Nurses have an ethical responsibility to interact respectfully with patients, colleagues, and students. Professional standards of practice in the United States, Canada, and Australia reflect the importance of developing and demonstrating values and frameworks that support collaborative, collegial, and ethical behaviors (American Association of Colleges of Nursing, 2008; Australian Nursing & Midwifery Council, 2008; Canadian Nurses’ Association, 2008; Royal College of Nursing, 2005). In nursing education, faculty plays an important role in students’ development of social responsibility and professional behaviors. A safe and appropriate teaching–learning environment must be created to support these practice competencies.
The purpose of this article is to examine the issue of uncivil faculty-to-faculty relationships in academia and nursing education, and it includes a review of the literature and the experiential reflections of seasoned nurse educators. The bioethical theory of symphonology, developed by Husted and Husted (2008), is used to provide a new way of framing this issue. Through the use of the bioethical standards within this context, this practice-based theory can help facilitate decision making during difficult interactions and sustain a focus on the central agreements that are foundational to nursing education. The nature of ethical interactions among nursing faculty is crucial in modeling ethically based relationships for nursing students.
Incivility has been defined by Clark (2013) as “rude or disruptive behavior often resulting in psychological or physiological distress for the people involved and, if left unaddressed, may progress into threatening situations (or result in temporary or permanent illness or injury)” (p. 98). Such behaviors may include disrespectful verbal attacks, offensive or condescending language, lack of collaboration, disregard for interdisciplinary input about patient care, public criticism, ethnic slurs or jokes, and sexual comments. Results of a national study of 588 nursing faculty representing 40 states in the United States indicated that 68% of respondents found faculty-to faculty incivility to be a moderate to severe problem (Clark, 2013; Clark, Olender, Kenski, & Cardoni, 2013). Uncivil behaviors specific to faculty interactions include resistance to change or unwillingness to negotiate, failure to perform one’s share of the workload, distracting use of media devices during meetings, refusal to listen to or openly communicate about work issues, making rude remarks or put-downs toward others, starting or perpetuating gossip and rumors, consistent interruption, and abuse of one’s position or authority (Clark et al., 2013). Persistent incivility can result in symptoms of work stress, organizational disruption, and threats to patient safety (McNamara, 2012). As noted by Clark (2013), the effects of unaddressed incivility can be “devastating, debilitating, and enduring” (p. 98).
Workplace incivility has been a significant problem in health care for more than three decades, and newly graduated nurses may be particularly susceptible to workplace incivility (Smith, Andrusyszyn, & Spence Laschinger, 2010). Strategies that have been proposed to address these problems include interventions to promote nurse empowerment (Spence Laschinger, Leiter, Day, Gilin-Oore, & Mackinnon, 2009), organizational culture change (Olender-Russo, 2009), and the development of a Nurse Incivility Scale on which to base interventions that target specific sources of incivility within an institution (Guidroz, Burnfield-Geimer, Clark, Schwetschenau, & Jex, 2010). In addition, professional nursing associations have developed standards for healthy work environments that serve as models for promotion of workplace civility (Luparell, 2011). However, these strategies may not be adequate as personal tools for addressing uncivil behavior.
Students in clinical learning environments are exposed to lateral violence among nursing staff, which they may perceive as acceptable and engage in themselves. Students are also frequent targets of uncivil behavior perpetrated by staff (Anthony & Yastik, 2011). Nurse leaders are encouraged to work together to promote a culture of civility to curtail this concerning cycle (Clark, Olender, Cardoni, & Kenski, 2011), yet they may lack a framework for doing so.
Students have described their experiences with faculty incivility in the teaching environment as demeaning and unfair, where they are pressured to conform to unreasonable academic demands (Lasiter, Marchiondo, & Marchiondo, 2012). These experiences can impede student learning, self-esteem, self-efficacy, confidence, and development of identity as a nurse and can negatively influence professional formation (Del Prato, 2013). As a result, students may experience increased stress and anxiety, leading to student incivility, manifested by anger, distrust, withdrawal, resentment, or overt hostility and violence (Altmiller, 2012). Thus, incivility breeds incivility.
