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Definition
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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