The effects of incivility on student nurses in the clinical setting: a grounded theory approach

Aim: To use a grounded theory approach to explore and understand the encounters of undergraduate nursing students with incivility in the clinical setting so that data-informed strategies for addressing this counterproductive behavior could be developed. Background: Nurses are being called upon to fill ever-increasing responsibilities associated with expanding roles in different specialties within healthcare. One issue that has developed in this high-pressure environment is an increase in incivility in the workplace that spills over into the clinical training environment. As a pervasive problem in the healthcare system, its effects on nursing students could compound the nursing shortage by undermining the integrity of nursing education and discouraging individuals from entering the profession. Therefore, it is vital to construct new theories regarding incivility so that this unprofessional practice can be eradicated or reduced. When this is done, there may be a renewed hope for new nursing students to practice their clinical rotations without feeling disrespected, undermined and intimidated. Students should be able to complete clinical rotations without these unnecessary barriers. Design: Qualitative grounded theory using philosophical underpinnings of symbolic interactionism and pragmatism. Methods: A classical grounded theory approach focusing on the Glaserian Model was used to develop an inductively derived theory from the data. Participants were interviewed about their encounters with incivility and then open coding was used to identify recurring concerns on which a model of the effect of these occurrences could be established. The study sample consisted of 32 participants of which 25 were undergraduate nursing students and seven were graduate students who participated in a focus group. Data were collected through face-to-face (in-person and virtual) structured interviews that were audiotaped. These individuals were recruited by flyers posted at varying strategic points on university campuses. Results: Open coding of student responses revealed three significant areas of concern: feelings of being disrespected, intimidated and undermined, from which the Inhibiting Actions Theory emerged. Conclusion: Nursing students' perceptions of incivility and their attitudes and behaviors toward this occurrence culminated in the Inhibiting Actions Theory, which provides a framework for implementing effective policies and personnel training in clinical settings. The hope is that these research findings will be a call to action for introducing systemic changes in the clinical training environment, thereby improving the clinical experiences of nursing students and patients.