Eradicating Incivility in Nursing: Connie Montalbo on Preventing Toxicity Through Strong Leadership
Written with the contributions of Linda Robinson, MSN, RN, CPXP, and Grace Schore
In a recent article published by the National Institute of Health (NIH), it was revealed that the incidence of incivility directed at nurses had exceeded 46%, with one-third of nurses reporting exposure to physical violence. Despite nursing consistently ranking as the most trusted profession, the issue of incivility remains a persistent challenge.
Nursing leaders are taking proactive measures to address workplace incivility, and in a recent discussion, Linda Robinson, VP of Clinical Excellence at MDM Healthcare, spoke with nurse executive and incivility expert Connie Montalbo, DNP, MBA, RN, NEA-BC.
Montalbo is a distinguished Nurse Executive with decades of experience. With an impressive career spanning multiple healthcare settings, she is a dynamic leader and change agent dedicated to fostering a more respectful and collaborative culture within the nursing profession. She is also an Incivility Expert and founded "End Incivility Today" in February 2019, a platform where she applies her expertise to address the pervasive issue of incivility in nursing. Her mission is to coach leaders in putting an end to passive leadership and disruptive behavior, emphasizing that doing so will not only improve the workplace culture but also positively impact quality of care, staff engagement, and financial outcomes. Prior to her entrepreneurial endeavor, Connie served as the Chief Nursing Officer and Vice President of Clinical Operations at B.E. Smith, overseeing various clinical areas for over five years. Her career also includes significant roles as a Nurse Executive at a variety of hospitals. Her extensive experience in diverse healthcare settings, coupled with her dedication to ending incivility, makes her a valuable asset to the nursing profession.
Montalbo illustrated the intricate nature of incivility within the nursing profession, emphasizing that nurses grapple with a myriad of stressors, including the demands of patient care. Furthermore, the workforce shortages resulting from the challenges posed by the COVID-19 pandemic have only served to exacerbate this already complex issue.
"I think there are just so many pieces to it. People come into the nursing profession from all walks of life; they bring their own personal stress into the workplace, then they face so much stress in the workplace. In addition to that, they have patients to take care of, the patients' families, the physicians, the leaders, their coworkers; there is just so much going on a nurse's plate all day every day that it is almost like a breeding ground for stress," she said.
Montalbo further explained that incivility comes in many forms, including toxic workplace behavior that ranges from eye-rolling to physical abuse, often stemming from impatience in stressful situations. Incivility disrupts communication, a critical element in the healthcare profession.
Montalbo explained that the consequences of incivility could be devastating. "There's research out there that documented the impact, which could amount to patient harm and even documented patient death from uncivil behavior. There was high nurse turnover, PTSD, civil litigation for an organization for allowing it to go on. There were also financial costs and emotional costs."
Montalbo stated that the challenge in dealing with the root causes of incivility lay in finding healthy ways of coping with the everyday stresses nurses faced. "The challenge for us in leadership is how do we create the environment and set the expectations that will cope in a more healthy way that's respectful and that doesn't impede on the coworkers," she said.
Montalbo named stress, poor colleague communication, and passive management as the root causes of this issue. She emphasized the need to address this stress and the challenges the healthcare industry faces.
Robinson and Montalbo discussed an alarming cycle where management tends to avoid assigning tasks to toxic nurses, which places an excessive burden on more professional nurses, leading to burnout and impatience. This cycle could even be perpetuated by other colleagues and contributed to the stress faced by nurses.
Another issue highlighted was the phenomenon of nursing's habit of discouraging new graduates with a toxic work environment, referred to as "eating their own young" in nursing culture. Montalbo emphasized the need to support those who were uncomfortable with confrontation.
In her doctoral project, Montalbo worked on improving nursing employees' communication by requiring disputes to be confronted within the employees' comfort zone. She asserted that leaders must set healthy precedents for coping with stress and enforce those expectations.
Montalbo recommended that leaders avoid using phrases like "that's just how she is" or "but he's a really good nurse," which she believed perpetuated incivility. She stressed the need to hold individuals accountable for their behavior, not just implementing new policies.
Leaders have the power to combat the issue of overloading "nice" nurses by ending passive behavior. Often, toxic employees feel out of control and need mentorship to change their behavior positively.
In the pursuit of creating a safer and more nurturing hospital environment, Robinson suggested harnessing technology as a valuable tool. For Robinson, the key was leveraging technology as a resource to optimize nurses' time, streamline clinical workflows, and maintain a personal touch in patient care.
MDM Healthcare is committed to supporting nurses and healthcare teams during these challenging times by providing innovative technology solutions. Journey PX, MDM Healthcare’s patient education and engagement solution, empowers medical teams to streamline clinical workflows by automating and simplifying the patient education process, offering video connections in patient rooms, and handling non-clinical tasks. This ensures that patients receive the necessary information while freeing up valuable time for hospital nurses and healthcare team members.
Enhancing the work environment for nurses can have a significant impact, particularly by enabling them to optimize their time effectively. Fortunately, healthcare organizations today can harness the potential of technology like Journey PX to support overburdened medical professionals.
The insights offered by Montalbo underscore the multifaceted issue of workplace incivility in nursing and highlight the importance of leadership, technology, and collective efforts in creating a safer, more supportive healthcare environment. Additionally, she emphasizes the significance of addressing nurses' well-being, offering mentorship, and readily available resources to combat nursing burnout and enhance the patient care experience. For a comprehensive exploration of this topic, listen to the complete PX Space podcast interview below.