Relation between Workplace Civility climate and Job Performance of Nursing Staff in Dialysis unit

Introduction

Health organizations dedicated to improving people's health have a major impact on a nation's economy and culture. When workers are healthy, they can do their jobs better, which has a positive effect on the economy as a whole. Because nurses play such a crucial role in the healthcare system, their work is never undermined. Proper patient care is impossible without their prompt involvement. Nurses, on the other hand, are vulnerable to workplace violence and hostility because of the negative stereotypes surrounding their profession (Faheem, 2017).

       Workplaces with high levels of civility should have rules, regulations, and processes that limit rudeness and verbal abuse. A positive civility climate denotes a setting that encourages honest communication and safer behaviors that boost self-efficacy. Contrarily, a hostile civility environment is marked by mistrust and fear and leads to a refusal to accept responsibility for errors (Ramsey, 2018& Beus, 2020). Good therapeutic relationships are maintained by nurses' civil behavior. Nurses who are shielded from uncivil behavior or problems are more likely to quit their jobs. Correct communication and a civil environment between head nurses and their nursing staff in a hospital setting not only increase self-efficacy, hope, optimism, and flexibility (Feldblum & Lipnic, 2016).

The prevalence of workplace incivility and deviance toward nurses is significant worldwide, with incivility focusing primarily on psychological abuse through verbal rather than physical harassment, indirect rather than direct mistreatment, and passive rather than active behavior toward the individual (Itzkovich & Heilbrunn, 2016).

Workplace incivility, which is considered a work stressor, is characterized as low-intensity aberrant behavior with ambiguous intent to injure the target and in violation of workplace norms for mutual respect (Demsky, Fritz, Hammer, & Black, 2019). According to estimates, 98% of nurses encounter rude behavior at least once every week. It is estimated that workplace incivility toward nurses costs organizations $14,000 per nurse each year. These statistics are concerning because they have a significant negative financial impact on the organizations that employ nurses and negatively impact many nurses. Additionally, the human costs suffered by nurses who are subjected to incivility at work are rather high. (Cho, Bonn, Han, & Lee, 2016)...

Job performance is the benefit an organization can anticipate from certain actions taken by nurses over time. The effectiveness of organizations depends on nurses demonstrating both task performance and contextual performance. When a nurse does a task, it immediately relates to the services and primary activity for which they were employed, however, when a nurse performs contextually, it does not directly relate to the task or main activity but rather demonstrates how they feel about the organization. It is seen as an additional performance. The most important aspect in accomplishing organizational objectives and enhancing organizational performance, in the end, is the nursing staff's job performance (Warr & Nielsen, 2018).

There are eight ways to encourage a culture of civility: self-reflection, self-evaluation, identifying personal strengths and areas for improvement, positive behavior modeling by a professional nurse, education about personality types and diversity in thought to foster a better understanding of oneself and others, establishing rules for nurses regarding mutual respect, and fostering an environment that is welcoming and free from judgment. Finally, promoting cultural humility training throughout the organization, delivers training in leadership, teamwork, and communication, and promotes incivility-related ethical and legal research, policy formulation, and enforcement (Stalter et al., 2020)

Significance of the study:

Enhancing the working environment and strengthening the bonds between nurses are crucial elements that can raise the organization's performance and productivity and preserve nurses' work (Ajayi et al., 2018). In Egypt, Hossny et al. (2015) assessed the effect of workplace civility structural and psychological empowerment on newly graduated nurses' organizational commitment at hospitals in Assiut city and reported that civility constitutes an important part of the organizational climate perceived by nurses.

Moreover, the study by Leiter et al. (2012) demonstrated that positive nurses and workplace outcomes have been linked to a more civil workplace climate, including increased job satisfaction, organizational commitment, management trust, performance on the job, and organizational citizenship behavior, and decreased turnover, absenteeism, anxiety, stress, and counterproductive behavior. A culture of civility is essential for building morale, strengthening relationships, and maximizing productivity in the workplace.

Aim of the Study                                                      

The aim of the current study is to assess the relation between workplace civility climate and job performance of nursing staff.

