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What is civility

Civility starts with you


Over the last decade, civility has become a hot topic. I got involved with it in 2000, when more than 700 nurses told the Maryland Commission on the Crisis in Nursing that civility was one of their top three workplace concerns. Since then, studies have linked lack of civility to potentially decreased patient safety, blueprints have been created for establishing a civil work environment, codes of conduct have been developed, and healthcare workers have been educated on the topic.

In 2005, VitalSmarts and the American Association of Critical-Care Nurses (AACN) published the study “Silence Kills: The Seven Crucial Conversations for Healthcare” and launched the Healthy Work Environments initiative. The 2010 follow-up study, “The Silent Treatment,” found more nurses had concerns about incompetence and disrespect, and a higher percentage of intensive care and operating-room nurses were speaking out on the topic.

Sounds good, right? Well, not really. Incivility remains a problem. Where did we go wrong? (Or did we go wrong?) Was it the timing? Have healthcare workers simply grown weary of dealing with yet another “issue”? Should we just accept that incivility and conflict are inevitable—especially with our multigenerational workforce and pressures on caregivers to navigate rapidly multiplying regulations, documentation requirements, resource shortages, and high acuity?

What is civility?

Civility is behavior that shows respect toward another person, makes that person feel valued, and contributes to mutual respect, effective communication, and team collaboration. Author P.M Forni describes civility as a form of benevolent awareness (respect, restraint, and consideration) in his book Choosing Civility: The 25 Rules of Considerate Conduct.

In Civility: Manners, Morals, and the Etiquette of Democracy, author Stephen Carter describes civility as the sum of the many sacrifices we’re called on to make for the sake of living together. He stresses that our duty to be civil to others doesn’t depend on whether we like them. Civility doesn’t require us to mask our differences but to resolve them respectfully—to express ourselves in ways that show we respect others. Civility allows criticism of others, but the criticism should always be civil. Being civil means thinking before you speak.

Why bother being civil?

Who has the time, energy, or resources to focus on being civil? Why should you bother? Because civility can be the foundation for patient safety, a healthy work environment, healthy staff, and increased productivity. Civility affects the quality and quantity of our hard work. Incivility, in contrast, is a short step away from aggressive behavior, which can lead to lateral or horizontal violence.

What if each of us made a commitment to change our behavior? To forgive those who’ve done us an injustice? To choose to revise our assumptions of others? To seek common ground, goals, and purpose? Why not just do it—even if you’re the only one? The goal of being civil is not to have other people reciprocate respect and kindness to you (though that’s usually a natural outcome). The goal is for others to see you as successful when you continue to practice civility, regardless of others’ responses. It’s about you, not them.

What’s holding us back

One of the biggest barriers to civility is the “bitter bag” nearly all of us carry—bags where we stash our grievances. They contain all the slights, rebuffs, injustices, rudeness, embarrassments, and other wrongs that have befallen us. We rarely address individual wrongs when they arise, instead tossing them into the “bitter bag.” We take the bag home and mull over these wrongs, usually distorting the facts. We think the bag’s acrid contents give us permission to be less civil to the perpetrators.

But until you begin to empty your bitter bag, you’ll have trouble moving forward and being committed to civility. If you don’t empty it, it’ll be an albatross around your waist—a barrier to moving forward. (See How to empty your “bitter bag.” by clicking the PDF icon above.)

Strategies to promote civility

Here are some strategies to help you behave in a civil way.

  • Know your triggers—the words, actions, and gestures that make you angry. Knowing your triggers helps you monitor and manage your reactions. You can’t control what others do or say, but you can control your response. So think before you speak or act. Always consider what impact your words or actions might have on others.
  • Assess your own behavior. What do you do to contribute to civility or incivility? Ask a trusted friend for feedback here.
  • Don’t jump to conclusions or assume you know another person’s intent or motive.
  • Walk in the other person’s shoes. This can show you the context for his or her words or actions and help you understand what triggered them.
  • When rumors or gossip come your way, let them go in one ear and out the other.
  • Resist looking for someone to blame. Remember that in many cases, a problem reflects a systemic shortcoming, not an individual’s.
  • Take the “temperature” of your milieu often to determine if colleagues could use a little proactive kindness—for instance, a soda run or a quick check of the unit to see who needs a hand.
  • Listen more and talk less, to show you respect others’ opinions.
  • Seek common ground, even if it’s to agree to disagree.
  • Go out of your way to say thank you.
  • When you get credit for something, spread it around to those who helped you.
  • Take the time to make it safe for the other person to have a dialogue with you.

For more ways to create a more civil workplace, visit This page describes AACN’s free web-based Healthy Work Environment Assessment.

