Lippincott Nursing Pocket Card - January 2024

Workplace Incivility



Also referred to as horizontal violence or nurse bullying, workplace incivility in nursing can contribute to consequences varying from work absenteeism to medical errors. Incivility should not be tolerated nor accepted in the professional workplace.



The ANA Position Statement (2015) on incivility states that nurses must make “a commitment to – and accept responsibility for – establishing and promoting healthy interpersonal relationships with one another.” The 2015 position statement and 2023 Magnet Application Manual include the following definitions (Meyers, Evans & Erickson, 2021):

  • Bullying: harmful acts intended to humiliate, undermine, offend, and cause stress to the recipient.
  • Horizonal violence: physically and psychologically damaging actions that happen in the workplace.
  • Incivility: rude and discourteous actions that violate professional standards of practice.

Incivility can occur between co-workers, staff and patients, staff and patient’s families, as well as students and faculty. Forms of workplace incivility include (Harris-Haman, 2023; Kisner, 2018):

  • Verbal abuse: publicly criticizing a coworker, using a condescending tone, gossiping, shouting, swearing, name-calling, or making threats
  • Nonverbal abuse: eye rolling, staring, making faces, excluding another from conversation
  • Passive-aggressive behavior: refusing to communicate, refusing to perform assigned tasks, sabotaging a coworker
  • Bullying: repeated negative actions by one person towards another and can include any of the above as well as social manipulation, insulting comments, aggressive behaviors, withholding information, failure to respect privacy, accusing a coworker of someone else’s error, assigning unfavorable work, or expressing untrue critique.

Key Clinical Considerations and Outcomes (Meyers, Evans & Erickson, 2021)

Any form of workplace incivility is unacceptable and has many adverse affects including:
  • Jeopardized patient safety
  • Negative impact on patient care
  • Diminished teamwork, communication, and department-level shared decision making
  • Medication and/or medical errors
  • Upsurge in sentinel events
  • Increased patient mortality
  • Reduced quality patient care
  • Higher cost of care
  • Decreased patient satisfaction
  • Lower morale and productivity
  • Absence from work
  • Reduced nursing engagement and greater staff turnover
  • Adverse effect on organization’s reputation
  • Destruction to the nurse/patient relationship
In addition, workplace incivility has been linked to higher rates of chronic illness, weight gain, social isolation, and substance abuse among healthcare providers.

Risk Factors (Torkelson, et al., 2016)

Factors that can contribute to incivility include:
  • Alterations in the work environment
  • Organization changes
  • Lack of educational training and accountability
  • Stressful patient workloads
  • New technologies for communication
  • Poor leadership or delegation
  • Lack of teamwork
  • Ineffective patient hand-offs
  • Time constraints/deadlines

Steps to Address Incivility

In an effort to decrease adverse events due to workplace incivility, organizations should develop a zero-tolerance policy. These behaviors should be well defined and outlined and the policy could include the penalty ensued for each infraction (i.e., verbal warning for first offense, written warning for second offense, leave without pay for third offense, and finally termination). The Human Resources department can also be of assistance with developing and enforcing a policy. 
Other suggestions include:
  • Refer to the American Organization for Nursing Leadership (AONL) and Emergency Nurses Association (ENA)’s Guiding Principles on Mitigating Violence in the Workplace (2014), created to assist leaders in developing measures to diminish violence against health care professionals.
  • Commit to the Joint Commission Sentinel Event Alert (2021) on Behaviors that undermine a culture of safety, which states, “Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.”
  • Develop educational programs for all members of the organization on this topic and discuss ways to advance communication skills and enhance team building. Key elements include building trust, clarifying roles, engaging staff in decision-making, and modeling positive interactions (Kisner, 2018).
  • Promote a culture of civility and staff empowerment.
  • Utilize simulation to identify ways incivility can damage patient care and ways in which the matter can be resolved.
  • Develop a committee to battle this epidemic and help create solutions for the organization at large.


Negative behaviors will continue and become common place in the work environment if workplace incivilitiy is tolerated. All team members within an organization should receive education on appropriate professional behaviors that align with their code of conduct. Both nurse leaders and all staff should be able to identify it, take it seriously, and stop the behavior in its tracks. 
American Nurses Association (ANA). (2019). Violence, incivility, & bullying.
American Nurses Association (ANA). (2015). American Nurses Association position statement on incivility, bullying, and workplace violence.
American Organization of Nursing Leaders (AONL) and Emergency Nurses Association (ENA). (2014). Guiding principles on mitigating violence in the workplace.

Harris-Haman P. (2023). Incivility and Microaggressions. Advances in neonatal care : official journal of the National Association of Neonatal Nurses23(3), 201–202. 

Kisner, T. (2018, June 18). Addressing workplace incivility. Nursing Critical Care 13(6):p 24-29.  

Meier, A., Evans, R., & Erickson, J. I. (2021). Strengthening a Culture to Address Bullying and Incivility in the Care Environment. The Journal of nursing administration51(10), 475–477.
The Joint Commission. (2021). The Joint Commission Sentinel Event Alert: Behaviors that undermine a culture of safety.
Torkelson, E., Holm, K., Bäckström, M., & Schad, E. (2016). Factors contributing to the perpetration of workplace incivility: the importance of organizational aspects and experiencing incivility from others. Work and stress, 30(2), 115–131.