Incivility in nursing education has become progressively more important to understand as ill-mannered behavior on college and university campuses continues to mirror that of contemporary society (Clark & Springer, 2007a; Putnam, 1995). Increasingly, nursing student incivility has been the focus of study in academia. However, incivility cannot fully be attributed to students. Clark (2008b) believed that incivility is “an interactive and dynamic process where both parties share responsibility” (p. 284), which includes both faculty and students in cases of academic incivility. Subsequently, she correlated incivility with disruption in the teaching-learning environment. However, compared with student behavior, uncivil actions by nursing faculty have been less prominently studied. In particular, the relationship between incivility by faculty and nursing student program satisfaction has not yet been addressed. Thus, the effects of faculty incivility on nursing students is the focus of this study.
In the past several years, nurse researchers and authors have identified student behaviors that constitute incivility, recognized causes of the problem, and fashioned possible strategies for addressing rude and disruptive classroom behaviors (Lashley & deMeneses, 2001; Luparell, 2004, 2005; Thomas, 2003). Uncivil actions committed by students include inappropriate cell phone or computer use, sarcastic remarks in class, arriving late for class, and inappropriate e-mails (Clark, 2008b; Clark & Springer, 2007a; Lashley & deMeneses, 2001). A key feature of this behavior is that it violates norms of respect within the environment but is less severe in nature than aggression or violent behavior (Andersson & Pearson, 1999). Similar in tone to these student behaviors, acts of faculty incivility include making condescending remarks or unannounced course changes, belittling students, being emotionally distant, and displaying arrogance toward students (Clark, 2008a, 2008b; Clark & Springer, 2007a, 2007b; Feldman, 2001). For both student and faculty incivility, the cause and purpose of the perpetrator’s behavior is typically unclear. Some incivility is unintentional, the result of ignorance or oversight on the part of the instigator with no conscious desire to hurt the recipient. However, other cases of incivility may be due to the perpetrator’s dislike of the target, desire to emotionally harm the target, or even the perpetrator’s rude personality (Andersson & Pearson, 1999).
Causes of Incivility
Clark and Springer (2007a) noted that personal incivility corresponds with uncivil behavior seen in the larger population. Transient campus populations and short-stay students have less investment in relationship-building and a lower sense of community (Leatherman, 1996). Additional factors such as the aversion to making judgments about others’ behavior, less formality in society as a whole, increased work and academic pressures, and autocratic environments contribute to incivility. Impersonal communication by way of technology (e.g., voicemail, e-mail, and text messaging) can foster uncivil exchanges between faceless individuals (Andersson & Pearson, 1999). Overall, changing societal norms with loss of differentiation between appropriate and inappropriate behavior is seen as a major cause of incivilities in organizational settings, including universities (Pearson, Andersson, & Porath, 2000; Thomas, 2003).
In assessing organizational incivility, Pearson et al. (2000) cited national polls in which 90% of respondents felt that incivility had become a serious problem and was getting worse. Similarly, Cortina, Magley, Williams, and Langhout (2001) found that incivility was very prominent in work environments and resulted in psychological distress and dissatisfaction with many aspects of employment. Given that professional and academic organizations have common characteristics in terms of power structures, social norms, and performance expectations, findings from research on workplace incivility may be applicable to academia (Caza & Cortina, 2007).
Braxton and Bayer (1999) argued that student incivility in academia was increasing, resulting in disruption of college education across the United States. The trend appears to have continued. Using their Incivility in Nursing Education Survey (INE), Clark and Springer (2007b) examined the problem of collegiate incivility from the viewpoint of nursing faculty and students. They found that the majority of both educators and students identified academic incivility as at least a moderate-level problem. Although several researchers have explored the dynamics, causes, and outcomes of incivility in higher education (Bray & Del Favero, 2004; Clark & Springer, 2007a; Cortina et al., 2001; Caza & Cortina, 2007), Clark and Springer (2007b) asserted that collegiate incivility continues to be an overlooked concern.
