Incivility in nursing can take many forms, ranging from subtle behaviors like eye-rolling during shift handoffs to more overt actions such as refusing to help overwhelmed colleagues. In high-pressure clinical environments where communication is critical, even small acts of disrespect can escalate quickly, contributing to medical errors, staff turnover, and burnout. So how can today's nurses effectively respond to this unfortunate reality?
In this article, we'll break down what incivility looks like within the nursing profession and share practical strategies for dealing with it. As a bonus, we’ll also provide a list of resources to assist you in seeking support and answer your frequently asked questions.
What Is Incivility in Nursing?
Incivility in healthcare refers to low-intensity harmful behaviors — both verbal and nonverbal — that show a lack of respect for others and go against the norms of professional conduct. It includes behaviors, words, or actions that breach expected standards of courtesy, often resulting in discomfort, conflict, or hurt feelings.
According to the American Nurses Association (ANA), not all negative workplace behaviors are the same — here’s how incivility differs from related actions:
- Incivility: Rude or discourteous actions that violate professional standards of practice. These behaviors may be subtle and not always intentional, but they are still disruptive to workplace culture.
- Bullying: Repeated, harmful behaviors intended to humiliate, undermine, or cause stress to the recipient. This is deliberate and often persistent over time.
- Horizontal violence: Physically or psychologically damaging actions that occur between colleagues at the same level, creating a hostile or unsafe work environment.
How common is this kind of harmful behavior? Research shows it’s more widespread than many realize — workplace incivility affects roughly 55% of nurses. And it doesn’t always start on the job. One study found that 79% of nursing students reported experiencing incivility during their training, which was strongly linked to higher stress levels.
Examples of Incivility in Nursing
Incivility can happen in many types of interactions — between coworkers, between staff and patients, with patients’ families, or even between students and faculty. To better understand this issue, it helps to look at some common incivility examples in nursing. These behaviors can take many forms, including:
- Accusing: Making unfounded claims against someone without clear proof or context.
- Aggression: Using intimidating or hostile behaviors toward another person.
- Blaming: Placing unfair responsibility on others for mistakes or outcomes.
- Condescension: Talking down to someone or asserting power over others unnecessarily.
- Dismissiveness: Minimizing, rejecting, or ignoring another person’s thoughts, feelings, or contributions.
- Disregarding personal boundaries: Intruding on someone’s personal space, privacy, or time, or failing to respect limits.
- Exclusion: Leaving someone out of decisions, meetings, or social interactions.
- Gossip and rumors: Spreading false or harmful information about others.
- Inequitable workload distribution: Unfairly burdening certain team members with excessive work or responsibilities.
- Micromanagement: Excessively controlling tasks, creating frustration and tension.
- Nonverbal abuse: Eye-rolling, staring, making faces, ignoring, or making dismissive gestures.
- Rudeness: Speaking or acting in a disrespectful, impolite, or discourteous manner.
- Sabotaging: Deliberately creating obstacles or undermining someone’s work.
- Undermining: Intentionally weakening a coworker’s credibility, authority, or confidence.
- Unhelpfulness: Not offering help when asked or needed, leading to difficulties in providing patient care.
- Withholding information: Failing to share important information or updates that affect patient care.
What Causes Incivility in Nursing?
Incivility can arise from a combination of factors. Understanding the causes of incivility can help healthcare organizations and individual nurses implement strategies to prevent and address it, creating a culture of safety that ultimately benefits both staff and patients. Some of the common causes of incivility in healthcare include:
- High levels of stress: The healthcare industry is known for its fast-paced, emotionally charged environment, which can lead to increased tension and frustration.
- Long hours and fatigue: Healthcare workers work long shifts and irregular hours, leading to physical and emotional exhaustion that can contribute to irritability and reduced tolerance for stress.
- Workload and staffing issues: Understaffing and heavy workloads can create a sense of overwhelm, which can lead to frustration and conflicts among staff.
- Hierarchical structure: Hierarchies in healthcare settings can sometimes foster an environment where more senior staff members exert control over or demean junior colleagues (i.e., “nurses eat their young” culture).
- Lack of communication: Poor communication among healthcare team members can result in misunderstandings, lack of support, and, ultimately, uncivil behavior.
- Burnout: Characterized by emotional exhaustion and depersonalization, burnout can make healthcare workers less patient, less empathetic, and more prone to incivility.
- Poor work culture: An unsupportive or indifferent organizational culture can foster incivility.
- Lack of training: Some healthcare professionals may not receive adequate training in conflict resolution, teamwork, and communication skills.
What Is the Impact of Incivility in Nursing?
Incivility in healthcare has a widespread impact, touching on both nurses and patient care. It takes a toll on nurse morale, leading to stress, burnout, and dissatisfaction, which can worsen the nursing shortage. The workplace itself also suffers in several ways, including the following:
- Compromised teamwork: Incivility undermines collaboration, communication, and information sharing among medical teams, reducing overall team performance.
- Lower quality of care: Teams experiencing incivility deliver care of lower quality, with errors in procedures, lapses in protocols, and reduced adherence to safety measures.
- Higher chance of medical errors: Incivility is linked to adverse events, medical errors, and near-misses, directly threatening patient safety.
- Lowered standards across healthcare settings: A workplace culture that tolerates incivility can make disrespectful behavior seem acceptable, weakening care standards system-wide.
Patients can sense a tense or negative environment, which may reduce their trust in the healthcare system and their satisfaction with care. Incivility touches everything in healthcare — from nurses’ well-being to the quality of patient care — making it essential to address and prevent.
