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The effects of incivility on nursing education

January 2013
Open Journal of Nursing 03(02):178-181

DOI:10.4236/ojn.2013.32023

Authors:

Incivility in the population has become of great interest within the past decade, particularly in the wake of the school massacre in Columbine and the recent movie theatre mass murder in Aurora, Colorado. While citizens struggle to make sense of these violent behaviors, higher education officials are perhaps most vested in exploring the causes, displays, and solutions to uncivil behavior among both faculty and students. The effects of incivility, whether classified as minor disruptions or major violence, may affect the student nurse and impede his or her progress and ability to become an empathic nurse, which is a goal of nursing education. Academic incivility may contribute to bullying in the workplace, which has been identified as a cause of attrition and contributes to the national nursing shortage. This article describes the effects of uncivil behavior on nursing faculty and students and the effect this may have on the nursing workforce.

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Open Journal of Nursing, 2013, 3, 178-181 OJN

http://dx.doi.org/10.4236/ojn.2013.32023 Published Online June 2013 (http://www.scirp.org/journal/ojn/)

The effects of incivility on nursing education

Amy Schaeffer

Shepherd Univeristy, Shepherdstown, USA

Email: amyshroades@yahoo.com

Received 31 March 2013; revised 30 April 2013; accepted 15 May 2013

permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Incivility in the population has become of great inter-

est within the past decade, particularly in the wake of

the school massacre in Columbine and the recent mo-

vie theatre mass murder in Aurora, Colorado. While

citizens struggle to make sense of these violent beha-

viors, higher education officials are perhaps most vest-

ed in exploring the causes, displays, and solutions to

uncivil behavior among both faculty and students.

The effects of incivility, whether classified as minor

disruptions or major violence, may affect the student

nurse and impede his or her progress and ability to

become an empathic nurse, which is a goal of nursing

education. Academic incivility may contribute to bul-

lying in the workplace, which has been identified as a

cause of attrition and contributes to the national nurs-

ing shortage. This article describes the effects of un-

civil behavior on nursing faculty and students and the

effect this may have on the nursing workforce.

Keywords: Incivility

1. BACKGROUND

The ability to foster an atmosphere of civility on college

campus is often elusive [1]. Clark and Springer describe

“civility” as being polite, respectful and decent. On the

contrary, “uncivil” behavior is identified as speech or

action that is disrespectful or rude and may range from

insulting remarks and verbal abuse to explosive, violent

behavior [1]. In academia, this can be construed as any

behavior which disrupts or impedes the learning envi-

ronment. The causes of this type of behavior have been

attributed to cultural and societal norms, such as increased

traffic, noise, crowding and crime [2]. In a cultural con-

text, many believe that anger is unavoidable, an instinc-

tive drive, and uncontrollable, thus excusing the behavior

when it occurs [2]. According to Thomas, it is common-

place to see inappropriate anger displayed in popular

culture, such as television, music, movies, and video

games, and aggressive role models who seem to have

little or no penalties, even for violent acts much outside

the scope of acceptable, legal behavior. It is with little

surprise that violence seems to be increasing on college

campuses, as well as all aspects of uncivil behavior [2].

Maladaptive anger behavior is a significant problem in

nursing education that not only interferes with student-

faculty relationships, but also is significantly disruptive

to student learning and desire to learn.

Generational divides further compound this problem,

with most Generation X and Y students being described

as “self-absorbed generations of slackers who have a

short attention span and a lack of work ethic” [2]. While

this is certainly a subjective generalization and not true

of all students, it is a phenomenon which contributes to

student and faculty expectations, hostility, anger, and

maladaptive expression of that anger.

Behaviors most commonly cited by faculty in Clark

and Springer’s 2008 survey, which included 324 nursing

students, were “making disparaging groans”, making sar-

castic remarks or gestures, not paying attention in class,

cheating on examinations, using cell phones during class,

and dominating class discussions [3].

According to Clark and Springer, the frequency and

intensity of student incivility has increased to include

verbal abuse such as name calling, yelling at faculty or

other students, and even engaging in physical contact.