Research Question

Is there a relation between workplace civility climate and job performance of nursing staff in Edfu general hospital?

Subjects and Methods

Research Design

A descriptive correlational research design was used to achieve the aim of the current study.

Setting

The study was conducted in the dialysis unit at Edfu General Hospital in Aswan city, Egypt.

Subjects

The subjects of the study sample included all staff nurses working in the dialysis unit in Edfu General Hospital during the data collection period. Their total numbers were 87 nurses.

Data Collection Tools

Data was collected through the utilization of two tools as follows:

Tool (1): Perceived Workplace Civility Climate (PWCC): It included two parts:

Part I: Personal Data

It was used to collect data about nurses and encompass seven (7) items such as department, age, gender, marital status, educational level, position, and years of experience.

Part II:  PWCC It was developed by Ottinot (2010) and translated into Arabic by the researcher. It was used to measure the workplace civility climate by the nurses themselves. It consists of 24 items grouped under two theoretical dimensions management (14 items) and employee (10 items). The items were measured by using a five-point Likert scale ranging as 5 = strongly agree, 4= agree, 3= neutral, 2= disagree, and 1= strongly disagree, and there were five items scored as reverse no. 2, 4, 8, 12, and 23

Workplace civility climate was rated on a scale from 24 to 120, with low scores corresponding to a civility level between 24 and 66, moderate scores falling between 67 and 89, and high scores, in the range of 90 to 120, indicating high civil work climate.

Tool (2): Job Performance scale (Observational checklist)

This tool developed by Samiei et al. (2016), adapted and translated by the researcher, was used to measure the job performance of nursing staff by the researcher herself; it consists of 52 items grouped under six theoretical dimensions as communication (12), leadership (5), critical care (7), teaching & collaboration (11), planning & evaluation (7), and professional development (10). The items were measured by using two-level, which concludes two parts of don or not done .as done =1 and not done = 0.

The scoring system for job performance ranged from 1 to 52, which was divided into satisfactory ≥ 31.2 (≥ 60%) and unsatisfactory performance < 31.2 scores (< 60.0%).

Validity of the tools:

A panel of five nursing administration specialists evaluated content validity of the tools, two reviewers from Assuit University faculty of nursing, two reviewers from Minia University faculty of nursing, and one reviewer from South University, and necessary modifications were done.

Reliability of the tools

The tools were tested for internal reliability by using Cronbach's alpha test as follows: perceived workplace civility climate at 0.833 and job performance at 0.855.

Pilot Study

                A pilot study was conducted prior to the main data collection phase, which involved 10% (8 nurses) of the nursing staff at the Edfu General Hospital. The purpose of the pilot study was to test the comprehensiveness, clarity, applicability, and accessibility of the tools and assess whether or not the tools were easy to understand and use.

Data Collection Procedure

Participants were recruited from the dialysis unit at Edfu General Hospital. Each participant was interviewed individually after taking their oral consent to participate in the study and explained the nature of the study to the participants. The time required for observation was estimated after making the pilot study.

Before distributing the questionnaires, the researchers met with the participants at a time established by the head of each department, introduced herself, and discussed the research aim as well as the components of the tools with the participants in the study environment. Next, the researchers distributed the data gathering tools to each participant at their workplace. The questionnaire form took roughly 20 minutes to complete. The researchers observed one nurse/shift/day in the morning, evening, and night shifts every Sunday and Monday / week. Data collection time took five months from the beginning of February 2021 to July 2021; tool (II): Perceived Workplace Civility Climate (PWCC): was distributed to nursing staff in the dialysis unit to fill the questionnaire., while Tool (II): Job Performance scale (observational checklist) was collecting the data by the researcher himself, who observed and record data.

Ethical Consideration

The Minia University Faculty of Nursing's Research Ethics Committee approved a formal letter. The dean of Minia University's faculty of nursing gave her approval for the study to be carried out. The nursing director and chief nurses in charge of each department gave their approval, as well as the hospital managers and the hospital's head nurse.