Faculty Role in Incivility
The bulk of nursing literature addressing incivility in higher education focuses on student behaviors. However, it is important to emphasize that uncivil behavior on the part of nursing faculty is also a problem (Braxton & Bayer, 1999; Bray & Del Favero, 2004; Clark & Springer, 2007a; Tiberius & Flak, 1999). Lack of focus on faculty incivility has been attributed to embarrassment or denial on the part of faculty, some of whom may be reluctant to reflect on personal contribution to the incivility cascade (Boice, 1996; Pearson et al., 2000). Boice (1996) conducted a 5-year study of interactions in large lecture courses and identified behaviors considered uncivil on the part of both faculty (e.g., acting uncaring, arriving late for class) and students (e.g., making sarcastic remarks, carrying on loud conversations). He concluded that teachers play a crucial role in academic incivility.
Several studies specific to nursing education document the role of faculty incivility as well. Thomas (2003) interviewed students and faculty in several nursing programs throughout the United States, uncovering contributions by both faculty (e.g., unfairness, unexpected course changes) and students (e.g., sense of entitlement, laziness) to classroom incivility. Likewise, in their published experiences of bullying, incivility, and violence in nursing education, Kolonko et al. (2006) described the important role faculty play in this unacceptable behavior. In her qualitative study of incivility, Clark (2008b) included students’ powerful descriptions of their encounters with uncivil faculty. Although nursing education research has traditionally focused on student incivility, the work described above highlights the need to pay closer attention to incivility by faculty.
A possible argument is that faculty may only commit uncivil behavior following enticement or incivility by students. Although spirals of incivility have been documented (Pearson et al., 2000), we do not believe student incivility is the primary trigger of most faculty incivility. Even in cases in which student incivility is present, tit-for-tat incivility by faculty should not be excused.
The Problem of Incivility
Incivility by nursing faculty is problematic for four primary reasons. First, it may increase stress and anxiety in student targets who already face significant stress in their programs (Caza & Corina, 2007). Students are sensitive to criticism and ridicule by instructors and may react to uncivil feedback with anger, distrust, physical or emotional withdrawal, or resentment (Tiberius & Flak, 1999). Although evaluations and advice are critical components of education, receiving information from faculty in an uncivil rather than constructive manner may negate the opportunity for students to learn from this feedback due to the arousal of negative feelings. In extreme cases, faculty incivility can escalate into desperation and even violence on the part of students (Clark & Springer, 2007a; Feldman, 2001; Hall, 2004; Thomas, 2003).
Second, ongoing incivility can interfere with learning and safe clinical performance (Caza & Cortina, 2007; Feldmann, 2001). Andersson and Pearson (1999) posited, “The need for civility becomes even greater when the interactions among people increase in complexity and frequency” (p. 452). Nursing education consistently places students and faculty in frequent contact within complex situations, particularly during clinical experiences. In this context, incivility during the education of nursing students may have a significant negative effect on learning and performance (Clark, 2008b).
Third, faculty incivility conflicts with the concept of caring that is central to the profession of nursing (Beck, 1991; Dillion & Stines, 1996; Golden, 1993; Grams, Kosowski, & Wilson, 1997). Norms within the nursing profession denounce disrespectful interactions with others, including patients, peers, and students. For example, the American Association of Colleges of Nursing (2008), in its Essentials for Baccalaureate Education, addressed the importance of civility as a component of professionalism. The American Nurses Association’s (2004) Nursing: Scope and Standards of Practice speaks to professionalism in interactions with others, stating that “the art of nursing is based on a framework of caring and respect for human dignity” (pp. 11–12). The National League for Nursing (2005) included the following characteristics in a list of core competencies for educators: “Demonstrates interest in and respect for learners” and “Uses interpersonal attributes (e.g., caring, confidence, patience, integrity, and flexibility) that facilitate learning” (p. 16). Despite these fundamental expectations, students often perceive nursing programs as rigid, demanding, and dehumanizing (Hall, 2004). Incivility toward students does not demonstrate care or concern on the part of faculty and paints nursing programs as uncaring environments. Further, uncivil faculty interactions model negative behavior for students, implicitly teaching them that incivility is acceptable in the nursing field.
