Donna M. Nickitas, PhD, RN, CNAA, BC
Editorial Board Member
Encouragement and
Empowerment:
Unlocking the Keys
To Excellence
Today’s health care environment demands enormous amounts
of energy and diligence, regardless
of clinical setting: acute care hospitals, long-term care facilities, community-based agencies, home, or
hospice care. Health work environments that channel their energy to
foster encouragement and empowerment by their nurses bear witness
to quality excellence and successful
patient care outcomes. In fact, AACN
Standards for Establishing Healthy
Work Environments (American
Association of Critical-Care Nurses,
2005) suggest that the link between
healthy work environments and
patient safety, and nurse retention
and recruitment is irrefutable.
To accomplish the formidable
task of unlocking the keys to excellence requires moral courage and
commitment on behalf of nursing
leadership.
Lachman
(2007)
defined moral courage as the
capacity to overcome fear and
stand up for personal core values
and ethical obligations. This
means nurse leaders must model
moral courage for their nursing
staff as well as ways to address
problems directly rather than
ignore them. Sidestepping problems and broken systems can lead
only to greater frustration and disappointment. Klein and Napier
(2003) suggested using courage as
a way of speaking and listening for
the express purpose of enhancing
relationships. When nurses communicate without feeling intimidated, ask appropriate questions, and
speak out about problems they
encounter, a culture of civility can
be born.
Cultivating Civility
How can nurses be encouraged and empowered to breathe a
culture of civility in their workplace? Lower (2007) described
civil behavior as conduct that consistently shows respect for others,
makes them feel valued, and contributes to effective communication and team collaboration.
Respect is integral to building relationships as well as a professional
mandate. The Code of Ethics for
Nurses (American Nurses Association [ANA], 2001) clearly indicates that nurses in all professional relationships practice with
respect for the inherent dignity,
worth, and uniqueness of all individuals. Therefore, when nurses
are encouraged and empowered
to demonstrate and validate their
professional expertise, contribute
to patient safety and excellence,
and illustrate their importance to
patient care, respect will flourish.
However, when disrespect and
conflict in the health work environment are allowed to percolate,
then lateral nurse-to-nurse violence (Rowell, 2007) and hostility
manifest.
High levels of nurse-to-nurse
violence lead to relational toxicity,
and create incivility and disrespectful behavior. Toxic work environments are disruptive and destructive
to patient care. Uncivil and disrespectful behavior often will include
verbal abuse, negative behaviors
such as co-workers’ refusal to assist
or answer questions, general rudeness, harsh speech, hostile attitudes,
and thoughtless acts and behaviors
(Lower, 2007). This unacceptable
level of violence and hostility is causing registered nurses (RNs) to leave
work environments. Bartholomew
(2006) noted that 60% of new RNs
leave their first positions within 6
months because of hostility. Hostility
may include behaviors such as nonverbal innuendo, verbal affront,
undermining activities, and withholding information.
Nurses’ refusal to address violence in the health work environment only adds to incivility and
hostility. Nurse leaders must break
the cycle of unethical, unprofessional violence by addressing
nurses’ lack of confrontation skills
and dealing with these hostile
behaviors. “Each professional
nurse has an ethical duty to
resolve workplace conflicts” (ANA,
2001, p. 9). Badger and O’Connor
(2006) recommended that nurses
work with their clinical managers
to create a care environment in
which ethical practice is the standard. Unethical and unprofessional
behaviors are contributors to the
nursing shortage and medical
errors and must be stopped.
Cleansing Toxicity
The consequences of ignoring
workplace violence and uncivil and
hostile behavior will exacerbate
the nursing shortage and jeopardize patient care (Lower, 2007).
Nurses must be encouraged to
identify the situations that most
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Editorial
continued from page 374
often lead to these distressing,
uncivil, hostile behaviors. Open
communication, collaboration, and
support will diffuse the violence.
Creating organizational policies
that do not tolerate uncivil and hostile behavior will provide a safety
net for nurses and allow them to
protect themselves against disruptive co-workers. Healthy work environments encourage and empower
nurses to seek assistance and ask
for an ethics consultation in the
clinical situation that warrants
intervention to clean up workplace
toxicity. Laschinger and Finegan
(2005) suggested “…creating conditions that empower nurses to practice according to the standards of
the profession and that foster positive working relations within an
atmosphere of trust and respect
can go a long way toward attracting
and retaining a sustainable nursing
workforce” (p.12). Healthy work
environments encourage and empower nurses, and promote respectful and civil behaviors — all
keys to unlocking excellence in clinical practice and patient safety.
390
References
American Association of Critical-Care Nurses
(AACN). (2005). AACN standards for
establishing and sustaining healthy work
environments: A journey to excellence.
Aliso Viejo, CA: Author.
American Nurses Association (ANA). (2001).
Code of ethics for nurses with interpretive
statements. Washington, DC: Author.
Badger, J., & O’Connor, B. (2006). Moral discord, cognitive coping strategies, and
medical intensive care nurses: Insights
from a focus group study. Critical Care
Nursing Quarterly, 29(2) 147-151.
Bartholomew, K. (2006). Ending nurse-tonurse hostility. Marblehead, MA: HCPro,
Inc.
Klein, M., & Napier, R. (2003). The courage to
act. Palo Alto, CA: Davies-Black.
Lachman, V. (2007). Moral courage in action:
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Laschinger, H.K., & Finegan, J. (2005). Using
empowerment to build trust and respect
in the workplace: A strategy for addressing the nursing shortage. Nursing
Economic$, 23, 6-13.
Lower, J. (2007). Creating a culture of civility in
the workplace. American Nurse Today,
2(9),49-52.
Rowell, P. (2007). Lateral violence: Nurse against
nurse. American Nurses Association
Continuing Education. Retrieved April 2,
2008, from http://nursingworld.org/mods/
mod440/lateralfull.htm
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