1. Alexander, Mary MA, RN, CRNI(R), CAE, FAAN

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Care and caring are the first descriptive words that come to mind when the public thinks of nurses.1 Nursing is often referred to as "the caring profession."1 As nurses, our professional life centers on what's in the best interests of our patients, as we work to provide quality and compassionate care.

Mary Alexander, MA, ... - Click to enlarge in new windowMary Alexander, MA, RN, CRNI(R), CAE, FAAN, INS Chief Executive Officer Editor,

Increasingly, however, attention has focused on how nurses themselves are being treated. In a profession committed to the health and well-being of patients, incivility, bullying, and violence have become a serious issue in nursing, with "incivility and bullying widespread in all settings."2 Such behavior, whether verbal or physical, not only harms the nurse who is the object of the abuse, but also impairs his or her ability to care for patients.


The American Nurses Association (ANA) Position Statement on Incivility, Bullying, and Workplace Violence requires that all "nurses...create an ethical environment and culture of...kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect."3(p1) It focuses particularly on the "individual and shared roles and responsibilities of registered nurses and employers to create and sustain a of incivility, bullying, and workplace violence."3(p1)


ANA's revised Code of Ethics for Nurses with Interpretative Statements4 reiterates that requirement, stating "nurses must be afforded the same respect and dignity as others...(and that) best practice strategies based on evidence must be implemented to prevent and mitigate incivility, bullying, and workplace violence; to promote the health, safety, and wellness of registered nurses... ."4(p4)


Although we may know it when we see it, how are incivility and bullying defined? Incivility can "take the form of rude or discourteous or disrespectful actions, of gossiping and spreading rumors, and of refusing to assist a coworker. ... (it) may also include name calling, using a condescending tone, and expressing public criticism."3(p2)Bullying involves "unwanted harmful actions intended to humiliate, offend, and cause distress in the recipient. ...(and) may include...hostile remarks, verbal attacks, threats, taunts, intimidation, and withholding of support."3(p3)


These behaviors can occur laterally, between 2 individuals at the same professional level, as well as vertically, when the behavior is directed toward a subordinate. As nurses, we need to be aware of how these behaviors are demonstrated. They may be verbal, such as disparaging remarks, or nonverbal, such as eye rolling.


What can we all do to support a respectful, collegial, and productive workplace? Start by modeling the behavior you want to experience in your workplace. Treat those around you in the way you want to be treated, and encourage colleagues to do the same. Strive for clear, effective, and professional communication. If your workplace does not have policies that address professional behavior, discuss developing written policies that will delineate and support a respectful environment. Seek the support of key leaders. Review policies from other organizations as part of this process, and advocate for policies that are right for your workplace.5


We all need to consider what is and what isn't acceptable behavior to promote our individual and collective professional health and well-being. Work environments that support positive behaviors enable all of us to perform at the peak of our profession, experience the professional satisfaction we seek, and minimize the potential for burnout and compassion fatigue.6


At a time when skilled, competent, and caring nurses are needed to address the health of our nation, we can't afford to have nurses leaving the profession because they are being bullied, instead of being appreciated. If nursing is indeed a caring profession, let's be sure we're also caring toward one another.




1. Nurses: a 'caring' profession or are we so much more? allnurses website. Accessed August 31, 2018. [Context Link]


2. American Nurses Association. Violence, incivility and bullying. Accessed September 5, 2018. [Context Link]


3. American Nurses Association; Professional Issues Panel on Incivility, Bullying and Workplace Violence. American Nurses Association position statement on incivility, bullying, and workplace violence. Published July 22, 2015. Accessed August 31, 2018. [Context Link]


4. American Nurses Association. Code of Ethics for Nurses with Interpretative Statements. Silver Spring, MD: 2015. Accessed September 5, 2018. [Context Link]


5. American Nurses Association. Toward civility. Accessed September 5, 2018. [Context Link]


6. Miller-Hoover S. Incivility in healthcare: how we can change the culture. Published 2016. Accessed August 31, 2018. [Context Link]