Due to the increase in the frequency and severity of these

incidents, it is important to examine how this affects

nursing education and those who provide and partake in

it. Nursing faculty is vulnerable to the effects of student

incivility as well, ranging from rudeness to actual physi-

cal assault and loss of life [4]. Clark and Springer (2007)

list various ways that they encounter incivility, most of

them being non-physically violent but considered uncivil

nonetheless: arriving to class late, leaving class early,

refusing to answer questions, rudely contesting test an-

swers, and being unprepared for class. These factors have

OPEN ACCESS

A. Schaeffer / Open Journal of Nursing 3 (2013) 178-181 179

been shown to significantly invoke anxiety, self-doubt,

and anger in nursing faculty [2].

While many factors related to academic incivility have

been cited, including desensitization to violence via me-

dia, inadequate secondary school education, and absent

or inadequate parenting, the faculty has rarely viewed

themselves as a source of conflict [5]. This is of great

interest because according to a study conducted by JM

Hall (2004), nursing faculty themselves may create a

situation that dehumanizes nursing students, leading to

student defensiveness, anxiety, and inability to moderate

angry feelings. Clark’s 2007 study identified factors that

led to student perception of faculty incivility, which in-

cluded behaviors that resulted in three themes: 1) the be-

littling and demeaning nature in which the faculty ad-

dresses students; 2) student favoritism including being

treated subjectively; and 3) the pressure to conform to

faculty demands that are not within the student’s capabil-

ity. According to Clark, students also reported that in-

timidation over time tended to cause actual psychological

and physiological symptoms, including anxiety, depres-

sion, gastro-intestinal distress, mood disorders, and other

physical ailments. Uncivil behavior by nursing faculty is

morally distressing and confusing to students, who are

taught through curriculum that nursing is a profession

that is founded on the principle of caring [5].

2. LITERATURE REVIEW

Clark’s 2008 study was a qualitative research that que-

ried insight from students on faculty incivility and ap-

plied the concept of Rankism, which she defined as “the

abuse of power and rank to disadvantage another”. Clark

asserts that achieving rank and position within academia

is a legitimate, expected goal of higher education; how-

ever, the abuse of rank by faculty and administrators

cause catastrophic problems that undermine the mission

of nursing schools. Rankism is a prejudicial concept that

can be compared to racism, sexism, and ageism, where a

more powerful group uses their power to an unfair ad-

vantage.

In the phenomenological Clark study, students who

were subjected to uncivil behaviors by faculty described

their experiences and encounters in various ways, all of

them with emotional intensity, and some of the encoun-

ters had been years before. Clark asserts that some stu-

dents described psychological symptoms that included

feeling hopeless, helpless, or emotionally traumatized.

Information ascertained from the students reveal that

they felt powerless to combat the faculty’s uncivil be-

havior, as they felt they may be penalized for speaking

out against such behaviors [5].

Clark utilized Robert Fuller’s concept of Rankism to

suggest ideas that may promote dignitarian values. The

suggestions for combating the phenomenon of Rankism

include “breaking the taboo”: recognize that rank is an

issue, talk about it openly, and listen to the thoughts and

feelings of others. Fuller also called for a need for trans-

parency, as secrecy, favoritism, and suspicion tend to

accompany Rankism. Fuller advocated for a program or

organization that facilitated questions and protected

those who dissented. In this manner, nursing faculty can

role model behavior that teaches respectful social dissent,

and honor concepts of cultural awareness, tolerance, and

non-discriminatory practice. Clark’s work using Fuller’s

concept on Rankism also suggests that delegation be in-

digenous in every nursing program so as to distribute

power and prevent situations in which one authority of

higher rank holds all the power.

In 2004, Clark studied 36 nursing faculty and 467

nursing students in a survey on the areas of student and

faculty incivility. All participants completed the incivil-

ity in nursing survey, which included demographic data

and utilized quantitative measures as well as qualitative

measures. Instruments were used that were derived from

the University Center for Survey Research. The author-

developed questionnaire was reviewed by faculty for

content validity. The quantitative measure reviewed un-

civil behaviors and the degree to which they were con-

sidered to be uncivil. The survey listen sixteen uncivil

behaviors, in which respondents used a Likert scale to

categorize the degree as to which behaviors were uncivil,

as well as the frequency in which they had experienced

the uncivil behaviors within the past month.

