Journal of Nursing Education

Major Article 

Faculty and Student Incivility in Undergraduate Nursing Education: An Integrative Review

Latoya Rawlins, DNP, RN-BC, CNE

Abstract

Background:

Incivility is a critical issue in undergraduate nursing education. Uncivil acts in academia are increasing and have the potential to affect future nursing practice and patient safety outcomes.

Method:

An integrative literature review was completed to describe faculty-to-student and student-to-faculty incivility in undergraduate nursing education.

Results:

Seventeen studies were included in the review. Four themes emerged from the data: (a) Detrimental to Health and Well-Being, (b) Disruption to the Teaching–Learning Environment, (c) Stress as a Catalyst, and (d) Incivility Incites Incivility.

Conclusion:

The results support data that incivility has harmful physical and psychological effects on both faculty and students, and also disturbs the teaching–learning environment. Causes of un-civil acts have been highlighted to provide groundwork for schools of nursing to implement strategies for mitigating incivility. [J Nurs Educ. 2017;56(12):709–716.]

Abstract

Background:

Incivility is a critical issue in undergraduate nursing education. Uncivil acts in academia are increasing and have the potential to affect future nursing practice and patient safety outcomes.

Method:

An integrative literature review was completed to describe faculty-to-student and student-to-faculty incivility in undergraduate nursing education.

Results:

Seventeen studies were included in the review. Four themes emerged from the data: (a) Detrimental to Health and Well-Being, (b) Disruption to the Teaching–Learning Environment, (c) Stress as a Catalyst, and (d) Incivility Incites Incivility.

Conclusion:

The results support data that incivility has harmful physical and psychological effects on both faculty and students, and also disturbs the teaching–learning environment. Causes of un-civil acts have been highlighted to provide groundwork for schools of nursing to implement strategies for mitigating incivility. [J Nurs Educ. 2017;56(12):709–716.]

The issue of incivility in nursing education has been on the rise and poses harmful effects to faculty and students, as well as to the teaching–learning environment and the profession (Bjorklund & Rehling, 2010; Lashley & de Meneses, 2001). Incivility can be defined as impolite or unruly behavior that often results in psychological or physiological distress for those involved and can develop into threatening situations when left unaddressed (Clark, Farnsworth, & Landrum, 2009). Anderson and Pearson (1999) described incivility as a violation of mutual respect during social interaction that is displayed in an offensive and impolite manner. Such disrespectful gestures pose a threat to patients and organizational safety, infringe on professional standards of respect, and have the potential to escalate into more serious acts of violence (American Nurses Association, 2015b; Rittenmeyer et al., 2012).

Incivility in academia may manifest in a variety of forms, such as student-to-faculty, faculty-to-student, student-to-student, and faculty-to-faculty incivility. Irrespective of the form of incivility, it is unacceptable in both academic and professional settings. Student-to-faculty and faculty-to-student in-civility are the main focus of this integrative review, as the literature suggests that these two types of incivility are intricately related and need to be addressed with a sense of urgency to mitigate the effects on faculty, students, the academic environment, and the profession (Clark, 2008a, 2013).

Student-to-faculty incivility is discourteous and unruly behavior that is directed from a student to a faculty member (Clark, 2008a). These behaviors may range from being late to class to outward aggression toward faculty. To highlight the criticality of this issue, Lashley and de Meneses (2001) conducted a survey of 409 faculties and found that 24.8% reported physical contact by students, 42.8% experienced being yelled at in the clinical setting, and 52.8% of nursing faculty reported being yelled at by students in the classroom. Although student-to-faculty incivility is a fairly common finding across academic settings (Lashley & de Meneses, 2001), faculty-to-student incivility, which refers to discourteous behaviors directed from educators to students, also is increasing. According to Clark (2008a), faculty often contribute to uncivil behaviors in the academic setting, and these unprofessional behaviors can have negative and long-term effects on nursing students. To best understand the effects of incivility, it is necessary to examine the role that both faculty and students play in creating an uncivil culture and learning environment.

This integrative review seeks to describe student-to-faculty and faculty-to-student incivility in undergraduate nursing education. It also analyzes the literature to identify factors that increase student-to-faculty and faculty-to-student incivility and how incivility affects teaching and learning, faculty and student retention, and the nursing profession.

