|Year : 2016 | Volume
| Issue : 1 | Page : 9-13
A pilot study examining the effects of faculty incivility on nursing program satisfaction
Dana Todd, Dina Byers, Katy Garth
Department of Nursing, School of Nursing and Health Professions, Murray State University, 120 Mason Hall, Murray, KY 42071, USA
|Date of Submission||21-Apr-2016|
|Date of Acceptance||04-May-2016|
|Date of Web Publication||2-Jun-2016|
School of Nursing, Murray State University, 120 Mason Hall, Murray, KY 42071
Source of Support: None, Conflict of Interest: None
Uncivil behavior in the classroom threatens the teaching-learning process. Research to date has focused on nursing student incivility in academia with little research examining the faculty role associated with incivility. Due to the lack of research examining faculty incivility toward nursing students, additional research in this area is indicated. The purpose of this study was to examine the effects of faculty incivility on nursing students' satisfaction with their Bachelor of Science Nursing (BSN) nursing program in a rural Southeastern state. Quantitative data was collected via surveys. Research questions included: (1) What percentage of senior nursing students report experiencing faculty incivility? (2) What is the relationship between faculty incivility and nursing students' ratings of program satisfaction? (3) In what educational settings does perceived incivility toward nursing students occur? (4) How do nursing students respond to perceived faculty incivility? The results of this survey revealed that 35.3% of students had at least one nursing instructor that put them down or was condescending toward them during their educational experience. Furthermore, 20.7% reported that two or more faculty put them down or were condescending toward them. Collectively, the pilot study revealed that over half of the participants reported faculty behaving in a way that was perceived as uncivil. Incivility in the nursing profession has been an on-going problem. The high number (over half) of participating students reporting that they perceived that at least one nursing instructor had put them down or was condescending toward them during their educational experience raises additional concerns for the level of civility in nursing programs and the role modeling that is presented to students. It is imperative that nursing faculty and students interact professionally and establish effective communication patterns.
Keywords: Incivility, nursing, program satisfaction
|How to cite this article:|
Todd D, Byers D, Garth K. A pilot study examining the effects of faculty incivility on nursing program satisfaction. BLDE Univ J Health Sci 2016;1:9-13
|How to cite this URL:|
Todd D, Byers D, Garth K. A pilot study examining the effects of faculty incivility on nursing program satisfaction. BLDE Univ J Health Sci [serial online] 2016 [cited 2019 May 21];1:9-13. Available from: http://www.bldeujournalhs.in/text.asp?2016/1/1/9/183268
Incivility in the nursing profession continues to be a growing problem. Gallo  explains that incivility includes disrespect, insensitivity to different points of view, and a lack of social discourse. The Joint Commission  issued a Sentinel Event Alert describing behaviors that threaten patient care safety and workplace environments. This alert maintains that incivility in nursing can result in hostile and disrespectful work environments that result in lower morale, increased employee turnover, increased employee distraction that can lead to errors, and diminished patient care.  Research confirms that nurses experiencing incivility in the workplace have greater psychological stressors and poor overall health, as well as higher absenteeism rates, reduced productivity, and lower job satisfaction. ,,
The National League for Nursing has acknowledged the problem of incivility among nursing students.  Uncivil behavior in the classroom threatens the teaching-learning process by creating an environment that is not perceived as safe, increases stress, and therefore is not conducive to learning. ,, Jenkins et al.  describe uncivil behaviors among nursing students toward other nursing students to include "rude or demeaning behavior, refusing to help others, taking advantage of others and gossip" (p. 98). Examples of uncivil actions of both students and faculty identified in the literature include arriving late for class, rude remarks or comments in class, sarcasms in the classroom or clinical setting, unprofessional E-mails, and inappropriate computer or cell phone use in class. ,,,, Faculty members have reported that students yelled at them in class, in the clinical setting, and they had been subjected to threatening physical contact.  In a study by Altmiller,  students indicated that students' incivility toward faculty was a reaction to faculty incivility and felt that the students' reaction was warranted. Andersson and Pearson  reported that the primary feature of uncivil behavior is the violation of respect. Robertson  conducted a review of literature that reports student incivility as a multidimensional problem with student anxiety, moral development, and demographics being contributing factors. Regardless of the cause, uncivil behavior has a negative impact on nursing education and the profession.  Literature reports that nursing students may continue uncivil behaviors as they enter the workforce, which increases the risk for unhealthy work environments and unsafe nursing care. 
