The Pivotal Preceptor: Promoter of Civility

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Don Berwick, MD, former administrator for the Centers for Medicare and Medicaid and President Emeritus of the Institute for Healthcare Improvement, asked those listening to his keynote address at the Institute for Healthcare Improvement National Meeting in 2016 to consider nine behaviors that he believed were necessary to move into a new era for health care. One of his recommendations was to protect civility (Berwick, 2016).
Incivility has insidiously infiltrated many aspects of society. Some cite the media and political rancor for its rise. In polls conducted regarding the breadth of incivility in the workplace, 98% of the respondents reported that they had experienced rudeness at least once a week, compared with only 25% polled in 1998 (Porath & Pearson, 2013). The nursing literature is replete with studies detailing horizontal hostility, lateral violence, and disruptive relationships (Lewis & Malecha, 2011; Moore, Sublett, & Leahy, 2017; Stagg, Sheridan, Jones, & Speroni, 2011; Wilson, Diedrich, Phelps, & Choi, 2011). Incivility impedes work productivity, impairs cognitive ability, undermines collegiality, strains personal relationships, diminishes a person’s self-worth, and contributes to unhealthy coping (Porath, 2016). Researchers Lewis and Malecha (2011) suggested that the yearly cost of incivility to organizations from lost productivity was $11,851 per nurse. Pearson and Porath (2009) published their findings of incivility on performance outcomes:
The word civility is derived from the Latin “civilis,” meaning “citizen.” Civility is characterized by engagement, respect, and common purpose. Incivility is the exchange of seemingly inconsequential inconsiderate words and deeds that violate conventional norms of workplace conduct (Pearson & Porath, 2009). Incivility is characterized by behaviors that violate respectful workplace norms and often appear vague in terms of intent to harm. The accumulation of these behaviors over time can have far reaching consequences. Seventy-one percent of physicians, nurses, and other caregivers stated that abusive, condescending, and belittling behaviors contributed to medical errors, and 27% of the 4,500 respondents attributed incivility to adverse patient outcomes (Porath, 2015). In a separate study, the most frequently cited uncivil behaviors by managers included interrupting, being judgmental, and sharing minimal interest in ideas of others, and the most frequently self-identified uncivil behaviors included focusing attention on electronic devices, using jargon to exclude others, and not responding to invitations (Porath, 2015).
How do preceptors and nursing professional development practitioners protect civility? In reviewing the literature, three overarching themes emerged: engage in self-reflection, embrace the ladder of inference, and thrive affectively.
Preceptors are pivotal to the well-being of new staff members. They observe a new nurse’s clinical shortcomings, vulnerabilities, and desire to be included. Preceptors can show respect, joy, and gratitude or can demean, exclude, and withhold information, impeding the success of the new nurse. Preceptors protect civility by modeling authentic listening, displaying respect, and expressing appreciation to all. In every interaction, preceptors can help their orientees thrive or feel diminished….
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