Guidance for recognition and response to subtle yet damaging harms.

Microaggressions in nursing and patient care remain under-identified and under-addressed yet have ethical significance in our profession. Better recognition of microaggressions when they occur will enable nurses to address them in the moment and help maintain a civil and safe work environment.

Pierce first introduced the term “microaggression”, describing it as frequent subtle and unintentional insults toward a marginalized racial group. Wing Sue reintroduced and expanded this definition to include microinsults, microassaults, and micro­invalidations.

The revised American Nurses Association (ANA) Code of Ethics for Nurses (Code) offers guidance for nurses in how to handle micro­agressions. The following provisions, among others, can help.

• Provision 1: Respect for human dignity
• Provision 8: Collaboration to protect human rights and reduce disparities
• Provision 9: Integration of social justice into nursing and health policy

Microaggressions, although often subtle and unrecognized, have a morally consequential impact, especially over time. As nurses, upholding the Code means choosing courage over comfort and justice over silence. Allowing microaggressions to occur violates nursing’s ethical commitment to dignity and justice for all. Over time, these occurrences erode team trust, harm nurse–patient relationships, and damage retention and morale.

The 2025 ANA position statement on workplace violence also calls on all nurses and employers in all settings to collaboratively create a culture of respect and to implement the best evidence-based practices to prevent and mitigate workplace violence; promote the health, safety, and wellness of nurses; and ensure optimal outcomes across the healthcare continuum. The following scenario illustrates an effective response to a microaggression.

During a medical–surgical clinical rotation, a nursing student enters a patient’s room accompanied by the patient’s primary nurse. As they care for the patient, a family member walks in and asks questions about discharge and home care plans. Pointing to the nursing student, the family member says, “I want that nurse to come for home care.” The primary nurse explains that a team of home care nurses that specializes in the care of patients after discharge is separate from nurses who provide care in the hospital. The family member then states, “I want that nurse; I like him.”

When the primary nurse ignores the comment, the family member repeats, “I want that nurse to do the home care.” The primary nurse sends the student out of the room for supplies but whispers to him as he’s leaving the room, “Don’t come back.” Later, the primary care nurse informs the clinical instructor and together they debrief the event with the student.

In this case, the primary nurse recognized the unhealthy environment and removed the student from it. If reporting systems were in place, she could have used them as well.

Recognizing and learning how to manage all types of microaggression are key to ending this type of harm. Nurses must increase their self-awareness, engage in ongoing bias training, and speak up when microaggressions occur. Nurse leaders and educators need to create safe reporting systems, embed equity into education, and model inclusive language.

The Code and the ANA position statement on workplace violence are valuable resources for nurses in all career stages and practice settings to promote and exemplify inclusion and respect for recipients of care as well as fellow nurses and the entire healthcare team.

Sophia Robinson-Harris is an assistant professor at the University of West Georgia Tanner Health System School of Nursing.

Reference

Byon HD, Harris C, Crandall M, Song J, Topaz M. Identifying type II workplace violence from clinical notes using natural language processing. Workplace Health Saf. 2023;71(10):484-90. doi:10.1177/21650799231176078

American Nurse Journal. 2025; 20(8). Doi: 10.51256/ANJ082519