Emerging Nurse Leader

A leadership development blog

When Incivility Runs Rampant

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By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

A nursing director recently asked me how to dial down incivility when it runs rampant in the work environment.  It is a great question because some of this reflects what is happening in society.  Research from the Pew foundation indicates that the majority of Americans (75%) believe that the lack of civility is a crisis in US society today  It is not surprising that these trends would spill over into the work environment.

Incivility versus Bullying

A key question is whether the behaviors are bullying or just incivility.  I like the definitions that Dr. Renee Thompson uses in her new book, Enough: Eradicate Bullying and Incivility in Healthcare.  She defines bullying as meeting the following 3 criteria:

  • There has to be a target.  The behavior is not targeted at everyone but rather specific individuals or groups of individuals such as new graduates.
  • It is harmful. The behavior has to cause harm to the individual or individuals involved.
  • It is repeated.  A one-time behavior is not bullying but a pattern over several months is considered to be bullying.

In contrast to bullying, incivility is pattern of rude and inconsiderate behavior that does not have a target and may or may not have negative intent. Some of the non-verbals such as sighing, eyerolling or ignoring you when you talk with them could look the same as bullying but do not meet the criteria identified above.

When a nurse leader realizes that incivility has become normalized on a unit, it is time to take action.  Before you begin to intervene, ask yourself the following important strategic question:  For incivility to stop in this environment – what has to be true that is not true today?   Your list could include any or all of the following:

  1. There is an expectation that staff will be civil.
  2. Uncivil behaviors will be clearly identified so that behavioral norms are understood.
  3. Staff are held accountable for incivil behaviors.
  4. Leaders need to role model civility in their own interactions.
  5. The values of the unit/department need to promote civility.
  6. Staff will call out incivility when they see it in others.
  7. Staff take the time to know each other personally.
  8. All members of the team will believe that incivility impacts teamwork and the patient experience.
  9. Quality of care is directly linked to civility.
  10. Interviews with new staff will address civility as a behavioral expectation.
  11. Leaders are willing to take disciplinary action including removal to wipe out incivility.
  12. Preceptors will defend new staff against incivility.
  13. Civility norms are identified for known risk situations such as end of shift/bedside report.
  14. Passive-aggressive communication is not tolerated.
  15. Staff assumes the best intentions in others.

Once you assess the problem areas, then you can identify a plan for change.  Cultural change is often challenging if these behaviors are deeply embedded.  New values and expectations will need to be developed.  All of this takes a great deal of leadership energy but is worth it in the long run.

Read to Lead

Thompson, R. (2019). Enough: Eradicate bullying and incivility in healthcare.  inCredible Messages Press.