Just as students exhibit uncivil behavior, faculty can be uncivil in their interactions with students and with one another. Marchiondo et al.  reported that 88% of the nursing students had experienced at least one encounter, in which faculty were perceived to exhibit incivility toward them. Faculty behaviors identified by nursing students as faculty incivility included making patronizing remarks, belittling students, changes in a course without notice, being emotionally distant, and displaying superiority toward students. ,,, A recent study revealed four major categories of faculty incivility perceived by students. These categories included: "incivility in the presence of others, talking about one student to others, comments making the student feel stupid, and comments making the student feel belittled" (p. 125).  Faculty to student incivility disrupts the educational process, just as student to faculty incivility does. Faculty to student incivility leads to student feelings of anger, lower confidence, dissatisfaction, and emotional distress. , This study was conducted to further define and identify the nursing student perception of faculty incivility and determine that influence on program satisfaction.
| Study Purpose|| |
The purpose of this study was to examine the effects of faculty incivility on nursing students' satisfaction with their Bachelor of Science Nursing (BSN) program in a mid-South state. Research questions were: (1) What percentage of senior nursing students in BSN program report experiencing faculty incivility? (2) How do nursing students respond to perceived faculty incivility? (3) In what educational settings does perceived incivility toward nursing students occur? (4) What is the relationship between faculty incivility and nursing students' ratings of program satisfaction?
| Research Design and Methods|| |
Sample and setting
The sample comprised 116 nursing students enrolled in the final semester of a BSN nursing program. Inclusion criteria for participation were (1) 18 years of age or older, (2) nursing student enrolled in a BSN nursing program, and (3) English speaking. The sample consisted of 9 (7.8%) men and 107 (92.2%) women with a mean age of 27.08 years. Ethnicity of the participants were 94.8% (n = 111) Caucasian, 0.9% (n = 1) Asian, 2.6% (n = 3) African-American, and 0.9% (n = 1) others with one participant skipping the question (0.9%). The grade point average (GPA) was 3.52 (n = 114) with a minimum of 3.0 and maximum of 4.0 (standard deviation = 0.312).
This was primarily a quantitative study. Quantitative methods were used to collect demographic data such as age, gender, educational background, monthly income, and GPA. A demographic questionnaire was administered that includes the items listed above. The analysis of the demographic questionnaire included descriptive statistics. Nursing program satisfaction, optimism, and incivility were measured using the Nursing Education Environment Survey.  Permission was obtained from the authors prior to distribution. This survey did include one qualitative question. Participants who had reported experiencing faculty incivility were asked to describe their worst experience. For the purpose of this study, the qualitative responses were not analyzed and will be reported in the future.
The Nursing Education Environment Survey consists of five nursing program satisfaction statements. Examples of the items include, "I would recommend this nursing program to others," and "Overall, I'm satisfied with this nursing program." Items are scored on a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Optimism was assessed using three items. These included "I always look on the bright side of things," "I'm optimistic about my future," and "I hardly ever expect things to go my way." These items were also scored using the 1-7 Likert scale listed above. Incivility was assessed by student-faculty interaction questions. Each question began with "During your educational experience in the nursing program, have any nursing instructors…" These questions included, "put you down or been condescending to you?;" "made insulting or disrespectful remarks to you?;" "yelled, shouted, or sworn at you?;" and "sent rude or insulting E-mails to you?." The responses to these questions were reported as "none," "once or twice," or "more than twice." Finally, students who reported incivility were asked to describe their worst experience of faculty incivility using an open-ended format question. 
The Institutional Review Board approval was obtained prior to beginning the study.
Information regarding the study was sent via E-mail to nursing Deans and Chairs across one mid-South state. The E-mails contained a recruitment statement that provided senior nursing students an explanation of the study and link to access if they chose to participate. The Deans and Chairs forwarded the recruitment statement to their students and the students implied consent with the access of the study link and participation in the study. Participation in the study was strictly voluntary and the student could withdraw from the survey at any time. The survey was administered by Survey Monkey, and summary of the survey results was provided in an aggregate format.
