UNCIVIL BEHAVIOR in Nursing Education

During small-group work, Connie text messages her friends and rarely pays
attention. The professor is impatient and uses harsh language with Connie in
front of other students.
THIS SCENARIO, a common one in many of today’s nursing programs, is typical of situations that are at best disparaging and, under the worst circumstance, potentially violent.

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Evidence suggests that incivility on American college campuses is a serious and growing
concern (1-8).
Fostering an atmosphere of civility on college campuses presents a challenge. To be “civil” is to be polite,
respectful, and decent. Conversely, “incivility” is defined as speech or action that is disrespectful or rude and
ranges from insulting remarks and verbal abuse to explosive, violent behavior (9). Academic incivility is any
speech or action that disrupts the harmony of the teaching-learning environment. Some uncivil behaviors
can be quite disruptive and affect the academic environment so radically that learning is effectively terminated (10). THIS ARTICLE reports on a study of perceptions of nurse faculty and nursing students in one school of
nursing regarding incivility in nursing education, its possible causes, and potential remedies.
ABSTRACT Faculty members complain about the rise of uncivil behavior in their students, and students voice similar complaints about faculty. Using
an interpretive qualitative method for research, this study examined student and faculty perceptions of incivility in nursing education, possible causes
of incivility, and potential remedies. Narrative analysis yielded the following categories: in-class disruption by students, out-of-class disruption by students, uncivil faculty behaviors, and possible causes of incivility in nursing education. The authors argue that further research is needed to increase
awareness and understanding about academic incivility, its impact, and its psychological and social consequences.
9 4 Nursing Education Perspectives
Review of the Literature INCIVILITY IN HIGHER EDUCATION
To create a more civil society, Eberly urges Americans to elevate
common good over self-interest, to encourage wider civic participation, and to renew social values (11). Carter believes that rudeness and disrespect are “the merest scratch of the surface of [our
societal] crisis” (12, p. 16) and evidence of our nation’s growing
incivility. According to Carter, selfishness and getting one’s own
needs met are crowding into the social life of America, including
our nation’s classrooms.
While academic incivility is not a new phenomenon, Braxton
and Bayer (2,3) suggest that it is on the rise, and that courtesy and
civility among faculty and students are fracturing and dissolving on
college campuses across the country. Faculty members complain
about the rise of uncivil behavior in their students (5,8,13,14), and
students voice similar complaints about faculty (1,2,15-17).
Education plays an important role in developing a civil society, and higher education plays a special role in helping students
develop a sense of civic and social responsibility and learn ways
to contribute to the common good (18). In the United States,
where public education is integral to preparing citizens for
employment and socioeconomic mobility, education also accepts
social responsibility for well-being in civil society (19).
Many explanations for academic incivility have been suggested,
including exposure to violence, poor secondary school preparation,
changing student demographics, and inadequate parenting (2).
Levine and Cureton describe contemporary college students as distrustful of leadership, lacking confidence in social institutions, and
being ill prepared for the rigors of academe (20). Braxton and
Bayer indicate that it is important to consider the changing demographics of students as well as the impact of faculty behaviors (2,3).
Clearly, a safe teaching and learning environment is needed
and deserved. Incivility within the academic community is too
damaging to ignore, and even though acts of disrespect and
harassment may be reflective of a changing nation, such behaviors must be immediately and effectively addressed (1,7,21).
INCIVILITY IN NURSING EDUCATION Further research in
the area of incivility in nursing education is needed. A qualitative study by Luparell used a critical incident technique to conduct extensive interviews with 21 nursing professors representing
nine different nursing programs in six states (5). Faculty
described aggressive and severe incidents of student incivility
and reported being verbally abused by students. As a consequence of significant and sustained negative effects of these
encounters, faculty reported losing sleep, having interrupted
sleep patterns, and experiencing a number of other negative reactions to these encounters. Some faculty changed their pedagogy
and modified grading criteria to avoid further conflict with students, and many harbored self-doubt about their teaching abilities and assumed much of the blame for what occurred.
