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The effects of incivility on nursing education

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Abstract

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.
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
Copyright © 2013 Amy Schaeffer. This is an open access article distributed under the Creative Commons Attribution License, which
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
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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).
Copyright © 2013 SciRes. OPEN ACCESS
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
Copyright © 2013 SciRes. OPEN ACCESS
A. Schaeffer / Open Journal of Nursing 3 (2013) 178-181
Copyright © 2013 SciRes. OPEN ACCESS
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-
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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,
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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-
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[8] Schmitz, K. and Schaffer, M. (1995) Ethical problems en-
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... According to Schaeffer, the primary goal of nursing education is educating emphatic nurses [15]. However, incivility, either with significant or minor effects on students, hampers their progress and their ability in becoming an emphatic nurse [15,16]. ...
... According to Schaeffer, the primary goal of nursing education is educating emphatic nurses [15]. However, incivility, either with significant or minor effects on students, hampers their progress and their ability in becoming an emphatic nurse [15,16]. In fact, today's students are tomorrow's colleagues. ...
... If the developed strategies aim at reducing incivility, improving the teaching-learning environment, improving postbellum faculty-student relations, and promoting a culture of civility in nursing education, investigating incivility is of paramount importance [11,20]. Moreover, incivility has been construed as the main reason for the attrition of nursing students and nursing faculty [15]. Thus, given the importance of civil behaviors in improving individual, team, and organizational performance, the importance of investigating strategies for improving civil behaviors among nursing students to prepare them to meet the future of their job [21], and given the necessity of conducting more studies to scrutinize students' perception of faculty incivility [22], the present study aimed to determine the importance and prevalence of faculty incivility from nursing students' perspective. ...
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Background: Little evidence exists concerning students' perception of faculty incivility. Given the growing trend of incivility and the stressful nature of these behaviors, the present study aimed to investigate the level and frequency of faculty incivility as perceived by nursing students. Methods: A stratified random sample of 178 students from four nursing faculties of Lorestan University of Medical Sciences participated in the present cross-sectional study. The Incivility in Nursing Education-Revised Survey, consisting of 24 items, was used to investigate the prevalence and frequency of faculty incivility, and the mean and frequency of each item was calculated separately. The data were analyzed using descriptive and analytical statistics (chi-square, independent t-test and analysis of variance), and the significance level was set at 0.05. Results: Most of the participants were single, did not live in a dormitory, and ranged in age from 19 to 23. From their perspective, disrespect, physical threat, property damage, and physical violence were of paramount importance. 61.8% of them argued that they had "sometimes" and "always" experienced "unfair assessment" during the last year. Creating codes of behavior, enhancing awareness of civility, and developing and implementing policies for managing incivility were proposed as the most important strategies for improving civility. Conclusion: Faculty members should be prepared for establishing friendly and respectful relationships, effective teaching, and applying a reality-based assessment. Identifying different and prevalent kinds of faculty incivility and making faculty members aware of them paves the way for faculty members to rethink their performance.
... This is particularly prevalent in relation to students who are more vulnerable to this type of behaviour, whilst attempting to grow confidence and gain competence, and being relatively powerless in their roles, resulting in many considering leaving the profession early in their careers (Bowllan, 2015). For those that do not leave the profession, the long-term impact of the experience of bullying or other similar behaviors during practical placements can be learnt incivility, thereby impacting the students' capacity to develop empathy and empathetic relationships which are crucial to nursing (Schaeffer, 2013). Some authors indicate that uncivil behaviour is increasing in higher education (Cahyadi et al., 2021; and more specifically in nursing education settings (Authement, 2016;Bowllan, 2015;Clark et al., 2021), further compounding negative experiences of students and exacerbating attrition from the profession. ...
... Academic incivility is disruptive and interferes with the students' learning experience (Clark & Springer, 2010). In particular, anger that is maladaptive remains an issue in nursing academia, interfering with student's relationships with academics as well as having a negative impact on their capacity to learn (Schaeffer, 2013). ...
... Academic incivility by students is a challenging issue in nursing education around Western countries [6,21,22] as well as oriental countries [1,4,23]. Incivility is not just about a particular behavior; it has implications in various contexts, and its impact can be vast and serious. ...
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... Academic incivility is also associated with maltreatment or intimidation in a work environment because today's undergraduate nurses become future registered nurses and nurse educators. Furthermore, nursing students and new graduate nurses' attrition which are connected to dearth of nursing workforce are equally linked with incivility (Schaeffer, 2013). ...
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... However, greater than 60 percent of the nursing schools specified that the shortage of faculty was the reason qualified applicants were not accepted into entry-level baccalaureate nursing programs. These shortages are predicted to only grow larger in the next decade [19]. ...
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