Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Addressing Bullying and Incivility Among Nurses Caroline Holland Combs Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Caroline Combs has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Robert McWhirt, Committee Chairperson, Nursing Faculty Dr. Melanie Braswell, Committee Member, Nursing Faculty Dr. Faisal Aboul-Enein, University Reviewer, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Addressing Bullying and Incivility Among Nurses by Caroline Combs MS, Walden University, 2012 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University June 2020 Abstract For decades, nurses have experienced some form of bullying and incivility throughout their careers. Incivility contributes to behaviors that constrain the sense of empowerment among nurses and directly encroach upon Provision 6 of the American Nurses Association code of ethics, which addresses sustaining a moral environment and the need to create a contagious culture of respect that is free from uncivil behavior. The nature of this staff education project was to bring awareness to the bullying behaviors and incivility that exist within an organization’s culture by assessing for the incidence of bullying and by providing an educational program for the nursing staff. The project question addressed whether continuing education, awareness, and focus on a mandated zero-tolerance policy could provide a foundation for a bullying-free and civil milieu in nursing staff on medical-surgical units. The use of Kotter’s change theory and Watson’s theory of human caring functioned cohesively to guide the transformation of a hostile milieu. The Nursing Incivility Scale was employed to collect data from nurse participants prior to, the pretest, educational initiative, posttest, and evaluation. The educational initiative was centered on awareness and training on the organizations workplace harassment policy. The data from the pretest and posttest were analyzed by calculating the change scores which reflected a 44.17% increase in awareness of the zero-tolerance policy. The findings support positive social change through recommended routine educational initiatives. The education must continue to promote awareness and prevention of uncivil behavior through cognitive rehearsal, conflict resolution, and emotional intelligence training to enhance communication among nurses. Addressing Bullying and Incivility Among Nurses by Caroline Combs MS, Walden University, 2012 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University July 2020 Table of Contents List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Section 1: Nature of the Project ...........................................................................................1 Introduction ....................................................................................................................1 Problem Statement .........................................................................................................2 Purpose ...........................................................................................................................4 Nature of the Doctoral Project .......................................................................................4 Significance....................................................................................................................5 Summary ........................................................................................................................7 Section 2: Background and Context ....................................................................................8 Introduction ....................................................................................................................8 Bullying and Incivility .......................................................................................... 11 Contributing Factors ............................................................................................. 12 Barriers to Success ................................................................................................ 13 Strategies to Reduce Bullying ............................................................................... 13 Relevance to Nursing Practice .....................................................................................14 Local Background and Context ...................................................................................16 Definition of Terms............................................................................................... 18 Role of the DNP Student..............................................................................................19 Professional Context ............................................................................................. 19 Summary ......................................................................................................................20 i Section 3: Collection and Analysis of Evidence ................................................................22 Introduction ..................................................................................................................22 Practice-Focused Question...........................................................................................23 Sources of Evidence .....................................................................................................23 Published Outcomes and Research ....................................................................... 24 Evidence Generated for the Doctoral Project ....................................................... 25 Analysis and Synthesis ................................................................................................27 Summary ......................................................................................................................28 Section 4: Findings and Recommendations .......................................................................29 Introduction ..................................................................................................................29 Findings and Implications ............................................................................................30 Recommendations ........................................................................................................33 Contributions of the Doctoral Project Team ................................................................34 Strengths and Limitations of the Project ......................................................................35 Summary ......................................................................................................................36 Section 5: Dissemination Plan ...........................................................................................37 Analysis of Self ............................................................................................................37 Summary ......................................................................................................................39 References ..........................................................................................................................40 Appendix A: The Nursing Incivility Scale ........................................................................45 Appendix B: Addressing Bullying & Incivility Among Nurses ........................................47 Appendix C: Pretest ...........................................................................................................52 ii Appendix D: Posttest .........................................................................................................54 Appendix E: Evaluation .....................................................................................................56 iii List of Tables Table 1. Results of Paired Samples t test ...........................................................................31 Table 2. Evaluations Scores for the Majority Ratings of Agreed/Strongly Agreed ..........33 iv List of Figures Figure 1. Interactions with other nurses .............................................................................30 Figure 2. Evaluation percentages based on a Likert scale. ................................................32 v 1 Section 1: Nature of the Project Introduction Bullying and incivility, which are defined as disruptive behaviors, have been experienced by 80% of