As attention associated with student and faculty incivility increases, new suggestions for fostering civility have emerged (Clark, Ahten, & Werth, 2012; Clark & Davis Kenaley, 2011; Clark & Springer, 2010). A shared responsibility for the problem has been noted, which Clark (2008a) described as a dance of incivility, where students and faculty respond to stress in dysfunctional ways. She proposed a change to this paradigm, where the dance might be healing, as opposed to a struggle, to create a more positive teaching–learning environment.
Although discussion of incivility has been present in the literature for some time, articles focusing on faculty-to-faculty incivility are less common. Heinrich (2007) described experiences of incivility between nursing faculty members as “joy-stealing games” (p. 35) and suggested that nurturing the relationships among faculty members may heal damage and foster a returned passion for teaching. King (n.d.) conducted an unpublished phenomenological study on the experiences of faculty-to-faculty incivility, which revealed the wounding effects on faculty in the workplace and suggested the need for further research on this issue. Systemic approaches to incivility are necessary, yet few exist that are nursing focused and practice based to support faculty who struggle with incivility. This article advances the potential of one such framework for an examination of lateral incivility among nursing faculty.
A Brief Overview of Symphonology
The bioethical theory of symphonology (Husted & Husted, 2008) establishes a workable theory of bioethics for nurses and other health care professionals by interweaving nursing and philosophy. Symphonology, derived from symphonia, the Greek word for agreement, is defined as “a system of ethics based on the terms and presuppositions of agreement” (Husted & Husted, 2008, p. 321). Interactions are based on a shared awareness of purpose, where the nature of the agreement between parties is both explicit and implicit, and ethical decision making within that agreement is guided by the “values… [one] seeks to attain, maintain, or regain in the relationship” (Husted & Husted, 2008, p. 42). This theory incorporates a practice-based decision-making model that values agreements, maintains respectful and professional interactions, and assists in determining when and what actions are appropriate for health care providers and patients.
The bioethical theory of symphonology highlights logical thinking and a holistic, individual approach that takes into account the context of a situation, preexisting knowledge, and contextual awareness to guide what is justifiable in a particular situation. The bioethical standards of autonomy, freedom, objectivity, beneficence, and fidelity serve as benchmarks for purposeful decision making. They act as preconditions to agreement and serve to guide nurses’ actions in terms of rights and capabilities within the agreement and for resolving dilemmas. This nursing theory, highlighting ethics and agreements, can be extended to understand and address the challenges of incivility.
Application of the Bioethical Standards to Faculty-to-Faculty Incivility Exemplars
The symphonological approach and the application of its model to faculty-to-faculty incivility offer a method for determining actions and justifying possible resolutions to such behaviors. Because the bioethical standards serve as preconditions to these agreements, they will each be discussed with exemplars from the perspective of faculty being treated uncivilly to demonstrate the application of symphonology as a means to ethically justifiable approaches for thinking about and addressing faculty-to-faculty incivility.
Autonomy is described as the individual uniqueness of each person, a characteristic of an informed decision maker who is independent, responsible, and cognizant of “his right to be who he is” (Husted & Husted, 2008, p. 59). Autonomy serves as the foundation for interactions and the agreement between parties. The symphonological approach integrates this standard and the idea of “ethical equality” (Husted & Husted, 2008, p. 312). As a precondition, autonomy maintains an individual’s purpose or goal without coercion. It serves as the basis for “the right to exist” (Husted & Husted, 2008, p. 59). The following exemplar represents a violation of the standard of autonomy through incivility:
After attending a nursing education conference, Patti (whose name has been changed for anonymity) is excited to implement some of the strategies she learned, which have shown merit in university circles. Upon sharing this information with several faculty member colleagues, she is told, “You can’t do that! If you do, the students will expect us all to do it, and we’re not changing!” Patti is deflated and feels minimized in her role as an educator. The other faculty’s resistance to change concerns Patti, in her role as educator and also in her relationship with faculty, where she does not feel free to discuss creative curriculum ideas. Should she pursue this change or actively recruit support through articulation and demonstration of methods?