Civility: A mission possible

Many of us see what’s happening in the workplace today as symptomatic of what’s happening in society at large. But dealing with a societal change can be overwhelming, whereas addressing civility on your own unit is manageable. If you work full time, you may spend more time at work than you do at home, so it’s worth the effort to make your workplace more civil.

Is this idea simplistic compared to the big civility programs that have been implemented recently? Will it produce results? Will it be faster than waiting for a larger program of external constraints and consequences to change the culture? Will it have more staying power than previous initiatives that didn’t ask individuals to change? Only time will tell, but in the interests of patient safety and healthier workers and workplaces, it’s worth a try. Great changes often begin with a simple first step. To achieve a civil workplace, choose to be the spark that ignites civility.

Visit for a complete list of references.

Judith (“Ski”) Lower is an independent lecturer and consultant in Water Valley, Texas.


  • Older nurses are left with the duty to teach the new nurses how to act civil, because in many cases such a lesson was not taught in the home from a child. In witnessing no morals to no morals has spawned this situation. This does need to be shared in orientation regardless of experiences or service. And I myself continue to check myself for civil/civility attitude and response. Unsafe work overload can cause one to act (without intention) negative. And I add, my spiritual side plays a big part in serving as a good civil nurse; serving others and not expecting anything in return; doing the right thing even if no one notices or can see.

  • Changing behavior is a long time process. A short 3-hour civility seminar may not be enough. Where I volunteer, a global non-profit group called IITTI, they developed a long-term cellphone learning where employees get a mini-lesson every week, and earn points towards their personal ‘World Civility Index’.

  • I was treated last week in a great teaching hospital and had excellent care. Only 1 nurse had no clue about how to interact with patients. Example: I asked for a medication ordered to abate nausea and her comment back was, “I don’t have any on me right now.” It went down hill from there. She was arrogant, no smile, and made me and the staff nurse with her work for every response we needed. This is not the CNO’s problem and yes, this facility deals directly with staff behavior. Bad egg?

  • Savingracesarah
    April 11, 2013 11:24 pm

    This title bugs me! The culture begins at the top and sets the tone. Leadership sets the tone. Nursing is what it is after years of being subjugated to the powers that be. Slaves infight until they can unite with a common voice!

  • It’s great to read about this timely and much needed discussion. Incivility permeates all aspects of health care including education, facility staff, and the bedside. As a nurse with over 33 years of experience, it is very sad to see the state of communication and nonverbal behaviors of nurses. Let’s take back the integrity and respect that our profession deserves by modeling civility ourselves.

  • This is a wonderful article. Every commentator has something significant to add. We definitely need the self care influences of prayer, meditation and outdoor exercise. If we could pray together with intention for health, healing and mutual concerns, we can direct the evil and bad energies of incivility out of our environments and hearts.

  • I left facility nursing because incivility made in unbearable for me. I feel that you can’t just control your responses by the power of will but must have something like prayer or meditation or outdoor exercise in order to raise your consciousness and retrain yourself.

  • Incivility is an pandemic. It is everywhere. I teach an incivility class to LPN students. They sit there and fiddle with cell phones, act uninterested, and not to mention are not highly motivated in the clinical setting either. It is sad!!!!

  • Good article but I think we should also decrease nurse stress and frustration with patient workloads. Even a saint will act out when frustrated, angry, and concerned about the unsafe working conditions of too much workload and too little help.

  • Thank you for this article! And many thanks to the lovely author. I am completely in agreement with the person who posted the quote from Ghandi as that is my life credo and how I lead others. We are the ones to hold the standard to which not only we aspire, but to lead others to reach for. Thank you, ANA, for your organization of our tremendous profession and for resources such as this. I am actually designing a presentation for my team at work now and this is a wonderful resource!

  • This article is very nice and short; it speaks right to the heart of the problem. It would be beneficial if institutions could include this into their orientation and staff development.thank you much for such straight forward steps that can help make changes.

  • belen ds. cartago
    July 31, 2012 11:05 am

    This article is TIMLESS!!! Applicable in any situation/setting…a must for interpersonal relationship especially for NURSES. More power to the author…we need more articles like this. Thank you for sharing this excellent article.

  • Civility was a given (not recommended or encouraged) when I became a new nurse 35 years ago. The problem should not be addressed in orientation or thereafter…it should once again be instilled in our children and they should be taught that if they live by the Golden Rule they will have a happier, healthier life. Parents have dropped the ball altogether. No one wants to be bothered with the work that is required to mold offspring. They don’t just learn to be nice-they must be taught to share

  • An excellent article which should be shared! I am reminded of our committment to holistic health which we so often try to micromanage and lose our perspective in the process. If I want to effect global (environmental, work culture or attitudinal) change, I must act locally first. As Ghandi said: We must be the change we wish to see in the world.

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