Finally, long-term incivility directed toward students may result in decreased program satisfaction and possible withdrawal (Caza & Cortina, 2007; Cortina et al., 2001; Hatcher, Kryter, Prus, & Fitzgerald, 1992; Tepper, 2000; Thomas, 2003). In their research of academic incivility, Caza and Cortina (2007) found that “as predicted, top-down incivility was associated with perceived injustice and perceived social ostracism, both of which linked to decreased satisfaction with the institution” (p. 342). Empathy, accessibility, and friendliness are faculty characteristics that foster rapport and communication between instructors and students (Boice, 1996; Luparell, 2005). Therefore, experiences of faculty incivility are likely to hinder baccalaureate nursing (BSN) student learning and nursing program satisfaction.
It has been suggested that incivility ignored is incivility condoned (Feldman, 2001). Deterrence theorists contend that incivility continues when the likelihood of punishment is low (Bray & Del Favero, 2004). This notion is particularly true in educational settings that do not have polices or repercussions for incivility. Targets of abusive supervision often take no action either because they feel powerless to do so or fear repercussions. Perpetrators of abusive supervision frequently fail to recognize and take responsibility for their actions, so their behavior continues (Tepper, 2000). Clark (2008b) advised there is a “need to develop best practices for preventing and effectively managing incivility in nursing education” (p. 289).
Nursing program administrators can ensure that policies and procedures are in place to address incivility on the part of students or faculty (Clark, Farnsworth, & Springer, 2008; Feldman, 2001; Lashley & deMeneses, 2001; Thomas, 2003). Prevention of faculty incivility may be possible by establishing clear expectations regarding acceptable behavior and educating faculty about appropriate social skills (Boice, 1996; Feldman, 2001; Kolonko et al., 2006). For example, written expectations for faculty-student conduct should be included in new faculty orientation programs, as well as in guidelines for faculty promotion and tenure. Incivility policies must include clear definitions of actions that breech rules of proper conduct (Hall, 2004). Further, expectations for appropriate conduct should be included in course syllabi and student-faculty handbooks, and stated consequences for acts of incivility should be upheld. (Luparell, 2005). Equally important is empowering nursing students so they feel confident to take action when incidences of incivility by faculty occur.
The current study drew on concepts of incivility in higher education (Caza & Cortina, 2007) and concepts of institutional satisfaction (Hatcher et al., 1992).
Three directions of incivility are identified in organizational literature: top-down incivility, lateral incivility, and bottom-up incivility. Top-down incivility is uncivil behavior by a higher-status individual toward someone in a lower-status position within an institution (Caza & Cortina, 2007; Pearson et al., 2000). Incivility directed toward students by faculty is clearly “top-down” in nature. Lateral incivility refers to uncivil acts between individuals in positions of equal status within an organization (Caza & Cortina, 2007). Bottom-up incivility is directed toward a person in a higher position by someone in a lower position (DeSouza & Fansler, 2003). In educational settings, academic incivility is “any action or speech that disrupts the harmony of the teaching-learning environment” (Clark, 2008b, p. 284).
According to Hatcher et al. (1992), academic “satisfaction” is the attraction or positive feelings that a student associates with the college or program in question. Two variables determine one’s satisfaction with the academic experience: rewards and costs of being in the program. Rewards are the positive aspects of college enrollment from the student perspective; costs are seen as negative features or hardships encountered during enrollment. Relationships with nursing faculty can contribute to either the positive (reward) or negative (cost) view of a student’s program and, thus, overall program satisfaction.
Review of the literature revealed only two authors who have specifically focused on students’ experiences of faculty incivility in nursing programs (Clark, 2008a, 2008b; Clark & Springer, 2007a, 2007b). Other researchers have addressed generalized faculty incivility in the classroom and faculty incivility as a prelude to student incivility, but few studies have explored instructor incivility directed toward individual nursing students (Clark, 2008a; Clark & Springer, 2007a, 2007b; Feldman, 2001). Moreover, no work has investigated the relationship between nursing faculty incivility and student satisfaction with their programs. In addition, incivility toward nursing students in specific academic settings (e.g., classroom, clinical, or laboratory) has not been considered. Nurse researchers (Clark, 2008b; Clark & Springer, 2007b) stress the need for continuing research in incivility as it affects nursing education, with which we agree.
Our study was designed to answer the following questions:
- What percentage of senior nursing students in BSN programs report experiencing faculty incivility?
- What is the relationship between faculty incivility and nursing students’ ratings of program satisfaction?
- In what educational settings does perceived incivility toward nursing students occur?