Features of the encounter may resonate with faculty who attempt change in an uncivil environment. The other faculty aimed to belittle Patti in such a way that would compromise her values and regard for her commitment to academic excellence. In this situation, Patti’s first commitment is to her ethical self and her autonomy. Her decision to share her excitement with other members of the faculty reflects her personal assignment of assertion. She used rationality in this process to understand the facts of the situation relative to bioethics as in symphonology. These facts acknowledge that each person has “…a right to growth, development, and pursuit of a destiny…and there is no justification…to refuse to accept the unique character structure of another” (Husted & Husted, 2008, p. 59). It may be difficult for Patti to maintain her autonomy in this situation because the interaction between parties is not based on a mutual respect and equality for one another. From a symphonological viewpoint, Patti must reflect on her uniqueness to guide her further actions. She should initiate new teaching strategies for the benefit of students and work on ways to gain faculty support by collaborating with others who seek to develop and implement contemporary practice strategies. Knowing that coercion or interference from others inhibits her autonomy, it is illogical for Patti to forego her right to autonomy; thus, the rights of others should not affect her rights. She acknowledged her purpose and obligation to the students when she accepted the position to become an educator. She must uphold her agreement as it reflects upon her character and nature as an individual.
Freedom is the right to take independent actions that are based on an agent’s self-evaluation of his or her circumstances and relates to an agent’s awareness of situation (Husted & Husted, 2008). The standard of freedom involves single events, as well as short or extended sequences of events, including sequences that extend over a lifetime (Husted, Scotto, & Wolfe, in press). It is a process to understand what one can and cannot do, and it is limited by the rights of others. A faculty member can pursue actions that fulfill his or her values and motivations. The freedom to move freely within the organization is based on the condition that no harm will come to others. The following exemplar demonstrates a violation of the agreement and the limitation of one faculty member’s freedom as her colleagues engage in uncivil behavior:
Beth (whose name has been changed for anonymity), an enthusiastic new faculty member, develops an innovative new clinical course orientation that incorporates the use of clinical simulation learning experiences. She receives positive student evaluations after implementing it and presents those findings at a faculty meeting. Without discussion or acknowledgment of Beth’s initiative, Rachel, a tenured faculty member (whose name has been changed for anonymity), forcefully states, “I think clinical simulation is meaningless to actual practice and I am not willing to support using that type of orientation plan in the upcoming term. We have enough to do and, frankly, I am surprised you had time to work on this in that you are working toward promotion and should be devoting your extra time to research and publication responsibilities.” Others say nothing and Beth’s idea is dismissed without a vote. Should Beth act to continue to pursue the dialogue, advocating for the new method of clinical course orientation?
In this interaction, Rachel exerts power over faculty who are less assertive. In so doing, she negates Beth’s right of freedom to take action toward her desired purpose, which is the creation of an improved teaching–learning process for clinical orientation. The cascading effect of Rachel’s curt and dismissive statement is significant; other faculty members fail to counter the remark or engage in the necessary discourse required to vet the idea and form a collegial and rational decision. In this way, they passively contribute to the violation of Beth’s right, and sacrifice their own right, of freedom. Beth’s situation also describes rankism (Clark, 2008b), a term that describes how senior or more authoritative faculty act to restrict the self-assertion of junior faculty. This reaction to intimidation from a person of higher rank is often accompanied by veiled threats to freedom in the form of tenure aspirations of junior faculty members. Despite this situation, Beth should uphold her right to freedom and self-assertion in that her action is directed toward improvement in the teaching–learning process and supports her role as a nurse educator and agreement with self.
Objectivity is defined as one’s desire to know something as it is observed without prejudgments (Husted & Husted, 2008). It represents an individual’s need to achieve and sustain objective awareness. With objectivity, the reality of the situation and the person’s capability to be aware of things as they are can affect the individual’s action on this awareness (Brown, 1998). A nurse faculty member must know the reality of a situation to exercise rationality. In the workplace, faculty should expect equal treatment and objectivity without judgment by colleagues and administration. In the following scenario, the dominance of one faculty member over another can be seen in the lack of objectivity and incivility:
Donna (whose name has been changed for anonymity) just administered her first examination to the students in her health assessment class. While reviewing the examination and conducting an item analysis, she noted that several questions had poor reliability, and most of the students incorrectly answered them. Thus, she decided to eliminate the questions from the examination. Donna mentions her actions to another faculty member, Jane (whose name has been changed for anonymity), who immediately exclaimed, “Why did you do that? I never throw out questions or add points to my examinations! Now the students are going to expect me to do that!” Donna is surprised by Jane’s reaction and has difficulty deciding her next action. Should she reverse her decision and keep the unreliable questions in the examination, knowing that the students will fail?