Thomas conducted extensive interviews with nursing students
from a variety of nursing programs across the country (14). These
students offered the opinion that faculty play a significant role in
academic incivility and provided examples of uncivil faculty
behaviors. They described themselves as being angry about unexpected changes in clinical schedules, changes to the syllabus, and
nurse faculty who “seem to make up the rules as they go” (14, p.
19). Several common triggers of their anger were identified, including perceptions of faculty unfairness, rigidity, being overly critical
of students, insistence on conformity, and discrimination against
nursing students based on gender, race, and ethnicity.
Lashley and deMeneses surveyed 409 nursing programs in the
United States regarding the frequency of uncivil student behaviors
(22). Inattentiveness, absence from class, and tardiness were the
most frequently reported uncivil behaviors. Fewer than 50 percent
of respondents reported verbal abuse of faculty and student peers
as a problem. Forty-three percent indicated that disruptive behaviors had increased over the last five years.
A plenary session panel at the National League for Nursing
Education Summit 2005 focused its attention on incivility in nursing education, and a report on the panel discussion was published
in Nursing Education Perspectives (23). Clark, a panelist, reported
on the use of the Incivility in Nursing Education (INE) survey,
which includes both quantifiable and open-ended items (24). Clark
and Springer used the INE survey to investigate incivility in nursing education from both faculty and student perspectives in a nursing program in the northwest United States (17).
Findings from the pilot study revealed that both nursing faculty
and students viewed academic incivility as a moderate to serious
problem. Both groups reported similar behaviors as uncivil, and both
indicated a desire to learn more about the problem. The qualitative
comments were illuminating and form the basis for this article.
The Qualitative Study This study was conducted using quantitative and qualitative methodologies to investigate the problem
UNCIVIL BEHAVIOR
Clearly, a safe teaching and learning
Incivility within the
and even though acts of disrespect and
a changing nation,
immediately
UNCIVIL BEHAVIOR
March / April 2007 Vol. 28 No.2 9 5
of incivility in nursing education in a university environment
from both student and faculty perspectives. Its purpose was to consider possible causes of incivility and to recommend potential
remedies. The qualitative portion of this study was developed to
examine three research questions:
• How do nursing students and nurse faculty contribute to incivility in nursing education?
• What are some of the causes of incivility in nursing education?
• What remedies might be effective in preventing or reducing
incivility in nursing education?
All faculty (n = 36) and students (n = 467) in the associate and
baccalaureate degree nursing programs of a metropolitan public
university received information about the study and were asked to
participate (17). Approval to conduct the study was obtained by
the university Institutional Review Board.
SURVEY INSTRUMENT All participants completed the Incivility in Nursing Education survey, which included demographic
questions, quantitative items designed to measure faculty and
student perceptions of incivility in nursing education, and four
open-ended questions used to gather perceptions of faculty and
students. This survey was developed by modifying items from two
instruments designed to measure faculty and student incivility in
higher education: 1) the Defining Classroom Incivility survey
designed by the Center for Survey Research at the University of
Indiana (25), and 2) the Student Classroom Incivility Measure
(known as the SCIM-Part C), where students are asked to rate
uncivil faculty behaviors in the classroom (4). After obtaining
permission, Clark developed the INE by modifying items from
these instruments to be more applicable to nursing education.
To establish initial content validity, faculty with experience in
student and faculty incivility reviewed the newly developed survey and compared the content to themes found in the literature.
Faculty and students pilot tested the survey for readability, and
revisions were then made to the wording of questions.
PROCEDURE The researchers emailed faculty in the department of nursing to invite them to participate in the study and
request permission to distribute surveys to their nursing students.
Faculty response was favorable; all agreed to assist in the distribution of the survey to nursing students.
Clearly written instructions were provided with the surveys.
