Recognize and Respond to Incivility in Nursing

March 22, 2019

By Ruth Frankenfield, MS, RN, PMHCNS

Five years ago, I was consulted, as a mental health clinical nurse specialist, by a nurse manager seeking assistance in determining an appropriate response to a bullying situation on one of her units. That was the first time I learned that our profession has a longstanding and significant problem with incivility and bullying from within.

What the Research Tells Us

Incivility is any rude or disrespectful behavior toward another with or without the intent to harm. It’s not uncommon for individuals to be completely unaware of the impact of their negative remarks. Bullying, on the other hand, is consciously repeated aggression with intent to inflict emotional pain ( and harm. Both incivility and bullying have the potential to leave individuals feeling humiliated, isolated, fearful and anxious. Burdened with such negative feelings impairs attention to detail and puts them at risk of making clinical errors ( In a work environment hampered by fear and lack of trust, communication and teamwork, which are vital to good patient care and safety, are significantly impaired.

Acts of incivility ( include name calling, criticizing, intimidating, gossiping, blaming, insulting, making unfair assignments, refusing to help, sabotaging, making lewd and demeaning gestures or facial expressions, or diminishing an individual’s reputation.

One of the major reasons that incivility in nursing has been tolerated for so long is that confronting the behavior can be difficult and frightening. However, it’s crucial to find the courage and means to do so for two reasons: First, it’s important to raise awareness of the impact of uncivil behavior and it’s unacceptable. Second, confronting harmful behavior helps to shift from feeling victimized to feeling empowered; it helps to re-establish a sense of personal and professional integrity.

How to Practice

A strategy that has proven to be a manageable and successful tool for navigating difficult conversations is the DESC model of assertive communication developed by Bower and Bower (1991) (see sidebar). 

Prepare for the possibility that the conversation may not go well; if that happens, simply state, “I’d hoped that our conversation would go better than it has. If you continue to speak with me this way, I’ll need to decide what additional steps I need to take.” Consider talking with your manager about what’s occurred, providing specific details of what happened and your effort to address it. 

Addressing incivility in nursing is a challenge for all of us, both individually and professionally. However, with knowledge, practice, and courage we can ensure more respectful and compassionate work environments. 

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