- How do nursing students respond to perceived faculty incivility?
Participants and Procedure
We recruited a sample of 152 senior nursing students from two public Midwestern universities for this descriptive study. Institutional review board approval was obtained from both universities. Senior nursing students were sought because they had been exposed to the maximum number of nursing faculty and courses at their respective universities. During the fall 2007 and spring 2008 semesters, all students in senior-level nursing courses in generic BSN programs were asked to participate in this study.
Guidelines for the protection of human subjects were strictly followed. The purpose of the study, instructions for completing the survey, risks and benefits of participation, and the option to withdraw from the study were explained. Consent was implied by completing the survey. Students who did not wish to participate were instructed to return their survey to the administrator. All 152 participants completed surveys for analysis.
A cross-sectional survey, titled the Nursing Education Environment Survey, was developed by two of the investigators (K.M., L.A.M.). The instrument was examined by two experienced nurse researchers and an incivility expert for content validity and clarity. Prior to use in the current study, the survey was pilot-tested with 35 undergraduate BSN students. Pilot participants were asked to complete the survey and evaluate its ease of use and readability. After editing the survey for clarity, we administered the revised version to study participants.
Demographics. Student demographic information collected included gender, age, race and ethnicity, and self-reported grade point average (GPA) (Table 1). Female students comprised 89.5% of the participants. Student ages ranged from 20 to 45 years (mean = 24 years), and the majority of participants reported their race as White (86.8%). Grade point average ranged from 2.33 to 4.00 (mean = 3.41) (GPA was not reported by 11 participants). Previous research shows a very strong correlation between self-reported GPA and school-reported grades, supporting the validity of this item on our survey (Bridgeman & Wendler, 1991, as cited in Caza & Cortina, 2007, and Huerta, Cortina, Pang, Torges, & Magley, 2006).
Table 1: Participant Demographic Information
Nursing Program Satisfaction. Participants completed a measure of global satisfaction with the nursing program that was developed by the primary investigator based on prior measures (Hatcher et al., 1992; Huerta et al., 2006). Questions related to program satisfaction assessed the primary dependent variable for the study. The scale contained five items, including “I would recommend this nursing program to others” and “Overall, I’m satisfied with this nursing program.” Participants rated these items on a Likert-type scale anchored from 1 (strongly disagree) to 7 (strongly agree). The measure showed very high reliability (alpha = 0.94).
Optimism. A measure of optimism was included to control for individual personality characteristics, such as general negativity, that could potentially increase reports of program dissatisfaction and perceptions of incivility (Caza & Cortina, 2007). The scale contained three items, including “I always look on the bright side of things” and “I’m optimistic about my future.” Participants rated these items on a Likert-type scale anchored from 1 (strongly disagree) to 7 (strongly agree). To minimize response bias, we placed measures of program satisfaction and optimism before measures of incivility in the survey.
Incivility. The scale for measuring student experiences of incivility was adapted from both the Workplace Incivility Scale (Cortina et al., 2001) and Incivility in Nursing Education Survey (Clark & Springer, 2007a, 2007b) with permission. Our revised incivility scale showed high reliability (alpha = 0.86). On the Nursing Education Environment Survey, students were to indicate which of the 14 faculty incivility behaviors they had experienced during their nursing education. Each behavior was prefaced by the statement, “During your educational experience in the nursing program, have any nursing instructors…” Examples of response items were “criticized or embarrassed you in front of others,” “sent rude or insulting e-mails to you,” and “put you down or was condescending to you.” Students who experienced any acts of incivility were asked to indicate the number of nursing faculty who had exhibited the listed uncivil behaviors. Respondents were also asked to indicate all academic locations (classroom, clinical setting, laboratory setting, and other) where they had experienced uncivil faculty behavior. To assess student responses to perceived incivility, we asked participants to choose any of 17 listed actions they had taken following experiences of faculty incivility (Caza & Cortina, 2007; Clark, 2008b).
Finally, an open-ended question asking students to briefly describe their worst experience of faculty incivility was placed at the end of the survey. This question was provided to elicit specific examples of faculty incivility in the students’ own words and will be reported in detail in a subsequent publication. These descriptions increased the validity of our incivility measure by allowing us to determine whether we were accurately tapping students’ most severe uncivil experiences. The descriptions also provided poignant examples of students’ perceptions of and reactions to specific cases of incivility.