Method

Cooper's (1982) classic five-step integrative review method was used to critically analyze and synthesize the literature on incivility in nursing education. This methodology follows a systematic process that include problem formulation, data collection or literature search, evaluation of data points, data analysis and interpretation, and presentation of results. The use of multiple studies and the combination of qualitative and quantitative studies provides the researcher with the ability to quantify and thoroughly describe the phenomenon of interest (Cooper, 1982; Torraco, 2005). The problem identification step was described in the introduction section; the remaining four steps will be discussed in subsequent sections.

Literature Search

A literature search was conducted to identify published and unpublished studies on incivility. Uncivil behaviors have increased drastically in nursing education during the past decade (Bjorklund & Rehling, 2010; Lashley & de Meneses, 2001). Despite the heightened awareness of disruptive conduct, incivility continues to be a significant focus of concern in academia as the incidence continues to grow rapidly (Milesky, Baptiste, Foronda, Dupler, & Belcher, 2015; Seibel, 2014). As a result, studies that were published from 2004 to 2016 were the focus of the review. Because several educational delivery methods commonly are used in undergraduate nursing education, the classroom, clinical, and online learning environments were included. Studies that addressed uncivil behaviors from preceptors or staff nurses were ineligible, as the acute care settings may have other variables contributing to uncivil acts that are not present in the academic setting.

The population samples for the studies selected were undergraduate nursing students. Only studies with nursing students in generic baccalaureate, associate degree programs, RN-to-BSN completion, and accelerated programs were included. The review did not include licensed practical nursing, diploma, or graduate programs.

Multiple sources were used for the search and included a combination of gray literature and databases such as CINAHL®, ERIC, Cochrane, ScienceDirect®, MEDLINE®, and PubMed®. The gray literature was examined for resources that were not accessed through the aforementioned databases. In addition, hand searches were conducted from the bibliographies of the literature used and from journals that were not available electronically.

The literature search yielded 309 potential articles; this amount of literature suggests that incivility in nursing is a serious problem. Various search terms were used to collect the best and most accurate results. The search terms included student incivility, faculty incivility, faculty-student incivility, teacher-student relationships, bullying, abuse in nursing education, incivility, and civility. These terms were searched separately and also combined with terms such as nursing, nursing education, classroom behaviors, and clinical education.

The 309 articles found were scanned for appropriateness and specificity to student-to-faculty and faculty-to-student incivility. Articles that did not meet the eligibility criteria were removed. For example, a majority of articles addressed lateral violence, workplace incivility, and newly graduated nurses, and therefore these articles were removed from the selection. Limiting by academic level narrowed the results further.

The abstracts for the remaining articles then were read for suitability for inclusion. Further eliminations were made if articles only discussed incivility or provided recommendations but were not actual research studies or focused on faculty-to-faculty and student-to-student incivility. The remaining articles were read in their entirety, and additional exclusions were made for specific eligibility criteria details that were not apparent when reading the abstracts, such as study sample with graduate students, licensed practical nurses, clinical preceptors, and staff nurses as perpetrators of incivility, and tool development research. The final selection yielded 18 articles that were included in the integrative review (Figure).

Diagram showing results of the literature search for articles on incivility in undergraduate nursing education.

Figure.

Diagram showing results of the literature search for articles on incivility in undergraduate nursing education.

Evaluation of Data Points

The 18 articles underwent quality appraisal to gain the highest level of evidence for the review. The Critical Appraisal Skills Programme (CASP) tools for quantitative and qualitative evidence were used. The CASP tools ask relevant questions to assess the rigor of studies; a higher number indicates a greater level of rigor (CASP, 2014). Studies were grouped based on the following methodological rigor: 0 to 3 = poor quality; 4 to 6, = moderate quality; and 7 to 10 = high quality. Only studies that were of high quality were included in the review. Of the 18 studies appraised, 17 were included in the final review as one study was removed for poor quality.

Cooper's (1982) integrative review method suggested the use of a secondary appraiser to confirm reliability. The selected studies were chosen randomly to be appraised by two independent raters to ensure interrater reliability. A random selection table was used from an online computer program to generate the numbers 1 to 17. The studies then were appraised independently by the two raters using the CASP tools and were found to be of high quality.

