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Effective intraprofessional (within a discipline) and interprofessional (across disciplines) communication and interactions are essential to effective work environments and quality and safety in healthcare. Civility is a key component of effective communication and interactions, and is particularly important because of the stressful and complex nature of healthcare environments and decision making.

Civility involves treating others (e.g., healthcare team members) with respect, listening to their perspective, considering their feelings within an encounter, and respecting differences, but also working to seek common ground when needed. It is essential to emphasize that civility involves engaging in authentic, respectful, and inclusive ways with others; civility fosters a feeling of belonging and community even when there is conflict or differences in perspectives (Clark et al., 2022).

Incivility is a serious issue in teamwork (in both intraprofessional and interprofessional environments). Incivility within communication encounters or interactions involves the covert (subtle) or overt disrespect of another person. Examples include discourtesy, eye rolling, gossiping, rude comments, name calling, complaining, and physical actions including violence – all of these behaviours that can cause emotional and physical harm to a person. Conflict management strategies and communication training are known to assist nurses to deter and address uncivil behaviours as well as foster clarity and trust.

Bullying and harassment are often referred to as types of incivility addressed to a specific person. Although these terms are similar, harassment specifically is a type of discrimination based on factors such as religion, race, age, sex, and disability (Canadian Human Rights Commission, n.d.). Bullying and harassment are typically repetitive behaviours (happen more than once) and harm or humiliate another person. However, they can also include serious one-time incidents of unwanted verbal and/or physical behaviour (Canadian Human Rights Commission, n.d.).

These behaviours usually occur in the context of a real or perceived power imbalance. For example, the person who is bullying often thinks they have more power (e.g., more seniority, authority, specialized title/role, more education). This type of incivility may also occur between nurses as forms of horizontal violence, which is lateral violence within a group.

Many forms of harassment and bullying can occur within the nursing profession (intraprofessional) and across various healthcare professionals (interprofessional). They may be physical such as unwelcome touching of your body or the attire you wear. More often, they take the form of non-verbal and verbal behaviours. This includes demeaning, humiliating, and belittling language, hurtful teasing/jokes, name-calling, slurs, insults, and criticism as opposed to critique. Non-verbal behaviours specifically can include eye-rolling and other facial and bodily expressions. Other bullying and harassing behaviours include ostracism and purposefully ignoring someone and not helping colleagues or continually assigning someone workloads that are considered difficult and problematic.

Keep in mind that intraprofessional or interprofessional conflict does not constitute incivility or harassment. You will have conflict in the workplace where you have strong opposing points of view. Additionally, your supervisor or a peer may even provide feedback or constructive criticism in a supportive manner – this also does not constitute incivility or harassment. There may be uncivil behaviour in the workplace that also does not constitute harassment or bullying, but still should be addressed (Government of Canada, 2015).

You may not readily recognize that you are being bullied or harassed, and not everyone who bullies or harasses is aware of their own behaviour. Sometimes these behaviours arise because of interprofessional conflict, but they can also be caused by personal issues. For example, healthcare team members could have stress at home, financial concerns, or anger management issues. All of these factors can affect how they engage with others in all settings, including the healthcare environment – and the stresses associated with the healthcare environment can also be contributing risk factors.

Whatever the reason, you have the right to a workplace that is free from any form of incivility including bullying and harassment. See Figure 3.6.

Figure  3.6: Workplace free from harassment

Professional nursing associations have been instrumental in addressing and managing bullying and harassment in the workplace. It is important for all nurses to attend to this form of violence in the workplace and take a leadership role in order to make change. Nursing has a legacy as an oppressed group because of its history as a subordinated profession (i.e., being considered subservient to the medical community) and because of socio-cultural structures like nursing being deemed gendered work. Oppressed group behavior can lead to horizontal violence, when parties in the same group lash out or exhibit violence toward each other in response to external dominant power. In such cases, members of an oppressed group feel subjugated and powerless against a dominant group and essentially take it out on each other. It is important to be aware of this dynamic as we work toward creating workplaces that are free from and intolerant to violence.

Why is it important to understand incivility, violence, harassment, and bullying?

Violence, harassment, and bullying are identified as occupational health and safety hazards that are underreported and often unrecognized (Becher & Visovsky, 2012).

As a nursing student, you need to be aware of what incivility, harassment, and bullying are and how to deal with them. These behaviours are not always conscious choices, so self-reflection and awareness are important first steps toward eliminating this type of incivility and violence in the workplace. Being the victim of bullying can have traumatic effects on self-esteem, mental health, and confidence in the workplace. Additionally, systemic bullying within an interprofessional team setting can affect staff morale, job performance, team functioning, and importantly, client care.

What should you do if you observe incivility, or someone being harassed?

First, if you observe incivility, step in and support the person on the receiving end.

Second, if you feel comfortable and safe, have a discussion with the person who is demonstrating the uncivil behaviour. Avoid participating in confrontational dialogue. Engage in an inquisitive discussion to better understand why it is occurring, and, if the person understands what they are doing and its impact on the other person. For example, you might say to them, I noticed that you have repeatedly rolled your eyes and interrupted X when they were sharing their perspective. Were you aware of your behaviour?

Third, if the incivility or harassment continues, report and document the incidents to your manager and the human resources department. If it is your manager who is creating the uncivil environment or doing the harassing, human resources should be your main point of contact.

Activity: Check Your Understanding

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