Cultivating a Culture of Civility in Nursing Education

Oklahoma City University Kramer School of Nursing Fifth Annual NURSE EDUCATOR CONFERENCE March 6, 2009

Cynthia Clark RN, PhD Professor Department of Nursing Boise State University

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PRESENTER: Cynthia Clark RN, PhD Professor; Boise State University [email protected] PRESENTER BIOSKETCH: Dr. Clark is a Professor of Nursing at Boise State University. Dr. Clark holds two Bachelor of Science degrees, one in Nursing from Boise State University and the other is a special major with an emphasis in Addiction Treatment and Recovery from Southern Illinois University at Carbondale. She is a psychiatric nurse/therapist and has earned advanced certification in addiction counseling. She holds a Master of Science degree in Human Development and Family Studies from Colorado State University, a post-Master’s certificate in Nursing Leadership from Idaho State University, and an earned doctorate in Educational Leadership from the University of Idaho. Dr. Clark’s principle body of research is in the area of incivility in higher education in general and nursing education in particular. She has conducted research on policy development for disruptive students in higher education and is the principal investigator on an international study on academic incivility in nursing education in Hangzhou China. Her Incivility in Nursing Education (INE) Survey has been translated into Hebrew, Farsi, and Mandarin Chinese. Studies using the INE are currently being conducted in China, Israel, and Iran. Dr. Clark is an award winning professor who has published professionally and presented nationally on the topic of incivility and how to address its effects. Her publications have appeared in several peer-reviewed journals including Nursing Outlook, Advances in Nursing Science, Journal of Nursing Education, Nurse Educator, Nursing Education Perspectives, and the Journal of Theory Construction and Testing. WORKSHOP OBJECTIVES: 1. Provide an overview of incivility in nursing education. 2. Discover how and why nursing faculty and students contribute to incivility in nursing education. 3. Apply ready-to-use strategies to promote a culture of civility in nursing education. PROPOSED WORKSHOP OUTLINE: 9:05-12:00** Welcome and Opening Remarks State of the Science—Understanding the Issues • Defining civility, incivility, disruption and their effects • Incivility and rudeness in social context • Changing demographics of today’s college students • Student and faculty incivility The ‘Dance of Incivility’ in Nursing Education: National Study Conceptual Model for Fostering Civility Nurse Leaders’ Perceptions of Incivility in Nursing Education Creating a Culture of Civility in Higher Education • Strategies for Stress Reduction • Communication and Socialization • Co-creating Norms: Syllabus Review • Cooperative Teaching Strategies • Addressing the Disruptive Behavior • Policy Development • Institutionalizing Change • ** A 15 minute break will be taken during this interactive session

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3 Cindy’s Two Minute ‘Incivility’ Free-Write 1. Please describe an uncivil encounter you have experienced in nursing education.

2. How did this encounter make you feel?

3. What did you do about it?

Please tear this sheet off and give to Cindy All materials copyrighted © Cynthia M. Clark, RN, PhD

4   Cindy’s Two Minute “Stress and Incivility” Free‐Write    1. What do you perceive to be the biggest stressors for nursing STUDENTS?            2. What uncivil behaviors do you see nursing STUDENTS displaying?       

3. What do you perceive to be the biggest stressors for nursing FACULTY?            4. What uncivil behaviors do you see nursing FACULTY displaying?            5. Do you believe that stress and incivility are related? Please explain.             6. In your opinion, what is the role of faculty regarding incivility in nursing education?             

      (Use back of this page if needed)  Please turn this page into Cindy after completing—THANKS!!

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The Case of Carmen Carmen is consistently late and unprepared for clinical lab. Lately her clinical performance has deteriorated, patient care has suffered, and her decision making is suspect. As her clinical instructor, when you address these concerns with Carmen, she becomes very angry and accuses you of “picking on her,” but she agrees to improve her clinical performance. During the next two weeks, Carmen’s behavior continues to decline. She rarely attends class, shows open distain for her classmates and teachers, and verbally lashes out at others. What do you do?

The Case of Professor Green Professor Green is often late for class and is very disorganized. He strays from the course content and does not grade papers or exams in a timely manner. Sometimes he changes due dates without sufficient notice and refuses to discuss his behavior with his students when they raise concerns. As a last ditch effort, several of Dr. Green’s students have collectively come to you (a trusted faculty member) complaining about their issues with Professor Green. What do you do?

The Case of Adam Adam is often late for class and frequently unprepared. He uses his computer in class to play games and text messages his friends when he seems bored with the class discussion. Sometimes he distracts the class with his sarcastic remarks and has been accused of sending sexually suggestive e-mail messages to other students. Lately, his behavior has started to escalate and he seems angrier and more agitated. Just yesterday, a group of students from the class collectively came to you complaining about Adam’s disruptive behavior. What would you do?