The student behaviors reported to be most uncivil by

both faculty and students was cheating on examinations

and quizzes, using cell phones in class, holding distract-

ing conversations, marking sarcastic or inappropriate re-

marks, sleeping in class, and refusing to answer direct

questions [1].

This study also queried students and faculty on faculty

behaviors that were considered uncivil. Reported by 295

students was the behavior “Belittling, taunting, sarcasm,

humiliation, intimidation or profanity” as the top uncivil

behavior displayed by nursing faculty. 222 students re-

ported “being cold or unapproachable” as an uncivil be-

havior.

According to Clark & Springer, faculty and student

perceptions were compared to see if they viewed the

same things as being uncivil by using a row-mean-score

test from epidemiology. The findings were that some

behaviors were viewed differently by staff and faculty.

Interestingly, faculty was less likely than other students

to view student behavior as uncivil. Particular behaviors

about which faculty members and student perceptions

differed included students acting apathetic or bored (p <

0.01), students making disapproving or sarcastic groans

(p < 0.01), and students arriving late to class (p < 0.05).

A. Schaeffer / Open Journal of Nursing 3 (2013) 178-181

180

In this study, the survey was used to determine the de-

gree as to which students and faculty perceived incivility

to be a problem. The majority (61.5%) of respondents,

both faculty and students, considered it to be a moderate

problem. The study concluded that uncivil encounters

have a pervasive negative academic setting and not only

disrupt the learning environment, but also leave students

unprepared to enter a workforce that is fraught with po-

tential for disputes and conflict [1].

Academic dishonesty has been identified by both fac-

ulty and students as “student incivility” [6]. According to

Kolanko, Clark, & Henirch, et al., as many as 70 to 95

percent of students have engaged in intentional practices

of deception that involves another’s work. The finding of

unethical classroom behaviors being related to unethical

clinical behavior is disturbing and incongruent with the

ethical practices in which the profession of nursing is

founded upon [6]. The most frequent unethical clinical

findings included infringement of patient confidentiality,

taking medical equipment home for personal use, and do-

cumentation of medications or treatments that were not

provided.

Cultural differences have been cited as causes of per-

ception of incivility as well [6]. The authors propose that

students who have immigrated from developing coun-

tries where “collective thought” is the norm may have

difficulty understanding the concept of plagiarism. The

authors conclude that as faculty encounter these types of

behaviors that are not acceptable in our academic society,

they need to be corrected respectively and in a non-pu-

nitive manner [6].

Although incivility is a problem that seems to be hap-

pening more and more throughout the United States, ac-

cording to Kolanko, Clark, & Heinrich, et al., very little

research exists related to faculty experiences with uncivil

student behaviors. However, the concept of Bullying is a

thoroughly studied phenomenon, and one that occurs in

nursing schools as regularly as any other academic insti-

tution. This may include direct bullying, such as verbal

or physical aggression, or more covert, indirect bullying,

such as passive aggressive behaviors and social isolation

from a group [6]. The results of bullying are widespread

and often long term, including physiological symptoms,

anxiety, nightmares, lowered self-esteem, and use of al-

cohol or drugs to cope. This may contribute to nursing

school attrition rates as well, whether the bullying is be-

ing done by faculty or students; many victims simply

cannot face going back into a bullying situation and

don’t have the resources to combat bullying. The authors

suggest that nursing faculty have frank discussions with

nursing students regarding bullying and policies that en-

force consequences for bullying.

Faculty incivility plays a major role in contributing to

student incivility [6]. Consequences of faculty incivility

were identified as impairment of the mentoring role that

faculty have an obligation to provide, problematic learn-

ing environments, increased potential for violence, and

increased stress in students’ personal relationships with

family and friends [6]. This creates a complex dynamic

in which students find themselves resisting and not learn-

ing, and faculty finds themselves disciplining instead of

mentoring. It is difficult for higher-level learning to take

place when such external and internal stressors exist. In

Clark’s study, students offered suggestions for combat-

ing the problem of faculty incivility, including enforcing

a campus code of conduct, having zero tolerance policies,

and creating an environment where respectful discourse,

dissent and discussion is welcomed [6].

