Healing from the Bitter Pill of Incivility

Not long ago, I was facilitating a workshop on fostering civility in nursing education when a faculty member approached me during the break. The soft-spoken professor related her thoughts in a quiet voice, her eyes reflecting a certain sadness as she spoke. She said, “Please think about us—the clinical faculty, I mean—when you are speaking about incivility in nursing education. I am a member of the clinical faculty, and I can tell you, unequivocally, that we are a marginalized group. We are not considered part of the ‘real faculty’ and are often referred to as ‘minions and underlings.’ We are frequently told that we have no clout nor can we provide input into the theoretical courses or exams.” I asked the faculty member how she responded to these incivilities. She said, “I just take it—it’s like swallowing a very bitter pill.”

What I call the in-group and the out-group of nursing faculty teams—and I use the word “team” lightly—is further illustrated by a story described in a study I recently conducted to examine faculty-to-faculty incivility and ways to effectively address the problem. Approximately 13% of the respondents reported experiencing racial, ethnic, sexual, gender, or religious slurs within the past 12 months. One respondent wrote, “During a faculty workshop, faculty members were asked to work in small groups. One group contained four minority faculty members. A non-minority faculty member asked, ‘Do I have to paint my face black to be in this group?’”

Another faculty member related the incivility of perceived ageism that exists in her nursing program. She explained that when she met with her dean to seek advice about returning to graduate school to complete her doctoral degree, the dean laughed and said, “Are you kidding, at your age? You can’t be serious. By the time you finish your degree, you’ll be ready to retire. We prefer to invest in younger faculty.” Other forms of discrimination are also apparent: a student recently commented on faculty bias in the classroom, saying, “Students are often subjected to religious, racial, and anti-gay/lesbian content. We [students] feel vulnerable and do not know how faculty and administrators will react if they complain. It’s appalling and inexcusable.”

Regardless of their origin, uncivil encounters are an affront to human dignity and an assault on a person’s intrinsic sense of self-worth. The effects can be devastating and longlasting. Incivility may come from myriad sources; it is complex, disordered, and multidimensional. Taking time to engage, communicate, and listen with intention has a profound effect on preventing and healing the effects of incivility.

I often refer to incivility as a dance, an expression of feeling and social interaction that gets articulated through a variety of movements, gestures, and actions.1 Each observer and participant interprets the dance within the context of his or her personal experiences, through the lens of his or her own world-view. Because of this individual perception and interpretation, it becomes essential to actively listen, consider the intent of the action, and engage in meaningful and solutionbased conversation.

More than two decades ago, Ernest Boyer asserted that institutions of higher education play a vital role in helping students develop a sense of civic and social responsibility, and become productive citizens of the academy and the community.2 The promotion of civility and good citizenry is especially important in nursing and other health-related disciplines where the risk assumed by not addressing uncivil behavior reaches well beyond the college campus and can negatively impact patient safety, recruitment and retention, and commitment to the nursing profession. Because nursing programs are places where students and faculty provide direct care to patients through clinical experiences, uncivil and disruptive acts must be addressed so that such behaviors do not spiral into aggression and jeopardize the learning and practice environment.

While promoting civility is one of the primary functions of higher education, in some respects the system is failing. This failure may be related to a lack of understanding about the topic in general, and ways to prevent and address incivility in particular. I define incivility as rude or disruptive behaviors that often result in psychological or physiological distress for people involved, and if left unaddressed, may progress into threatening situations.3 Exposure to uncivil behaviors can result in physical symptoms such as headaches, interrupted sleep, and intestinal problems and can cause psychological conditions like stress, anxiety, irritability, and depressive symptoms. Thus, it is important to foster civility—an authentic respect for others requiring time, presence, a willingness to engage in genuine discourse, and an intention to seek common ground.4