Before conducting the pilot study and the actual study, oral consent was obtained from nurses who were willing to participate in the study after explaining the nature and purpose of the study. The study subject can refuse to participate or withdraw from the study without any rationale. Study subject privacy was considered during the collection of data. Participants were assured that all their data were highly confidential; anonymity was also assured by assigning a number for each nurse instead of names to protect their privacy.

Data statistical analysis

After the data collection process was complete, the "Statistical Package for Social Science" (SPSS) was used to score, tabulate, and analyze the data (IBM 28). Descriptive statistics were used to show the data as percentages, frequency means, and standard deviation. The Chi test, Fisher exact test, and Pearson correlation were employed to determine group differences and the relationships between the research variables in inferential statistical tests of significance. When the p-value is greater than 0.05, the result is non-significant; nevertheless, when the p-value is lower than 0.05 and higher than 0.01, the result is very significant. Based on their individual data, the Fisher exact test/chi test was utilized to determine the relationship between perceived workplace civility climate and job performance.

Correlation is used to test the nature and strength of the relation between personal data of the nursing staff, perceived workplace civility climate, and job performance. The sign of the coefficient indicates the nature of relation (positive/negative) while the value indicates the strength of relation as follows: no correlation for rho value less than 0.19, a weak correlation for rho of value between 0.20 - 0.29, a moderate correlation for rho of value between 0.30-0.39, a strong correlation for rho of value between 0.4-0.69, and very strong correlation for values between 0.7-0.99

Results

Table (1): Distribution of the studied nursing staff according to their personal data (n= 87).

Table (1): presents that more than half (51.7%) of the studied nursing staff were aged between 20 - < 25, with a mean age of 25.0 ± 3.2 years. Most of the studied nursing staff was female and working as a nurse (92.0% & 90.8%, respectively). Nearly two-thirds of the studied nursing staff were married (65.5%), and the majority (86.2% & 80.5% respectively) of them graduated a nursing technician, and their years of experience in the current department ranged from 1- < 6 years with mean experience 4.0 ± 3.5 years in the nursing field.

Figure (1): Distribution of the nursing staff according to their gender (n = 87)

Figure (1): illustrates that most (92.0%) of the nursing staff were female, and a minority (8.0 %) of them were male.

Figure (2) Distribution of Nursing Staff Level of Perceived Workplace Civility Climate and its domains (n= 87).

      
Figure (2): presents that one-third (33.3%) of the nursing staff had a high level of perceived workplace civility climate dimension; more than one-third of them (40.3%) had a high level of employee workplace civility dimension and near to one-quarter of them (21.8%) had a high level for head nurse perceived workplace civility climate domain.

                Figure (3): Distribution of Nursing Staff regarding dimensions levels of Job Performance (n= 87).

Figure (3): present that near to two-thirds (64.4%) of the nursing staff had a satisfactory level of communication, most (93.1%) of them had a satisfactory level of professional development, and the majority (83.9%) of them had a satisfactory job.

Table (2): Relation between personal data of nursing staff about their perceived workplace civility climate (n = 87).

Fisher exact test was used to calculate p value NS= Not statistically significance differences   * = statistically significance differences   at < 0.05   * * = statistically significance differences    at < 0.01

Table (2) presents statistically significant relations between nursing staff's perceived workplace civility climate with qualification and their current position. The majority (87.5%) of the nurse's staff who had bachelor's degrees in nursing and worked as head nurses have had a high-level workplace civility climate with a (P-value <0.017& 0.003, respectively).

Table (3): Relation between personal data of nursing staff with their job performance (n = 87).

Fisher's exact test was used to calculate P – value. NS= Not statistically significant differences

Table (3) shows no statistically significant relationship between the gender, marital status, qualification, and current position of nursing staff with their job performance.

Table (4): Correlations between perceived workplace civility climate of nursing staff and their job performance (n = 87).

*Correlation is significant at the 0.05 level          **Correlation is significant at the 0.01 level

Table (4): there were a positive planning & evaluation of the nursing staff and their management, employee domains and perceived workplace civility climate (r= 0.310, P < 0.003; r=  0.365, P  < 0.001 r=  0.356, P  < 0.001 respectively). Also, there was a positive correlation between the professional development of the nursing staff and their employee domain (r= 0.228, P < 0.033