How to Deal With Incivility in Nursing
If disrespectful behavior has happened to you — you are not alone. Addressing bullying and incivility requires a concerted effort from nurses individually and healthcare organizations collectively. Here are some strategies you can use to combat these issues:
1. Voice your boundaries: Start by speaking directly with the offender using assertive communication. Share your concerns openly and request that they put an end to their inappropriate actions. If the person doesn’t stop after this conversation, continue with the next items on the list.
2. Document incidents: Keep a record of all instances of incivility at the workplace, including dates, times, locations, individuals involved, and descriptions of the events.
3. Use workplace policies: Familiarize yourself with your organization's anti-bullying policies and reporting procedures, and follow these policies to ensure that established guidelines address your concerns.
4. Report to supervisors: Notify your nursing supervisor or manager about the incivility incidents and request that the issue be addressed.
5. Seek support: Reach out to human resources, employee assistance programs, or a designated department within your workplace to report incidents and get support.
6. Seek legal advice: If the bullying persists and is causing harm, consult with legal counsel or professional associations for guidance on potential legal actions or protective measures that can be taken to ensure your safety and well-being.
Workplace Incivility Resources
Standing up to incivility is scary, but you don’t have to do it alone. There are organizations and support resources that can help you through this stressful situation. Here are some government organizations and resources that can help:
1. U.S. Equal Employment Opportunity Commission
- Website: https://www.eeoc.gov/
- Description: The EEOC is responsible for enforcing federal laws that make it illegal to discriminate against employees based on their protected characteristics, such as race, gender, age, or disability. They provide resources and support for addressing workplace discrimination.
2. Equal Rights Advocates
- Website: https://www.equalrights.org/
- Description: This organization is dedicated to fighting gender discrimination, particularly in the workplace. They offer legal assistance, advocacy, and educational resources to help combat gender-based discrimination.
3. Workplace Bullying Institute
- Website: https://workplacebullying.org/
- Description: The Workplace Bullying Institute focuses on addressing and preventing workplace bullying. They provide information, resources, and support for those dealing with bullying at work.
4. Stop Bullying (U.S. Department of Health & Human Services)
- Website: https://www.stopbullying.gov/
- Description: Stop Bullying is a federal government initiative dedicated to preventing and addressing bullying among children and youth. They provide information and resources for parents, educators, and individuals dealing with bullying.
5. OSHA Worker Rights and Protections
- Website: https://www.osha.gov/workers
- Description: The Occupational Safety and Health Administration (OSHA) enforces workplace safety regulations and provides resources to protect workers' rights and safety. If bullying has escalated to the point of creating workplace violence and safety issues, OSHA may be able to assist.
6. American Nurses Association - End Nurse Abuse
- Brochure: ANA End Nurse Abuse Brochure
- Description: The ANA has resources specifically addressing nurse abuse in the workplace. Their brochure offers guidance on how to combat abuse and promote a healthier work environment for nurses.
7. American Bar Association - Free Legal Help
- Website: https://www.americanbar.org/groups/legal_services/flh-home/flh-free-legal-help/
- Description: The American Bar Association provides resources for free legal assistance and support. If you're dealing with workplace issues such as discrimination, harassment, or bullying that may require legal intervention, they can offer guidance and information on accessing free legal help.
Workplace Incivility Support Groups
Finding a safe environment where you can open up and share your stories of incivility in nursing is very important. Therefore, don't hesitate to seek assistance. You might want to think about joining one of these support groups:
1. Mental Health America Support Groups
- Website: https://www.mhanational.org/find-support-groups
- Description: Mental Health America provides information on finding support groups for various mental health challenges. Support groups can offer a safe space to connect with others who are going through similar experiences.
2. HelpGuide Support Groups
- Website: https://www.helpguide.org/articles/therapy-medication/support-groups.htm
- Description: HelpGuide offers information and resources on the benefits of support groups. They provide guidance on how to locate and participate in support groups that can aid in emotional healing and well-being.
3. Support Groups
- Website: https://supportgroups.ai/
- Description: SupportGroups.ai specializes in offering online support groups for a wide range of mental health challenges, including trauma and abuse. These forums provide a platform for individuals to connect, share experiences, and receive support.
4. In The Rooms Online Recovery Community
- Website: https://www.intherooms.com/home/
- Description: In The Rooms is an online recovery community that offers support for those dealing with addiction and mental health issues. They provide resources, forums, and virtual meetings to connect with others on a journey toward emotional healing and recovery.
These resources are designed to help you find emotional support during challenging times. Whether you're dealing with incivility, bullying, or other difficulties, these support groups and communities can be valuable sources of help and understanding.
Frequently Asked Questions About Incivility in Nursing
What should I do if I experience incivility in the workplace?
Start by documenting what happened, including dates and details. If you feel comfortable, address the issue directly and ask the person to stop. If it continues, bring it to your supervisor. You can also check your organization’s policies for guidance and reach out for support, like a peer group or counselor, to help you through it.
Are there policies or guidelines in place to address incivility?
Yes, many healthcare organizations have policies in place to address this issue. These often outline expected behavior, reporting mechanisms, and consequences for uncivil conduct.
What resources are available for nurses dealing with incivility?
You can access national resources like the ANA and the Workplace Bullying Institute (WBI). Some organizations may also offer internal support, such as employee assistance programs (EAPs), mentorship programs, or confidential reporting systems.
What are the common forms of incivility in nursing?
Common forms of incivility include verbal abuse (like criticizing or dismissing others), nonverbal behaviors (such as eye-rolling or exclusion), passive-aggressive actions (like refusing to communicate), and bullying, which involves repeated negative behaviors such as undermining or withholding information.
When should I consider leaving nursing?
Consider leaving nursing if you consistently experience overwhelming stress, burnout, or health issues, and have exhausted available resources for support and coping. It's a decision that should be made carefully and with consideration of your well-being.
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