Response to Brenda

After completing the Work Environment Assessment by Clark (2015), I learned that my workplace is very unhealthy. The assessment scored my workplace at a 45; I did not think it was that unhealthy; however, I tried to answer each question based on the organization and not our unit. The areas with the lowest scores include poor communication on an organizational level, employee satisfaction, competitive pay, workload, inclusion in decision making, and attracting/retaining the “best and brightest.” Short staffing, which has led to low job satisfaction and increased workload, which has driven nurses out of the organization, are two reasons why I agree that my workplace is not healthy or civil. A significant problem is a lack of communication between senior management and administrators with staff. When it comes to staffing, the psychiatric unit is sometimes overlooked; there are statements like “it is just psych.” Administrators have forced admits to our unit regardless of patient history or staffing concerns. The whole psychiatric unit’s personnel share the same feeling of being bullied and undervalued.

Incivility in the workplace is more common than we think. Incivility has been shown to negatively influence employees’ physical and emotional health, as well as their productivity. According to a poll, 27% of Americans have experienced workplace incivility (Griffin & Clark, 2015). I believe my workplace is not civil due to the lack of understanding from other departments and administration on what our unit does, the type of patient population we serve, and our mission as a unit. Our unit and staff are constantly being put down with demeaning comments.

While working short-staffed and with a higher-than-normal nurse-to-patient ratio, we received a call from one of the administrators asking about our patient census and how many patients we could admit. I informed this administrator we were closed to admits due to short staffing. Shortly after, we received a call from a doctor in the ED, demanding we accept three patients; this doctor yelled at our secretary over the phone, saying our department is psych and we needed to admit those patients sitting in the ED when she informed the doctor that our unit is a medical, psychiatric unit. The patients were not a good fit because of their violent history; given we have vulnerable elderly patients, the doctor became angrier and yelled, “well, then you are not REAL psych,” and hung up. Unfortunately, some people do not understand the mental health population, and psychiatric disorders present with uncontrollable psychosis. After this incident, our psychiatric medical director filed a report on behalf of our department against this doctor. The doctor apologized and admitted that his behavior was not correct. According to Clark et al., when uncivil and disruptive acts become normalized or neglected, they can escalate into an incivility spiral, ranging from an unintended act to planned retaliation, workplace bullying, and even violence (Clark et al., 2011).

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/2-15/11/ant11-CE-Civility-1023.pdf

 Clark, C. M., Olender, L., Cardoni, C., Kenski, D. (2011). Fostering civility in nursing education and practice. The Journal of Nursing Administration, 41(7/8), 324-330.

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.

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Solution

Work Environment Assessment

Discussion response

Health care is both physically and emotionally demanding. The environment within which nurses and other health care professionals perform their work can either hinder or support productivity and employee health.  According to   Donley (2021) unhealthy and toxic work environment causes negative outcomes for management, staff, and the organization as a whole.  Traditional factors that contribute to an unhealthy work environment include poor working conditions and salaries, and disrespect which cause nurses to leave the organization or profession in high numbers. Other factors include a shortage of staff, a heavy workload, and a lack of support. Abuse, bullying, and lateral violence by physicians and coworkers, and also an ineffective response to these incidents by the leadership, lead to job strain, exit from the profession, and turnover.

A healthy work environment is an environment in which procedures and policies are designed in such a manner the staff can concurrently respond to the goals of the organization and be satisfied with their jobs in the workplace.  Components of a healthy work environment include appropriate staffing, effective decision-making, true collaboration, communication skills, authentic leadership, and meaningful recognition (Salehi et al., 2020).  Donley (2021) emphasizes that in a healthy work environment, individuals are treated fairly and respectfully, valued, supported to grow both professionally and personally, and collaboration and communication are championed. This leads to a sense of trust and community, which enhances effective making of decisions.

Healthcare organizations have nourished the problem of uncivil/ disrespectful behavior for a long time by ignoring it, thus tacitly acknowledging such behaviors. According to Grissinger (2017),   the health care culture has allowed disrespect while regarding this as a usual communication style.  Disrespectful behaviors are more often put up within unhealthy/ unfavorable work environments.  Organizations fail to address disrespectful behavior because the behavior usually occurs every day but is usually unreported because victims fear being punished or stigmatized for becoming whistleblowers.

References

Donley, J. (2021). The Impact of Work Environment on Job Satisfaction: Pre-COVID Research to Inform the Future. Nurse Leader, 19(6), 585-589. doi: 10.1016/j.mnl.2021.08.009

Grissinger, M. (2017) Disrespectful Behavior in Health Care: Its Impact, Why It Arises and Persists, And How to Address It—Part 2.  Pharmacy and Therapeutics, 42(2), 74-75.

Salehi, T., Barzegar, M., Yekaninejad, M., & Ranjbar, H. (2020). Relationship between Healthy Work Environment, Job Satisfaction and Anticipated Turnover among Nurses in Intensive Care unit (ICUs).  Annals of Medical and Health Sciences Research, 10, 826-825.