This article addressed the issue of collegial incivility

as well, which the authors believe to play a part in all

other types of academic incivility. While collegial inci-

vilities may be causing faculty to resign and leave their

positions, there is little research to support this theory [6].

During a plenary session, nurse faculty were asked to

recall a time in which a colleague, administrator, or sub-

ordinate did or said something to make the faculty mem-

ber feel belittled, marginalized, or dismissed. Approxi-

mately 25% of the audience (261 faculty members) had

“mean girl” stories to tell, which included things such as

name-calling, relational aggression, or social exclusion.

The authors concluded that while there is a wealth of

information available in the literature on elementary and

secondary education, very little research has been done

on student nurse or student faculty bullying, and this

topic is timely and ripe for further research [6]. Nursing

faculty is a vulnerable population due to the effects of

student incivility [4]. The authors propose that while

nursing faculty is not typically viewed as a vulnerable

population, those who teach are susceptible to psycho-

logical, physical, and emotional harm [4]. The authors

identified student incivility, aggression and bullying,

horizontal violence, and abuse of power by administra-

tors as some of the incivilities that nursing faculty face.

Dal Pezzo and Jett concluded that the emotional toll on

nursing faculty was significant: reported trouble sleeping,

anxiety, low self-esteem, poor morale, absenteeism, and

depression. When conflict or tension among peers be-

comes unbearable, faculty may choose to leave academia,

which is a very serious issue considering the lack of

available nursing faculty in the United States [4].

While academic integrity has been cited as a major

student incivility, it is surprising to realize that discus-

sions about academic integrity are minimal, particularly

given that the profession of nursing is one that is founded

upon the expectations of trust, honesty, respect, integrity,

and responsibility [7]. According to the authors, 253

nursing students were studied for trends in cheating. The

survey was a questionnaire with a yes/no response, as

A. Schaeffer / Open Journal of Nursing 3 (2013) 178-181

181

well as open ended questions asking how students cheat

[7]. More than 75 percent of students admitted to cheat-

ing, including using “cheat sheets”, copying from an-

other student’s test answers, writing on body parts, and

whispering answers. This study points to a very serious

problem of lack of personal integrity, while personal in-

tegrity is held as a hallmark of nursing. It would seem a

logical assumption that those who would cheat during

their academic career may continue this behavior into

their working lives [7].

Smith and Schaffer (1995) studied positive and nega-

tive relationships between nursing faculty and students

and how it affected the learning experience. Their meth-

odology included a sample of two groups: 34 second se-

mester senior students and 12 faculties from two nursing

schools in the Midwest. The six problems posed in the

mixed survey included inconsistent grading, late paper

policies, disagreement about amount of clinical supervi-

sion needed, how student complaints were handled, un-

expected low grade in clinical, and students’ “covering

up” for a classmate’s incomplete nursing care [8]. The

survey revealed that the most common problem for stu-

dents was inconsistent grading (70.6%). Students also

reflected twice as many barriers to ethical action (mean =

16) as did faculty (mean = 6.92). This may reflect their

developmental status or is a result of their feeling of de-

creased power [8]. The implications of this study high-

light the need for both students and faculty to be sensi-

tive to identifying and reacting to ethical situations, as

well as to incorporate more of the “caring” aspect of

nursing into the education of the nursing profession. At-

tention must be given to barriers which prevent faculty

and students from addressing these concerns [8].

3. DISCUSSION

While incivility is not a new problem in nursing educa-

tion, it is an issue that has not been thoroughly re-

searched [8]. Gaps in the literature still exist, including

the relationship between unethical or uncivil behavior in

the classroom and uncivil behavior in the professional

nursing role once the student has graduated.

Current research to date has established that incivility

in nursing education is a major distraction to higher learn-

ing levels, may contribute to psycho-social problems,

physiological ailments, and is a major cause of both nurs-

ing student and nursing faculty attrition. Nursing student

and faculty attrition is of special concern as there is a

shortage of both registered nurses and nursing faculty in

the United States, and it is projected by experts to grow

larger in the next decade. Further research is needed to

discover ways to combat and prevent incivility in nursing

education, in order to provide our population with the

reputable qualities that the nursing profession holds.

