Doing what’s right is not always easy, but it is necessary. (Republished from 2017.)
At the heart of every nurse interaction is the ability to communicate effectively. Whether you are a student in a nursing program or a “practicing” nurse in one of the profession’s diverse and challenging career options, civility is crucial.
Today’s nursing student will work in an environment that reflects our changing society. Incivility and bullying are not new—to society at large or to academics and nursing—but we live in a time when incivility is often portrayed as the “norm,” acceptable in some situations or a given in our fast-paced technological world. I am here to tell you that neither is true.
As a student, faculty member, and consultant, or in any of my other nursing roles, I have been on the receiving end of incivility and bullying. Sometimes the behavior has been obvious; other times I would not have immediately identified it as such. More behaviors are associated with incivility than most of us would acknowledge. My reactions to incivility and bullying have varied, depending on the situation, stage in my career, or personal and professional development. I share some of my student-related experiences with you to illustrate that when we are confronted with incivility, we often push it to the side, ignore it, blame ourselves, or simply accept it as the new norm.
But no matter what degree you are pursuing or where you are in your professional career, I want you to know that incivility is never normal or acceptable. Whether it’s rolling of the eyes by a peer or colleague, being interrupted when speaking in class or during clinical rotations, being yelled at or otherwise inappropriately addressed, being made fun of or bullied on social media, or being harmed in a physical way, incivility is not acceptable—no way, no how. It doesn’t matter if it’s you or a peer, faculty member, clinical preceptor, or supervisor who is being uncivil. I hope my experiences will enable you to see yourself and others more clearly and, as a result, help put a stop to these uncivil behaviors—whether verbal, psychological, or physical.
My generation of nurses—those in their 50s and older—did not often identify with or speak about the behavior of others in terms of civility, incivility, or bullying. The line separating civility from incivility was not well-defined, and we did not have social media and the 24-hour communication cycle so dominant today. In general, we were more inhibited about reporting what we regarded as bad behavior, especially toward us as nurses. When we did discuss our concerns with others, we didn’t have the anonymity that today’s technology provides; we owned the opinions that we expressed openly or not at all.
In nursing school, I had a very good friend who had some issues that she discussed with a faculty member who was willing to listen. She was so grateful to have someone who was objective and could help her deal with stressors in her life while pursuing her nursing education. Unfortunately, whispers started circulating around class that my friend was the “teacher’s pet” and that her status as such—not her hard work—was why she received good grades. Those of us who knew the student tried to counteract the unfair allegations, but her accusers didn’t want to hear it and, although there were only a few, they made their voices heard.
At one post-clinical conference, without warning, they started bullying both our classmate and the faculty member. Claiming they were not being treated fairly, they threatened to go to both the dean and the provost. It was horrible. My friend ran out crying, and the instructor was in disbelief. Although she tried to talk rationally to the group and with authority, for a time it just made matters worse.
Still, the instructor did act professionally throughout the entire situation and, when I became a faculty member, I often reflected on the skill and thoughtfulness she exhibited. She found my classmate to be sure she was OK and brought her back to the conference. Although I wondered if doing so was best for my friend, the instructor thought it best for both the group and my classmate. In requiring us to talk the situation through, she gave each student an opportunity to voice his or her opinion. Eventually, the conflict died down, but our group was never the same. For the rest of our time together, we were split into two co-existing factions that communicated with each other only when absolutely necessary.
In today’s competitively driven educational environment where everyone seems to be looking at what the next one is doing or getting, I am not sure how students would handle this. Would the reaction be the same, or maybe worse? If you are a student, how would one of your instructors deal with a similar situation? How would you respond?
As a faculty member for 27 years, I have had thousands of interactions with students, and most have been positive. I still communicate with former students, many of whom have made significant contributions in their careers. But, of course, nothing is perfect. I have had many instances when students threatened to sue me over grades they earned. I’ve had students yell at me and give me poor evaluations to retaliate over something they did not like or agree with in class or a clinical. And yes, I’ve even indirectly been threatened with violence. Today, this may be more commonplace, but it is not acceptable and wasn’t in the 1990s, either.