| Results|| |
A pilot study conducted from April 2012 to December 2012 surveyed 116 nursing students in BSN program in one mid-South state. Reverse coding was utilized for the appropriate survey items prior to analysis. Quantitative data were analyzed using SPSS Version 21 software and reported. The results of this survey revealed that 35.3% (n = 41) of the nursing students indicated that during their educational experience, they had a nursing instructor, "put them down or was condescending toward them" once or twice and 20.7% (n = 24) reported more than twice. From this pilot study, over half (56.0%) of the nursing student participants reported that faculty had behaved toward them in a way that could be perceived as uncivil. The survey also revealed that 45.7% (n = 54) of the nursing students perceived that faculty had "interrupted or spoke over" once or twice and more than twice. Students also reported that 25% (n = 16) had been insulted once or twice by nursing faculty and 13.8% (n = 16) reported that they had been insulted more than twice. [See [Table 1] for a summary of the student-faculty interactions.] Most students reported experiencing incivility from one (33.6%, n = 39) or two (34.5%, n = 40) different faculty members. Only 5.2% (n = 6) of the students reported that three or more of their faculty had been uncivil toward them. The majority of students (90.1%, n = 82) reported that the faculty who had been uncivil toward them was female.
The university classroom setting was the most common location where perceived incidents of incivility occurred with 49.1% (n = 57) of the students reporting the classroom as the setting for uncivil interactions. The second leading location was the clinical setting which included hospital or community facilities with 30.2% (n = 35) of the participants reporting this incivility in the clinical setting. Twenty-seven percent or 23.3% of the students reported other situations in which incivility occurred, including faculty offices, E-mail communication/virtual office hours, lunch room/cafeteria during clinical experiences, and after class in hallways. Finally, the university laboratory was identified by 9.5% (n = 11) of the participants as a site where faculty incivility had been experienced.
Multiple regression analysis was conducted to determine the predictive value of faculty incivility on nursing students' ratings of program satisfaction. Age and GPA were also included as independent variables in the model. The analysis accounted for 21.3% of the variance in program satisfaction reported by nursing students. Of the three independent variables included, only faculty incivility contributed significantly to the analysis (P = 0.000). Age and GPA were not significant (P = 0.76 and P = 0.23, respectively). Pearson's correlation of faculty incivility revealed a direct correlation between students who indicated they were dissatisfied with their nursing program and their perceived experiences with faculty incivility (P = 0.000).
The majority of students, i.e. 49.1% (n = 57) reported that in response to the faculty incivility, they "just put up with it." Over 45% (n = 53) indicated that they talked to a friend or classmate about the perceived incivility. Almost half, i.e. 32.8% (n = 38) reported that they tried to avoid future encounters with the instructor. Only 12.9% (n = 15) talked with the instructor about what happened. Several students (31%, n = 36) reported that they felt anxious, nervous, or depressed about the occurrence. [See [Table 2] for a summary of student responses to faculty incivility.] Almost all of the students, i.e. 82.8% (n = 96) reported that they did not know if the university or nursing program had any written statements/policies regarding negative faculty behaviors toward students.
Generalizability of the study findings is limited due to the small sample size and the use of a convenience sample. Nursing students were recruited from several schools in only one mid-South state. Therefore, it is impossible to generalize the findings to all populations. Further limitations include the utilization of self-reported data collection. Self-reported data tools have been associated with recall bias and overestimating adherence. The study design also limited the study, as incivility was the only variable examined. Examining civility and student incivility could have added richness to the study and reduced bias. Finally, data were collected from only the students' perception of incivility among nursing faculty. The faculty perspective is missing from this study and is a recommendation for future research.
| Discussion|| |
The results of this study indicated that over half of the students in BSN program report experiencing faculty incivility in a variety of settings. Students reported uncivil communication patterns as the most commonly occurring examples of uncivil behavior. These findings are consistent with other research that has examined student perceptions of faculty incivility. ,,,, Furthermore, the study found that faculty incivility was a correlation between students who indicated they were dissatisfied with their nursing program. Research supports this finding, as civility in the education setting has been associated with students' perception of program satisfaction, stress, and coping. , Finally, an overwhelming majority of the students, i.e., 82.8% (n = 96) reported that they did not know if the university or nursing program had any written statements/policies regarding negative faculty behaviors toward students. Establishing policies that define incivility and the consequences of incivility need to be published and reviewed with students. Policy development and enforcement provides awareness that will arm students with critical education that will allow them to have the opportunity to be proactive instead of reactive to the problem of incivility in nursing education.