Similarly, it is important to raise awareness about the importance of fostering a civil and healthy academic work environment. According to researchers, a healthy academic environment consists of a number of factors, including a clear mission with shared values and norms; high morale, job satisfaction, and an esprit de corps; competitive salaries and benefits; reasonable workloads; positive employee recruitment and retention; policies to eliminate incivility; respectful communication, teamwork, and shared decision making; organizational support and collegial relationships; and competent, honest leaders who collaborate with faculty to share decision making.5,6,7

Awareness may be raised by describing specific rationale for establishing and sustaining healthy academic work environments. First, the costs of incivility are vast. Uncivil behavior adds to employees’ stress level, erodes self-esteem, damages relationships, and threatens workplace safety and quality of life.8 Incivility also lowers morale, causes illness, and leaves workers feeling stressed, vulnerable, and devalued. The human and financial costs of these behaviors may be disastrous.9 Second, the recent Institute of Medicine Report10 includes several recommendations that call for nurses and other health care workers, such as physicians, to collaborate to advance the nation’s health. To fulfill these recommendations, we must establish civil and respectful relationships and interactions. Third, the American Nurses Association Code of Ethics for Nurses with Interpretive Statements Provision 1.5 promotes a civil, healthy work environment by requiring nurses to treat colleagues, students, and patients with dignity and respect, and states that any form of harassment, disrespect, or threatening action will not be tolerated.11 Similarly, the American Nurses Association Standards of Practice reinforce the need for objective standards such as collaboration, ethical conduct, and communication for nurses to be accountable for their actions, their patients, and their peers.12 These rationales and fostering a healthy academic work environment are difficult, if not impossible to achieve in the absence of skilled, ethical leadership. Successful change requires both formal and informal leadership—leaders who hold formal positions as well as individuals without a formal title or authority, but who have significant influence with members throughout the organization.

Once awareness is raised and leaders agree that changes are needed to foster a civil workplace, it is highly desirable to use empirical measures to determine levels, types, and frequency of civil and uncivil factors, and to reveal strategies for fostering a healthy workplace. Some examples of empirical measures include the Organizational Civility Scale (OCS)13 and the Culture/Climate Assessment Scale (CCAS).14 Other data sources are also helpful, such as formal and informal reports, evaluations, satisfaction surveys, performance evaluation information, regulatory reports, and information from focus groups and open forums. Once a comprehensive organizational assessment has been conducted, strategies can be implemented to improve areas of concern and to reinforce efforts already in place to enhance areas of strength and excellence.

Specific strategies include aligning the organizational mission and values with a focus on civility and respect. Successful organizations intentionally focus their vision for the future so that employees are able to meet organizational objectives as well as achieve personal satisfaction in their work. Organizational values undergird the formulation and implementation of norms of decorum. Without functional norms, desired behavior is ill defined and thus, members of the campus community are left to “make things up as they go along.”

Healthy academic work environments do not occur by accident—creating them requires intentional and purposeful focus. Unfortunately, many faculty, students, and administrators are unaware of how their behaviors affect others, and many are ill equipped to deal with incivility. Thus, strategies to prevent and address incivility must be taught, practiced, reinforced, and supported. We must make civility a priority. Faculty and staff meetings are excellent venues to raise awareness, discuss acceptable and unacceptable behaviors, establish norms of behavior, and practice and role-play civil interactions. When faculty and staff collectively co-create norms for behavior, they are more likely to approve of and conform to these behaviors. Once the norms are agreed upon, they become the standard for faculty and staff interactions. It is also important to establish, implement, and widely disseminate confidential, non-punitive policies and procedures for addressing incivility. This includes enforcing sanctions if indicated, and perhaps more importantly, to reward civility and collegiality. Although positive motivators are preferred, the consequences for violating the agreed-upon norms must be clearly stated and enforced. Ignoring or failing to address the uncivil behavior damages the organization as much, if not more, than the incivility itself.

