Date Presented 04/13/21
Incivility in health care has adverse effects on patient care coordination, patient outcomes, practitioner well-being, and organizational costs. This study examined the relationships between perceived incivility and practitioners’ demographics, workplace factors, and resilience. The highest rates of incivility were reported by practitioners with 2–10 years of experience, working in skilled-nursing or long-term care, and with lowest resilience. Practices for mitigating incivility are discussed.
Primary Author and Speaker: Deborah J. Bolding
Contributing Authors: Taniya Varughese, Allison King
Civil behaviors include treating others with trust, collaboration, and inclusion. Uncivil behaviors are discourteous and disrespectful, and have been broadly reported in health care workplaces (Evans, 2017). Workplace incivility originates from many sources, including managers, colleagues, students, patients, and families of patients. An uncivil workplace has negative impacts on client care (e.g., medical errors, understaffing due to sick calls, patient satisfaction) and an organization’s finances (e.g., turnover, mistakes, decreased productivity). Adverse consequences for the recipient of uncivil behaviors include acute physiological and psychological stress and long-term effects on health, work effort, quality, and creativity (Wright & Khatri, 2015).
PURPOSE: The purpose of this study was to survey the prevalence and types of perceived incivility among occupational therapy (OT) practitioners using the Negative Acts Questionnaire-Revised (NAQ-R) (Einarsen et al., 2009). Furthermore, it examined the relationships between scores on the NAQ-R and resilience, as measured by the Brief Resilience Scale (BRS) (Smith et al., 2008).
METHOD: Occupational therapists were recruited to complete an online survey via postings on OT social media, online forums, university alumni, and fieldwork educators. Participants were encouraged to share the survey with other OT practitioners. The relationships between scores on the NAQ-R and demographic information (age, gender, experience, work setting, etc.) were examined using a one-way analysis of variance and Tukey’s HSD test for post hoc analysis (p < .05 chosen as significance level). A Spearman’s rank correlation test was performed to examine the relationship between NAQ-R and resilience, as measured by the BRS.
RESULTS: The NAQ-R has an overall score and three subscores: work-related incivility, person-related incivility, and physical intimidation. Overall scores on the NAQ-R delineate three levels of incivility or bullying, and based on these scores, practitioners’ responses (N = 1320) were as follows: not bullied (66%), minor bullying (23%), and bullying (11%). Of the three types of incivility, work-related incivility was the most common, and included behaviors such as having unmanageable workloads, having opinions ignored, or having information withheld. Regarding demographic comparisons, persons with 2–10 years of experience reported significantly more frequent acts of incivility compared to those with 20 or more years of experience. Respondents working in skilled nursing/long-term care facilities and those working in the southern United States also reported significantly higher rates of incivility than other practitioners. Comparisons between race, gender, workplace size and job title were non-significant. Spearman’s rank correlation of the resilience and incivility data suggested that those who perceive themselves as more resilient have a decreased likelihood of experiencing workplace incivility (p = .000, â’ = -0.269).
CONCLUSION: This study provides important baseline information for educators and managers about the prevalence and types of incivility in occupational therapy workplaces and the relationship between resilience and perceptions of incivility. Failure to correct problems may adversely affect client outcomes and professional growth. In academic settings, educators must consider ways to model and promote activities to improve communication skills and strengthen resilience. Managers must examine their own role in establishing a positive and supportive workplace environment that is safe, inclusive, and where uncivil behaviors are not tolerated.
References
Einarsen, S., Hoel, H., & Notelaers, G. (2009). Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work and Stress, 23(1), 24–44. https://doi.org/10.1080/02678370902815673
Evans, D. (2017). Categorizing the magnitude and frequency of exposure to uncivil behaviors: A new approach for more meaningful interventions. Journal of Nursing Scholarship, 49(2), 214–222. https://doi.org/10.1111/jnu.12275
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The Brief Resilience Scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972
Wright, W., & Khatri, N. (2015). Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Management Review, 40(2), 139–147. https://doi.org/10.1097/HMR.0000000000000015 _x005F_x000C_