Many times, faculty and students may not be aware of what constitutes uncivil behavior or more commonly may not be aware that their behavior is being perceived as uncivil. Therefore, faculty and students may benefit from education regarding behaviors that are perceived as uncivil by the recipient. Recognizing inappropriate behavior is one of the first steps toward a solution. Inappropriate behaviors include verbal abuse, nonverbal abuse, sexual harassment, passive aggressive behaviors, and bullying.  Examples of verbal abuse include shouting, yelling, or insulting others whereas nonverbal abuse includes eye rolling, making faces, or excluding someone from a conversation. Sexual harassment includes any inappropriate sexual behavior or comments. Passive aggressive behaviors include refusal to communicate with others, talking behind the back of others, and undermining the works of others.  Bullying is an example of incivility. Bullying behaviors include those previously listed, but these behaviors are continuous and occur over time and are usually directed at the same person. 
Educating students and faculty on the recognition of inappropriate behavior and techniques to change behavior and appropriate responses can lead to environments of mutual respect where learning can occur. Mutual respect and professionalism will lead to safer environments where the exchange of ideas is encouraged. Safe environments are necessary for the recognition and effective discussion of uncivil behavior and allow for correction of the behavior. In order for education to be effective, policies need to be developed that clearly outline incivility and the consequences associated with the incivility. Policy development and education are the essential components for the reduction of incivility in the profession.
Implications for students
In order for students to promote civility, they should recognize and reflect upon their own behaviors and take responsibility for their actions. Students should promote civility by being respectful, on time, avoiding or discouraging gossip, and holding each other accountable for their actions.  Furthermore, students need to behave civil not only to faculty but also to fellow classmates. Hirschy and Braxton  reported that student-to-student incivility disrupted academic and intellectual progress and resulted in decreased program satisfaction. As students are more aware of their own behaviors, they will reflect a positive image for civility in nursing education. Students who understand the importance of civility in the nursing profession should serve as mentors to classmates. Incorporating this mentorship concept in professional student organizations and in areas where students hold leadership roles will help to improve the standards of civility in nursing education and the profession.
Implications for faculty
Faculty need to be sensitive to the student perception of their behavior and their communication styles in the classroom, hallways, clinical settings, and through electronic communications. Faculty should have discussions about incivility among each other and between students. Clark and Ahten  suggest that faculty should be discussing whether norms of acceptable professional behavior exist and outline how they should interact with one another, their students, and community partners. Didactic and clinical faculty need to evaluate their communication patterns with students. In the event inappropriate communication or behaviors are identified, then faculty should make adjustments in communication patterns. Being more aware and vigilant of faculty personal behaviors and communication styles is essential to overcome these student perceptions. Communication can often be misconstrued and misunderstood. Faculty need to become more self-aware of how their communication is perceived by students and clearly communicate with students in a mutually respectful manner.
It is essential to establish policies related to incivility and to ensure these policies are in place and utilized by students and faculty. Policies that outline uncivil behavior and the consequences associated with the behavior for both students and faculty will allow for recognition and discussion that will enhance communication. It is suggested that nursing students need to be aware of professional behavior expectations in the beginning stages of their nursing curriculum.  It is the faculty's responsibility to educate nursing students of professional behavior expectations. Students not only need to be aware of their professional expectations but also they should know what behaviors to expect from others. Integrating these expectations into orientation programs that then are reinforced into other didactic and clinical courses will provide students with awareness of policies and will help reduce incivility in the education setting. 
| Conclusion|| |
A better understanding of incivility experienced by nursing students in the educational setting has the potential to reduce incivility perpetuated by nurses in the workplace. Incivility in the workplace has been linked to adverse events, medical errors, reduced patient safety, decreased quality of care, and patient mortality.  The overall improvement in patient outcomes that could come from reducing incivility in the work environment is significant, but also the improvement in the work environment can lead to increased job satisfaction. In particular, it has been reported that 60% of new nurses leave their first position within 6 months because of incivility.  In addition, it is estimated that workplace incivility costs an estimated $1.2 million in annual direct care staff alone.  The educational setting has the opportunity to influence change for the next generation of nursing professionals.
Finally, additional research that examines the faculty role in perpetuating incivility in the educational setting is warranted. Findings presented here support research in this area with over half of the participants reporting at least one incident of incivility in the nursing education setting. Faculty need to have the conversations about the existence of incivility among themselves and with their students. Incivility should be clearly defined by the nursing program and communicated to students and faculty through policy. Faculty and students in turn should follow the policies and should model the policies by demonstrating the expected behaviors. This modeling could lead to improved program satisfaction by nursing students and faculty workplace satisfaction.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]