Donna must remain objective in her response to Jane. She must be civil in her communications with Jane but use her own objectivity in the choice to delete the unreliable test questions in the examination. In the conversation with Jane, Donna’s objectivity is characterized by a neutral tone and body language. It may be difficult for Donna to remain objective in this decision because Jane is not a partner in the collegial agreement; Jane is prejudging this situation. Donna is fully aware of the complications if she includes the problematic questions from the original examination and of her agreement with her students to be fair in the evaluation. If Donna decides to keep the original examination, then she has broken this agreement. Donna must make the most rational decision.
Beneficence, as a bioethical standard, is defined as “the act of assisting [one’s] effort to attain that which is beneficial” (Husted & Husted, 2008, p. 312). It refers to the need to achieve good (benefits) and avoid harm (burden). Beneficence must be a precondition to any agreement and faculty should rightly anticipate the benefits of personal and professional fulfillment through altruistic encounters with students, colleagues, and leadership. The ultimate beneficiary is the patient, as ethical agreements made between and among those parties contribute to healthier work environments where “all can flourish” (Fontaine, Koh, & Carroll, 2012, p. 558). The following is an example of an imbalance of benefits and burdens that results in incivility among faculty members:
Barbara (whose name has been changed for anonymity), a faculty member in a new administrative role, noticed that the students are stressed with the current unbalanced clinical course timetable. She completed various revisions and created a schedule that might benefit both students and faculty. She shared her idea with several trusted colleagues, and they agreed that it seems feasible. When she presented her proposal, several other faculty leaned back in their chairs, folded their arms, rolled their eyes, and laugh sarcastically. After the proposal, one faculty member stated to another faculty, “So, apparently she thinks she can just come in here and change things. We’ve tried that before, and it will never work.” When Barbara looked to her colleagues for support, they say nothing, apparently fearful of recourse themselves. She is bewildered and drops the subject. The clinical schedule persists without being addressed, resulting in student resentment and hostility. Barbara wonders if she should still pursue change for the students’ benefit.
Barbara has a responsibility to promote an environment conducive to student learning and includes collegial relationships that support her capabilities as an educator. This change should be a shared responsibility, and no individual should benefit at the expense of undue burden on another. When the beneficiary of an action is in question, clarity may be achieved through contextual analysis. In this example, the bioethical lens of the other faculty was out of focus, as they considered the burden of change to be greater than any potential benefits to the intended recipients of their actions—the students. The behavior of the colleagues, motivated by fear of repercussion served to perpetuate this lack of focus on beneficiaries. Barbara was honoring the agreement she made with herself, her colleagues, and her students when she proposed a schedule that might benefit all stakeholders without undue burden. Although faced with resistance to her idea, if she does not make another attempt at revising the schedule, the students will continue to suffer and the faculty will continue to feel oppressed. In addition, Barbara may never know the benefits of leading a potentially successful change, and she may not be able to fulfill her administrative role.
Fidelity for a nurse is a “commitment to the obligation [one] has accepted in [one’s] professional role” (Husted & Husted, 2008, p. 72). For nurses in faculty roles, an agreement is formed with nursing students and colleagues with whom curriculum-related and academic projects are shared in the academic environment. An agreement made without anticipating fidelity, or faithfulness to the agreement and the patient, is illogical. In nursing education, this commitment demonstrates models of caring practices with students and colleagues, which is ultimately reflected in patient care. The following exemplar highlights a violation of fidelity:
Two faculty members, Jennifer and David (whose names have been changed for anonymity), are leading a team involved in a complex project to support student clinical learning and have been communicating by e-mail and telephone. After a minor misunderstanding due to a missed message, Jennifer sends a scathing e-mail message to David and includes the whole team in the communication. She reprimands him for his lack of commitment to the project and their working relationship, instead of asking for clarification at a face-to-face meeting. The message is so demeaning and threatening to David that the relationship is irreparable, and the project and the students’ learning are in jeopardy. Although he feels he cannot address this conflict himself, David is unsure of whether to approach the director of the department about what happened. Should he raise a concern about this behavior?