Acting civilly and respectfully isn’t always easy, especially in a high-stress learning environment where constant change is the norm, and where faculty and students experience complex and demanding workloads. Yet, we must make civility a priority for our students, colleagues, practice partners, and ourselves. Incivility takes a tremendous toll on everyone throughout the campus and practice community. In a fast-paced work environment, patience is often in short supply, yet it remains a virtue we should value and uphold. Each individual must set a positive example to lead the transformation for cultivating civility in nursing education.


  1. C.M. Clark, “The Dance of Incivility in Nursing Education as Described by Nursing Faculty and Students,” Advances in Nursing Science (2008), 31(4), E37–E54.
  2. E. Boyer, Campus Life: In Search of Community. Princeton: The Carnegie Foundation for the Advancement of Teaching, 2009.
  3. C.M. Clark, “Faculty Field Guide for Promoting Student Civility,” Nurse Educator, 34(5),194–197.
  4. C.M. Clark and J. Carnosso, “Civility: A Concept Analysis,” Journal of Theory Construction and Testing, 12(1), 11–15.
  5. C.M. Clark (in progress), “Pathway for Fostering Organizational Civility.”
  6. M. Brady, “Healthy Nursing Academic Work Environments,” OJIN: The Online Journal of Issues in Nursing (2010), 15(1),Manuscript 6.
  7. National League for Nursing. “Healthful work environments for nursing faculty.” Retrieved February 26, 2012, www.nln.org/newsletter/healthfulworkenv.pdf.
  8. P.M. Forni, The Civility Solution, New York, NY: St. Martin’s Press, 2008.
  9. C. Pearson and C. Porath, The Cost of Bad Behavior: How Incivility is Damaging Your Business and What to do About it. New York, NY: Penguin Group, Inc, 2009.
  10. Institute of Medicine Report (2010). “The future of nursing: Leading change, advancing health,” Robert Wood Johnson Foundation Publisher.
  11. American Nurses Association. (2001). Code of Ethics for Nurses With Interpretive Statements. Washington, D.C.: American Nurses Association.
  12. American Nurses Association. (2010). Nursing Scope and Standards of Practice. (2nd ed). Silver Spring, MD: American Nurses Association.
  13. C.M. Clark and R.E. Landrum, “Organizational Civility Scale.” Retrieved February 26, 2012, http://hs.boisestate.edu/civilitymatters/
  14. C.M. Clark, M. Belcheir, P. Strohfus, and P.J. Springer, “Development and Description of the Culture and Climate Assessment Scale, Journal of Nursing Education (2012), 51(2), 75-80.

Is a Career in Academia Right For You?

Previous installments of “Academic Pursuits” offered tips and advice on getting into grad school—such as how to write a personal statement or how to acquire letters of recommendation. This time, however, we thought we would take a different angle and answer the question: “What does it take to teach in the academic field as an allied health professional?”

There are as many answers to this question as there are allied health professions and academic institutions, and it’s impossible to cover them all in a three-page column. Instead, we hope to provide you with a starting point. Below you’ll find general information for prospective allied health faculty on the job market, education requirements, typical workday—and last but not least—salary. Who knows? Pretty soon you might find yourself working on the other side of the podium.

The Job Market

First, let’s start with some good news: Nationally, there is a very strong demand for qualified allied health faculty. “There is a national shortage of faculty in nearly all allied health disciplines,” says James D. Blagg, Jr., Ph.D., and dean of the College of Health Professions at Northern Arizona University in Flagstaff. “And this situation is expected to worsen because many faculty members are ‘boomers’ and are approaching their retirement years.”

According to David A. Lake, PT, Ph.D., head of the Department of Physical Therapy at Armstrong Atlantic University in Savannah, Ga., the demand is greatest at the doctoral level. “There will be a generation of faculty retiring in the next 10-15 years that will need to be replaced,” he says. “The particular need is for faculty with doctoral degrees. Although there are clinical tracks in which those with master’s degrees can work, the preferred pathway is the tenure track, which requires a doctoral degree.”

