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Building Collegiality

Create a high-quality work environment by developing mutual respect and strong bonds among colleagues.

For a printer-friendly version of the exam you can print out, complete and mail in to ADVANCE, click here.

To view the Course Outline and take the exam online, click here.

This continuing education offering is sponsored by an educational grant from MJHS.

Learning Scope #384
1 contact hour
Expires May 7, 2014

You can earn 1 contact hour of continuing education credit in three ways: 1) Grade and certificate are available immediately after taking the online test. 2) Send the answer sheet (or a photocopy) toADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.

Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 221-3-O-09), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).

The goal of this continuing education offering is to provide nurses with current information on building collegiality. After reading this article, you be able to:

1. Discuss the importance of collegiality in the workplace.
2. Describe ways to practice civility to promote collegiality in the workplace.
3. Describe ways nursing leadership can foster an environment of civility and collegiality in the workplace.

* The author has completed a disclosure form and reports no relationships relevant to the content of this article.

The International Council of Nurses Code of Ethics requires that nurses conduct themselves in ways that reflect well on the profession and enhance public confidence.1 The American Nurses Association Code of Ethics compels nurses to treat colleagues, students and patients with dignity and respect.2 Adherence to these tenants promotes a positive image of nursing and facilitates the development of high-quality work environments. This article focuses on building high-quality work environments by developing mutual respect and strong bonds among colleagues, otherwise known as collegiality.

Collegial work environments are crucial to work success, and in the case of nursing staffs, this means the ability to provide safe and high-quality care that meets with each patient's satisfaction. Collegial work environments also reduce work-related stress experienced by nurses and add to their mental and physical well-being.

Collegiality and civility are closely related. Cynthia Clark, PhD, RN, ANEF, FAAN, a nursing expert on civility within nursing, defines civility as "an authentic respect for others that requires time, presence, willingness to engage in genuine discourse and intention to seek common ground."3 She believes that to achieve a more civil work environment each nurse needs to agree to a code of conduct that describes how nurses treat each other.

Why Practice Civility?

Besides encouraging mutual respect, civility in the workplace promotes patient safety, increases patient satisfaction and leads to the retention of a solid workforce. Conversely, incivility in the workplace has a negative impact: Staff members leave, patient care and patient satisfaction suffers, and the facility's resources are used to respond to and handle complaints of inappropriate behaviors among staff.

In July 2008, the Joint Commission outlined how hospital leadership is to address "disruptive and inappropriate behaviors" among employees within their facilities. The Joint Commission's evidence shows that disruptive and inappropriate behaviors lead to medical errors and preventable adverse patient outcomes, as well as increase the costs of care.4 Reducing disruptive and inappropriate behaviors by developing collegial relationships is essential for patient safety.

Taking a positive approach, nurses can follow the 25 Rules of Considerate Conduct (25 Rules) outlined by P.M. Forni, PhD, in his book on civility (see box). Forni's 25 Rules emphasize respect: respect of another's opinions, their time and their personal space. He also suggests that asserting yourself, being a considerate guest and not shifting responsibility and blame are crucial to collegial working relationships.5

Applying the 25 Rules, individual nurses can take a big step toward developing collegiality:

• Speak kindly. This means choosing your words wisely and avoiding gossip. Gossiping is not benign. Did you know that it is a form of bullying?

• Don't speak ill. Recognize that people behave in certain ways for their own personal reasons, not always apparent to us. Just because you are impacted by another's behavior does not mean that it was directed toward you. Complaining about another person's behavior without seeking first to understand it only spreads around the negative feelings.

• Think the best and avoid making assumptions. Many life coaches share that everyone's behavior starts with a positive intent - a misinterpretation of the behavior without knowing the intent can cause interpersonal difficulties. Ask for clarification if needed. This protects us from jumping to conclusions.

• Don't shift responsibility and blame and always do your best. Recognize that "your best" may change depending on life circumstances. Always take pride in your work and apologize earnestly if you have caused problems for others. This shows your commitment to your work and to your team.

• Apply the same skill set you use to develop rapport with your patients to develop rapport with your colleagues. This includes being visible and offering help as needed, being reliable, acting in a confident manner and accepting and giving constructive criticism.

Besides applying Dr. Forni's 25 Rules to your work, you also might want to pay attention to how you present yourself to others. There is evidence to support that the way we look and dress directly impacts the way we think, feel and act: dress down and our manners break down, our productivity can suffer and our sense of responsibility can be reduced.6-8

The way we look also impacts the way others see and treat us. Recent research shows that nurses who wear print or T-shirt attire are viewed as less skilled and knowledgeable. Nurses with visible piercings and tattoos were viewed as the least caring as well.9 In another research project, when asked to select a photo of how they would like to see nurses dress, patients chose photos of nurses with their hair back off their face wearing a large print "RN" name badge.10

The researchers for these projects give clear suggestions for professional attire: solid colored uniforms with limited visible body art, hair pulled off the face and prominent display of name badges.

Advancing Collegiality

We can't stop with personal changes. We all need to become active participants in producing high-quality work environments through team work.