Data Analysis and Interpretation

Each article was read and reread multiple times for thorough understanding and analysis. The content was analyzed, and both manual and electronic notes were made. Data were extracted from each study using the Joanna Briggs Institution data extraction tool for qualitative and quantitative evidence. The data extraction tools also were read, reread, and hand-coded. Finally, the hand-coded data were synthesized into four themes reflecting the description of faculty-to-student and student-to-faculty incivility in undergraduate nursing education.

Results

Four themes emerged from the data to describe faculty-to-student and student-to-faculty incivility in undergraduate nursing education: Detrimental to Health and Well-Being, Disruption to the Teaching– Learning Environment, Stress as a Catalyst, and Incivility Incites Incivility.

Detrimental to Health and Well-Being

The theme of Detrimental to Health and Well-Being comprised two subcategories: harm to student well-being, and harm to faculty well-being. It was evident from the literature that incivility is a significant issue in nursing academia that has physical and psychological effects on both faculty and students. Faculty and students have reported anxiety, depression, and loss of sleep, as well as feeling attacked and feelings of helplessness, when encountered with uncivil behaviors (Clark, 2008b; Luparell, 2004, 2007; Sprunk, LaSala, & Wilson, 2014). These effects are long-lasting, and faculty tended to relive the experience years after it occurred (Luparell, 2007). Damage to health and well-being of students' is of concern because this can directly affect professional formation, students' intent to stay in the nursing program, and future practice (Altmiller, 2012). For faculty, it may affect their intent to stay in teaching, morale, and productivity level (Luparell, 2004; Sprunk, et. al., 2014).

The most frequent uncivil faculty behaviors identified in the literature were demeaning remarks and belittling of students (Altmiller, 2012; Clark, 2008b; Clark & Springer, 2007a; Clark, Ahten, & Werth, 2012; Clark, Werth, & Ahten, 2012; Del Prato, 2013; Lasiter, Marchiondo, & Marchiondo, 2012; Mott, 2014; Rieck & Crouch, 2007). Students felt that negative faculty comments and behavior were detrimental to their self-esteem and self-perception of becoming a nurse because these comments and behaviors produced feelings of anger, fear, and powerlessness (Mott, 2014). Students also reported a loss of sleep, frustration, and feelings of depression when encountered with faculty incivility (Altmiller, 2012; Clark, 2008b).

Injury to health and well-being caused by faculty incivility also created issues with intent to stay in the nursing profession and overall program satisfaction. Marchiondo, Marchiondo, and Lasiter (2010) found a significant relationship between perceived faculty incivility and student satisfaction with the program. Similarly, Clarke, Kane, Rajacich, and Lafreniere (2012) found a significant association between perceived incivility and intent to leave the program.

Faculty description of harm to well-being was similar to students' descriptions but also included loss of morale, lower self-esteem, loss of joy in teaching, loss of credibility, and tarnished reputation (Luparell, 2004; Sprunk et al., 2014). Faculty also experienced feelings of attack and threats to safety (Luparell, 2004, 2007; Sprunk et al., 2014). Sprunk et al. (2014) found that nursing faculty subjected to uncivil student encounters questioned their future faculty role. Luparell (2007) found that intent to stay in nursing education diminished as a result of student incivility and that faculty left the teaching role when faced with these unruly behaviors.

Disruption to the Teaching–Learning Environment

The most uncivil acts from student-to-faculty were primarily behavioral concerns related to disrespect in the classroom, clinical setting, or online learning environment that caused a disruption to the teaching–learning environment. The disruption occurred secondary to faculty taking time away from class to deal with uncivil student behaviors (Luparell, 2007). Both faculty and students found uncivil behaviors such as arriving late to class, side conversations, and inappropriate use of technology as distracting and contributing to a loss of focus and reduction in teaching and learning (Clark & Springer, 2007a). Luparell (2004) identified that out-of-class time spent on documentation, administrative responsibilities, and meeting with students impeded the time needed to prepare course materials.

