1. Perregrini, Michelle MSN, RN, NPD-BC, CAPA, CPAN

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The American Nurses Association (ANA) describes incivility as one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them. The ANA defines bullying as repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient. In an ANA survey of workplace bullying and aggressive behaviors between February 2017 and May 2018, 29% of 9,117 nurses and nursing students reported experiencing verbal or nonverbal aggression from a peer during the past year, and 22% from a person in a higher level of authority. The literature is consistent regarding the impact of incivility: increased staff turnover and callouts, decreased retention, and declining staff mental health. Furthermore, the significance of incivility affects the care and safety of patients when nurses fear approaching uncivil coworkers with questions or for assistance.

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It's been suggested that nurse-to-coworker incivility is associated with the healthcare work environment. Organizational factors that contribute to incivility include hierarchical management, high stress, and conflicting loyalties between staff and patient needs. Positive organizational characteristics, such as authentic leadership and structural empowerment, are associated with reduced coworker incivility. A quantitative cross-sectional study of 3,500 nurses found that the nurse work environment was significantly inversely associated with coworker incivility. So, what can we do to combat incivility in our workplaces?


Recognizing your own behavior is integral to making positive changes to workplace culture (see Uncivil behaviors: Are you at risk?). Think about your unit's culture and try to self-identify whether you're actively involved in verbal or nonverbal communication that has the intention to intimidate, threaten, demean, or insult. A change in practice may be achieved by realizing how your verbal and nonverbal messages are being received and whether you should consider alternate forms of communication. It may also be helpful to explore how uncivil behavior is role-modeled during nursing school and orientation. Let's take a closer look.


In the classroom

Researchers have explored the concept of incivility in the classroom setting, noting that many educators and students may not find uncivil behaviors, such as acting disinterested or dominating discussions, to be disruptive. This may be construed as reinforcing negative behavior, enabling students to conduct themselves similarly in the professional practice setting.


Students may also be exposed to uncivil behavior from their educators, empowering them to behave comparably with their coworkers and orientees. Examples of educator behaviors considered to be uncivil include not allowing open discussion, acting disinterested or cold, or belittling or taunting students. In addition, students may observe educator behavior that perpetuates hierarchies, such as favoring or only calling on select students and coercing students into scenarios that don't align with a positive learning experience.



Consider your own orientation and the behavior of your preceptor at the time. Recall if you felt that the environment was safe for learning or whether your preceptor seemed intimidating. For example, "You should be doing this on your own by now, that was how I learned."


The period of orientation is one of intense vulnerability. As they continue to hone their clinical skills, orientees are also looking to their preceptor as a role model to demonstrate proper unit etiquette and professional interactions with other caregivers. If orientees observe that uncivil behavior, such as rolling eyes at a coworker's response or complaining about his or her practice, is accepted on the unit, they may perpetuate that behavior.


Unit culture

When nursing students are on your unit, is the general feeling that students aren't welcome? Reflect on your own clinical rotations during nursing school. If you were treated as a nuisance, what impression did that leave on you or your fellow students? As you discussed your day with your clinical instructor during your postconference, were you inclined to share your observations of how the nurses received students or did you perhaps assume it was part of the expected culture?


Students are in a vulnerable position in that they're eager to gain acceptance, nervous about approaching a professional nurse, and may in some cases be less inclined to call attention to uncivil behavior.


Conflict management

Take into consideration your interactions with feedback. Do you counter feedback in a defensive way, or do you listen objectively and contemplate your level of responsibility for the behavior noted in the feedback? Ideal approaches to feedback include listening to the full account and responding in a clear, neutral, and nonescalating tone. Examples include, "I'm hearing what you're saying. Can you elaborate on this? Can you provide an example? What are some ways I can work on this?"


Think back to the last time you were involved in a handoff report with another nurse who had less than favorable communication techniques. Recall if you or the other nurse interrupted frequently or if there was passive-aggressive commentary regarding lack of tasks completed. Then acknowledge if you continued to comment on this to other nurses on your unit. If you were in the position of a preceptor, consider if you afforded time to practice a handoff report that included a review of respectful communication in addition to the clinical information.


Leadership's responsibility

The role of leadership is integral in recognizing and addressing uncivil behavior. New nurses may participate in a standardized lecture on incivility in the workplace and how frontline staff should respond when it occurs. However, as a new leader transitions into nursing management, there may be a lack of formalized training regarding their role in coworker incivility.


Other factors that may hinder a nurse manager's ability to recognize or proactively intervene with nurse-to-coworker incivility include the level of work stress and difficulty with work-life balance. Hospital administrators should support nurse managers in monitoring, evaluating, and addressing staffing and resource adequacy as a strategy to decrease coworker incivility among nurses.


Leading the charge

The concept of leading the charge against workplace incivility is a complex one. Nurse leaders themselves may be aligned with an uncivil employee, and it's difficult to stand up to fellow nurses who've contributed to a toxic environment over the years. In its position statement "Incivility, Bullying, and Workplace Violence," the ANA notes that it's the responsibility of both employers and nurses within clinical and academic settings to maintain workplace cultures in which incivility, bullying, and violence aren't tolerated. Employers have a legal, ethical, and moral responsibility to create safe work environments that are conducive to the health and well-being of nurses, other healthcare team members, and patients and their families.


Nurses are in a prime position to change workplace culture by exhibiting positive role model qualities such as mentoring new nurses, calling out negative behavior, and engaging in constructive communication to resolve conflict when incivility occurs (see Cultivating civil behavior). Recognizing verbal and nonverbal uncivil communication is fundamental to changing behavior. During your next staff meeting, consider suggesting an opportunity to work on communication techniques that contribute to a healthy work environment. Reach out to your human resources partners, unit practice committees, or nursing education specialists to assist with available courses and unit-specific role-playing scenarios to support your unit's journey to zero tolerance for incivility.


Uncivil behaviors: Are you at risk?


* Rolling your eyes as a nonverbal disparagement


* Deflecting blame when attention is called to your uncivil behavior


* Countering a conflict resolution discussion with aggressive speech


* Vaguely referring to other coworkers to argue your point, without the presence of the coworkers being there to affirm


* Immediately responding to a suggestion with a negative response


* Having side dialogues during professional meetings


* Engaging others in criticism of a colleague with whom you're having a conflict




American Nurses Association. Incivility, bullying, and workplace violence. 2015.


American Nurses Association. Violence, incivility, and bullying.


Clark CM, Springer PJ. Incivility in nursing education: a descriptive study of definitions and prevalence. J Nurs Educ. 2007;46(1):7-14.


Grant E. Incivility and bullying. American Nurse. 2019.


Green CA. Workplace incivility: nurse leaders as change agents. Nurs Manage. 2019;50(1):51-53.


Layne DM, Anderson E, Henderson S. Examining the presence and sources of incivility within nursing. J Nurs Manag. 2019;27(7):1505-1511.


Meires J. Workplace incivility--the essentials: here's what you need to know about bullying in nursing. Urol Nurs. 2018;38(2):95-98.


Smith JG, Morin KH, Lake ET. Association of the nurse work environment with nurse incivility in hospitals. J Nurs Manag. 2018;26(2):219-226.