Incivility in Nursing Education: Sources of Bullying and Their Impact on Nursing and Psychiatric Nursing Students

Abstract

Purpose: The purpose of this study was to identify who were the key sources of incivility, how frequently uncivil behaviours occurred, and determine the impact of incivility among a sample of Bachelor of Nursing (BN) and Bachelor of Psychiatric Nursing (BPN) students at one university in a Western Canadian province.

Methods: A mixed-methods study was conducted that incorporated findings from an anonymous cross-sectional survey of second-, third-, and fourth-year students from the BN and BPN programs (n = 68) and narrative findings from a live discussion forum (n = 48) with third-year student participants.

Results: The most frequent sources of incivility included nurses, faculty, clinical instructors, student peers, patients, and physicians. Out of a total of 26 uncivil behaviours, 10 were identified as being the most common among the sample. They included: 1) feeling undervalued; 2) that high and impossible expectations were set; 3) students experienced feeling resentment; 4) were frozen out, ignored, or excluded; 5) were unjustly criticized; 6) that student efforts were undervalued; 7) information was withheld; 8) there were changing expectations; 9) they experienced hostility, felt belittled or undermined; and 10) 45.6% of students felt they were treated poorly on grounds of race. Non-parametric statistical analysis revealed that students who self-identified as a visible minority had a statistically significant positive relationship with intent-to-leave their baccalaureate program (rs = 0.262, p = 0.031). Thematic analysis (Braun & Clarke, 2006) of the narratives discussed by students revealed three overarching themes. The themes included a) practising in a toxic culture; b) feeling like a burden; and c) having a lack of positive role models and support.

Conclusions: Students from BN and BPN programs experience bullying and uncivil behaviours from a variety of sources. Of great concern, was the number of student participants who reported the occurrence of horizontal bullying and incivility experienced by nursing students from fellow nursing students. The findings indicated the presence of horizontal violence among students that requires further study. The presence of a toxic culture can jeopardize patient safety if learners are afraid to speak up and advocate for their patients. Students seeking employment planned to avoid clinical units where negative encounters occurred amid a toxic environment. This has implications for employers engaged in recruitment and retention efforts with students seeking alternate employment opportunities upon their graduation and entry into the nursing profession. Although students felt humiliated at times and treated like a burden by clinical staff, they remained hopeful for the nursing profession as they looked to their future careers in health care settings. Greater efforts are required to minimize racism and incivility experienced by students during their education in addition to disrupting the cycle of violence that begins while students are enrolled in their nursing education program.