Decreasing Incivility Through Improved Communication and Teamwork

Problem: Workplace incivility (WI), lateral violence (LV), and bullying in healthcare settings are pervasive issues negatively impacting staff morale, turnover rates, and patient care outcomes. High turnover and low employee satisfaction scores from a September 2023 culture of safety survey signaled a toxic work environment characterized by ineffective communication and unprofessional behavior. Context: A 24-bed telemetry-stroke unit at a 172-bed acute care facility in the North Bay area of San Francisco. Interventions: The Transtheoretical Model (TTM) of behavior change and the Crucial Conversation frameworks were used to improve staff communication and reduce incivility. Measures: September 2023 and March 2024 culture of safety surveys were used to measure and compare the project's impact on staff morale, turnover rates, and patient care outcomes. Results: Both Cultures of Safety and Culture of Health Indices decreased from a baseline of 59 to 53 and 56 to 52, respectively. Incident reporting related to interpersonal issues was reduced by 1.59 % from the baseline of 12.89% to 11.3% during the intervention phase. Conclusions: Despite the decrease in both indices, TTM and Crucial Conversions are practical frameworks that nurse leaders can utilize to help improve communication among staff in the workplace. Implementing these frameworks effectively fostered a more supportive and respectful work environment.