Students who graduate and are now new nurses in practice are the most likely to experience uncivil and bullying behaviors.

Is your program doing informing and teaching practical strategies to respectfully address a bullying nurse to directly address and see this behavior stopped?

One effective strategy is called cognitive rehearsal and has been in the literature for over ten years. Yet when I speak around the country, I find that most educators are nor aware of this article and strategy.

This needs to change in order to prepare students for professional practice.

---

Cognitive Rehearsal Defined

The article, “Teaching Cognitive Rehearsal as a Shield for Lateral Violence: An Intervention for Newly Licensed Nurses” (Griffin, 2004) is a must read for every nurse educator. It defines what is professional behavior as well as the most common uncivil behaviors experienced in nursing and uses an effective strategy of cognitive rehearsal.

Cognitive rehearsal teaches nurses to have a prepared plan to respond respectfully when specific uncivil behaviors are directed toward them. Because incivility thrives in an environment of passivity where it has become normalized and NOT addressed, incivility can often be stopped in its tracks when it is CONFRONTED in an assertive, direct, and respectful way (Griffin, 2004).

In one study where nurses were empowered by this strategy, 100 percent of the nurses reported that when the perpetrator was confronted, the bullying behavior stopped (Coursey, Rodriguez, Dieckmann, & Austin, 2013).

This is an effective strategy that must be implemented when a nurse experiences incivility personally. For example, if a nurse has a pattern of raising eyebrows or sighs when asked for help, the empowered nurse has practiced and is prepared to respond in the following manner, “I sense (I see from your facial expression) that there may be something you wanted to say to me. Please speak directly to me” (Griffin, 2004).

My Story

I have experienced a wide variety of uncivil behaviors in my career. One uncivil behavior I recently experienced in clinical practice is non-verbal behavior that communicates disrespect.

For example, one morning I was giving report to the oncoming nurse in the ICU. Her facial expression and body posture communicated that I had nothing to tell her. She was unnecessarily abrupt and asked questions that were not directly relevant to the patient plan of care that I did not have an answer to.

Her arms were crossed and she refused to make eye contact and instead was looking down at the floor with a disinterested look on her face. She continued this posture the entire report and took no notes. I was completely unprepared for this response as I had not experienced this type of behavior before. I left the unit angry, knowing that I was disrespected by this uncivil behavior but said nothing to address it at the time.

It Works!

After reading Griffin’s article I had an opportunity to put its recommendations into action.

I had to give report to the same nurse who was uncivil to me in my last encounter during report two months later.

She began our encounter with the same harsh start-up, irrelevant questions and body language and facial expression that communicated I had nothing of value to tell her. I tried to be friendly but to no avail. As I started report, nothing in her attitude and demeanor changed.

But having a prepared response by using cognitive rehearsal to this uncivil nurse brought about a completely different outcome. Instead of continuing report to just get through this difficult experience, I stopped, looked at her directly and in a matter of fact tone of voice said, “It appears by the way you are looking at me you have something you would like to say to me. Please feel free to speak directly to me.”

She was obviously caught off guard by being called out and sat up in her chair, and said “No, it’s all good” and as I continued report, she was a bit more engaged, asked relevant questions and completed report with no further drama. I left for home that day with a smile on my face knowing that I had done the difficult though needed thing by respectfully addressing disrespectful behavior using cognitive rehearsal.

Discuss in Post Conference!

Though post-conference in the clinical setting should emphasize student reflection on the day, it is imperative that essential and relevant topics to clinical practice become an item of discussion in each clinical rotation as well.

For nursing students in the final year, a frank discussion on incivility and how to be empowered to address it through cognitive rehearsal are NEED to know topics that must be addressed before graduation.

Encourage your students to be the needed change in nursing by using cognitive rehearsal in their work and academic environment if they encounter incivility.

In Closing

To change culture in nursing, nurse educators must embrace the responsibility of being a role model by living out respect towards students and other faculty. Practical professionalism includes never criticizing another student or colleague publicly, standing up for the absent colleague when they are not present, working as a team, and accepting your share of the workload (Griffin, 2004).

Remind your students that being a new nurse can feel like being in middle school again. You will want to do whatever it takes to fit in and be a part of the new peer group, even if it means being passive or indifferent to incivility around you.

By being passive and doing nothing, you are actually part of the problem. Instead, encourage your students to hold themselves to the highest standards of professionalism in practice and be the change that is so desperately needed in nursing today by using cognitive rehearsal as a practical tool to make this vision realized!

Comment Question:
What strategies have you found effective to directly and respectfully address incivility in academia or clinical practice?
What do you teach your students about incivility to prepare them for professional practice?
Comment below and let the conversation begin!

References

Coursey, J. H., Rodriguez, R.E., Dieckmann, L.S., & Austin, P.N. (2013). Successful implementation of policies addressing lateral violence. AORN Journal, 97(3), 101–109.

Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal of Continuing Education in Nursing, 35, 257–263.