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Promoting civility in the workplace


To: Ethics Inbox   

From: An ANA member

Subject: Bullying and incivility

Bullying and incivility are rampant on my nursing unit. My manager doesn’t address the situation, which contributes to an unhealthy work environment. Things escalated recently with one physician on the unit throwing a clipboard at another physician and yelling at him. Does the American Nurses Association (ANA) have resources that would help my nursing unit develop more civility in the workplace?? 

From: ANA Center for Ethics and Human Rights

ANA is concerned with the issues of bullying and incivility and their impact on nurses’ well-being and job satisfaction and retention, as well as the safety and quality of patient care. The ANA position statement defines bullying as “repeated, unwanted harmful actions intended to humiliate, offend, and cause distress in the recipient. These actions can harm, undermine, and degrade.”

ANA further explains that incivility can “take the form of rude and discourteous actions, of gossiping and spreading rumors, and of refusing to assist a coworker.” Research by Clark, Sattler, and Barbosa-Leiker indicated that these lower levels of hostility may escalate and result in harm, causing detrimental mental or physical outcomes for those involved.

Healthcare professions are experiencing bullying and incivility at an alarming rate. Literature indicates that it occurs in both clinical and academic settings, which can affect faculty, students, and the campus environment. Many of these incidents go unreported due to embarrassment by the victim and fear of retribution from the perpetrators.

The Code of Ethics for Nurses with Interpretive Statements (the Code) states: “The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect.” In addition, the Code states: “Verbal and other forms of abuse by patients, family members, or coworkers are also threats; nurses must be treated with respect and need never tolerate abuse.”

Nurses on the unit should report any disruptive behavior to their manager or a higher-level administrator if warranted. It is leadership’s responsibility to implement corrective measures to ensure a safe environment for their staff and patients.

Strategies to address bullying and incivility and to promote a healthy workplace begin with nursing faculty who must role model appropriate behavior and embed ethical topics in the nursing curriculum with case studies, post-clinical conferences, and reflection to develop the student’s self-awareness about civil behavior. Teamwork and analysis in the classroom can facilitate an understanding about professionalism.

It is important that healthcare systems promote positive values and a healthy work environment. Healthcare leadership must develop orientation, onboarding, and residency programs that include policies and procedures for handling bullying and incivility issues, the process to report such events, and appropriate follow-up. Leadership should receive ongoing education and engage in discussion groups so they can develop an awareness of and reflect on their own behavior and take corrective measures as needed. It is imperative that disruptive behaviors, such as bullying and incivility, not be tolerated, so that the safety of both employees and patients is improved.

— Response by Teri Chenot, EdD, MS, MSN, RN, CCE,
FNAP, FAAN, member of the ANA Center for
Ethics and Human Rights Advisory Board.


Clark, CM, Sattler, VP, Barbosa-Leiker, C. Development and psychometric testing of the Workplace Civility Index: A reliable tool for measuring civility in the workplace. J Contin Educ Nurs. 2018;49(9):400-406.

The Joint Commission. Bullying has no place in health care. Quick Safety Issue #24. 2016. jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-24-bullying-has-no-place-in-health-care/

Sauer PA, McCoy TP. Nurse bullying and the intent to leave. Nurs Econ. 2018;36(5):219-224, 245.

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