Assignment Week 9 – NURS 6053

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

• Review the Work Environment Assessment Template you completed for this Module’s Discussion.
• Describe the results of the Work Environment Assessment you completed on your workplace.
• Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed.
• Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

• Briefly describe the theory or concept presented in the article(s) you selected.
• Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.
• Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

• Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.
• Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment Assignment: Workplace Environment Assessment.

 Module 4 Assignment: Work Environment Assessment – NURS 6501: Interprofessional Organizational and Systems Leadership

Module 4 Assignment: Work Environment Assessment

Workplace incivility, which is described as repetitive, low-intensity unacceptable social behaviors, is a common occurrence in nursing practice (Armstrong, 2018). Uncivil conducts range from passive aggression and sexual harassment to nonverbal and verbal abuse and are predominantly intended to undermine and scare another group or an individual (Bambi et al., 2018) Assignment: Workplace Environment Assessment. In nursing settings, incivility aimed at colleagues represents a form of harassment that possibly contributes to physical and psychological anguish in victims, which, in turn, adversely influence the quality of nursing care delivered (Armstrong, 2018). The present assignment aims at analyzing the Clark Healthy Workplace Inventory results from my workplace and applying evidence from published pieces of literature in formulating interventions to address cases of uncivil behaviors discovered during the assessment. The three-part assignment entails a summary of the Work Environment Assessment, theory or concept discussed in the assignment articles, and evidence-based strategies for creating high-performance inter-professional teams.

Part 1: Work Environment Assessment

My workplace scored 83 on the Clark Health Workplace Inventory indicating that it is moderately healthy. The highest scores were recorded on members sharing a collective vision and mission that is grounded on trust, respect, and collegiality. Our nurse leaders recognize that being on the same page with all the patient’s clinical care providers is at the crux of patient-centered, evidence-based, and outcome-oriented care delivery and effective leadership (Martin et al., 2017). In my view, a shared vision reinforced by teamwork and broadening clinical scopes of nurses has led to shared care in my workplace as the collective vision has provided the path for change and inspired individuals to focus their energies on the core mission of fostering a healthy environment that guarantees patient safety (Martin et al., 2017). For instance, the shared vision provides a strong purpose and clear orientation to the nurse manager and team members of the L&D unit, which enables them to set priorities accordingly and stay on track, thereby leaving no room for uncivil behaviors. Other factors that have led to the moderate healthy workplace environment in our worksite include the use of effective communication, evident teamwork and collaboration, provision of competitive remunerations, and availability of adequate resources for professional growth and development.

Our hospital CEO and nurse manager strive to promote a healthy workplace that reflects a high degree of team involvement in decision-making as well as positive patient outcomes (Clark et al., 2016). Thus, I would rate my workplace environment as somewhat civil, since there have been seldom cases of incivility that threatened inter-professional collaboration, especially between nurses and clinicians (Shoorideh et al., 2021). From the available literature, power dynamics particularly between managers and junior staff is a primary recipe for uncivil behaviors, mainly verbal abuse including hostility, overt scolds or convert criticisms, sarcastic reactions, and impoliteness (Abdollahzadeh et al., 2017; Shoorideh et al., 2021). It was surprising, however, that the nurse leaders in our workplace were unlikely to direct incivility toward their subordinates. Covert uncivil conduct occurred among nurses with colleagues showing mutual disrespect during clinical rounds. Second, the frequency of reported cases of incivility is non-existent due to its covert nature, implying that cases remain undocumented and unaddressed. An idea I believed before the work environment assessment was that the unit and hospital leadership proactively investigated cases of incivility Assignment: Workplace Environment Assessment. However, the results indicated that while there is a perceived moderate healthy environment, interventions are needed to expose and prevent covert incidences of uncivil conduct amongst clinicians.

Part 2: Reviewing the Literature

I analyzed Clark’s (2019) and Clark’s (2015) articles highlighting the concept of cognitive rehearsal, an evidence-based technique proposed for employment in tackling discourteousness and disrespect during difficult dialogues. The technique is at the crux of Bandura’s social learning theory, whereby persons work with an experienced facilitator to deliberate and rehearse effective approaches to tackling a certain social issue or problem (Clark, 2019). It entails mentally practicing desired reactions to situations involving conducts frequently allied to workplace incivility like physical violence, verbal disrespect, subversion, gossiping, humiliation, and nonverbal allusion (Kousha et al., 2022). Cognitive rehearsal is intended to improve impulse control, increase confidence, and reduce nervousness by exercising pragmatic techniques to handle possibly nerve-wracking experiences. The covert cases of incivility at my workplace are examples of nerve-wracking social experiences that are characterized by discourteousness, disrespect, and difficult conversations, which call for the application of such psychological techniques as a cognitive rehearsal to address it.