Listening is an important component of building collegiality. Dr. Forni recommends that we all listen. Stephen Covey tells us to listen so that we understand, and listen and understand before we reply or try to make ourselves understood.11 Listen carefully without interrupting. Refrain from doing other tasks when a colleague speaks to you. Acknowledge his or her concern if there is one. Colleagues usually bring concerns to our attention to discover ways to correct them. Only offer a solution once you're sure you know what your colleague's concern is about. A great way to offer a solution is to say "have you considered" rather than "here's what you need to do."

Foster an environment of mutuality. Mutuality is a reciprocal relationship between two or more people. Nurses working in teams depend on each other. Sometimes we give directions and sometimes we are given directions. In an editorial for National Nurses Week, Maureen Kennedy, MA, RN, relates that "our work is too important; we can't afford to be sidetracked by bullying and other forms of relational aggression." She suggests that nurses focus on what we accomplish as colleagues through our mutual reliance on each other.12

Strong Leadership

Nothing changes without leadership's commitment. Employees are quick to sense when leadership is promoting a campaign half-heartedly or when leadership gives subtle hints that the tenets they are suggesting do not apply to them. An ounce of humility on leadership's part to accept the need to change too makes for a more successful outcome to any change initiative.

Using a shared governance format, leadership partners with nurses share decision-making and ownership of any initiative. Leadership sets the tone by empowering all members of the healthcare workforce to work together for goal achievement. In the case of creating work environments based on collegiality, leadership's role is to set the stage and bring together those individuals who can make it happen as well as give them the support and resources they need as they move on.

Dr. Clark suggests that leadership use John Kotter's process to make sustainable change toward civility and collegiality:13,14

• Create urgency. To create a sense of urgency, leaders need to name and address the types of disruptive and inappropriate behaviors noticed within the organization. They then are responsible to bring this information to all employees, making it clear that it is time to change to a more collegial environment.

• Achieve transformational change. Setting a goal and developing a vision are important next steps. Clear statements need to be made to identify who is responsible for what and who has the authority for making change happen. All leadership needs to buy in before the employee group takes the initiative seriously.

• Communicate a shared vision for creating meaningful change. Using a variety of methods, leadership then develops creative ways to share the vision of a collegial workplace with all employees. Everyone needs to be clear on the vision of collegiality and be able to note those times when the vision is being compromised.

• Empower broad-based action and generate short-term wins. Removing obstacles to change and empowering all employees takes time and courage. Communication between groups of employees who have not been regularly communicating with each other needs to occur. Sacred cows need to be eliminated. Statements such as "that is how it is done here" or "change is difficult" need to be substituted with "we are off on a new course" and "change is good for growth." Employees who are natural change agents need to be identified and then invited to join leadership to stimulate others to change.

• Consolidate gains to produce more change and to anchor new approaches. Another group of individuals within the employee group, who could be called the sustainers, need to be recruited. These employees are good at monitoring changes and seeing that the processes set in place are kept in place. In other words, sustainers make the changes stick and help others refocus when things get a bit askew.

Civility Champions

Leadership also can solidify their commitment to collegiality and civility by naming civility champions, whose major task is to engage others at the grassroots level in honest conversation meant to change things to a more mutually respectful environment. Civility champions, meeting with small groups of staff who routinely work together, can help them streamline their efforts to foster meaningful and purposeful changes to increase collegiality and civility, thereby reducing inappropriate and disruptive behaviors.

At one facility I worked at, civility champions, invited by specific work teams, held workshops to discuss the 25 Rules and helped the teams make specific plans to create more collegial work environments. Some teams requested posters of the 25 Rules to be displayed in their work areas for constant reminders of their team's commitment to change. Civility champions play a key role in aligning people on every level of the organization with a shared vision.

Nursing Evaluations

The Veterans Health Administration (VHA) includes collegiality in its Nurse Qualification Standards and defines it as the "extent to which the RN contributes to the professional development of peers, colleagues, and others." The VHA tiers the expectations on collegiality so that expectations increase as the nurse advances in practice and education.

For example, a newly graduated nurse is expected to "establish professional relationships with peers (and) seek out colleagues for mutual information exchange"; whereas a master's prepared RN is expected to "coach colleagues in team building (and) share expertise within and/or outside the medical facility."15 Reviewing the details of the VHA's Nurse Qualification Standards is helpful when considering how nursing departments can include collegiality in their nursing councils, policies and career ladders.

Turn Dreams Into Reality

Wanting a high-quality work environment based on mutual respect and cooperative work relationships is not something we should only dream about. Everyone wins when a healthcare facility embraces civility, challenges disruptive and inappropriate behaviors, and commits to creating a truly collegial work environment. Patients receive safer care and are more satisfied with their care; nurses experience less work-related stress. Facility leadership may find they have additional resources they would have used for recruitment and retention or investigating complaints of disruptive and inappropriate behaviors to use for more uplifting and innovative projects.

References for this article can be accessed here.

To view the Course Outline and take the exam online, click here.

For a printer-friendly version of the exam you can print out, complete and mail in to ADVANCE, click here.

Joan M. Lorenz
is a clinical specialist in psychiatric mental health nursing. Throughout her nursing career, she has held a variety of clinical positions, including patient safety manager, nurse manager, staff development educator and patient education coordinator. She currently provides consultation and workshops on issues designed to empower work teams to make changes needed to improve their work environments.

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