Scale items were reverse-coded where appropriate. We computed mean scores for incivility, optimism, and program satisfaction measures for use in further analyses. Higher means denote greater degrees of the variables.
Approximately 88% of study participants reported experiencing at least one instance of uncivil nursing faculty behavior. Most students reported experiencing incivility from either one (40%) or two (43%) different faculty members. Few students (4%) reported encounters with three or more uncivil faculty.
Students reported the highest frequencies of incivility in the classroom (n = 91; 60%), followed closely by clinical settings (n = 76; 50%). Faculty incivility was present, but less common, in “other” settings (n = 22; 14.5%) and least frequent in laboratories (n = 15; 10%). Participants communicated in written comments that other places where they experienced incivility included faculty members’ offices and through online communication. Students who indicated that they experienced faculty incivility in more than one location (n = 66; 43.4%) were then asked to choose the one setting in which the mistreatment was most prevalent. Forty-five percent of these students indicated that incivility was slightly more common in clinical settings; 37% reported the classroom as the most frequent location. Six percent of participants indicated that faculty incivility was equally present in multiple locations.
The most common actions taken by participants who experienced faculty incivility were “talking about it with a friend, partner, or spouse,” “talking to classmates about it,” and simply “putting up with it.” Students were least likely to make formal complaints to the university, make excuses so the instructor would leave them alone, or assume that the instructor meant well. With the exception of the three most common responses, less than half of mistreated students selected any of the other 14 options (Table 2). However, it is worth noting that 35% of students reported having felt anxious, nervous, or depressed in response to incivility by faculty.
Table 2: Frequencies of Student Coping Strategies for Faculty Incivility
We performed multiple regression analyses to determine whether students’ nursing program satisfaction varied as a function of their experiences of faculty incivility. We controlled for age, GPA, and optimism to rule out the possible differential effects of these variables. Program satisfaction was regressed on the mean frequency of faculty incivility. We found that student dissatisfaction with the nursing program varied significantly as a function of experiences of faculty incivility (β = −0.47, p < 0.001). As indicated by the R2 change, 22% of variance in students’ reported program satisfaction could be explained by their experiences of nursing faculty incivility.
The samples of male and non-White participants were too small to draw conclusions about group differences in experiences of faculty incivility. Finally, we found no correlation between experience of faculty incivility and student age or self-reported GPA.
The purpose of this study was to explore the relationship between BSN students’ experiences of faculty incivility and their satisfaction with their nursing education programs. We also set out to determine the prevalence of faculty incivility, in which educational locations incivility occurs, and how students respond to perceived faculty incivility.
Top-down incivility has been found to correlate with perceived injustice on the part of victims (i.e., students), which, in turn, can lead to decreased satisfaction with their organizations (i.e., universities) (Caza & Cortina, 2007). Individuals who are targets of nonphysical abusive supervision in organizations have also been found to be less able to perform expected behaviors within their organizations (Tepper, 2000). However, the effects of top-down incivility on program satisfaction was not explored in nursing education prior to this study. In fact, most research on incivility in nursing education has examined students as perpetrators rather than as targets of interpersonal mistreatment. Addressing this gap in the literature, we found a strong relationship between perceived nursing faculty incivility and students’ dissatisfaction with their nursing programs. Our work also uncovered the high prevalence of nursing faculty incivility, with 88% of BSN students reporting having experienced at least one uncivil incident within the past year.
The current study also addressed the educational locations where faculty incivility is most likely to occur. The most common location is classrooms, followed closely by clinical settings. These environments involve regular interactions between faculty and students and include elements of feedback and criticism. Under these conditions, the opportunity for incivility can be high. Although not reported as being as frequent, faculty incivility through online communication is noteworthy as a context for mistreatment. Had the online location been listed as an option in the survey, rather than written in, its reported frequency may have been higher. Future research should specifically investigate online communication as an avenue for incivility between faculty and students.
