Response to Christy

While completing the work environment assessment by Clark, on page 20, I realized my workplace environment is considered unhealthy as I had a score of 50. Prior to the assessment, I believed that my workplace environment, even though moral seemed to be fading, was rather decent. However, after overviewing the assessment questions, I realized a lot of things were left with question. While I feel members of my workplace “live” by trust and respect, I do not believe employees are viewed as valuable members of the organization and are expandable. Another factor weighing in on the assessment that was rated low, “The workload is reasonable, manageable, and fairly distributed”. Many times, assignments are based on how well you know the previous shifts charge nurse. We are also very short staffed, so assignments are often dangerous and unmanageable. Because of this, patients go without ordered tests, and sometimes even scheduled medications such as breathing treatments are missed. There is a delay in care as physicians are also overwhelmed with the workload and are often pulling sixteen to twenty hour shifts before returning the next morning.

Incivility is described as rude or unsociable speech or behavior. As a new nurse, I was met with unwelcoming looks for certain individuals. This is the case with other places and individuals as some are not so welcoming to change. As time went on, majority warmed up and became welcoming. However, there are a few that remain unapproachable and are not welcoming to different individuals into their group. You will meet this anywhere you go so while it may need to be addressed, it does not affect patient care.

One problem in my workplace that does impact patient care, is the tension between physician and nurse. Our physicians are overwhelming with many patients and with new physicians being added to the team and needing to learn how things are done etc. there comes frustrations between physicians as will and it tends to spill over to the nurses. There is one physician who is an amazing doctor and treats her patients with the upmost respect, however she treats the nurses very poorly. I have not met a nurse who was eager to notify her of changes. Many times, I have seen nurses asking each other how to contact this physician with an update and what would be the best way. I have had many conversations with this physician and to be honest, its hard to know which one you are going to get, the nice doctor or the angry “my way or the highway” doctor.

Recently, I had a patient that no longer met criteria for an ICU bed. For forty-eight hours, this patient has been sitting in the ICU for no other reason than and overwhelmed doctor. The patient had no scheduled medications, no drips hanging, did not even require cardiac monitoring, which is what all of our ICU patients require. In the first twenty-four hours after the patient no longer met criteria, I asked the physician during rounds if we could downgrade the patient to be moved to a medical floor. I was met with a death glare and a “I am too busy right now to even worry about something like that, I have patients down in the emergency room that I need to evaluate.” I did not want to push this issue even further, so I responded with a “yes ma’am, no problem”. This is frustrating, not only for me, but for the family and patient as well. An ICU bed is rather expensive for someone who does not require the services. Also, visitation is limited in the ICU. On top of these things, there are patients in the ER waiting for an ICU bed, but none are available due to physicians being too busy to move non criteria out. This physician is such a problem that even the charge nurse was unable to get this patient moved out and eventually my director had to address the situation with the physician’s boss to have the patient moved out. This physician will not allow any orders to be placed (which is fine with me, that way I know exactly what she would like) and she also does not like having things suggested to her.

We also encounter incivility between family members and staff. A few weeks ago, a coworker of my had a sweet little old lady as a patient. Her sweetest was not even able to make up for the hate and disrespect her family brought into the environment. This patient’s family member was very demanding and condescending. Any time a nurse would enter the room, she would continuously spray them with Lysol from the moment they entered, until the moment they left. One evening, this nurse has one patient who was actively passing away and hospice/family was at bedside so most of the chairs were in that room. The other family had already left for the day as they had said they would be returning in the morning. However, they decided to stop back by prior to shift change. Upon entering, the told this nurse, “You better go get my chair out of that room right now, I don’t care if they are dying or dead you better do it now!” Before any of us could go find this nice lady a chair, she had come behind the nurse’s station and taken one of our computer chairs into the room. The family member then decided the toilet in the ICU room was too disgusting to look at and demanded we stop patient care and cover it with a blanket. As I was monitoring the desk since the other two nurses were in a patient room, this family member came out and said, “I just don’t know about this”, I stood there waiting for her to finish her sentence as she obviously hadn’t finished. But she finished with “why are you looking at me like you are stupid?” I want this toilet scrubbed now, its disgusting and my mother isn’t going to be sitting in here with that thing”.  Things became so bad that nurses were refusing to take this patient as an assignment and even refusing to go into the room if the family member was present. There needs to be protocols in place for these types of situations. I understand having family members removed can become stressful but if its at the point that patient care if suffering because of such, it needs to be addressed.

Prior to this discussion/assignment, I was unable of what incivility was or how to even address it. One article mentioned having new grads attend cognitive rehearsal. (Griffin & Clark, 2014).  I believe this is a good idea as it gives avenue on addressing tough situations. We should also be aware that this does not occur just between employees but can occur between family members and staff and I have encountered more hostility and violence from patients’ family members than I have staff members. Having a class or even online instruction on how to address these situations and what to do should they continue or escalate would be a positive impact.

Reference

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. Journal of Continuing Education in Nursing, 45(12), 535-542.

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-Civlity-1023.pdf

Place your order today!

Solution

Response to Christy

Hello Christy, I concur with you completing the work environment assessment enables individuals to determine the health and civility of their workplace. According to Clark (2015), a workplace environment assessment score of 50fd% and below indicates unhealthy organization. Therefore, having scored 50% during your workplace environment assessment means that your workplace is unhealthy. The assessment results might differ with one’s belief and perception towards the workplace environment. In your case, you believed that your workplace was a bit decent before conducting the assessment. On the contrary, the assessment results indicated that employees are not valued. Additionally, the assessment results showed issues with workload distribution in the organization. In most cases, employees are assigned duties depending on how well they completed a similar task before. The healthcare organization is also understaffed, resulting in a high workload among nurse practitioners and burnout, which compromises the quality and safety of patient care. According to Dall’Ora et al. (2020), burnout among nurses is associated with lowered job performance, adverse events, poor safety and quality of patient care, adverse patient outcomes.

Furthermore, I agree with you that incivility is experienced at the workplace. According to Griffin and Clark (2014), incivility refers to rude or unsociable behavior or speech. Mostly, new employees become victims of incivility. Other employees tend to be harsh and hostile towards the new employees, making the workplace environment unconducive for them. Finally, I agree with you that some issues in the workplace do not impact patient care. In your case, patient care is not compromised by the tension between physicians and nurses. Despite physicians being overwhelmed, they manage to deliver quality and safe care to all patients.

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-Civlity-1023.pdf

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human resources for health, 18, 1-17.

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. Journal of Continuing Education in Nursing, 45(12), 535-542.