In several disciplines, this need for Ph.D.s is exacerbated by the steady progression of the terminal degree offered. In physical therapy, for example, the terminal degree has steadily progressed from a simple certificate to a bachelor’s degree to a master’s degree and, most recently, to a DPT—the clinical doctorate. Currently, about half of physical therapy programs offer DPTs, and as this number continues to grow, there will be a greater demand for Ph.D.s to teach these programs.


So does that mean that you must have a Ph.D. in order to teach in an allied health program? “It depends on the discipline and the level of the program,” says Blagg. “Generally, one needs to have a degree one level higher than the degree being offered. For example, if teaching associate degree-seeking students, one should have a baccalaureate at minimum. If teaching master’s degree-seeking students, one should have a doctorate.”

“The answer also depends upon the institution and whether the person is seeking tenure or not,” adds Lake. “There are a large number of faculty members who hold the master’s degree, however, most institutions do require the doctoral degree for promotion from assistant to associate and for tenure.”

But perhaps you aren’t interested in a tenure track. Maybe you just want to pick up a few lectures or labs to supplement your full-time job as a clinician or to get a taste of what it is like to teach before committing to a Ph.D. If this is the case, a master’s is probably sufficient. However, a master’s alone will not get you a teaching gig. Most teaching positions require three to five years clinical experience, and if you want to teach a lab, a specific area of expertise. “Many physical therapists who don’t have a Ph.D. come in as adjunct instructors,” says Mira Mariano, PT, MF, OCF, a senior lecturer in the School of Physical Therapy at Old Dominion University in Norfolk, Va. “Instead of giving lectures, they teach particular techniques in lab and pass on their first-hand knowledge to the students.”

As Lake points out, this type of arrangement has benefits for both the clinician and the academic institution. “Typically, a clinician will start by guest lecturing or doing a lab section while still in full-time clinical practice,” he says. “The part-time teaching experience gives the academic institution a chance to see how the clinician teaches, and it gives the clinician an idea of what it is like to be a faculty member.”

A Day at the Office

A full-time allied health instructor can expect to spend anywhere from 12-18 hours in the classroom or lab each week. But that’s only a fraction of the time they’ll have to devote to the job. Lecture and lab preparation, student advisement, grading, faculty meetings, and time for professional development and research, all add to a considerable workload. In order to free-up time for research or service activities during the day, Lake says that many faculty members use evening and weekends for class preparation and grading.


“Many folks both inside and outside the university don’t understand how much time it really takes to prepare for an hour or two of lecture or lab,” says Faye E. Coleman, M.S., CLS, MT (ASCP), program director of the Medical Technology/Clinical Laboratory Science Program at Old Dominion University. “If you aren’t spending your time in the lab or the classroom, you’re spending a good portion of it preparing for one or the other or both.”

Professional development can also take up a huge amount of time. “It is up to the instructor to make sure that he or she is updated in terms of new techniques, theories and concepts,” Coleman continues. “This can be a huge task, because whereas a practitioner’s job often focuses on a specific area, an instructor may be responsible for providing his or her students with information covering a broad range of topics.”

The technical nature of the allied health professions means that teachers must continually change their lectures and lesson plans as new technologies and techniques are developed. “One of the big jokes that we have in our department is that we sometimes wish we were all history professors,” says Mariano. “Then we could take out the same folder and teach the same stuff 20 years in a row. But in physical therapy, as in all the allied health professions, we have to change our course content to keep up with changes in the medical profession.”

Despite the huge time commitment, most positions offer one strong advantage: flexibility. Other than set times for classes and meetings, faculty members are free to use their time as they please. As long as the work gets done, it doesn’t matter when you do it. This freedom is particularly beneficial to faculty members with young families. “I have two little ones,” says Mariano. “So I correct a lot of my papers at night when my kids are asleep. And since I don’t have to go into work at eight o’clock in the morning, I have the freedom to stay with my kids if one of them gets sick.”

