Featured Article| Volume 21, P40-45, August 2018

Empowering Nursing Students to Address Incivility


      • Incivility is common in the nursing profession.
      • Nursing students have minimal experience handling conflict.
      • Simulation allowed students to apply TeamSTEPPS tools.
      • Simulation allowed practice of handling incivility in clinical setting.



      Nurses frequently face incivility. Nursing students are ill-prepared to cope with incivility in the workplace.


      This study evaluated nursing students' responses to a simulation activity focused on incivility. Students' anxiety and self-efficacy were measured before and after simulation.


      Prelicensure nursing students (n = 44) had a mean age of 22.73 years (SD = 5.32). Mean anxiety levels decreased from presimulation (M = 44.9) to postsimulation (M = 41.5) (t [36] = 1.69; p = .098). Similarly, the self-efficacy decreased from presimulation (M = 30.13) to postsimulation (M = 29.67) period (t [36] = 0.4, p = .69). In postsimulation reflections, 89% (n = 39) of students found the simulation beneficial.


      Simulation provides students a safe environment to practice communication, resulting in increased student comfort and agency.


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        • Agency for Healthcare Research and Quality [AHRQ]
        TeamSTEPPS® 2.0.
        2017 (Retrieved from)
        • Ajilchi B.
        • Nejati V.
        Research paper: Executive functions in students with depression, anxiety, and stress symptoms.
        Basic and Clinical Neuroscience. 2017; 8: 223-232
        • Baker V.O.T.
        • Cuzzola R.
        • Knox C.
        • Liotta C.
        • Cornfield C.S.
        • Tarkowski R.D.
        • Carlson J.N.
        Teamwork education improves trauma team performance in undergraduate health professional students.
        Journal of Educational Evaluation for Health Professions. 2015; 12: 36
        • Baker M.J.
        • Durham C.F.
        Interprofessional education: A survey of students' collaborative competency outcomes.
        Journal of Nursing Education. 2013; 52: 713-718
        • Brock D.
        • Abu-Rish E.
        • Chiu C.-R.
        • Hammer D.
        • Wilson S.
        • Vorvick L.
        • Zierler B.
        Interprofessional education in team communication: Working together to improve patient safety.
        BMJ Quality & Safety. 2013; 22: 414
        • Brodsky D.
        • Gupta M.
        • Quinn M.
        • Smallcomb J.
        • Mao W.
        • Koyama N.
        • Pursley D.M.
        Building collabrative teams in neonatal intensive care.
        British Medical Journal of Quality and Safety. 2013; 22: 374-382
        • Cardoza M.
        • Hood P.
        Comparative study of baccalaureate nursing student self-efficacy before and after simulation.
        Computer Informatics in Nursing. 2012; 30: 142-147
        • Chernomas W.M.
        • Shapiro C.
        Stress, depression, and anxiety among undergraduate nursing students.
        International Journal of Nursing Education Scholarship. 2013; 10: 252-266
        • Cowen K.J.
        • Hubbard L.J.
        • Hancock D.C.
        Concerns of nursing students beginning clinical courses: A descriptive study.
        Nurse Education Today. 2016; 43: 64-68
        • Crary P.
        Beliefs, behaviors, and health of undergraduate nursing students.
        Holististic Nursing Practice. 2013; 27: 74-88
        • Floyd J.
        RS12 Depression, anxiety, and stress among nursing students and the relationship to grade point average.
        American Journal of Critical Care. 2012; 21: e78
        • Jernigan S.
        • Magee C.
        • Graham E.
        • Johnston K.
        • Zaudke J.
        • Shrader S.
        Student outcomes associated with an interprofessional program incorporating TeamSTEPPS®.
        Journal of Allied Health. 2016; 45: 101-108
        • Kerber C.
        • Woith W.M.
        • Jenkins S.H.
        • Astroth K.S.
        Perceptions of new nurses concerning incivility in the workplace.
        The Journal of Continuing Education in Nursing. 2015; 46: 522
      1. Knowles M. Andragogy in action: Applying modern principles of adult education. 1984, Jossey-Bass; San Francisco.

        • Knowles M.S.
        • Holton E.F.
        • Swanson R.A.
        The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development.
        Eighth ed. Routledge Taylor & Frances Group, London and New York2015
        • Kolb D.
        Experiential Learning: Experience as a Source of Learning and Development.
        Prentice-Hall, Upper Saddle River, NJ1984
        • Oh P.-J.
        • Jeon K.D.
        • Koh M.S.
        The effects of simulation-based learning using standardized patients in nursing students: A meta-analysis.
        Nurse Education Today. 2015; 35: e6-e15
        • Rowbotham M.
        • Owen R.M.
        The effect of clinical nursing instructors on student self-efficacy.
        Nurse Education in Practice. 2015; 15: 561-566
        • Sanner-Stiehr E.
        • Ward-Smith P.
        Increasing self-efficacy: Lateral violence response training for nursing students.
        Journal of Nursing Education and Practice. 2016; 6: 1-9
        • Sauer P.
        • Hannon A.
        • Beyer K.
        Peer incivility among prelicensure nursing students: A call to action for nursing faculty.
        Nurse Educator. 2017; 42: 281-285
        • Sauer P.A.
        • McCoy T.P.
        Nurse bullying: Impact on nurses' health.
        Western Journal of Nursing Research. 2016; 39: 1533-1546
        • Schwarzer R.
        • Jerusalem M.
        Self-efficacy as a resource factor in stress appraisal process.
        in: Schwarzer R. Self-efficacy: Thought Control Action. Hemisphere, Washington, DC1992: 195-213
        • Spielberger C.D.
        STAI-Adult Manual.
        Mind Garden, Inc, 1983, 2015 (Retrieved from)
        • Sweigart L.I.
        • Umoren R.A.
        • Scott P.J.
        • Carlton K.H.
        • Jones J.A.
        • Truman B.
        • Gossett E.J.
        Virtual TeamSTEPPS® simulations produce teamwork attitude changes among health professions students.
        Journal of Nursing Education. 2016; 55: 31-35
        • The Joint Commission
        Sentinel event statistics released for 2014.
        (Retrieved from)
        • Turner K.
        • McCarthy V.L.
        Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015.
        Nurse Education in Practice. 2017; 22: 21-29
        • Wallace L.
        • Bourke M.P.
        • Tormoehlen L.J.
        • Poe-Greskamp M.V.
        Perceptions of clinical stress in baccalaureate nursing students.
        International Journal of Nursing Education Scholarship. 2015; 12: 1-8