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Cultivating Healthful Environments: Incivility in Nursing

The development of a healthful environment is an important aspect of competent health care. It is not enough to improve the quality of care and eradicate medical errors, but it is expected to support nurses’ progress, enhance professional skills, and identify the required number of personal qualities. Incivility is a well-documented issue in nursing that challenges the healthy environment’s cultivation (Armstrong, 2018).

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It includes rude behaviors in the workplace and discourteous acts that harm the dignity of an employee (American Nurses Association, 2015). Much attention is paid to control and predict such actions and avoid conflicts or other forms of aggression. In this paper, a case of incivility will be discussed to explain the essence of this term and describe the strategies for creating a healthful environment regarding a specialty track and a personal attitude towards a situation.

The Issue of Incivility

Patients’ and nurses’ safety is one of the main goals to be achieved in a working environment by reducing patient-related errors. According to the representatives of the World Health Organization (2017), about one million patients’ deaths because of such mistakes can be avoided annually. Incivility is one of the challenges that may interrupt safe care and promote the growth of inefficient systems (Phillips, Stalter, Winegardner, Wiggs, & Jauch, 2018).

The American Nurses Association (2015) defines it as “the form of rude and discourteous actions, of gossiping and spreading rumors, and of refusing to assist a coworker” (p. 2). The cases of incivility are explained as intentional or unintentional human actions to affront employee’s dignity and violate the already existing standards of respect (American Nurses Association, 2015). Its forms vary from a discourteous look or phrase to insulting behaviors or actions.

Incivility Importance in Nursing

In nursing, incivility plays a crucial role because it considerably determines the quality of care and communication with patients and medical workers. Nurses are exposed to multiple stresses because of the lack of professional support, the presence of unequal treatment, and other forms of unprofessional behaviors (Muliira, Natarajan, & van der Colff, 2017).

Using the investigations of the Washington State Department of Labor and Industries, Armstrong (2018) explains nursing incivility as repetitive behavior that aims to undermine a nurse, patient, or a group of people. Individuals are not always prepared for discourteous words or actions, and, as a result, their reactions to such behaviors are hard to predict. The rejection to use or offer healthcare services, dissatisfaction, and emotional changes are the possible outcomes in nursing.

In addition to personal assaults, incivility has a strong association with general terms and experiences. For example, it may be embedded within a complex system in nursing practice where leadership and open communication have to be identified (Phillips et al., 2018). Finally, incivility influences the profession of nursing by defining major professional values and skills for clinical practice (Kim, 2018). A gossip or inaction can become an example of incivility that changes the direction of nursing and its urgency in healthcare settings.

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Incivility Scenario

There is a situation in a practical setting when Kelly and Betty, the two nurse practitioners (NPs) who have recently got a promotion at their clinical units, meet at the cafeteria and begin discussing their new nurses. It seems that they neglect the people around them and do not think about the consequences. When a novice nurse, Jenny, reaches one of those NPs to ask for a piece of advice in patient communication, Kelly underlines that it is her break, and no one should bother her. In addition, the NP says that even a beginner could handle such a task. When Jenny leaves, Kelly and Betty continue talking and complaining about the lack of professionalism of new workers. Mr. Burns, the son of the patient, becomes an unintentional witness of the whole situation.

In this situation, a novice nurse could experience a lack of professional support. Moreover, the inability to get an answer to an urgent problem may result in a decreased quality of services. Any nurse should feel respected in the workplace, and the NP demonstrates her neglect and no interest in cooperating with her colleague. Finally, the patient’s family obtained awkward impressions and questioned his father’s stay in the hospital and the quality of nursing care offered.

The environment was challenged by such a case of incivility between the nurses. In addition to the impossibility of establishing trustful and honest relationships in the hierarchy of nurses, it is hard to make sure of the quality of communication. Although subordination was followed, the response of the main nurses was not professional and polite. The result of such a rude response could influence the environment in low performance, employee dissatisfaction, low self-esteem, and even nurse turnover.

Strategies for Creating a Healthful Environment

The creation of a healthful environment includes the reduction of incivility, error management, and the establishment of professional relationships. The three main strategies for cultivating good working conditions include communication, codes of conduct, and education training. One of the leading strategies in the establishment of a healthy nursing environment and incivility prevention is effective communication (Abdollahzadeh, Asghari, Ebrahimi, Rahmani, & Vahidi, 2017).

The staff should improve an understanding of their tasks and clarify the situation to decrease burnout and increase the feeling of dignity and respect. Specific codes of conduct promote adequate reactions and behaviors in nursing practice (Authement, 2016). Regardless of their current positions, all nurses should know their tasks and never misunderstand their responsibilities. Finally, education training is a step to explain appropriate workplace activities to manage incivility (Armstrong, 2018).

A healthful environment includes not only professional relationships between nurses but also the recognition of patient’s needs and attitudes towards care. Education and training help recognize different aspects of nursing care, including the satisfaction of patients and their families, as well as high-quality communication and explanations.

Specialty Track and a Healthful Environment

Any family nurse practitioner (FNP) has to contribute to cultivating a healthful environment in the chosen setting. Among the offered strategies, the idea to support effective communication and education training turns out to be an effective solution. Communication among nurses helps discuss all unclear points and promotes support and respect in relationships (Abdollahzadeh et al., 2017). The role of family members is also crucial in treatment, and an FNP should contact the family, demonstrating care and desire to cooperate. Education of nurses and patients is also a responsibility of a chief nurse due to the already obtained experiences and knowledge.

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Incivility reduction and the discussion of all concerns in the form of education help both nurses and patients (Armstrong, 2018). In the case under analysis, a novice nurse must privately talk to a chief nurse and explain her concerns and intentions to be supported and respected in this environment. The chief nurse, in her turn, should understand her responsibilities and take care of the situation, including the attitudes of patients and other nurses’ education.


FNPs and chief nurses are responsible for promoting education and training to support all the participants of nursing practice, demonstrate their respect, and properly use their professional skills. Incivility may be intentional and unintentional discourteous behaviors that result in low self-esteem and unwillingness to be a part of the clinical environment. Therefore, communication, education, and the codes of conduct cannot be ignored as a good way to cultivate a healthful environment and removing incivility.


Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. Web.

American Nurses Association. (2015). American nurses association position statement on incivility, bullying, and workplace violence. Web.

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403–410. Web.

Authement, R. (2016). Can a comprehensive code of conduct discourage incivility in nursing students? Nursing, 46(8), 14-19. Web.

Kim, J. S. (2018). Relationship between incivility experiences and nursing professional values among nursing students: Moderating effects of coping strategies. Nurse Education Today, 65, 187–191. Web.

Muliira, J. K., Natarajan, J., & van der Colff, J. (2017). Nursing faculty academic incivility: perceptions of nursing students and faculty. BMC Medical Education, 17(1). Web.

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Phillips, J. M., Stalter, A. M., Winegardner, S., Wiggs, C., & Jauch, A. (2018). Systems thinking and incivility in nursing practice: An integrative review. Nursing Forum, 53(3), 286–298. Web.

World Health Organization. (2017). Best practices in patient safety: 2nd global ministerial summit on patient safety. Web.

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