In this example, one of David’s obligations as a faculty member is to provide the best environment for nursing students and colleagues to learn and work and, therefore, to protect or advocate for others. Faculty members often view students as vulnerable. However, advocacy includes colleagues in the academic context, which in turn includes self-advocacy. The agreement with Jennifer cannot be upheld because she has not interacted in a manner consistent with a mutual agreement. Although David may opt to let Jennifer know he will be seeking the assistance of the director in this situation, blowing the whistle on Jennifer’s behavior is an act of fidelity and upholds the agreement he has as a faculty member (Husted & Husted, 2008, p. 73). If David does not honor the terms implied by his agreement as a faculty member, not only does he also violate the agreement but he violates his own purpose in education. In instances of incivility, this is how faculty become disconnected from students, from each other, and, most significantly, from themselves.
In the exemplars of incivility presented, reflection on the bioethical standards within a given context enable faculty to choose a response to incivility that ethically aligns with agreements made and supports an understanding of one’s nature and needs for personal development (Husted & Husted, 2008). The above exemplars demonstrate how application of a symphonological model for ethical interaction can be considered as a new perspective from which to frame solutions for faculty-to-faculty incivility.
Ryan, Bohlin, and Thayer (n.d.) posited that “education in its fullest sense is inescapably a moral enterprise and one of our most precious resources” (p. 1), whereas Clark and Ahten (2012) stated that “it is impossible to separate education from practice in the profession of nursing” (p. 17). As such, the application of symphonology (Husted & Husted, 2008) may be appropriate for addressing incivility in nursing academia. In this approach to ethical interaction, faculty and clinical educators enter into agreements founded on the bioethical standards and are directed toward a common and justified purpose—the provision of quality nursing education. The goal of educating competent, caring nurse professionals therefore serves the ultimate recipient of this educational enterprise—the patient.
The concept of agreements, which is foundational to the symphonological approach, includes the recognition of the individual character structures “signified by the bioethical standards” (Husted & Husted, 2008, p. 78), along with a desire to support and nurture each other. Entering such agreements is viewed as the “beginning of a nurse’s ethical journey—and its principle” (p. 52), in which “all…understanding arises in the context of this agreement” (p. 52). Relative to this theory and collegial relationships, the ethical agreement can be seen as a type of “mutual trust—as would befit a state of friendship” (p. 77). Rather than an agreement based merely on goals of utility or personal desire, it is an agreement grounded in virtuous thought and action in which colleagues interact from a set of shared ethical values to form constructive and caring relationships.
The value of using the symphonological approach to frame issues of faculty-to-faculty incivility is strengthened by its development from observations of nurses and nursing practice (Scotto, 2010) and tenets that align with nursing and nursing education standards. Centering on individuality, reason that is directed by context, and ethics, this practice-based approach can reveal resolutions to dilemmas while avoiding a prescriptive path. Although broad, concrete directives currently found in existing standards serve to establish system policies, they are less successful in serving individuals experiencing uncivil situations. Symphonology guides faculty toward justifiable and appropriate actions in their practice setting and offers educators, students, and nurses in various practice settings the ability to be true to their nature, to employ the bioethical standards that capture the ideals of the individual, and to provide holistic care to those involved in the interaction.
Clark et al. (2013) noted that faculty may avoid addressing peer incivility for numerous reasons, such as fear of retaliation or alienation, lack of administrative support, and lack of clear policies for addressing the problem. Respondents to their survey suggested that the most effective way to address faculty-to-faculty incivility is through direct communication and critical conversations. Heinrich (2010) described a strategy for cultivation of civility among nursing faculty and a “zestful workplace” (p. 325) from a relational perspective. Such an initiative requires skilled effective leadership and modeling of civil behaviors by influential formal and informal leaders. Lack of such support may defeat individual efforts to promote a civil culture, ultimately leading one to flee to a more conducive environment.
