Incivility in Healthcare: How We Can Change the Culture

By Suzan Miller-Hoover, DNP, RN, CCNS, CCRN, Contributor
Incivility in Healthcare: How We Can Change the Culture
Regardless of what we call it, incivility, bullying and/or lateral violence exists in nursing and we need to figure out how to end it. Unfortunately, the problem can be found in nurses working across all areas of practice. Perhaps most damaging is the fact that nurses have been role modeling this behavior in full view of student nurses (the future stewards of our profession!)

In a 2006 survey conducted by the American Association of Critical-Care Nurses (AACN), 24.1% of respondents stated they had been verbally abused by a peer (Luparell, 2011). This is not a phenomenon exclusive to the nursing profession; research shows that all professions are experiencing an increase in incivility. In a January-February 2013 Harvard Business Review article, researchers found that 98% of respondents, including lawyers, architects, coaches and physicians, reported experiencing uncivil behavior at work (ANA, 2016).

The increase in incivility has resulted in the American Nurses Association (ANA) revising the Code of Ethics for Nurses with Interpretive Statements to state that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect. Similarly, nurses must be afforded the same level of respect and dignity as others. Thus, the nursing profession will no longer tolerate violence of any kind from any source. All registered nurses and employers in all settings, including practice, academia, and research must collaborate to create a culture of respect, free of incivility, bullying, and workplace violence. Best practice strategies based on evidence must be implemented to prevent and mitigate incivility, bullying, and workplace violence; to promote the health, safety, and wellness of registered nurses, and to ensure optimal outcomes across the health care continuum. This position statement, although written specifically for registered nurses and employers, is also relevant to other health care professionals and stakeholders who collaborate to create and sustain a safe and healthy interprofessional work environment. Stakeholders who have a relationship with the worksite have a responsibility to address incivility, bullying, and workplace violence” (ANA, 2015).

Additionally, in 2010, The Joint Commission (TJC) implemented new standards to require healthcare organizations to have mechanisms in place to deal with incivility, and the AACN developed standards for a healthy work environment. But despite these initiatives, incivility in healthcare has remained a persistent problem. 

Reversing this behavior isn’t all that difficult. Start with yourself: Be responsible for your behavior. Be proactive in your work environment. Role model the kind of nurse you would want in the workplace, with the behaviors you would expect from a healthcare professional. Remember the GOLDEN RULE: “Do unto others as you would have them do unto you.”

At the same time, help develop a culture of zero-tolerance when it comes to incivility. Reinforce those lessons with education regarding effective communication, setting up boundaries, identifying acceptable behavior, and finally holding the offender accountable fairly and equitably. This is not about blame, but accountability for one’s own actions.

For more on bullying, peer hostility and more, check out the RN.com course, “Lateral Violence in the Workplace: Stop the Cycle.”

American Nurses Association [ANA]. (2015). Incivility, Bullying, and Workplace Violence. Retrieved from http://www.nursingworld.org/Bullying-Workplace-Violence

American Nurses Association [ANA]. (2016). Towards Civility. The American Nurse, Retrieved from www.theamericannurse.org/index.php/2014/02/27/toward-civility

Luparell, S. (2011). Incivility in Nursing: The connection between academia and clinical settings. Retrieved from http://ccn.aacnjournals.org/content/31/2/92.full

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Dr. Miller-Hoover is a certified Acute and Critical Care Pediatric Clinical Nurse Specialist and has worked in nursing for more than 30 years. Her nursing career has taken her from the bedside, to education and leadership in critical care units where she has cared for patients of all ages. Dr. Miller-Hoover is a published author in peer-reviewed nursing journals and has been accepted for various poster and podium presentations at national conferences.