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6 Selected Readings on Academic Incivility Cynthia M. Clark RN, PhD Boise State University American Health Association: National College Health Assessment (ACHA-NCHA Reference Group Data Report), Journal of American College Health.2006; 55(1):5-16. American Psychological Association (October 24, 2007). Stress in America. Retrieved December 8, 2008 from http://apahelpcenter.mediaroom.com/file.php/138/Stress+in+America+REPORT+FINAL.doc Andersson, L.M. & Pearson, C.M. (1999). Tit for Tat? The spiraling effect of incivility in the workplace, Academy of Management Review, 24,(3), 452-471. Arehart-Treichel, J. (2002, Mar 15). Mental Illness on rise on college campuses. Psychiatric News, 37(6). Begley, C.M. (2002). Big fleas have little fleas: Irish student midwives views of the hierarchy in midwifery, Journal of Advanced Nursing, 38 (3), 310-317. Boice, B. (1996). Classroom incivilities. Research in Higher Education, 37, 453-486. Boice, B. (1998). Classroom incivilities. In K.A. Feldman & M.P. Paulsen (Eds.), Teaching and learning in the classroom. Needham Heights, MA: Simon & Schuster Custom Publishing. Boyer, E. (1990). Campus life: In search of community. Princeton: The Carnegie Foundation for the Advancement of Teaching. Braxton, J.M. & Bayer, A.E. (1999). Faculty misconduct in collegiate teaching, Baltimore, MD: Johns Hopkins University Press. Braxton, J.M. & Bayer, A.E. (2004). Addressing faculty and student classroom improprieties. New Directions for Teaching and Learning, Vol. 99, San Francisco, CA: Jossey-Bass. Childers, L. (April 26, 2004). Bullybusting: Nurses in hostile work environments must take action against abusive colleagues, Nurse Week, Retrieved December 8, 2008 from http://workplacebullyinglaw.org/press/nw042604.html Clark, C.M. (in press). Faculty field guide for promoting student civility, Nurse Educator.

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7 Clark, C.M. (2008). The dance of incivility in nursing education as described by nursing faculty and students, Advances in Nursing Science, 31(4), E37-E54. Clark, C.M. (2008). Faculty and student assessment and experience with incivility in nursing education: A national perspective. Journal of Nursing Education, 47(10), 458-465. Clark, C. M. (2008). Student voices on faculty incivility in Nursing Education: A Conceptual Model, Nursing Education Perspectives, 29,(5), 284-289. Clark, C.M., Farnsworth, J, & Springer, P.J. (2008). Policy Development for Disruptive Student Behaviors, Nurse Educator, 33(6), 259-262. Clark, C.M. & Carnosso, J. (2008). Civility: A concept analysis. Journal of Theory Construction & Testing, 12,(1), 11-15. Clark, C.M. (2008). Student perspectives on incivility in nursing education: An Application of the Concept of Rankism, Nursing Outlook, 56,(1), 4-8. Clark, C.M., Farnsworth, J., Landrum, E. (in press). Development and description of the Incivility in Nursing Education (INE) Survey, Journal of Theory Construction & Testing. Clark, C.M. & Springer, P.J. (2007). Incivility in nursing education: Descriptive study on definitions and prevalence. Journal of Nursing Education, 46,(1), 7-14. Clark C.M., & Springer, P.J. (2007). Thoughts on Incivility: Student and faculty perceptions of uncivil behavior in nursing education, Nursing Education Perspectives, 28(2), 93-97. Clark, C.M. (2006). Incivility in nursing education: Student perceptions of uncivil faculty behavior in the academic environment (Doctoral dissertation, University of Idaho, 2006). Dissertation Abstracts International. AAT 3220867. Dellasega, C. A. (2009). Bullying among nurses, American Journal of Nursing, 109(1), 52-58. Emily Post Institute (2003). Survey: Are we more or less civil? Retrieved September 13, 2008 from http://www.emilypost.com/surveys/results/poll11.html Emry, R.A. & Holmes, O. (Spring, 2005). Civility: The value of valuing differences, The Senate Forum, XX, No. 2, California State University, Fullerton, Academic Senate Forum.