During a two-week period in October 2004, faculty self-administered their own surveys and provided time during classes and
clinicals for students to complete their surveys. All participation
was voluntary. All responses were collected and placed in a large
envelope, which was then given to a research assistant to compile.
Fifteen of 36 nurse faculty (41.6 percent) and 168 of 467 nursing students (35.9 percent) completed the qualitative parts of the
survey. An interpretive qualitative method was used to analyze
the data from narrative responses (26). Each researcher independently reviewed the student and faculty comments to identify
recurring responses and organize them into themes. Areas of
agreement and disagreement were discussed and verbatim comments reviewed until both researchers were comfortable that the
analysis was a valid representation of the comments.
Findings The first research question asked students and faculty
how each group contributes to incivility. Findings were grouped
into two themes: in-class disruption and out-of-class disruption.
Table 1 lists uncivil in-class student behaviors as identified by
faculty; response frequencies are provided in descending order.
With regard to in-class student disruption, respondents wrote
about disruptions in class, negative remarks, and other forms of
student incivility. Cited behaviors included challenging professors regarding test scores in class, dominating class discussion,
carrying on side conversations that disturb other students, and
sighing to express displeasure with assignments. Students commented as follows:
• “Students are disruptive when they do not listen to faculty and
other students, text message their friends, and use cell phones
during class.”
• “It is most frustrating when students challenge professors,
especially during class.”
With regard to out-of-class disruption, respondents wrote
about discrediting faculty, complaining about faculty, and failing
to use appropriate communication channels. (See Table 2.) Uncivil
behavior in this category included students discrediting faculty
knowledge, publicly bad-mouthing professors, and turning in
assignments late, without making prior arrangements. Students
commented as follows:
• “I hear students bad-mouthing professors between classes. I
don’t think it’s helpful to prejudice another student against a professor in that way.”
• “Students send inappropriate emails, are negative toward faculty and other students, and sigh because they think that an
environment is needed and deserved.
academic community is too damaging to ignore,
harassment may be reflective of
such behaviors must be
and effectively addressed.
9 6 Nursing Education Perspectives
assignment is stupid.”
The students identified six themes of uncivil faculty behaviors
as shown in Table 3. Comments referred to faculty condescension,
poor communication skills, and superior attitudes toward students. Uncivil behavior included challenging students’ knowledge
or credibility in front of others, demeaning the profession of nursing, and failure to provide a respectful forum for discussing concerns. Students commented as follows:
• “Some faculty make belittling comments and try to weed out
students. They are arrogant and show superiority over students.”UNCIVIL BEHAVIOR in Nursing Education
• “Some faculty treat students like they are stupid and make
condescending, rude remarks.”
The second research question asked students and faculty to
suggest possible causes for uncivil behavior in nursing education.
Their responses are presented in descending order in Table 4.
Themes included the high-stress environment of nursing education, faculty arrogance, and a lack of immediacy in addressing
incivility when it occurs. Students commented as follows:
• “Faculty lose their patience and take out their personal stress
on students. They either do not deal with uncivil behaviors or are
overly harsh and demeaning.”
• “Incompetent, rude professors encourage the same rude behavior from students. If you can’t teach, don’t! Students are frustrated
by the lack of resources to report a rude, incompetent professor,
and fear retaliation if they go to the top to report it. We’ve been
told that it can cost us our degrees and that we’ll be flunked out if
we speak up. This simply encourages incompetence and incivility
to continue.”UNCIVIL BEHAVIOR in Nursing Education
• “Many students believe they can be as rude as they want
because they are paying customers.”
The third research question asked students and faculty to suggest possible remedies for incivility in nursing education. In many
cases, the respondents called for a swift, immediate response to
incivility, and some suggested a “zero tolerance” approach to the
problem.
Several possible remedies were offered, including setting forth
standards and norms, strengthening university policies and support for faculty, and enforcing campus codes of conduct. It was
recommended that incivility be addressed immediately and that
open forums and mediation panels be developed to resolve conflicts related to incivility. It was also recommended that faculty
and students learn conflict negotiation/mediation skills.
