Reducing the Cost of Incivility

A nurse colleague spreads rumors about a new staff member. A nursing instructor criticizes a student in front of her peers. A care provider speaks rudely to a nurse. These acts of incivility in the workplace may not seem like a big deal, but they take a major toll on nurses’ health, workplace productivity, and patient safety. What can be done about them?

To understand the toll it can take, first consider what incivility is: rude, disruptive, intimidating, and undesirable behavior directed toward another person. This low-intensity behavior may not be deliberately intended to cause harm, but it violates social norms and can inflict damage even if it’s not intended. Incivility exists on a continuum that ranges from distracting, annoying, or irritating behavior at one end to physical violence at the other. Common examples include:

  • eye-rolling and sarcastic comments
  • bullying and taunting
  • undermining the work of others
  • racial or ethnic slurs
  • losing one’s temper
  • verbal harassment or intimidation

The Growing Cost of Incivility

Incivility is a growing concern—in health care and in society in general. Even in nursing, a profession that focuses on caring, incivility is on the rise. And its costs are high. For nurses, the personal effects of incivility can include:

  • decreased self-esteem
  • increased anxiety, resentment, and anger
  • increased stress, perhaps leading to depression, post-traumatic stress disorder, and suicide
  • headaches, eating disorders, and substance abuse

Healthcare organizations have reason to be concerned about workplace incivility, too. Although the rate of incivility varies by practice area, one study at the University of Michigan School of Nursing found that 75% to 85% of nurses experienced this antisocial behavior. Incivility can affect the organization by:

  • reducing patient safety, morale, and trust
  • decreasing productivity, work performance, and commitment
  • producing an unhealthy work environment with damaged working relationships, poor cooperation, and grievances
  • decreasing job satisfaction and increasing employee turnover

Some healthcare facilities are taking steps to build a culture of civility for their employees by reinforcing its importance and adopting organizational strategies such as:

  • developing a code of conduct that defines disruptive behaviors and applies to all employees as well as nonemployees, such as care providers.
  • enforcing a zero-tolerance policy for incivility.
  • providing coaching and mentoring to nurses and other employees on how to improve social interactions.
  • dealing with incivility promptly by gathering data quickly and taking action as needed.
  • sustaining a culture of civility by encouraging open communication, constructive feedback, and acceptance of differing ideas and opinions.

Healthcare facilities that promote a culture of civility have the full support of professional nursing organizations, such as the American Nurses Association (ANA), the American Association of Critical-Care Nurses (AACN), and the Emergency Nurses Association (ENA). These organizations believe civility is a critical component of a healthy workplace and offer strategies to support civility in the workplace.

Building a Culture of Civility: What You Can Do

You can contribute to creating a civil culture in your workplace by adopting these strategies:

  • Think before you speak. Consider the effect your words may have on others.
  • Identify triggers that make you angry so you can control your reactions.
  • Pay no attention to rumors and gossip and avoid blaming others.
  • Perform random act of kindness for your colleagues, such as offering them a cup of coffee or lending them a hand on the unit. Say thank you regularly and share credit with others who help you.
  • Listen actively and respect others’ opinions.
  • Seek common ground but, if you disagree, do so respectfully.

When an incidence of incivility occurs, regardless of how it came about, try to resolve the issue with the other person. Begin by describing how the behavior made you feel. If you can’t discuss the behavior or reach a resolution, step away and try to gain perspective.

If you feel you have become the target of uncivil behavior, document the date, time, and details of each incident and check for a pattern. Make copies of any written messages with a rude or bullying tone. If needed, meet with a supervisor or human resources representative and provide your evidence along with the names of any witnesses.

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