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8 Ehrmann G. (2005). Managing the aggressive nursing student. Nurse Educator, 30, 98-100. Farkas, S. & Johnson, J. (2002). Aggravating circumstances: A status report on rudeness in America. A Report from Public Agenda Prepared for the Pew Charitable Trusts, Public Agenda Foundation, New York, NY. Federal Bureau of Investigation (FBI) National Center for the Analysis of Violent Crime. (2000). The school shooter: A threat assessment perspective. Retrieved September 13, 2008 from www.fbi.gov/publications/school/school2.pdf Felblinger, D.M. (2008). Incivility and bullying in the workplace and nurses’ shame responses. Journal of Obstetric, Gynecological, and Neonatal Nursing, 37(2), 234-242. Feldman, L. J. (2001). Classroom civility is another of our instructor responsibilities. College Teaching, 49,(4), 137-140. Fisher, K., & Wilson, R. (September 7, 2007). Va. Tech Was Slow to Respond to Gunman, Panel Finds, Chronicle of Higher Education, 54,(2), A30-A31. Florida Gubernatorial Task Force for University Campus Safety: Report of Findings and Recommendations (May 24, 2007). Frost, P. (2007). Toxic emotions at work. Boston, MA: Harvard Business School Press. Fuller, R.W. (2003). Somebodies and nobodies: Overcoming the abuse of rank. British Columbia, Canada: New Society Publishers. Fuller, R.W. (2006). All rise: Somebodies, nobodies, and the politics of dignity. San Francisco, CA: Berrett-Koehler Publishers. Hegge, M. & Larson V. (2008). Stressors and coping strategies of students in accelerated baccalaureate nursing Programs, Nurse Educator; 33(1), 26-30. Heinrich, K.T. (in progress). An optimist’s guide for cultivating civility among academic nurses. Heinrich, K.T. (in press). How to turn stress into zest: DDN nurses’ stories and strategies. News Network Newsletter: Developmental Disabilities Nurses Association. Heinrich, K.T. (in press). How to turn your stress into zest, one relationship at a time. In Linda Caputi (Ed.), Teaching Nursing: The Art and Science. College of DuPage Press.

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9 Heinrich, K.T. (2007, Third Quarter). Full-circle moment: Recognizing the joy-stealer within. Reflections on Nursing Leadership. Available: http://www.nursingsociety.org. Heinrich, K. T. (2007, February). Joy Stealing: Ten Steps to becoming your own ally. The Pulse of ANSC. Association of School Nurses of Connecticut Newsletter. 3(2). 5. Heinrich, K.T. (2007, January/February). Joy stealing: Ten mean games faculty play and how to stop the gaming. Nurse Educator. 32(1), 34-8. Heinrich, K.T. (2006, Third Quarter). Joy-stealing: How some nurse educators resist these faculty games. Reflections on Nursing Leadership. Available at: http://www.nursingsociety.org. Heinrich, K.T. (2006, Second Quarter). Joy-Stealing Games. Reflections on Nursing Leadership. Available at: http://www.nursingsociety.org. Hutton, S.A., & Gates, D. (2008).Workplace incivility and productivity losses among direct care staff, American Association of Occupational Health Nurses, 56(4), 169-175. Hutton, S. A. (2006). Workplace incivility: State of the science. Journal of Nursing Administration, 36(1), 22-28. Kadison, R. & DiGeronimo, T.F. (2004). College of the overwhelmed: The campus mental health crisis and what to do about it, San Francisco, CA: Jossey-Bass Publishers. Kerfoot, K.M. (2007). Leadership, civility, and the ‘no jerks’ rule. Nursing Economics, 25,(4), 223-225. Kolanko, K.M., Clark, C.M., Heinrich, K.T., Olive, D., Serembus, J.F., Sifford K.S.(2006) Academic dishonesty, bullying, incivility, and violence: Difficult challenges facing nurse educators. Nursing Education Perspectives, 27(1), 34-43. Komives, S.R. & Woodard, D. B. (2003). Student services: Handbook for the Profession, (4th ed). San Francisco, CA: Jossey-Bass Publishers. Kotter, J.P. (1996). Leading Change. Harvard Business School Press. Kuhlenschmidt, S. L., & Layne L.E. (1999). Strategies for dealing with difficult behavior. In S.M. Richardson & M.D. Svinicki (Eds.), Promoting civility: A teaching challenge, No. 77 (pp.45-58). San Francisco, CA: Jossey-Bass Publishers.