Loss of motivation, morale, and joy in teaching also contributed to disruption of the teaching–learning environment as faculty was not as engaged in uncivil environments (Luparell, 2007; Sprunk et al., 2014). In addition, a sense of insecurity and loss of self-esteem developed over time in faculty due to uncivil environments (Luparell, 2007).

The investigators also highlighted that student incivility frequently occurred when faculty provided critiques or evaluated students' performance (Luparell, 2004; Sprunk et al., 2014). To avoid conflict, faculty may avoid providing necessary evaluation of failure as a means of coping. This is detrimental to the learning environment because an essential component of the faculty role is to assess student learning outcomes and provide appropriate feedback for growth.

Interruption to the teaching–learning environment, occasioned by faculty incivility, caused a loss of self-confidence in students due to the belittling and condescending remarks from faculty (Altmiller, 2012; Clark, 2008b; Clark & Springer, 2007a; Clark et al., 2012; Lasiter et al., 2012; Rieck & Crouch, 2007). When encountered with faculty incivility, students harbored feelings of fear and intimidation (Cooper, Walker, Askew, Robinson, & McNair, 2011; Mott, 2014). This behavior creates a learning environment that is unsafe. Students felt that rigid expectations and the need to be perfect created an environment were not favorable to learning (Clark, 2008b; Del Prato, 2013). Consequently, students avoided faculty and failed to seek help when necessary due to fear (Altmiller, 2012; Clark, 2008b; Cooper, et. al., 2011).

Failure to act also caused a disturbance in the teaching– learning environment. The failure of faculty to address incivility when it occurred was perceived by students as acceptance of the unwanted behavior (Rieck & Crouch, 2007). This resulted in loss of respect for faculty, as students look to faculty to maintain an environment that is conducive to learning.

Finally, the theme of disruption to the learning environment was influenced by the hierarchy in the academic environment. Several authors described increased faculty-to-student incivility in authoritarian and dictatorial classrooms (Altmiller, 2012; Clark, 2008b; Cooper et al., 2012). Students felt undervalued and had a fear of speaking up or of asking pertinent questions due to instructor rigidity and poor instructor receptiveness to students (Altmiller, 2012; Cooper et al., 2011; Del Prato, 2013).

Stress as a Catalyst

There are many factors that influence incivility in nursing education. However, a resounding and primary factor that fostered incivility, for both faculty and students, was stress. The types of stress for faculty and students differed but were clearly distinct in the literature. Student stress that invited incivility was related to workload demands, curriculum rigidity, perceived bias, lack of faculty availability, and poor time management (Clark, Nguyen, & Barbosa-Leiker, 2014; Cooper et al., 2011; Lasiter et al., 2012). Study participants believed that the demands of nursing school were overwhelming and that faculty set unrealistic expectations that were almost impossible to meet, which increased students' stress levels (Clarke et al., 2012; Del Prato, 2013).

Few studies highlighted perceived bias from faculty-to-student (Altmiller, 2012; Clark, 2008b; Del Prato, 2013). Students felt that faculty displayed bias related to gender, age, and personal attributes (Del Prato, 2013). Although this information was limited in the literature, it was cited as a source of stress that caused students to feel anger and resentment, which resulted in uncivil behaviors as a response.

Lack of availability of faculty also caused student stress; this was a common thread in the classroom, out-of-classroom, online, and clinical environments (Rieck & Crouch, 2007). Nurse faculties were cited as being unresponsive to e-mail or had extended delays in responding to e-mail (Lasiter et al., 2012). This was similar to the online environments as students were stressed when faculty did not respond to online postings or assigned grades without proper feedback (Clark, Werth, et al., 2012).

The “weeding out” phenomenon was found to be a source of stress for students in various studies (Altmiller, 2012; Clark, 2008b; Clark & Springer, 2007b; Del Prato, 2013). Students felt they were targeted by nurse faculty, and it was the perception of students that faculty sought to identify students based on personal attributes, intellect, and suitability for the profession. Students who did not meet the criteria of the nursing image were weeded out or exposed to subjective grading, with the ultimate goal of dismissal from the program (Altmiller, 2012; Del Prato, 2013; Mott, 2014). This phenomenon caused undue stress in nursing students as they attempted to be the ideal nursing student in an already competitive environment.

