Lippincott Nursing Pocket Card - January 2022

Workplace Incivility

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Introduction

Workplace incivility is an experience that many health care professionals are familiar with. Also referred to as horizontal violence or nurse bullying, 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.

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Definition

The American Nurses Association (ANA) (2019) has defined incivility as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them.”  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.”
 
Forms of workplace incivility include (McNamara, 2012):

  • Verbal abuse (i.e., gossiping, shouting, or swearing)
  • Nonverbal abuse (i.e., eye rolling, making faces, excluding another from conversation)
  • Passive-aggressive behavior (i.e., refusing to communicate, sabotaging a coworker)
  • Bullying (i.e., accusing a coworker of someone else’s error, assigning unfavorable work, expressing untrue critique)

Key Clinical Considerations and Outcomes

Incivility impacts patient care, and any form of workplace incivility is unacceptable. The culture of workplace incivility can lead to:
  • Jeopardized patient safety
  • Diminished teamwork
  • Medication and/or medical errors
  • Upsurge in sentinel events
  • Increased patient mortality
  • Reduced quality patient care
  • Lower morale and productivity
  • Absence from work
  • Greater staff turnover
  • Adverse effect on organization’s reputation
  • Destruction to the nurse/patient relationship

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

Overall, organizations should develop a zero-tolerance policy for workplace incivility. These behaviors should be well defined and outlined. 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 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.
  • 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.

Education

If workplace incivility is tolerated, negative behaviors continue and become common place in the work environment. All team members in an organization should be educated on appropriate professional behaviors that align with their code of conduct. Both nurse leaders and staff must be able to identify it, take it seriously, and stop the behavior in its tracks. 
References:
American Nurses Association (ANA). (2019). Violence, incivility, & bullying. https://www.nursingworld.org/practice-policy/work-environment/violence-incivility-bullying/
 
American Nurses Association (ANA). (2015). American Nurses Association position statement on incivility, bullying, and workplace violence https://www.nursingworld.org/~49d6e3/globalassets/practiceandpolicy/nursing-excellence/incivility-bullying-and-workplace-violence--ana-position-statement.pdf
 
American Organization of Nursing Leaders (AONL) and Emergency Nurses Association (ENA). (2014). Guiding principles on mitigating violence in the workplace. https://www.aonl.org/system/files/media/file/2020/12/Mitigating-Workplace-Violence.pdf
 
 
McNamara S. A. (2012). Incivility in nursing: unsafe nurse, unsafe patients. AORN journal, 95(4), 535–540. https://doi.org/10.1016/j.aorn.2012.01.020
 
The Joint Commission. (2021). The Joint Commission Sentinel Event Alert: Behaviors that undermine a culture of safety.
https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea-40-intimidating-disruptive-behaviors-final2.pdf
 
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. https://doi.org/10.1080/02678373.2016.1175524