Kousha et al. (2022) conducted a randomized controlled trial (RCT) involving 80 emergency nurses to explore the efficacy of cognitive rehearsal and educational intervention on perceived incivility among emergency nurses. The findings of the RCT showed that cognitive rehearsal enabled the emergency nurses to decode the training they acquired on effective conversation approaches into appropriate behaviors they can apply in their clinical settings to maintain mutual respect during heated discussions. In the above view, the tenets of the cognitive rehearsal technique can be applied in our hospital to promote a healthier workplace environment and prevent cases of nurse-to-nurse incivility. In line with the three-step process described by Clark (2015), the cognitive rehearsal technique will involve a nurse manager-led training presentation on incivility, modeling and demonstration of desired responses during dialogues, including the desired calm, respectful tone, and allowing the nurses to teach back to exercise the acquired behaviors to reinforce the instruction and rehearsal (Clark, 2015). The expectation is that the application of the cognitive rehearsal and role modeling technique in my clinical setup will result in a more conflict-capable staff, enhanced communication, improved nurse satisfaction, and subsequently, enhanced nursing care delivery.

Part 3: Evidence-Based Strategies for Creating High-Performance Inter-Professional Teams

One recommendation to develop high-performing inter-professional teams devoid of the convert nurse-to-nurse uncivil behaviors in our workplace is simulation-based Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training. TeamSTEPPS is a systematic methodology and set of instruments formulated by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) designed to enhance teamwork skills and communication among medical professionals with the principal goal of optimizing patient outcomes (AHRQ, n.d.). Assignment: Workplace Environment Assessment TeamSTEPPS facilitates team building and synergistic behaviors grounded on clearly defined purpose, active listening, demonstration of compassion and honesty, flexibility, and dedication to conflict resolution, all of which are necessary for fostering inter-professional collaboration and mutual respect. The second recommendation for creating high-performing inter-professional teams is the provision of effective leadership. In particular, the presence of transformational leaders facilitates shared governorship, goal alignment, creativity and innovation, team building, effective communication, and direction setting necessary for high-performing inter-professional teams (Mitchell et al., 2017).

In line with Eggenberger et al. (2019) recommendations, transformational leaders inspire members of interdisciplinary teams to partake in establishing a collaborative team culture and encourage them to nurture novices for team continuity and sustainability. Apart from cognitive rehearsal, I recommend the application of the tenets of the DESC models among nurses to communicate their beliefs, thoughts, and feelings in an open, honest way without infringing the rights of others and subsequently avoiding avoidable conflicts associated with incivility (Clark, 2019). The second strategy to bolster successful practices and desired behaviors in our clinical setting among nurses is to inculcate a culture of patient safety by actively investigating and tackling uncivil behaviors. The above will demonstrate the leadership’s commitment to tackling incivility, promoting a healthy workplace environment, and encouraging reporting of uncivil conduct.

Conclusion

The present assignment aimed at analyzing the Clark Healthy Workplace Inventory results from my workplace and applying evidence from published pieces of literature in formulating interventions to address cases of uncivil behaviors discovered during the assessment. The three-part assignment provided a summary of the Work Environment Assessment, showing that my workplace scored 83 on the Clark Health Workplace Inventory suggesting that it is moderately healthy. The reviewed pieces of literature highlighted the concept of cognitive rehearsal, an evidence-based technique proposed at the crux of Bandura’s social learning theory for employment in tackling discourteousness and disrespect during difficult dialogues. The concept is based on the premise that persons work with an experienced facilitator to deliberate and rehearse effective approaches to tackling a certain social issue or problem. The evidence-based strategies recommended for creating high-performance inter-professional teams include TeamSTEPPS-based training and transformational leadership.

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility? Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157–163. https://doi.org/10.4103/1735-9066.205966

AHRQ. (n.d.). About TeamSTEPPS®. https://www.ahrq.gov/teamstepps/index.html

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health and Safety, 66(8), 403–410. https://doi.org/10.1177/2165079918771106 Assignment: Workplace Environment Assessment

Bambi, S., Foà, C., De Felippis, C., Lucchini, A., Guazzini, A., & Rasero, L. (2018). Workplace incivility, lateral violence, and bullying among nurses. A review of their prevalence and related factors. Acta Biomedica, 89(6), 51–79. https://doi.org/10.23750/abm.v89i6-S.7461

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace: Let’s end the silence that surrounds incivility. American Nurse Today, 10(11), 18–23.

Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44(2), 64–68. https://doi.org/10.1097/NNE.0000000000000563

Eggenberger, B. T., Sherman, R. O., & Keller, K. (2019). Creating high-performance interprofessional teams leading the way. American Nurse Today, 9(11), 12–14.

Kousha, S., Shahrami, A., Forouzanfar, M. M., Sanaie, N., Atashzadeh-Shoorideh, F., & Skerrett, V. (2022). Effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses: A randomized controlled trial. BMC Nursing, 21(1), 1–9. https://doi.org/10.1186/s12912-022-00930-1

Martin, J., Mccormack, B., Fitzsimons, D., & Spirig, R. (2017). The importance of inspiring a shared vision. International Practice Development Journal, 4(2), 1–15.

Mitchell, R., Boyle, B., Parker, V., Giles, M., Joyce, P., & Chiang, V. (2017). Transformation through tension: The moderating impact of negative affect on transformational leadership in teams. Human Relations, 67(9), 1095–1121. https://doi.org/10.1177/0018726714521645

Shoorideh, F. A., Moosavi, S., & Balouchi, A. (2021). Incivility toward nurses: A systematic review and meta-analysis. Journal of Medical Ethics and History of Medicine, 14(12), 123–134. https://doi.org/10.18502/jmehm.v14i15.7670 Assignment: Workplace Environment Assessment