1. Park, Chan W. MD, FAAEM
  2. Holtschneider, Mary Edel MEd, MPA, BSN, RN, NPD-BC, NREMT-P, CPTD

Article Content

Our current series on microaggressive behavior in the interprofessional learning environment has generated much interest from readers over the past several months. We have gotten a variety of questions and comments regarding the effects of microaggressions on the workplace as a whole, as these effects often have far-reaching impact beyond the individuals who are initially exposed. We are pleased to report that many of our readers have expressed relief that this topic is finally getting more attention.

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In this column, we will highlight several real-life examples from our readers of the subtle, harmful effects of tolerating microaggressive behavior and comments in the workplace and explore a few practical suggestions on how to use the "six mindfulness strategies" to mitigate these effects, particularly in the interprofessional learning environment.



When we explore negative workplace behaviors such a microaggression, incivility, and bullying, we all know anecdotally that individuals respond differently to these behaviors based on a variety of factors. Certainly, what bothers one individual might not bother someone else, though no negative behaviors should be tolerated. In their study on workplace negative behaviors, Pearson and Porath (2013) surveyed 800 managers and employees from 17 different industries and found the following individual reactions. Though these percentages are individually focused, they have broader implications for the larger workplace environment:


As we spoke with readers who have shared personal stories of microaggressive behavior directed at them, many validated that they experienced one or more of the above "reactions." TS from the Northeast shared how a newer member of her team would make indirect comments toward her, suggesting that she "lacked knowledge as to what was really happening in the clinical setting." Though these comments were subtle, they were deeply hurtful, and TS described how she eventually had to confront the person making these comments. In looking at the above "reactions," she admitted to losing time worrying about the situation and avoiding the person. Such reactions can negatively impact the interprofessional learning environment and the productivity of the team as they can get in the way of positive communication and collaborative efforts, even though these effects are difficult to quantify.

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RL from the Southwest validated that she sometimes spends excessive time thinking about negative interactions in the workplace, even though she knows that it would serve her better if she could refrain from dwelling on these incidents. When we spoke with her on the phone, she shared her perspective involving a situation of mistaken professional identity. Here is what she shared:


Before I became a nursing professional development (NPD) practitioner, I remember taking care of an elderly patient in the surgical ICU when a colleague, a physician assistant, entered the room to help care for the patient's needs. Appreciating the care rendered to her husband, the wife asked her, "Are you also a nurse?" My colleague politely responded, "No, I am the physician assistant." However, as she walked out of the room, I heard her mutter under her breath, "Oh my. I cannot believe she thought I was a nurse. I studied hard to become a physician assistant." She appeared as if she was offended by the mistaken professional identity. The physician assistant went on to angrily remark, "Not all females are nurses!"


RL noted, "Upon hearing the comment, I could not help wonder, did my colleague feel insulted by being asked if she was a nurse?" RL admitted that she did not have the tools at the time to appropriately handle this situation. RL told us how proud she is to be a nurse and could not understand why anyone would take offense at being mistaken for such an esteemed profession.


As we delved into this deeper with RL, we discovered that some nonnurse healthcare professionals interpret being mistaken for a nurse as a form of microaggression. RL told us, "Nursing gets voted the most trusted profession in this country every year. I am proud of my work!" We could not agree more with RL. Is it possible that there are many layers involved in microaggressive comments, behaviors, and attitudes? Is it possible that a female nonhealthcare professional actually does respect nurses yet might also feel that she is being stereotyped because she is female? Perhaps it has nothing to do with being a nurse or not being a nurse but more to do with gender-based stereotyping and attitudes. Nevertheless, if we do not recognize these miscommunications and talk about them, we risk harming interprofessional collegiality.



Another reader, JT from the Midwest, shared his thoughts about our May/June 2021 column. He explained,


I really appreciated your discussion involving the use of unequal titles in the healthcare setting. It's interesting how some persons are afforded a title while others are simply referred to by their first name. I was taught by one of my nursing school instructors to refer to everyone deferentially (patients, family members, visitors, employees) by a title until directed otherwise. I call everyone Mr., Ms., Dr., or whatever their salutation is.


JT continued on to explain that he finds it personally uncomfortable to be in situations when some people are referred to by a title whereas others are referred to by first name. As JT explains,


I have even been in situations where one physician is called Dr. while another physician is called by first name, and doctorate nurses are referred to by title while nondoctorate nurses in high management positions are referred to by first name! I think the interprofessional work environment is an ideal place to elevate the value of each participant by flattening the hierarchy. At minimum, in the interprofessional work environment, we should strive to achieve consistency in how we refer to one another, such as consistently using first name or consistently using title. The goal is to confer professional respect to everyone in the interprofessional workplace.


