Decreasing Incivility in Med Surg Through Education

Project Topic:

Incivility

Hospital, City and State:

Boston Medical Center, Boston, Massachusetts

Units:

• 7 East Medical/Surgical Renal
• Family Medicine Unit

CSI Participants:

• Jaceline Fianza, BSN, RN
• Nneka Nwokeji, BSN, RN
• Yetunde Oyenuga, BSN, RN
• Zandra Williams, BSN, RN

Project Goals/Objectives:

1. Reduce incivility scores by 20% as measured by the Nursing Incivility Survey (NIS)
2. Increase Skilled Communication from 3.47 → 4.00 (≈15%) as measured by the Healthy Work Environment Assessment Tool (HWEAT)
3. Reduce unplanned absences 10% compared to baseline (Sept 2024–Mar 2025)
4. Reduce staff turnover 10% on 7 East
5. Achieve ≥80% staff participation in interventions

Project Outcomes:

1. 7 out of 8 NIS items showed improvement or remained stable post-intervention
2. Decreased HWEAT Skilled Communication score from 3.47 to 3.38
3. Reduced unplanned absences 10% compared to the baseline period
4. Decreased staff turnover greater than 10% on 7 East, exceeding the target goal
5. Achieved ≥80% of staff participation in interventions
6. These outcomes resulted in a positive estimated annual fiscal impact of $311,766.

Project Overview:

This nurse-led project occurred on the 36-bed Medical/Surgical, Renal and Family Medicine unit (7 East) at Boston Medical Center. The purpose of this project was to reduce incivility on 7 East and emphasize its negative effects on staff morale, nurse turnover and productivity, while developing educational strategies to help staff identify, prevent and address incidents of incivility. The project aimed to promote a healthy work environment through targeted staff education and skilled communication training, while also examining the fiscal impact of incivility on the health system.

The team utilized the AACN Healthy Work Environment Assessment Tool (HWEAT) (AACN, 2025) and the Nursing Incivility Survey (NIS) to evaluate pre- and post-intervention efforts. Pre-intervention survey results confirmed that incivility was affecting the unit's work environment. Between January and March 2026, the team implemented an evidence-based staff education program drawing on the work of Dr. Renee Thompson, DNP, RN, FAAN, an internationally recognized expert on eradicating workplace bullying and incivility. Interventions included Dr. Thompson's videos shown at huddle to introduce and define incivility, followed by focused group and anonymous one-on-one sessions to identify incivil behaviors experienced on the unit. The program was complemented by healthy words posters and daily reminders to reinforce positive communication norms, as well as Unit-Based Council (UBC)-led staff recognition initiatives, including a "shout-out board" and peer recognition emails, to foster a culture of appreciation and positive peer interaction. The team achieved ≥80% of staff participation across all interventions.

While the team did not meet their goal of improving the HWEAT Skilled Communication score from 3.47 to 4.00, the post-intervention score of 3.38 reflects near-stability in collaborative practice and suggests a foundation for continued growth. The project successfully reduced unplanned absences by 10% compared to the baseline period (September 2024–March 2025) and decreased overall RN turnover by more than 10% on 7 East, dropping from 8 RN departures during the pre-intervention period to 5 during the post-intervention period. These workforce improvements reflect a meaningful positive shift in staff behavior, engagement and unit culture.

The team assessed the financial impact of incivility through tracking overall RN turnover and unplanned absences. Using a national cost of turnover of $61,100 per RN and an average hourly wage of $61.98, the project yielded $274,950 in annualized cost savings from reduced turnover and $36,815 from reduced unplanned absences, for a total annualized cost savings of $311,766.