BSN students’ primary methods for coping with faculty incivility were to voice their experiences to peers, as well as simply put up with the treatment. Similar to working adults targeted with incivility (Cortina & Magley, 2009), it was rare for students to make formal complaints or assume that faculty were well-intentioned in their behavior. In addition, our study suggests that psychological outcomes of faculty incivility experiences could be significant. More than one third of students reported feeling anxious, nervous, or depressed following faculty incivility, and 61% of participants shared specific written examples of uncivil encounters with faculty (some very early in their programs) that had a lasting impact on them. Consistent with organizational literature, we believe students’ resistance to formally report antisocial behavior may exacerbate these negative emotions and psychological outcomes, which in turn, affect program satisfaction (Boyd, Lewin, & Sager, 2009).
Among limitations of our study was the fact that it included students from only two universities, both located in the midwestern United States. Future research sampling a larger number of schools throughout the United States would be useful.
In addition, our results suggest that faculty incivility leads to student program dissatisfaction, although we cannot demonstrate causality. It is possible that students already dissatisfied with the program were more apt to classify instructor behavior as uncivil. However, in our incivility measure, students rated the frequency with which they experienced various behaviors (previously empirically classified as uncivil), rather than rating the amount of “uncivil behavior” they experienced.
It is also possible that students interpreted negative performance feedback as incivility, although written examples by students of uncivil encounters with faculty did not reflect that contention. The majority of students (83%) identified uncivil experiences as stemming from only one or two faculty members, indicating that students did not simply report most authoritative figures evaluating them as being uncivil. Future research could use longitudinal or experimental methods to examine causal relationships between faculty incivility and student program dissatisfaction.
Another limitation is that our participant pool under-represented minority and male nursing students based on national percentages; therefore, we were unable to test whether students of different genders or races differed in their experiences of incivility or program satisfaction. Future studies should clarify any role gender, ethnicity, or race may play in students’ experiences of faculty incivility.
Finally, an important limitation is that our findings exclude students who may have left their nursing program or university prior to their senior year due to experiences of incivility.
We discovered that a high percentage of senior-level BSN students experience incivility from nursing faculty during their programs of study. Although students’ experiences of incivility often stem from only one or two faculty members, the relationship between this interpersonal mistreatment and students’ dissatisfaction with their nursing programs is strong. These rude interactions most commonly occur in settings where students regularly interact with and receive performance feedback from faculty. For this reason, faculty should be provided educational opportunities on the benefits of offering constructive criticism and feedback to students, as well as demonstrating professionalism within nursing education.
To cope with faculty incivility, students in our study were reluctant to directly confront or report uncivil behaviors of faculty members or other employees of the university. Therefore, in addition to universities promoting methods for decreasing faculty incivility, we recommend that students be encouraged and empowered to adopt more active responses to incivility. In addition, both students and faculty would benefit from examining their behavior as it affects others in the learning environment. Improving interactions between BSN students and nursing faculty will likely enhance student learning and program satisfaction.
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Participant Demographic Information
| American Indian||2||1.3|
| Asian, Pacific Islander||5||3.3|
| Black, African||8||5.3|
| 20 to 22||80||52.6|
| 23 to 25||31||20.4|
| 26 to 29||20||13.1|
| 30 to 34||9||6|
| 35 to 39||6||4|
| 40 to 45||4||2.6|
|Grade point average|
| 2.0 to 2.5||1||0.7|
| 2.6 to 3.0||22||14.5|
| 3.1 to 3.5||74||48.7|
| 3.6 to 4.0||44||28.9|
Frequencies of Student Coping Strategies for Faculty Incivility
|Coping Strategy||Students Who Used Each Strategya|
|I talked about it with a friend, partner, or spouse.||75%|
|I talked to classmates about it.||73%|
|I just put up with it.||65%|
|I tried to avoid the instructor.||46%|
|I just tried to forget about it.||39%|
|I talked with family for understanding/support.||39%|
|I expressed my concerns in the course or faculty evaluation.||38%|
|I asked for advice from someone I trust.||37%|
|I told myself it wasn’t really important.||37%|
|I tried not to make the instructor angry.||35%|
|I cried and/or felt anxious, nervous, or depressed.||35%|
|I talked with another university faculty member.||19%|
|I blamed myself for what happened.||16%|
|I let the instructor know I didn’t like what was happening.||15%|
|I assumed the instructor meant well.||10%|
|I made excuses so the instructor would leave me alone.||5%|
|I made a formal complaint to the university.||1.5%|