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Incivility in Healthcare Settings


Identification of Incivility

Incivility in healthcare settings is impolite and offensive behavior, which aims to humiliate or insult a person. It is a significant issue in modern clinics and healthcare centers because it influences different aspects of healthcare professionals’ work. In particular, this type of behavior influences the mental state and emotions of the nurses and their coworkers. In addition, it affects the ability of these employees to complete the assignments and provide service of appropriate quality. The necessity to regulate the relationship between employees and patients in the healthcare setting defines the introduction of the American Nurses Association (ANA) statement (2015). This statement concerns identifying the specific rules that frame how people should interact with each other to guarantee that the culture of mutual esteem and civility governs the nurses’ work environment. Since incivility impedes the ability of nurses to provide appropriate care, such initiatives as HealthyNurse™, the publication of standards, and the introduction of reporting bullying cases policies are essential in struggling with violence.

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Components of Incivility

The cases of incivility within the healthcare metaparadigm include violence, bullying, and disrespectful communication. The stressful situations and environment cause people to demonstrate aggression and uncivil behavior. The ANA (2015) defines several types of violence, which may occur in hospitals. The first type is a criminal act against a person, which has no relationship with the perpetrator. The second type is the clients’ violence, which happens when the nurses interact with their patients providing their caregiving services. Then, the next category is the act of aggression intended to offend a coworker or colleague. Finally, the last type of uncivil attitude is caused by difficulties in personal relationships between people (“Violence, Incivility,” n.d.). All these situations require specific attention in healthcare settings to guarantee that they are excluded from the regular practice of the nurses.

Incivility in Healthcare Settings

The Influence of Incivility on the Level of Judgment

Medication Errors

The acts of violence and impolite attitude influence the ability of the nurses to use a high level of judgment, making them commit medication errors. The improper communication with the nurses and the feeling of intimidation impede the healthcare professionals’ ability to think clearly. It may force them to make wrong judgments and become inattentive in the process of carrying out their duties. Consequently, the nurses report that many of their errors result from their feeling of intimidation (ANA, 2015). This statement reveals that stressful situations associated with humiliation and bullying make the nurses lose their ability to make proper decisions at work.

Inappropriate Quality of Services

In addition, the nurses may start to provide services of inappropriate quality due to acts of violence and aggression. The feeling of inferiority and indignity resulting from the offensive behavior of coworkers or patients makes nurses feel stressed and question their competence. They start to feel less self-confident and optimistic regarding their decisions and professional judgments (ANA, 2015). Consequently, the quality of their work suffers because they may hesitate, postpone medication administration, or fail to assist the patients in need. These cases display that the safety of clients becomes questionable when the nurses experience bullying at work.

Issues with Clinical Site Incivility

Adverse Patient Care Outcomes

The acts of incivility cause the issues of adverse patient care outcomes. Impolite communication and bullying cases influence the work environment in clinics, making the nurses and other healthcare specialists feel stressed and lose their feeling of self-worth. It may lead to such issues as the degradation of services quality and adverse patient care outcomes. Mainly, the healthcare workers’ inability to focus on their responsibilities, their feeling of doubt and embarrassment, and the physical responses to stress make them pay less attention to their professional skills. In these circumstances, the policies and procedures defining the emotional environment in clinics are not followed. Consequently, the quality of services may suffer, and clinics may experience issues associated with their reputation as providers of caregiving services.

Physical Violence and Injuries

The next issue connected with clinical site incivility is physical violence and injuries. In healthcare settings, nurses may experience not only psychological stress but also acts of intentional violence. ANA (2015) introduces the analysis of injury cases, indicating that the number of illnesses connected with aggression increases. This finding demonstrates that the levels of stress associated with the nursing profession make the nurses and their colleagues experience anxiety and impatience, resulting in physical assault. Moreover, patients and their families may also attack healthcare workers because their stress levels are high due to their experience of difficulties related to health issues. Consequently, the acts of incivility may significantly influence the mental and physical state of nurses.