Sources of faculty stress that contributed to uncivil behaviors included heavy workload demands, multifaceted role requirements, tenure requirements, lack of administrative support, and disruptive student behaviors (Clark & Springer, 2007b; Sprunk et al., 2014). Faculty members have competing roles, and like students, it is vital for them to find a work–life– school balance. Academia is a competitive field that requires a multidimensional role in teaching, service, and scholarship, which can be a great source of stress for faculty. Faculty also voiced feelings of increased stress if there was a lack of administrative support when handling troublesome behaviors (Luparell, 2004).

Incivility Incites Incivility

The theme of incivility Incites Incivility Emphasizes that unprofessional, rude, and discourteous behaviors elicit the same behaviors in return. A consistent finding throughout the review was that incivility breeds incivility (Altmiller, 2012; Mott, 2014). This was especially true of student-to-faculty incivility. Student incivility was seen as justified by offenders when it was triggered by faculty incivility (Altmiller, 2012; Mott, 2014). Lack of respect for students was seen as an uncivil faculty behavior that triggered incivility in students (Altmiller, 2012). It was the perception of students that faculty must show respect to receive it (Mott, 2014). Lack of availability and unsupportive faculty behaviors also were vehicles for student incivility. In addition, the undervaluing of students and the hierarchical structure of the classroom also bred incivility (Clark, 2008b).

A few authors explained that student incivility often occurred after critiques, evaluations, or examination reviews (Luparell, 2004; 2007; Sprunk et al., 2014). Students perceived criticism from faculty as belittling; this, in turn, caused students to react in an uncivil manner. Although constructive critique is a necessary part of the learning process, students perceived it as demeaning. Perceived incivility was a reality for those affected. Similarly, students believed that their lack of engagement and irresponsibility, considered uncivil, triggered faculty incivility (Altmiller, 2012). This creates a potentially vicious cycle of ill-mannered behaviors that may escalate to more serious acts of violence.

A major factor that promoted uncivil acts in students and faculty was poor and ineffective communication techniques. Communication is essential to all relationships; this is also true of faculty–student relationships. Impolite communication was a common finding among the studies, and it transcended the classroom, clinical setting, and distance learning environments. Examples of this behavior included condescending remarks from faculty to students, unprofessional student behaviors, gesturing, and unclear postings in the online learning environment (Altmiller, 2012; Clark, Werth, et al., 2012; Del Prato, 2013; Lasiter et al., 2012; Rieck & Crouch, 2007). Perceived communication breakdown also was related to age, generational differences, and gender (Altmiller, 2012; Del Prato, 2013; Luparell, 2004). The sender's message may be perceived as uncivil to the receiver, even if that was not the intent.

Ineffective communication was evident in the online learning environment. The lack of face-to-face contact and anonymity with distant learning increases the risk of uncivil acts (Clark, Ahten, et al., 2012; Rieck & Crouch, 2007;). It is also more challenging to create a sense of belonging in online learning environments (Clark, Ahten, et al., 2012). In some instances, the student and faculty have never met, which impedes their ability to personally understand each other. Poor netiquette was another means of impolite communication. The use of all capital letters, exclamation marks, slang, or unprofessional means of e-mail communication promoted uncivil behaviors and a sense of disrespect (Clark, Werth, et al., 2012; Rieck & Crouch, 2007).

Discussion

This integrative review elucidates that student-to-faculty and faculty-to-student incivility can result in harm to well-being, can disrupt the teaching–learning environment, and is propelled by stress and uncivil behaviors. Harm to health and well-being due to incivility has been supported in the literature in both academia and in practice (Condon, 2015; Edmonson & Bolick, 2017; Hakojarvi, Salminen, & Suhonen, 2014; Thomas, 2003). Schools of nursing are charged with addressing incivility with a sense of urgency to decrease the effects on faculty, students, the learning environment, and clinical practice (American Nurses Association, 2015b; Clark & Springer, 2010).

Faculties described uncivil encounters with students as similar to that of being on a battlefield; this analogy validates that incivility is a dreadful experience (Luparell, 2004). The psychological and physical effects of these negative behaviors have the potential for long-term effects. White (2013) revealed that faculty members who were exposed to student harassment felt verbally and personally attacked. DalPezzo and Jett (2010) described nurse faculty as a vulnerable population at increased risk for psychological and physical symptoms due to uncivil behaviors from other faculty, students, and administrators.