Husted and Husted (2008) described the symphonological ethical agreement as one in which each individual interacts with the other in the “pursuit of vital and fundamental goals” (p. 248), and the cultivation of civil relationships within the nursing profession is that sort of vital mandate for nursing education. The socialization of students into the nursing profession begins in academia. The modeling of collegial faculty-to-faculty relationships is an important component of nursing education’s “hidden curriculum” (Del Prato, 2013, p. 289). Nurse educators must be cognizant of their roles in modeling ethical comportment, as well as being committed to a course of action for improvement of the workplace by shifting the focus to agreements and ethical actions. The “mindful engagement by faculty” (Saltzberg, 2011, p. 239) in the formation of caring relationships with one another will assist this effort through application of the symphonological approach. The union of academia and ethics, using symphonology to address faculty-to-faculty incivility, enhances nursing education practice and the application of the art and science of human caring. For symphonology, character matters and what must follow is the intention to benefit everyone with whom one has an agreement.
- Altmiller, G. (2012). Student perceptions of incivility in nursing education: Implications for educators. Nursing Education Perspectives, 33, 15–20. doi:10.5480/1536-5026-33.1.15 [CrossRef]
- American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author.
- Anthony, M. & Yastik, J. (2011). Nursing students’ experiences with incivility in clinical education. Journal of Nursing Education, 50, 140–144. doi:10.3928/01484834-20110131-04 [CrossRef]
- Australian Nursing & Midwifery Council. (2008). Code of professional conduct for nurses in Australia. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx
- Brown, B. (1998). A bioethical decision-making guide: A synopsis of symphonology. Retrieved from http://www.personal.psu.edu/dxm12/n458/symphonology.htm
- Canadian Nurses’ Association. (2008). Code of ethics. Retrieved from https://cna-aiic.ca/∼/media/cna/files/en/codeofethics.pdf
- Clark, C. (2008a). The dance of incivility in nursing education as described by nursing faculty and students. Advances in Nursing Science, 31, E37–E54. doi:10.1097/01.ANS.0000341419.96338.a3 [CrossRef]
- Clark, C. (2008b). Student perspectives on faculty incivility in nursing education: An application of the concept of rankism. Nursing Outlook, 56, 4–8. doi:10.1016/j.outlook.2007.08.003 [CrossRef]
- Clark, C.M. (2013). National study on faculty-to-faculty incivility: Strategies to foster collegiality and civility. Nurse Educator, 38, 98–102. doi:10.1097/NNE.0b013e31828dc1b2 [CrossRef]
- Clark, C.M. & Ahten, S. (2012). Beginning the conversation: The nurse educator’s role in preventing incivility in the workplace. Georgia Nursing, 72(3), 16–17.
- Clark, C.M., Ahten, S. & Werth, L. (2012). Cyber-bullying and incivility in the online learning environment, part 2: Promoting student success in the virtual classroom. Nurse Educator, 37, 192–197. doi:10.1097/NNE.0b013e318262eb2b [CrossRef]
- Clark, C.M. & Davis Kenaley, B.L. (2011). Faculty empowerment of students to foster civility in nursing education: A merging of two conceptual models. Nursing Outlook, 59, 158–165. doi:10.1016/j.outlook.2010.12.005 [CrossRef]
- Clark, C.M., Olender, L., Cardoni, C. & Kenski, D. (2011). Fostering civility in nursing education and practice: Nurse leader perspectives. Journal of Nursing Administration, 41, 324–330. doi:10.1097/NNA.0b013e31822509c4 [CrossRef]
- Clark, C.M., Olender, L., Kenski, D. & Cardoni, C. (2013). Exploring and addressing faculty-to-faculty incivility: A national perspective and literature review. Journal of Nursing Education, 52, 211–218. doi:10.3928/01484834-20130319-01 [CrossRef]