REFERENCES

[1] Clark, C.M. and Springer, P.J. (2007). Incivility in nurs-

ing education: A descriptive study on definitions and

prevalence. Journal of nursing education, 47, 7-14.

[2] Thomas, S.P. (2003) Handling anger in the student-tea-

cher relationship. Nursing Education Perspectives, 24, 17-

24.

[3] Clark, C.M. and Springer, P.J. (2007) Thoughts on inci-

vility: Student and faculty perceptions of uncivil behavior

in nursing education. Nursing Education Perspectives, 28

93-97.

[4] Dalpezzo, N. and Jett, K. (2010) Nursing faculty: A vul-

nerable population. Journal of Nursing Education, 49,

132-135. doi:10.3928/01484834-20090915-04

[5] Clark, C.M. (2008) Student perspectives on faculty inci-

vility in nursing education: An application for the concept

of Rankism. Nursing Outlook, 56, 4-8.

doi:10.1016/j.outlook.2007.08.003

[6] Kolanko, K.M., Clark, C., Heinrich, K.T., Olive, D., Se-

rembus, J.F. and Sifford, K.S. (2006) Academic dishon-

esty, bullying, incivility, and violence: Difficult challenges

facing nurse educators. Nursing Education Perspectives,

27, 34-42.

[7] Tippitt, M., Ard, N., Kline, J., Tilghman, J., Chamberlain,

J. and Meagher, P. (2009) Creating environments that

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tives, 30, 239-244.

[8] Schmitz, K. and Schaffer, M. (1995) Ethical problems en-

countered in the teaching of nursing: Student and faculty

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Nov 2009

Nursing faculty are seldom viewed as a vulnerable population, yet those who teach nursing are susceptible to physical, psychological, and emotional harm from students, peers, and administrators. Such harm can arise from uncivil or dangerous encounters with students, horizontal violence from colleagues, and abuse of power by administrators. Although faculty vulnerability is a serious issue, strategies exist that can minimize the problem.

Creating environments that FOSTER academic integrity

Article

Jul 2009
Nurs Educ Perspect

A number of studies related to academic dishonesty within the nursing student population have been published; however, little has been written in the nursing literature regarding academic integrity and means of promoting this value. In addition to the many short-term solutions to prevent cheating and dissuade academic misconduct that are offered, solutions that promote long-term affective changes underlying the acquisition of academic integrity are needed. This article provides a context for discussions related to academic integrity, explores issues facing faculty when dealing with this challenge, and offers short-term and long-term strategies for creating environments that foster academic integrity.

Ethical Problems Encountered in the Teaching of Nursing: Student and Faculty Perceptions

Article

Feb 1995

Handling anger in the teacher - Student relationship

Article

Jan 2003
Nurs Educ Perspect

Sandra P Thomas

Educators across the nation are voicing concern about increases in student incivility, anger, and violence. This article explores causes, manifestations, and consequences of nursing students' anger. Recommendations are offered to faculty for dealing with angry and potentially violent students.

Student perspectives on faculty incivility in nursing education: An application of the concept of rankism

Article

Feb 2008
NURS OUTLOOK

Cynthia M Clark

Incivility in nursing education is an emergent problem and one that seriously disrupts the teaching-learning environment and often results in conflicted and stressful student/faculty relationships. Nursing faculty who demonstrate positive, respectful behaviors, encourage similar behaviors from their students. Conversely, faculty who are aloof, disinterested, and demeaning may invoke hostility. The author conducted a phenomenological study to examine nursing students' perceptions of faculty incivility and its impact on the students. Students identified 3 main themes of faculty incivility: (1) faculty behaving in demeaning and belittling ways, (2) treating students unfairly and subjectively, and (3) pressuring students to conform to unreasonable faculty demands. In all cases, students felt powerlessness to address the problem and described faculty arrogance and abuse of power (rankism) as primary contributors to the problem. This article describes nursing students' perceptions of faculty incivility and interprets them in the context of Fuller's concept of rankism. Understanding how rankism impacts nursing education may provide insight into developing preventative strategies to produce a healthier teaching-learning environment and to improve relationships between students and faculty.

The effects of incivility on nursing education

Abstract

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