The well-being of nursing students affected by incivility is of utmost concern. Ineffective coping in nursing students has been addressed in the literature; it has found that nursing students have poor coping strategies when faced with undue stress (Alzayyat & Al-Gamal, 2014; Chernomas & Shapiro, 2013). Students' progression in the program and intent to stay is directly related to their physical and physiological well-being. Consequently, factors that pose a threat to intent to stay in the profession cannot be dismissed during the current time of concerns for a future workforce shortage.

Disturbance of the teaching–learning environment also is concerning because it is difficult to adequately educate and prepare qualified nurses in a setting that is not conducive to learning. An uncivil environment diminishes students' ability to learn (Decker & Shellenbarger, 2012; McNeill, Denemn, Einhellig, & Clukey, 2017). Incivility decreases productivity and student clinical performance (Smith, Gillespie, Brown, & Grubb, 2016). The psychological and physical impact of incivility is a basis for student disengagement and decreases motivation to learn; students described uncivil behaviors as a learning hindrance that created feelings of incompetence and decreased self-worth (Hakojarvi et al., 2014).

Stress in the academic setting tends to create environments that are prone to incivility from both faculty and students. Covert acts of incivility may escalate into more overt violent behavior as stress builds (Clark, 2008a). Examining sources of stress and employing strategies to mitigate them is essential to addressing the issue of incivility in nursing programs. In addition, societal shifts have revealed a trend in the demographics of traditional nursing students as many have multiple roles and familial and financial obligations that increase stress (Bowllan, 2015; Robertson, 2012). Loss of qualified nursing students and nurse faculty due to academic incivility brings major concerns for the future nursing workforce.

Incivility cannot combat incivility. This behavior can only be modified with behaviors that reflect the expected code of conduct of the profession. Professional nurses and future nurses have a responsibility to abide by the American Nurses Association's (2015a) Code of Ethics for Nurses With Interpretative Statements and demonstrate behaviors that are kind, compassionate, and free of harm for both patients and health care workers. Several provisions explain that nurses are obligated to demonstrate caring, compassionate, and respectful behaviors not only just to patients but also to all individuals (American Nurses Association, 2015a). To decrease incidents of incivility, academic institutions should establish code of conducts for both faculty and students (Jones, Echevarria, Sun, & Ryan, 2016).

It is equally imperative that nurse faculty, as leaders in the classroom, role model expected civil behaviors and create a culture of inclusiveness and mutual respect (Clark, 2017; Lim & Bernstein, 2014; Milesky et al., 2015; Rad & Moonaghi, 2016; Schmidt, MacWilliams, & Neal-Boylan, 2017). Faculty conduct should mirror the professional behaviors expected of students. Nurse educators are obligated to create and maintain an academic culture that fosters civility and should be held accountable when they fail to adhere to these standards (Bowllan, 2015). Consequently, educators are charged to conduct a self-reflective analysis of their own behavior and how it contributes to creating an uncivil environment (Edmonson & Bolick, 2017; Milesky et al., 2015; Rad & Moonaghi, 2016). This can begin with Clark's Civility Index for Faculty, which is a reflective tool to aid faculty in identifying their level of civility and raises self-awareness of behaviors (Clark, 2013).

Uncivil faculty behaviors disrupt learning, create undue stress for students (Altmiller, 2012), and cultivate a vicious cycle of uncivil acts; therefore, self-awareness is important. The attitude of nurse faculty should parallel civility, positivity, mutual respect, inclusion, and regard for others in an effort to end the circle of incivility.

Behaviors such as an attitude of entitlement among students and an attitude of superiority among faculty potentially can spark uncivil behaviors (Clark, 2008a; Knepp, 2012; Lippmann, Bulanda, & Wagenaar, 2009). Faculty must be aware that rankism fosters uncivil acts, and faculty members should strive to maintain awareness of their own behaviors both in the face-to-face and online learning settings (Clark, 2008a; Plante & Asselin, 2014). Student incivility and entitlement is further promoted by generational differences and by the consumerist approach to academia (Robertson, 2012). Many academic institutions have adopted a business approach, in which students are considered consumers of services (Morrissette, 2001; Robertson, 2012). This potentially can create an environment in which faculty members are seen as providers of services and students are entitled to good grades because they are payees.