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10 Kupperschmidt, B.R. (May 31, 2006). Addressing multigenerational conflict: mutual respect and carefronting as strategy. Online Journal of Issues in Nursing, 11(2), 4. Levine A., & Cureton J.S. (1998). When hope and fear collide: A portrait of today’s college student. San Francisco, CA: Jossey-Bass Publishers. Lower, J. (2007). Creating a culture of civility in the workplace, American Nurse Today, 2 (9), 49-52. Lower, J., Jefferson, L., Simmons, L., Agnes, K., Flowers, J., & Young, J. (nd.) Civility in the Workplace: Workplace Subcommittee Commission on the Crisis in Nursing. Retrieved May 15, 2008 from http://www.mbon.org/commission/workplace_civility.ppt Luparell, S. (In progress.) Managing difficult student situations. In Caputi, L. Teaching Nursing: The Art and Science (2nd ed.). Luparell, S. (2007). The effects of student incivility on nursing faculty. Journal of Nursing Education, 46(1), 15-19. Luparell, S. (2007.) Dealing with challenging student situations: Lessons learned. In Oermann, M.H. & Heinrich, K.T. (Eds.), Annual review of nursing education: Vol. 5. Challenges and new directions in nursing education (pp. 101-10). New York: Springer. Luparell, S. (2005). Why and how we should address student incivility in nursing programs. In Oermann, M.H. & Heinrich, K.T. (Eds.), Annual review of nursing education: Vol. 3. Strategies for teaching, assessment, and program planning (pp.23-36). New York: Springer. Luparell, S. (2004). Faculty encounters with uncivil nursing students: An overview. Journal of Professional Nursing, 20(1), 59-67. Macintosh, J. (2005). Experiences of workplace bullying in a rural area, Issues in Mental Health Nursing, 26 (9), 893 – 910. Marks, J. (1996, April 22). The American uncivil wars: How crude, rude and obnoxious behavior has replaced good manners and why that hurts our politics and culture. U. S. News & World Report, pp. 66-72. Pavela, G. (2007). Memorandum to the faculty: Teaching troubled students after the Virginia Tech shootings. Retrieved December 8, 2008 from http://docs.google.com/View?docid=dfdpvzp9_14263m73s

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11 Pearson C.M., Andersson L.M., & Wegner J.W. (2001). When workers flout convention: A study of workplace incivility. Human Relations, 54(11), 1387-1419. Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing, 43(4), 395-401. Randle, J. (2003). Changes in self-esteem during a 3-year pre-registration diploma in higher education (nursing) programme. Journal of Clinical Nursing, 12, (1), 142-143. Rieck, S. & Crouch, L. (2007). Connectiveness and civility in online learning, Nurse Educ in Practice, 7, 425-432. Rowe, M., & Sherlock, H. (2005). Stress and verbal abuse in nursing: Do burned out nurses eat their young? Journal of Nursing Management, 13, 242-248. Segrest, M. (April 17, 2007). Getting Inside the Mind of a Killer, MSN Lifestyle, Retrieved April 17, 2007 from http://men.msn.com/article.aspx?cp-documentid=4724826 Schneider, A. (1998, March 27). Insubordination and intimidation signal the end of decorum in many classrooms. The Chronicle of Higher Education, A12-A14. Sharif F. & Masoumi S. (2005). A qualitative study of nursing student experiences of clinical practice. BMC Nursing, 4(6). Retrieved December 8, 2008 from http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1298307&blobtype=pdf. Shirey M.R. (2007). An evidence-based solution for minimizing stress and anger in nursing students. Journal Nursing Education, 46(12), 568-571. Shirey, M.R. (2006). Stress and burnout in nursing faculty, Nurse Educator, 31(3):95-97. Spratlen, L.P. (1994). Workplace mistreatment: Its relationship to interpersonal violence, Journal of Psychosocial Nursing, 32 (12), 5-6. Suplee, P.D., Lachman, V.D., Siebert, B., & Anselmi, K.K. (2008). Managing nursing student incivility in the classroom, clinical setting, and on-line, Journal of Nursing Law, 12(2), 68-77. Sutton, R. (2007). The no asshole rule. New York, NY: Warner Business Books. Twale, D.J. & De Luca, B.M. (2008). Faculty incivility: The rise of the academic bully culture and what to do about it, Jossey-Bass Publishers.

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12 Twenge, J.M. (2006). Generation Me: Why today’s young Americans are more confident, assertive, entitled—and more miserable than ever before. New York, NY: Free Press. United States Secret Service and United States Department of Education (May, 2002). Threat assessment in schools: A guide to managing threatening situations and to creating safe school climates. Washington, DC. Retrieved December 8, 2008 from http://www.secretservice.gov/ntac/ssi_guide.pdf Virginia Tech Review panel (August, 2007). Mass Shootings at Virginia Tech April 16, 2007: Report of the Review Panel. Commonwealth of Virginia. Workplace Bullying Institute, U.S. Workplace Bullying Survey (September, 2007), Zogby International. Retrieved December 8, 2008 from http://bullyinginstitute.org/zogby2007/wbi-zogby2007.html

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