A new year represents a new beginning. But despite a fresh start, incivility is an ongoing struggle and the elephant in the room that many educators continue to experience in nursing education.

I received an email from a nurse educator who was lamenting her current struggles with student behavior in her class and clinical.

I had a student raise her voice to me during a test review.  I lowered my voice and spoke directly to her (she was in the front row) and I believe I was able to bring her down to a level of coping versus losing control.  However, she followed that up with an email that essentially put my test writing abilities, my teaching style, and the current state of the notes I provide to the class to question. There was not one “I” statement in that email where she took any responsibility for her learning.

Now that a new school year is about to begin, how do you plan to address incivility when it crops up so this year can be different and not a “joy stealing” experience?

Defining Student Incivility

Entitlement and incivility have become increasingly pervasive in American society and contribute to incivility in nursing education (Clark & Springer, 2010).

The most common student behaviors include:

• Disruptive behaviors in class/clinical that include
  • Rude comments, engaging in side conversations, dominating class
  • Cell phone, texting, inappropriate computer use in class
  • Late to class and leaving early
  • Sleeping in class (Clark & Springer, 2010)
• Anger or excuses for poor performance
• Inadequate preparation (Clark, 2008)
• Pressuring faculty until they get what they want (Clark, 2008)
• Bad-mouthing other students, faculty, and the nursing program (Clark, 2008)

Personal Consequences

When incivility is experienced in any context, it produces a broad range of painful emotions including:

• Self-doubt
• Anger
• Depression
• Self-blame…something is wrong with me
• Burnout
• Leave academia entirely or worse yet, stay but are checked out and disengaged.

Student Responsibilities

Students must recognize the part they play to create a healthy academic culture. This includes communicating to your students the importance of holding themselves to the highest standards of professionalism, which includes:

• Be prepared, respectful, and engaged in your learning (Clark, 2011).
• Do not speak in a negative, derogatory manner openly about other STUDENTS, FACULTY, or the nursing PROGRAM.
• Abide consistently by the standards of student conduct of your institution.
• Communicate your needs, and what you need/expect from faculty (Clark, 2011).
• Work toward a common goal of civility and RESPECT (Clark, 2011).

Academia can be a tinderbox because of the high levels of STRESS that both students and educators experience. This can spark an inferno when incivility and disrespect are present or manifest.

By practicing self-care, students and educators can have the emotional, spiritual, and physical strength to confront most challenges in academia (see my blog on Helping Students THRIVE!).

How Faculty Can Bring Needed Change

Educators need to reflect and role model the core values of the profession to students that include caring, compassion, nurturing of the other, and respect.

To create a healthy academic culture, pursue healthy, caring relationships with your students.

This includes the foundation of open/honest communication, working together, and establishing boundaries that are defined and enforced (see blog How to Change an Uncivil Academic Culture).

The following are practical steps that educators can implement to create a culture of respect and civility:

1. Model caring and respect in all that you do so your students can see what true professionalism looks like in practice!
2. Provide opportunities to dialogue with students in open formats, such as a town hall meeting.. This can provide needed dialogue and understanding.
3. Establish clearly written policies or place expectations in student codes of conduct that address incivility and consequences. Enforce them consistently.
4. Listen carefully; give students positive feedback.
5. Incorporate time management/stress reduction/self-care in the curriculum (Clark & Springer, 2010)

Transforming the Profession

Incivility is all too common in the nursing profession.

Why is this?

One reason is that nurses do not consistently value and respect one another.

This needs to change.

Unfortunately, students who will soon be new nurses will be most likely to be targeted.

The devaluing and disrespectful behaviors of incivility and bullying are all too common, and cancer and blight on a profession that is known for its virtues of caring and compassion.

Nursing education must lead the way to positively role model to the next generation of nurses what caring, compassion, and civility looks like, instead of perpetuating the ongoing cycle of incivility in the profession, our graduates must be empowered and equipped to be the needed change.

A New Vision

The power to transform academia and even health care itself is possible. This transformation begins with each nurse educator restoring the identity, values, and legacy the profession was founded upon, and instilling this in every nursing student we touch in our program.

To empower nurses with a transformational vision of the profession that can be communicated and championed by nurse educators to the next generation of nurses, this is where I would start…

• Nurses care, but they first care for one another.
• Nurses have value and value one another.
• Nurses bring healing as they demonstrate caring in all they do.
• Nurses are as powerful. They can save a life.
• Nurses serve and as a result become the greatest of all.

Following Florence

Florence Nightingale chose to become not only an educator but a reformer and transformer of the nursing profession. When incivility wounds one nurse, we all hurt. The following quote captures her spirit that needs to be distilled to nursing students today:

“Are we proud to be Nurses? To be called Nurse? Let us run the race where all may win: rejoicing in their successes, as our own, and mourning their failures, wherever they are, as our own. We are all one Nurse.” (Attewell, 2012, p. 74, 76)

Though she has been dead for over 100 years, Nightingale continues to speak. She wrote the following that remains relevant to nurse educators today. Let these words inspire you to follow in her steps and embrace the responsibility of becoming a transformational nurse educator in this generation:

“I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results…data is passive; only people can ACT.” (Attewell, 2012, p. 8, 22)

 In Closing

Nightingale recognized that statistics had no power to change practice unless acted upon to reform and transform nursing and nursing education.

Educators today need to have this same spirit and motivation to implement and bring needed change to the classroom and clinical settings that will better prepare students for practice.

Action is also necessary to develop and role model to students the caring and professional behavior that is expected of a nursing professional.

It is my hope and prayer that a new school year will inspire both educators and students to do what is needed to create a culture of civility that will not only transform nursing education but ultimately the nursing profession!

What do you think?
How will you communicate a vision of nursing to the next generation of students?
Comment below and let the conversation begin!

References

• Clark, C. M. (2008). The dance of incivility in nursing education as described by nursing faculty and students. Advances in Nursing Science, 31, E37–E54.
• Clark, C. M. (2011). Pursuing a culture of civility: An intervention study of one program of nursing, Nurse Educator, 36(3), 98–102.
• Clark, C. M. & Springer, P.J. (2010). Academic nurse leaders’ role in fostering a culture of civility in nursing education, Journal of Nursing Education, 49(6), 319–325.

Framework for Transformation

Today’s topic is step 5 (part 5) in a series that provides an overview of a practical framework to transform nursing education to help students clinically reason and think more like a nurse.

These five areas or steps are laid out in my new book for educators, TEACH Students to THINK Like a Nurse.

Here is a quick overview:

Step 1: Transforming the EDUCATOR. (7/28)What does an educator need to know to THRIVE in academia and remain passionate and teach with excellence in the class and clinical settings.

Step 2: Transforming the CONTENT. (8/4) Identify content that is MOST important so students acquire DEEP knowledge of what is MOST important and transfer that knowledge to the bedside.

Step 3: Transforming the CLASSROOM. (8/11). Practical strategies to prepare the way for classroom transformation.

Step 4: Transforming the CLINICAL. (8/18). Practical strategies to be a highly effective clinical educator.

Step 5: Transforming the PROFESSION. Today’s blog!

Implement each step, and you will be well on your way to teaching students to think more like a nurse and help them be better prepared for clinical practice!