- Clark, C.M. & Springer, P.J. (2010). Academic nurse leaders’ role in fostering a culture of civility in nursing education. Journal of Nursing Education, 49, 319–325. doi:10.3928/01484834-20100224-01 [CrossRef]
- Del Prato, D. (2013). Students’ voices: The lived experience of faculty incivility as a barrier to professional formation in associate degree nursing education. Nurse Education Today, 33, 286–290. doi:10.1016/j.nedt.2012.05.030 [CrossRef]
- Fontaine, D.K., Koh, E.H. & Carroll, T. (2012). Promoting a healthy workplace for nursing faculty and staff. Nursing Clinics of North America, 47, 557–566. doi:10.1016/j.cnur.2012.07.008 [CrossRef]
- Guidroz, A.M., Burnfield-Geimer, J.L., Clark, O., Schwetschenau, H.M. & Jex, S.M. (2010). The nursing incivility scale: Development and validation of an occupation-specific measure. Journal of Nursing Measurement, 18, 176–200. doi:10.1891/1061-37220.127.116.11 [CrossRef]
- Heinrich, K.T. (2007). Joy stealing: 10 mean games faculty play and how to stop the gaming. Nurse Educator, 32, 34–38. doi:10.1097/00006223-200701000-00010 [CrossRef]
- Heinrich, K.T. (2010). An optimist’s guide for cultivating civility among academic nurses. Journal of Professional Nursing, 26, 325–331. doi:10.1016/j.profnurs.2010.07.002 [CrossRef]
- Husted, G.L., Scotto, C. & Wolfe, K. (in press). Bioethical decision making in nursing (5th ed.). New York, NY: Springer.
- Husted, J.H. & Husted, G.L. (2008). Ethical decision making in nursing and health care: The symphonological approach (4th ed.). New York, NY: Springer.
- King, L. (n.d.). The lived experience of incivility between nursing faculties: A Heideggerian hermeneutic study. Retrieved from http://www.capitaldistrictnursingresearchalliance.com/images/incivility.pdf
- Lasiter, S., Marchiondo, L. & Marchiondo, K. (2012). Student narratives of faculty incivility. Nursing Outlook, 60, 121–126.e1. doi:10.1016/j.outlook.2011.06.001 [CrossRef]
- Luparell, S. (2011). Academic education. incivility in nursing: The connection between academia and clinical settings. Critical Care Nurse, 31, 92–95. doi:10.4037/ccn2011171 [CrossRef]
- McNamara, S.A. (2012). Incivility in nursing: Unsafe nurse, unsafe patients. AORN Journal, 95, 535–540. doi:10.1016/j.aorn.2012.01.020 [CrossRef]
- Olender-Russo, L. (2009). Creating a culture of regard: An antidote for workplace bullying. Creative Nursing, 15, 75–81. doi:10.1891/1078-4518.104.22.168 [CrossRef]
- Royal College of Nursing. (2005). Working with care: Improving working relationships in health care. Retrieved from http://www.rcn.org.uk/__data/assets/pdf_file/0005/78638/002487.pdf
- Ryan, K., Bohlin, K. & Thayer, J. (n.d.). Character education manifesto. Retrieved from the Boston University School of Education Center for Character and Social Responsibility Web site: http://www.bu.edu/ccsr/about-us/partnerships/character-education-manifesto/
- Saltzberg, C.W. (2011). Balancing in moments of vulnerability while dancing the dialectic. Advances in Nursing Science, 34, 229–242. doi:10.1097/ANS.0b013e31822723b9 [CrossRef]
- Scotto, C.J. (2010). Gladys L. Husted and James H. Husted: Symphonological bioethical theory. In Alligood, M.R. & Tomey, A.M. (Eds.), Nursing theorists and their work (7th ed., pp. 560–580). Maryland Heights, MO: Mosby Elsevier.
- Smith, L.M., Andrusyszyn, M.A. & Spence Laschinger, H.K. (2010). Effects of workplace incivility and empowerment on newly-graduated nurses’ organizational commitment. Journal of Nursing Management, 18, 1004–1015. doi:10.1111/j.1365-2834.2010.01165.x [CrossRef]
- Spence Laschinger, H.K., Leiter, M., Day, A. & Gilin, D. (2009). Workplace empowerment, incivility, and burnout: Impact on staff nurse recruitment and retention outcomes. Journal of Nursing Management, 17, 302–311. doi:10.1111/j.1365-2834.2009.00999.x [CrossRef]