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Incivility Within the Healthcare Metaparadigm

The healthcare system has always been an extremely complex phenomenon, as multiple spheres constitute its core. All medical workers encounter an enormous amount of stress daily. Therefore, it is of major importance to provide them with the opportunity to work in proper conditions which are free of excessive stress factors. In some cases, the repercussions of this issue can be especially tough for the nursing experience, as nurses constantly have to communicate with patients. Moreover, the emotions which a nurse radiates (and receives) play a key role in the quality of medical services that are provided to patients in general.

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Therefore, all forms of incivility should be eliminated from a nurse’s workday. Nurses’ ability to show compassion and provide emotional support at every stage of treatment and recovery is crucial not only for the outcome in each patient’s case but also for the perception of the hospital and the healthcare system as a whole. Although it may seem hard to institutionalize the kind of relationship established between a patient and a nurse, it is increasingly important to outline certain boundaries which allow for polite communication and secure dignity.

How Incivility Impacts High-Level Clinical Judgement

Incivility and other types of inappropriate behavior undermine the respect that underpins the relationship between the person who receives the care and the one who is in charge of the whole vital process. Healthcare is one of the institutions which relies heavily on trust between parties, as a person’s health or even life is at stake. Therefore, hospitals cannot tolerate any type of behavior, which may lead to misunderstandings and anger.

Nurses, at times, experience an insurmountable amount of stress that they usually withstand only due to the vivid importance of their profession and respect that patients and society show them. That is why any rude comments or phrases can disrupt the usual pattern of nurse’s activities and

result in a poor outcome. Thus, clinical judgment can be jeopardized if a patient undermines the importance of a nurse’s efforts by showing discontent and acting disrespectfully. Nurses’ ability to critically think is undermined by incivility, as they have multiple patients and the entire process should not be interrupted by the negative emotions caused by the communication with colleagues or patients. The critical thinking process always requires low levels of stress and enough time to think over the options available. For instance, if a nurse spends excessive amount of time arguing with one patient she then lacks time to make the best decision for another. Moreover, the ability to think critically is undermined when a nurse is constantly being influenced by her aggressive colleagues. Many nurses may not resist the amount of pressure and begin to agree with others on all issues.

Incivility Issues and Communication

Incivility continues to undermine the efforts of both doctors and nurses. Nevertheless, the latter tend to suffer from it to a much greater extent, as their job and their duty require communicating with patients. Therefore, nurses are more likely to be impacted by such an attitude. They can miss the patient’s treatment or avoid the patient in general. In such a case, patients may even begin to rely on themselves and develop a more skeptical approach to treatment as a whole.

Such an approach caused by the lack of attention may lead to further health problems and injuries, which often raises questions about the effectiveness of the initial treatment strategies. Therefore, incivility shown by any side finally initiates a vicious cycle, with nurses and patients being equally dissatisfied. Thus, incivility in such important institutions easily leads to serious repercussions, which can cause great damage. Therefore, staying polite and professional allows for proper cooperation and eliminates the risks which the patient’s health and the hospital’s reputation can be exposed to.

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One of the examples of poor outcomes caused by incivility is the quality of services that is offered to people who undergo lengthy treatment and need to stay in hospitals for a significant amount of time. Staying in a hospital is already a stressful experience, which is always exacerbated by the lack of new information and new emotions which patients are used to. Such people lose connections and cannot be involved in their everyday activities. Therefore, for them, it may seem that staying in a hospital is just a waste of time that hinders many opportunities in their lives. Moreover, the prices for American health care services are admittedly high, which may contribute to the number of reasons which tend to cause discontent. In some cases, patients may even perceive a lengthy treatment as an undertaking designed to increase the cost of the services.

Under such circumstances, patients are more likely to openly show their discontent, even in an offensive manner. They often begin to perceive medical personnel as one of the many stress factors. Therefore, their everyday communication with nurses can gradually worsen. The altered tone of the conversation may result in lower quality of services. Nurses may even pay less attention to such patients and forget about certain vital procedures. Therefore, incivility within the workplace or clinical sites can rapidly result in poorer treatment and, eventually, sufferings. Patients that undergo stressful situations are generally more likely to initiate various forms of incivility.

Current Initiatives

Although it may be truly difficult to prevent incivility, which comes from patients, numerous nursing organizations are desperate in their desire to eliminate another important form of inappropriate behavior. Horizontal incivility remains a great threat that undermines teamwork among nurses. Despite the fact that bullying has become almost an integral part of the workplace atmosphere in many hospitals, it is of significant importance to prevent the institutionalization of the highly hierarchical approach, which often causes it. The American Nurses Association has often called for zero tolerance towards any kind of incivility and bullying and actively promotes its Code of Ethics (American Nurses Association [ANA], 2015). Introducing some of the concepts described in the Code and making them the cornerstone of the nurses’ interaction is instrumental for the establishment of proper working conditions.

There are numerous ways to address the issue, and every hospital should opt for an appropriate combination. Introducing a reporting system and using exit interviews in order to identify the triggers which undermine the performance of nurses (especially young and newcomers) is of major importance. Moreover, these methods can help realize the underlying processes that contribute to bullying and unjust attitude. What is more, several studies have investigated the issue from a different angle and came to the conclusion that in some cases, leaders play a crucial role in confronting or supporting various forms of incivility and bullying. According to Kaiser (2017), although certain leadership styles do not necessarily lead to incivility, the communication tactics that leaders choose correlate with the acceptance of incivility significantly. Moreover, transformational leadership generally leads to low incivility levels, which can be considered by hospitals when choosing the best strategies for the enhancement of nurses’ everyday performance.


Although incivility has become a part of the nursing profession, it is essential to mitigate the repercussions caused by it. Numerous studies tend to recognize the importance of establishing codes of ethics and protecting nurses from incivility, which is triggered by patients’ style of communication. Nevertheless, the easiest and most effective step to improve nurses’ working conditions is to encourage nurse managers and leaders to be more empathetic and show the compassion needed to establish a proper attitude. Supportive managers can rapidly transform the working atmosphere, eliminate multiple stress factors, and decrease levels of at least horizontal incivility.


American Nurses Association. (2015). Violence, incivility, & bullying. Web.

Kaiser, J. A. (2017). The relationship between leadership style and nurse‐to‐nurse incivility: Turning the lens inward. Journal of Nursing Management, 25(2), 110−118. Web.

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