Communication Problems

Suffering of Patients

The clinical site communication also deteriorates due to disrespectful attitude and incivility, making patients suffer. First, the negative feelings and emotions of the employees influence their communication and exchange of information. In particular, the nurses may have insufficient knowledge about specific aspects of symptoms, treatment, and therapies provided by other healthcare specialists due to the lack of communication. They may experience mutual disrespect and refuse to communicate or avoid their colleagues. Consequently, patients receive inappropriate care or are unable to interact with clinicians that experience anxiety and stress. The clients may feel dissatisfied with the services or even suffer from medication errors caused by a lack of knowledge.

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Missed Treatments

Workplace violence and disrespectful behavior affect communication, making patient treatments missed. The inability of nurses to establish positive interaction with their colleagues, their failure to cope with stressful situations, and expression of their thoughts make them less skilled in working with patients. Clients may feel hesitation and problems with the self-confidence of the healthcare professionals, refusing to attend appointments and postponing their treatment. Simultaneously, these communicative issues may lead to conflicts with patients and their family members, negatively influencing the quality of provided services. This situation reveals that the workplace environment affects the ability of clinicians to interact and share information with patients appropriately, which, in its turn, impedes the process of treating clients.



ANA provides the chance to overcome the problems connected with incivility by launching the initiative of HealthyNurse™. It is a social movement aimed at improving different aspects of nurses’ life and work (ANA, 2015). This initiative focuses on sport, rest, healthy nutrition, life quality, and protection. It mainly helps healthcare professionals improve their personal well-being, balance their life and career, and enhance the positive experience on clinical sites providing support and information using an online platform. It is a social network that enables healthcare workers to find resources, connect, understand their problems, and find support among colleagues. This initiative contributes to the nurses’ social, emotional, and personal well-being, allowing them to cope with instances of violence and intimidation.

Code of Ethics

The next initiative concerns the publication of a code of ethics and standards of behavior defining how the nurse should treat and communicate with others to support positive interaction and well-being of all the parties involved. ANA constantly observes harassment and disrespectful communication in healthcare settings to define what aspects require further explanation and modification. This strategy concerns identifying the specifics of expected behavior and recommendations regarding the particular techniques that might help avoid the conflicts. An example of such methods includes constant evaluation of personal behavior and communication skills to understand what interaction elements should be improved (ANA, 2015). This attention to the problems of nurses at work allows caregivers to be aware of the existing issues and comprehend how to overcome them.

Policies Regulating Reporting

Additionally, ANA introduces the initiative of making the instances of workplace violence evident. The issues panel, called End Nurse Abuse, aims to identify the specific cases of violence, making the healthcare professionals report about their experience of uncivil attitude at work (“Violence, Incivility,” n.d.). This panel provided the chance to introduce specific policies and procedures. These policies concern the presentation of barriers to announcing the cases of inappropriate behavior, the description of methods to implement the techniques of reporting such incidents, and the explanation of the reporting process. This initiative plays a significant role in acknowledging the problem and demonstrating that it can be solved with the application of particular policies and procedures.


Thus, disrespect at work leads to difficulties in providing appropriate healthcare services, which makes such initiatives as HealthyNurse™, code of conduct, and the implementation of policies regulating reporting necessary in healthcare settings. Incivility in clinics became one of the most significant issues because it makes the nurses feel stressed and lose self-confidence, commit medication errors, and fail to provide necessary services. Consequently, it may lead to adverse patient care outcomes and injuries. In addition, incivility complicates communication, which may cause inadequate or missed treatments. Therefore, such initiatives as creating a social network to support and inform healthcare workers and introducing the specific rules and policies regulating awareness are crucial in overcoming violence.


American Nurses Association. (2015). Incivility, bullying, and workplace violence.

Violence, incivility, & bullying. (n.d.). Nursing World.

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