Implications for Nursing Education and Research Nurse faculty and students perceive incivility as a problem both in and out
of the classroom. Stress, disrespect, faculty arrogance, and a
Table 1. In-Class Disruption by Students as Identified by Faculty
UNCIVIL STUDENT BEHAVIOR FREQUENCY OF RESPONSE
Disrupting others by talking in class 20
Making negative remarks/disrespectful
comments toward faculty 11
Leaving early or arriving late 9
Using cell phones 7
Sleeping/not paying attention 3
Bringing children to class 1
Wearing immodest attire 1
Coming to class unprepared 1
Table 2.
Out-of-Class Disruption by Students as Identified by Faculty
UNCIVIL STUDENT BEHAVIOR FREQUENCY OF RESPONSE
Verbally discrediting faculty 4
Turning in late assignments without proper notification 2
Sending inappropriate emails to faculty 2
Not keeping scheduled appointments 1
Complaining about constructive feedback from faculty 1
Stealing/driving too fast on campus 1
Making veiled threats toward faculty 1
Table 3. Uncivil Faculty Behaviors as Identified by Students
UNCIVIL FACULTY BEHAVIOR FREQUENCY OF RESPONSE
Making condescending remarks 26
Using poor teaching style or method 23
Using poor communication skills 19
Acting superior and arrogant 15
Criticizing students in front of peers 7
Threatening to fail students 7
Table 4. Possible Causes of Incivility in Nursing EducationUNCIVIL BEHAVIOR in Nursing Education
as Identified by Students and Faculty
POSSIBLE CAUSE FREQUENCY OF RESPONSE
High-stress environment 10
Lack of professional, respectful environment 9
Lack of faculty credibility and responsiveness 8
Faculty arrogance 6
Sense of entitlement among students 3
Students not really interested in nursing 3
Not being clear about expectations 2
Competitiveness 2
Lack of immediacy to address incivility 2
Distance learning (virtual) environment 2
Lack of student preparation 1
UNCIVIL BEHAVIOR
sense of student entitlement contribute to incivility in nursing
education. To deal effectively deal with these issues, faculty and
students must work together with administrators to develop and
implement comprehensive codes of conduct and effective strategies to prevent incivility. Further, they must craft remedies for
effective intervention when incivility occurs.
Standards and ethical principles that define the profession
exist to ensure that qualified, ethical nurses are graduated from
nursing programs. Nurse faculty and students must be accountable to these standards and bear a shared responsibility to conduct themselves in an ethical, professional manner. They must
engage as partners in lively dialogue to address these problems.UNCIVIL BEHAVIOR in Nursing Education
This study of incivility in nursing education is timely. Most
earlier studies on this topic have focused on the problem of student incivility. These findings shed light on possible causes of
incivility, potential remedies, and how faculty, as well as students, contribute to the problem. From the classroom to the practice setting, further research is needed to address several topics:
• The nature of incivility and its impact on the educational
process and on the profession as a whole
• The relationships between student and faculty perceptions of
incivility and ways to effectively address the problem
• Whether there are gender differences in ways that faculty
and students experience incivility
• How civility experienced by students — or perpetrated by
students — affects patients
It is clear that uncivil encounters have a negative effect on
the academic environment and have the potential to disrupt the
teaching-learning environment. Greater awareness and understanding about academic incivility, its impact, and its psychological and societal consequences are needed.
About the Authors Cynthia M. Clark, PhD, RN, is associateUNCIVIL BEHAVIOR in Nursing Education
professor, Department of Nursing, Boise State University, Boise,
Idaho. Pamela J. Springer, PhD, RN, is professor and department
chair, College of Nursing. Boise State University. For more information, contact Dr. Clark at cclark@boisestate.edu.UNCIVIL BEHAVIOR in Nursing Education
Keywords Codes of Conduct – Incivility – Student Behavior – StudentFaculty Relations
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