ and employers’ ethical, moral, and legal responsibilities regarding incivility, bullying, and workplace violence; and makes recommendations for RNs and employers to create safe work environments along with primary, secondary, and tertiary prevention strategies that extend across the healthcare continuum and academia.

Given the expansive composition of these phenomena (incivility, bullying, and workplace violence), members of the panel were challenged to craft a position statement that included all RNs and employers across the healthcare continuum, including practice and academia, while recognizing that all parties have an ethical, moral, and legal responsibility to create a healthy and safe work environment for RNs and all members of the healthcare team, healthcare recipients, families, and communities.

The new position statement is closely aligned with the ANA’s Code of Ethics for Nurses with Interpretive Statements, which states that all nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect” and that any form of bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable and will not be tolerated from any source. This position statement, although written specifically for RNs and employers, is also relevant to other healthcare providers and stakeholders who collaborate to create and sustain a safe and healthy interprofessional work environment.

When reviewing the statement, you will find a few suggested resources interspersed throughout the recommendations section, along with a detailed list of additional resources and references at the end of the position statement. In addition, ANA plans to develop a variety of tools and continuing educational materials to guide and support RNs’ and employers’ efforts to promote healthy relationships and work environments.

This new statement articulates the ANA position with regard to individual and shared roles and responsibilities of RNs and employers to create and sustain a culture of civility, respect, and safety—a culture that is free of incivility, bullying, and workplace violence. By implementing best practice strategies based on evidence, together we can prevent and mitigate the harmful actions taken and those not taken, promote the health, safety, and wellness of RNs, and ensure optimal outcomes across the healthcare continuum.

To read the position statement upon its release in August, visit ANA’s website, www.nursingworld.org.

Selected references

American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Washington, DC: American Nurses Association; 2015.

American Nurses Association. Incivility, bullying, and workplace violence. Silver Spring, MD: American Nurses Association (in press).

Saltzberg CW. Balancing in moments of vulnerability while dancing the dialectic. Adv Nurs Sci. 2011;34(3):229-42.

Wallace RB. Wallace/Maxcy-Rosenau-Last Public Health & Preventive Medicine. 15th ed. Philadelphia, PA: McGraw-Hill; 2008.

Christine W. Saltzberg is an associate professor of nursing, Crystal M. Lange College of Health and Human Services at Saginaw Valley State University in University Center, Michigan, and an ANA-Michigan member. Cynthia M. Clark is professor emeritus, nurse consultant with ATI Nursing Education based in Boise, ID, and headquartered in Leawood, KS, and an Idaho Nurses Association member.

 

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