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civility, clinical nurse specialist, incivility, NAQ-R, Negative Acts Questionnaire-Revised, work environment



  1. Garcia, Mayra G. DNP, APRN, PCNS-BC
  2. Allen, Stephanie MS, APRN, CNS
  3. Griffis, Leigh DNP, RN, CPN, NEA-BC
  4. Tidwell, Jerithea PhD, APRN, PCNS-BC, PNP-C
  5. Watt, Jennifer MSN, APRN, CNS, CNRN


Purpose/Objectives: Incivility contributes to employee dissatisfaction, turnover, patient errors, and a disrespectful culture. Turnover rates and employee exit interviews alerted hospital leaders to uncivil behaviors exhibited by staff. A clinical nurse specialist (CNS) team captured this as an opportunity to create a civility program to develop team cohesiveness and improve patient safety. The purpose of this process improvement project was to identify uncivil behaviors in a pediatric hospital.


Description of the Project/Program: Using the Plan-Do-Study-Act model, an interprofessional team led by CNSs collaborated on a program to assess, intervene, and evaluate a program to improve civility. A preprogram survey, the Negative Acts Questionnaire-Revised, was used to assess staff perceptions of their work environment. Staff attended an education program on ways to recognize and intervene in situations involving less than standard civil behavior. Classes included communication application in uncivil situations using scenarios paired with evidence-based practice articles. Unit leaders reset behavioral expectations learned from a leader-specific class on managing unproductive behaviors.


Outcome: Staff completed a postprogram Negative Acts Questionnaire-Revised survey 6 months after conclusion of classes. Survey results indicated the civility program effected a reduction in frequency of negative behaviors indicating an overall positive shift in workplace civility.


Conclusion: The program provided staff with tools to recognize and intervene for improving civility, which impacted the overall work environment and patient safety.