These comments from our readers are so encouraging as they seek to reevaluate various societal norms with the intent to promote respect, equity, and diversity in the interprofessional learning environment. We hope that our community of NPD practitioners continues to be curious about these subtle interactions that have become commonplace in our healthcare workplaces yet might be hindering optimal interprofessional respect and collaboration.



As with many of our readers, we too wish we could develop an innovative training curriculum that could remove negative behaviors from our culture all together. As NPD practitioners, we are change agents and work to "transform processes[horizontal ellipsis]through inspiration, initiation, adoption, and sustainment" (Harper & Maloney, 2016). Approaching this issue from the change agent role, we have developed and previously written about our "six strategies for mindfulness" to equip our learners with practical tools that are easy to remember and put into practice in the busy work environment.


In the past, these strategies have proven useful to our learners to help improve resiliency and to reduce burnout. We believe the same strategies can be used to help mitigate the harmful impact of microaggressive behaviors and comments encountered in the interprofessional learning environment, including those described by our readers in this column. Perhaps these strategies will be of great benefit to you when confronted by potentially negative interaction:


1. Pause: Stop, reflect, and avoid any immediate retaliatory action. Avoid returning insult or unkind act, which is a natural primal survival instinctive behavior. Remember that you cannot jump to conclusions about the other person's intent. Indeed, that person may have no idea that what they said was hurtful or caused any harm. In fact, they may respond to your strong emotional response with confusion and resentment.


2. Breathe: Take 6 seconds to breathe deeply. This will aid the mind to restore calmness. During this time, allow the mind to rest. These 6 seconds will be key to allowing the cortisol and norepinephrine released by the amygdala (fight or flight response center) to dissipate. Your pulse and respiration will slow down. The effect of the norepinephrine will begin to wane. Hopefully, the survival instinct and reflexive behavior will give way to a more rational and measured response controlled by the executive functions of the prefrontal cortex.


3. Identify your emotion: Name your emotion and allow yourself to feel that emotion. What specific emotion are you feeling right now? For example, if the emotion is one of disapproval/remorse, then what is the intensity level? Is it pensiveness, sadness, or grief? If the emotion is one of contempt/aggressiveness, then what is the intensity level? Is it annoyance, anger, or rage? If the emotion is one of submission/awe, then what is the intensity level? Is it apprehension, fear, or terror? Because intensity levels can range widely within a given emotion, the ability to identify and manage this range is imperative (Six Seconds Emotional Intelligence Network, 2020).


4. Recognize the opportunity between stimulus and response: Take a moment to realize that you have the power to change the course of action by how you choose to interpret the situation. Recognizing that you possess the full capability to determine how you wish to respond to the perceived negative interaction can be tremendously empowering. It reminds you that you hold the power to exercise judgment and delivery of your response. Be careful to avoid placing external blame or labeling the other person as "rude," "mean," or "disrespectful." They may be unaware of the impact of what they said and the fact that it was hurtful to you.


5. Choose how to respond mindfully: Accept the situation as it happened and make a conscious effort to handle it appropriately. Perhaps the situation would benefit from seeking clarification for either the spoken words or behavior witnessed. Perhaps the situation allows for the person who experienced the microaggression to explain how the comments or behavior made them feel and the reasons behind it. Although we know that responding in this manner requires a great deal of effort, bravery, and humility, the end result may be a profound change in the dynamics of the relationship between the two parties.


6. Respond: After consciously considering how to best handle the situation, take action and respond in a measured manner. This requires deliberate practice and a lifelong commitment to respectful dialogue. When done well, this type of response often invites an opportunity for open dialogue that conveys your desires to restore the relationship from the strain that it just experienced.



Given these steps, how can NPD practitioners integrate this into daily practice? One way is to role model this behavior ourselves so that others can see its positive impact on the interprofessional learning environment. Sometimes role modeling is not always apparent, so being able to articulate this behavior and demonstrating deliberate practice is also paramount.


We invite you to continue this dialogue with us by sharing your experiences with microaggressive behavior and how it has affected you, the interprofessional learning environment, and those around you. How have you been tackling these tough questions? What have you learned about yourself and/or others when you have committed to implementing the "six mindfulness strategies," instead of instinctively reacting to perceived negative interactions? Have you mindfully talked with individuals about your perceptions and strived to understand theirs? Please e-mail us at and to discuss further.




Harper M., Maloney P. (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Association for Nursing Professional Development. [Context Link]


Pearson C., Porath C. (2013). The price of incivility. Harvard Business Review, [Context Link]


Six Seconds Emotional Intelligence Network. (2020). Plutchik's wheel of emotions: Exploring the emotional wheel. [Context Link]