Civility expert Cynthia M. Clark, PhD, RN, ANEF, FAAN, ATI Strategic Nursing Advisor, continues our conversation about incivility in nursing. She helps us gain insight into being more self-aware and identifying where we may be failing to treat others with respect and kindness. Then she helps us create a path to civility within our nursing programs. 

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Gina Kellogg [00:00:18] Welcome back to our conversation with Dr. Cynthia Clark. We're on episode three of our series on civility. And, once again, we're fortunate to have the world's leading expert on civility to lead us in gaining a better understanding of its importance within the nursing profession. Dr. Clark, some of your research has delved into being self-aware and how it's such a crucial part of creating civil and healthy workplaces. Can you give us some insight into this area?

Cynthia Clark [00:00:43] Oh boy, you're singing my song now. So, when I was a very novice researcher on this topic -- oh, gosh, probably 15, 16, maybe even another year, but beyond that, in some of my early studies -- I was shocked to discover -- and I no longer am -- but I was shocked to discover that people didn't have a clue how they were coming across to other people. And I should have known that, because I'm also a behavioral health nurse and a trained cognitive therapist. So I should have known some of that. But, in my early works, that was that early finding is that when people were asked to self reflect, it wasn't really part of their DNA. It wasn't really on the radar of how I might be coming across to other people. So, years ago, I started developing self-reflection tools to take a look at that -- not only how I might be coming across to others, so I can self-reflect using that tool. And we now know it's a valid and reliable tool. The paper on all of its psychometric and development will be published later this year in the Journal of Continuing Nursing Education and looking at this whole idea of of self-awareness. But it's one thing for me to do a self-evaluation and go, "Okay, this is kind of how I must be coming across to people." But I encourage -- and did this with my students for many semesters -- had students pair up. And I would coach them along the semester that they knew that, eventually, about week 9 or 10 of the semester, they were going to do a self-reflection of themselves and a reflection of their classmate. That classmate would do a self reflection of themselves and of their classmate. And then sit down together and talk about, "Here's how I perceive you. Here's how I think you have great strengths in these areas." And I would have them identify just one area that, maybe, their classmate could improve. And then I had them switch and then begin to have a conversation. Now, the question becomes when we've heard Dr. Banner and others for years talk about the importance of bringing classroom to the clinical and clinical to the classroom, so always making those connections with our students. So, suggesting to them, "Why would I ask you to do this kind of experience? What -- why would I want you to engage in this kind of dialogue?" And, ultimately, there's myriad reasons, but one of them is -- is that every single day, on that patient floor, or in that community setting, or in that school -- wherever we find ourselves -- there will be conflict. Being able to give and receive feedback in a respectful way is a highly valued skill, and you will be asked to do that. Second point, you may be asked to do peer review or a 360 evaluation of one of your colleagues. You now will have had some experience doing that.

Gina Kellogg [00:03:35] Well, when a program starts taking steps in the new cultures they're building, are there any specific steps they can take that will encourage further growth?

Cynthia Clark [00:03:44] So, yeah, that's a great question. So, many years ago -- I'm thinking about 2011-ish or so -- I started creating more formidably a pathway for fostering organizational civility. And it has eight steps, and it's not always linear like that, because change is very messy. Change takes time. But I'll give you the eight steps very quickly. No. 1: We have to get leadership on board. And I'm not just talking about all of us as leaders at all levels of our organization, but we really need to engage our executive leadership, our deans, our directors, our chairs, our V.P.s. Are they on board? And there are schools where that is one of their major initiatives -- is to start a civility campaign that is campus-wide, that spreads into the community. And, so, we have very strong leaders. But we must get our leadership on board. The second thing we need to do is we need to measure the problem as I measure -- mentioned before. We need good data. What's going on in that school? The third thing is that we need to create a team. In different places we call them different things. In the school that I worked -- one of the schools where I worked -- we called it an organizational design team. I'm working with a school in Canada that calls it the Spirit of Well-Being Team. But, the point is, that we need to have a dedicated team -- not one that does all the heavy lifting in the work to transform the workplace, but the nucleus to be certain that we keep our eye on the ball -- that we're using our data to begin to put together step four, which is an action plan. What is our data-driven, evidence-based action plan and the interventions we're going to take to move the needle? Step five, now we've got to do it. So we have our action plan. Now we need to implement it. And there's multiple ways that organizations can think about investing and implementing best practices to do that. Step six, we absolutely need to evaluate it. How are we doing? Are we making change? Are we moving in the right direction? So all that evaluation piece and using that data to keep the change moving. The seventh -- and my personal favorite is -- you celebrate. Short-term gains, long-term gains, informal, formal -- but to really cheer ourselves on and, as we make those changes, it really allows us to say, "Hey, we've got this! We can keep that momentum going." So that's step seven. And eight, really, is what needs to be done next to keep this going. So, that is the pathway. It's been implemented in many places with great success. But it takes strong leadership, and it takes a strong team.

Gina Kellogg [00:06:35] Well, when a program starts taking steps in the new cultures they're building, are there any specific steps they can take that will encourage further growth?

Cynthia Clark [00:06:43] Yes. As I -- as I mentioned, you know, celebrations big and small -- with students especially. And I know that people are on tight budgets, so I'm not talking about a huge thing that's going to cost a lot of money. But, how can we build in -- without much expense -- to celebrate what's going on? Here's one example that I've seen implemented, and have done myself, which is to have kind of a civility summit within your school. Students can present their projects -- maybe their posters of what they've done to create healthy work environments, either in the academic side and the practice side -- how they're doing that -- to showcase their work in their efforts. And maybe it's just tea and homemade cookies? But a way to really showcase that without spending a lot of money.

Gina Kellogg [00:07:35] Meanwhile, every step we take in helping to build a world where everyone treats everyone with respect and kindness -- that's really a step in the right direction. So thank you, Dr. Clark, for helping to inspire each of us moving toward that direction.

Cynthia Clark [00:07:49] All right! Well, thank you very much.

Gina Kellogg [00:07:52] It's been a great experience learning about this important topic, and today's discussion was especially helpful as we talked about how to become more self-aware and how we can foster organizational civility. We have more information from Dr. Clark on this topic at the ATI blog, which you can find by clicking on the blog link at the top of the page. Simply visit www.atitesting.com/educator/blog, and you'll see articles, infographics, and videos. This is an important subject, and we'll be continually adding to the conversation. Thank you for listening.

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