What Does It Pay?

Compared to a job outside academia, working as an allied health faculty member does not pay that well. Blagg says that it’s not unusual for recent graduates working outside the university to make as much, if not more, than the faculty who taught them. In fact, lower pay is a main factor contributing to the current shortage of allied health instructors. “In the past two years I have had two faculty lured back to clinical or health care supervisory work,” Blagg says. “One at double her salary and one at two and a half times his.”

But you may be able to avoid this disparity if you can land a job with a university that is associated with a hospital or medical facility. According to Danielle Ripich, Ph.D. and dean of the College of Health Professions at the Medical University of South Carolina in Charleston, pay at academic medical centers is almost on par with clinical pay.

Keep in mind, however, that lower pay is tempered by a more flexible work schedule and long vacations. The faculty at most universities work on nine- or ten-month contracts, with their summers free, and long periods off for Christmas and spring break. Many faculty members use this time off to pick up per diem work, which can make up a lot of the salary differences. Others simply enjoy the time off.

Starting Your Own Search

As you might imagine, there is no single resource that provides teaching requirements and information for all of the allied health disciplines. The closest thing to that is The Association of Schools of Allied Health Professions (www.asahp.org), which provides links to dozens of allied health programs, health and higher education organizations, government agencies and accrediting bodies. Under the “Surveys” button, you’ll also find the results of the “Faculty Vacancy Survey,” which provides the average number of part-time and full-time teaching vacancies at member institutions for 20 separate areas of allied health. If you’re interested in a teaching career, it’s a good place to start.

Another good source is any professional organization within your discipline. The education section of the American Physical Therapy Association (www.apta.org), for example, provides multiple resources and links for both potential students and educators.

But perhaps your best resources are the allied health professionals who are already working in academia. Talk to your current or former professors. Or find the nearest allied health program that you would like to teach for and contact the dean. Most of these professionals would be happy to discuss the experience and qualifications you need to land a part-time or full-time teaching position.

How Do You Solve the Minority Nursing Faculty Shortage? Put Them Online!

Although many nursing schools around the country have successfully increased the racial and ethnic diversity of their student populations, there is still a severe shortage of minority nursing faculty. According to the American Association of Colleges of Nursing, less than 10% of the nation’s nursing educators are people of color. Even worse, many of these minority professors are rapidly nearing retirement age. How can nursing education meet the needs of a more culturally diverse generation of students when there just aren’t enough culturally diverse faculty to go around?

One school that has come up with an innovative solution to the minority faculty shortage is the School of Nursing at Thomas Edison State College in Trenton, N.J. The college has received a $600,000 grant from the Health Resources and Services Administration (HRSA) to recruit and prepare minority nurse educators for online teaching. Training existing minority faculty to teach in distance learning programs will make these educators accessible to more students from all over the country, especially those in remote or rural areas. It will also help reduce the retirement brain drain by enabling minority faculty to extend their tenure in the profession, at least on a part-time basis, after they reach retirement age.

The school plans to recruit 45 minority nurse educators for the program during the next three years. Candidates must have an MSN degree or higher and will complete the college’s 32-week Certificate in Distance Education Program. Upon completion, they will teach one 12-week online nursing course at the college and will then be able to bring their distance education skills back to their own local institutions. The grant will also be used to create a database of minority distance educators, which will be made available to nursing schools throughout the country.

“The potential benefit of educating minority nurse faculty in online pedagogy is vast,” says Susan O’Brien, EdD, RN, dean of the School of Nursing at Thomas Edison State College. “We anticipate that the number of students and nursing schools impacted by this program will increase exponentially as the minority nurse educators recruited and educated through this grant begin to use and share their online skills.” If you’re an eligible nurse educator interested in participating in this program, contact the college at [email protected].