Implications for Nursing Education

Addressing sources of faculty and student stress is crucial to creating a civil academic culture. Realistic faculty workload and requirements are essential to decreasing uncivil acts. Institutions of higher education should critically examine the nurse faculty role, as there are multiple realms that may cause increased stress. Academic institutions should foster environments that support collaboration rather than competition. Likewise, student workload also should be pragmatic because student stress contributes to attrition and incivility.

Faculty and students must be held accountable for uncivil behaviors. Faculty–student relationships are imbalanced, which places a greater burden on faculty to take the lead in preventing and mitigating incivility. As a result, the role of faculty in mitigating incivility is even greater than students as they have the ability to set the atmosphere for teaching and learning. Environments that foster collegiality, mutual respect, and inclusiveness are necessary. Educators should maintain self-awareness of their own beliefs and behaviors as it relates to promoting or reacting to uncivil acts. Faculty should be a role model for professional behaviors and classroom decorum as student socialization to the profession is influenced by faculty behaviors and conduct. Upon inception of the course, faculty should demonstrate effective classroom management skills and establish classroom norms.

Ineffective communication techniques and communication breakdown were identified as major causes of uncivil behaviors. Learning outcomes and courses that address professional behaviors, communication, conflict resolution, and de-escalation communication techniques should be integrated throughout the curriculum to ensure that students are properly equipped to engage in mutually respectful dialogue. Faculty development on conflict resolution and how to recognize and de-escalate incivility and violence is also essential.

Implications for Nursing Research

More in-depth understanding of the causes of incivility is needed due to the increased incidence of uncivil behaviors in society and the profession. Critical examination of the literature revealed that research related to age, gender, ethnicity, and incivility is scarce. Studies that examine these factors will allow a better understanding of possible demographic correlations with incivility. There was a correlation between incivility and students' level in the nursing program, as identified in this review. This requires further exploration to understand why civility tends to increase as students' progress through nursing programs. Further research also is needed on incivility in the online learning environment. Finally, it would be interesting to examine whether faculty-to-student incivility varies among adjunct faculty versus full-time faculty or tenured versus nontenured faculty.

Conclusion

The aim of this integrative review was to describe faculty-to-student and student-to-faculty incivility in undergraduate nursing education. The four themes that emerged from this review were Detrimental to Health and Well-Being, Disruption of Teaching–Learning Environment, Stress as a Catalyst, and Incivility Incites Incivility. This review suggests incivility in nursing education is a serious problem. The harmful effects, incivility on students, faculty, and the academic environment cannot be ignored. Effective communication and conflict resolution skills are necessary to curb uncivil behaviors because incivility inflames incivility. The health and wellness of both students and faculty are of concern as they are negatively affected by incivility. Moreover, implementing strategies to address faculty and student stressors is crucial to mitigating incivility. Describing the effects of incivility provides the ability to better understand and address it, and reduces the incidence of uncivil acts as students and faculty strive to foster a harmonious and civil culture.

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Authors

Dr. Rawlins is Clinical Assistant Professor, School of Nursing, Rutgers The State University of New Jersey, New Brunswick, New Jersey.

The author has disclosed no potential conflicts of interest, financial or otherwise.

The author thanks Patricia Hindin, PhD, CNM, CLC, Assistant Professor, Division of Advanced Nursing Practice, Rutgers The State University of New Jersey, and Denise Tate, EdD, APRN-BC, Associate Dean, Undergraduate Studies, Thomas Edison State College, for their invaluable expertise, insight, and guidance.

Address correspondence to Latoya Rawlins, DNP, RN-BC, CNE, Clinical Assistant Professor, School of Nursing, Rutgers The State University of New Jersey, 180 University Avenue, Newark, NJ 07102; e-mail: Rawlinln@sn.rutgers.edu.

Received: March 15, 2017
Accepted: June 22, 2017

10.3928/01484834-20171120-02

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