Full Answer Section

• Communication Gaps Across Departments: Communication flow between different departments (e.g., nursing and administration, different medical specialties) is identified as an area needing improvement. Information sharing can be inconsistent, leading to frustration and occasional misunderstandings.
• Perceived Power Imbalances: Some junior staff members, particularly newer nurses, express feeling hesitant to voice concerns or challenge decisions made by senior colleagues or management, indicating a potential power imbalance.
• Occasional Instances of Microaggressions: While not widespread, there have been reports of occasional microaggressions, often unintentional, related to professional roles or perceived status within the hierarchy.
• Stress and Burnout Impacting Interactions: The high-pressure environment and reported levels of stress and burnout among staff sometimes contribute to less patient and courteous interactions among colleagues, particularly during peak times.

Civility in the Workplace:

Based on the assessment, I would characterize the civility of Nairobi Community Hospital as moderately civil, with room for significant improvement.

Why the Workplace is Moderately Civil:

The foundation of civility exists in the strong intra-unit teamwork and the consistent respect shown towards patients. This indicates a shared understanding of core professional values and a commitment to providing quality care. The collaborative spirit within teams helps to foster a sense of psychological safety and mutual regard at a micro-level.

Why the Workplace is Not Fully Civil:

The identified communication gaps across departments hinder a sense of shared purpose and can lead to unnecessary conflict and frustration. The perceived power imbalances can stifle open communication and create an environment where some individuals feel their contributions are not valued or that speaking up carries risks. The occasional microaggressions, even if unintentional, contribute to a less inclusive and respectful atmosphere. Furthermore, the impact of stress and burnout on interpersonal interactions highlights a systemic factor that can erode civility, leading to impatience, curtness, and reduced empathy among colleagues.

Experience of Incivility in the Workplace:

During a particularly busy shift in the medical-surgical unit, I witnessed a senior physician speaking dismissively to a junior nurse regarding a perceived delay in obtaining lab results. The physician, visibly frustrated and under pressure, raised their voice and made a sarcastic remark about the nurse’s efficiency in front of other staff members. The nurse appeared visibly upset and embarrassed by the public reprimand.

How This Was Addressed:

As a colleague who witnessed the interaction, and recognizing the potential negative impact on the nurse and the team environment, I took the following steps:

1. Immediate Support for the Nurse: Immediately after the physician left the area, I approached the junior nurse privately. I acknowledged that the interaction seemed unfair and expressed my support. I validated their feelings and reassured them that such behavior was not reflective of their competence.
2. Informal Conversation with the Physician (Later): When the situation had cooled down and in a private setting, I approached the senior physician. I used “I” statements to express my perspective, focusing on the impact of their communication style rather than directly accusing them. For example, I might have said, “I noticed the interaction with [Nurse’s Name] earlier, and I was concerned about the tone. In our team, it’s important that we all feel respected, especially when we’re under pressure.” The goal was to raise awareness of their behavior and its potential impact on team morale and psychological safety.
3. Unit-Level Discussion (General): During a subsequent unit staff meeting (without specifically naming individuals), we had a general discussion about the importance of respectful communication, especially during stressful periods. We reviewed the hospital’s code of conduct regarding professional behavior and emphasized the need to provide constructive feedback privately and respectfully. This aimed to reinforce expectations for civil interactions within the team.
4. Escalation (If Necessary): Had the behavior been more egregious, repeated, or if the informal conversations had not yielded any change, the next step would have been to escalate the issue to the nurse manager or a designated individual responsible for addressing workplace conduct. This would involve formally reporting the incident and allowing for a more formal investigation and intervention.

In this particular instance, the informal conversation with the physician seemed to have a positive impact, as their communication style appeared more considerate in subsequent interactions. The unit-level discussion also served as a reminder for the entire team about the importance of maintaining a civil and respectful work environment, even under pressure. Addressing incivility promptly and at multiple levels is crucial for fostering a positive and productive workplace.