Action is critical. I asked one of my students who was not doing well in a course to wait after class to talk to me. I suggested that, rather than risk receiving a failing grade, he drop the course and retake it the following semester. He listened, quiet for the most part, and I thought for a while he was taking my recommendation under consideration. But I was stunned and a little frightened when he said he had to leave to make sure no one had broken into his truck and seen his guns. I didn’t want to make too much of what he said, but I did feel threatened.
Not wanting to overreact, I thought about doing nothing and not making a big deal of it, but I also did not want to fail to respond appropriately. Because he didn’t make a direct threat against me, I did not report him, but I did call security and ask to be walked to my car, an action I continued for the remainder of the semester. It made me feel safe. The student did not drop the course, and I did give him a failing grade, but he never again mentioned his guns in subsequent conversations we had. I always wondered what happened to him. I felt secure in taking steps to protect me and not report him, but would I do the same today? I’m not sure; the environment is different. Would you?
Yes, cheating is uncivil!
Incivility often takes the form of actions and behaviors one might not associate with being uncivil. Cheating is never acceptable—not as a student and not as a nursing professional. Accountability and responsibility are at the forefront of what we do and expect of ourselves as nurses. Anytime a person cheats, he or she is negatively impacting a situation, whether it occurs during one’s educational process or a peer’s, during clinical rotation or when practicing as a nurse, or when advocating for a patient and his or her family.
Often, students don’t view cheating as a form of incivility, but it is. Civility is based on respect for others, even with our differences. Cheating disrespects others. I have been amazed at the many ways students try to cheat—themselves, their classmates, the system—and I always wonder what they will do in practice. Will they cheat the patient? Will they provide less than optimal care—thinking, for example, that it is OK to sign for a medication as given when they in fact forgot to administer it? Will they make up vital signs because they are behind in their work or don’t “like” a patient they have been assigned?
You know the old saying, “Once a cheater, always a cheater.” It’s an axiom that should give you pause, especially when you observe cheating in your classes or are a victim of cheating. Cheating needs to be reported to the appropriate person(s) when you become aware of it. Cheating indicates contempt for accountability and responsibility, and if you do not report it, you are exhibiting similar contempt. Yes, you might be bullied, especially on social media. Yes, you might be called names, to your face and to others. Yes, you might lose some friends. But in the end, the guiding force of our profession is the need for honesty in everything we do.
Yes, I did, and no, I don’t!
Above all, nurses have a responsibility to their profession. Doing what’s right is not always easy, but it is necessary. As a student, did I report cheating? Yes, I did. As a faculty member, did I fail students who cheated? Yes, I did. As an educator, did I encounter students who threatened to sue me if I didn’t fix “this situation”? Yes, I did.
Did I ever regret any of my decisions? I did not. Did I enjoy a minute of the experience? I did not. But remember, whether you are a student or a professional, the responsibility of reporting what is wrong and how you feel about a situation is irrelevant. Cheaters are accountable and responsible for their actions. They should regret their actions—their incivility. What have you experienced? How have you handled it? Would you handle it differently?
As you enter the professional world of nursing, you should know from your education that nothing we do as nurses is ever easy. If it were easy, everyone would be doing it, as the saying goes. Nursing students are no different from other people who find themselves affected by incivility—sometimes as the target, sometimes as the perpetrator, and sometimes as an observer. Whether or not you identify certain behaviors as uncivil or bullying doesn’t mean they don’t occur or that they don’t affect you in your student, personal, or professional life.
Knowing what constitutes incivility and having open dialogue about such behaviors help you develop strategies for dealing with people and situations that are often uncomfortable. Having access to and utilizing resources of all types—from peers, faculty members, and colleagues you trust or from what you read on the topic—will assist you in positively shaping the world in which you learn and practice. I am confident you will do just that.
Lois S. Marshall, PhD, RN, NCLEX expert and nurse education consultant (LSM Education Consulting), is author of Take Charge of Your Nursing Career: Open the Door to Your Dreams, published by Sigma Theta Tau International Honor Society of Nursing (Sigma). In addition to coordinating Sigma’s Career Management Center, she is corresponding author, Research Commentary, Journal of Radiology Nursing.
Editor's note: This article has been reposted because of technical problems with the RNL website when the article was first published on 9 March 2017.