Learning to Manage Incivility in Nursing

• The American Nursing Association (ANA) defines incivility in nursing as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them.” 
• Incivility in the workplace can be toxic and detrimental. Feelings of bullying can affect mental health ultimately impacting the quality of care one can provide to patients when they are in an already fragile headspace. 
• It is the responsibility of nurse leaders and administrators to monitor and educate staff on workplace incivility to keep a positive, collaborative nursing environment. 

Incivility in Nursing

The nursing profession is dedicated to helping others. However, the hectic nature of the work environment can lead to stressful situations where emotions boil over and take it out on their colleagues. 

Incivility in nursing is often with violence and bullying, and can be defined as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them” by the American Nursing Association (ANA). 

Incivility in nursing usually progresses on a scale and advances from low risk to high risk. The continuum of incivility moves from disruptive behaviors such as eye rolling, sarcastic comments, bullying, racial/ethnic slurs to more aggressive and potentially violent behaviors like intimidation and physical violence. 

Acts of aggression, whether verbal or physical, from patients, family members or colleagues should not in any way be accepted by anybody.  

These incidents not only have a serious effect on the wellbeing of the nurse in question but also their ability to care for their patients. 

Some of the reasons why new nurses hesitate to report acts of incivility in nursing include: 

• Fear that their manager may ignore or discipline them 
• Nervous that other team members may view them as a negative or a complaining employee  
• Unsure if what they’re witnessing is workplace incivility because they haven’t yet received training to properly identify it  

Incivility in nursing is preventable and is the responsibility of nurse managers to adequately inform existing staff on how to treat new team members. New team members should be trained during their onboarding on how to spot incivility as it occurs and to encourage employees to act respectfully toward each other. 

What Does Incivility in Nursing Look Like?

It is important for every nurse to know what incivility in nursing looks like.  

This makes it easier to be addressed and resolved before they escalate into bullying and possibly physical violence.  

Here are common examples of incivility in the workplace:  

• Acting temperamental and yelling at others  
• Showing up late repeatedly to meetings  
• Being disrespectful to other employees  
• Blackmailing or talking about other employees behind their backs 
• Sabotaging someone’s project or assignment 
• Trying to ruin an employee’s reputation 
• Failing to pay attention during meetings 
• Refusing to respond to emails or calls or purposely responding late 
• Interrupting employees during meetings, presentations or conversations 
• Ignoring employees as they talk 
• Keeping important client or company information from an employee.
  

By promoting a positive atmosphere, training staff on proper prevention methods and establishing clear behavior guidelines for the team, the work environment will be civil and respectful.  

Examples of Incivility in Nursing

Example One

The following conversation ensued between a charge nurse and a new nurse on the floor: 

Charge nurse: “Jane! Have you called back the ED to get report on the new patient coming to room 221? 

Jane: No, I haven’t been able to call back, I am not caught up with medication administration and I have a patient that I need to feed, his NG tube got clogged up and I have been trying to unclog it for the past 45 minutes, can you help me get that report on the new patient? 

Charge nurse: It seems this floor is quite heavy for you to work on, I suggest you brace yourself up because this is just how we flow on the floor, we don’t tolerate laziness! 

Is the above conversation rude or was it just an honest opinion of one’s observation? I really think it is rude. This really happened and not only did the charge nurse address the other colleague that way, she went ahead and told the other floor nurses that the new nurse is lazy to work and how she wouldn’t just do anything on her own except someone helps her out. 

Example Two

Sarah: Hi Lee, can you help check if I put in this medication order correctly? My patient in room 715 keep asking for pain killers, I have told the doctor and he gave me a verbal order with readback and I just put it in, so can you please check if the order is correctly put in? 

Lee: Oh no, Sarah, don’t you think you should go get a refresher course on medication orders and administration of opoids? You can also buy the book, “medication administration for dummies”, I think it will help you out.

Ways to Manage Incivility in Nursing

Listed below are some ways to ameliorate incivility in nursing: 

Staff Should Be Positive and Respectful to Others

Staff often follow the examples set by their leaders and that encourages them to do the same. Once civility and kindness are shown to all staff equally, they’ll feel more comfortable in the workplace and enjoy collaborating with each other.  

No Excuses

Some nurses ride on the fact that they are impressive in their role, they can get away with acts of incivility in nursing. This is often fostered by the managers when they give preferential treatment to such staff.  

If an employee comes to a manager with incivility in nursing concerns, it’s the responsibility of the nurse manager to address it. If the employee still refuses to act civil in, consider hiring a new team member with a more positive attitude.  

Conflict Resolution

If employees are regularly disagreeing and putting each other down, meet with them to find ways to solve their issues with one another.  

Urge them to take conflict resolution training classes or consider hiring someone trained in these skills to effectively help with the resolution of the problems.  This helps your employees better understand how to maturely and professionally resolve problems. 

Establish Expectations

Setting clear rules and guidelines for how employees should act towards each other makes it easier for them to follow and reference. Write down the standards for behavior and list what is and isn’t acceptable in the workplace.  

Schedule meetings with employees at intervals and clearly communicate these guidelines to them and constantly remind them to make civility a core value to follow. Encourage employees to act respectful and courteous toward one another. 

Pay Attention

As a manager, it’s important to observe how employees interact with each other. Try to spend time working closely with your team, rather than sitting in the office for extended portions of the day. This helps you realize how your employees act and shows them you are paying attention.

Listen

Develop a safe and open environment for employees to confidently speak up about concerns or issues they’re facing. This helps them feel more relaxed and comfortable reporting any incivility they experience with other employees.

Promote constructive feedback among employees to show them the proper way to act around each other when it comes to listening and providing positive and constructive input to their team members.  

The Bottom Line

Create awareness on workplace incivility and the signs to look out for. Hold training sessions to educate employees and teach them what to do when it happens at work.  

Provide clear definitions and examples to accurately explain what it is. Increasing your employees’ awareness helps will help the nurse manager and other nurses stop incivility once it occurs and will always let team members prevent it from happening again.

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