Imagine a workplace where respect and civility are the norm between co-workers. Imagine where we build up rather than drag down. Imagine where conflict negotiation entertains active listening, respect, and tolerance.

Workplace civility fosters an atmosphere of mutual respect, trust, and collaboration. It encourages open communication, constructive feedback, and positive relationships among team members, contributing to a more cohesive and supportive work environment and a sense of wellbeing and belonging amongst staff.  When nurses (and other team members) feel valued and respected, they are more likely to engage in effective teamwork, communicate openly, and deliver high-quality care to patients. By promoting workplace civility, our nursing workforce can experience greater job satisfaction, resilience, and retention.

Unfortunately, many of our colleagues and healthcare leaders not only fail to acknowledge that there is a problem in our workplaces, but also unknowingly perpetuate an unhealthy and unsafe culture through our own poor behaviors and acceptance of poor behaviors in our workplaces.

Awareness and recognition of incivility and disrespectful behaviors, see Table.

In a 2008 national survey of 4500 healthcare professionals, 71% tied disrespectful behaviors to medical errors and 27% tied disrespectful behaviors to deaths of patients (Rosenstein and O’Daniel, 2008).

The Institute of Safe Medication Practices conducted three surveys over 20 years (2003, 2012, 2021). The survey results suggest that healthcare has a long history of tolerance or indifference to disrespectful behaviors. Results showed little or no improvement, and in some cases, an increase in the prevalence of disrespectful behaviors between healthcare providers. 75% of the respondents in the 2021 ISMP survey reported that their organization does NOT effectively deal with disrespectful behaviors (ISMP, 2022).

A global survey of twenty-five frontline industries verified what we already know. Incivility is more common than not with 75% of the respondents experiencing incivility once per month and 70% witnessing incivility at least 2-3 times per month. When we witness incivility, it negatively affects us with 85% report being annoyed, 80% are upset, 75% are angry, 61% feel distressed, and 43% feel threatened (Porath, 2022).

Bad behavior is an ongoing global concern with negative consequences. Incivility conflicts with the ethics of healthcare professions. Bad behavior damages the reputation of our profession. Incivility is a threat to patient safety and patient care. Being exposed to disrespectful behaviors and incivility can cause stress, anxiety, sleep disturbances, frequent illnesses, depression, reduced productivity, fear of going to work, impaired relationships, poor quality of life, and suicide.

There is a need to break the cycle of disrespectful behaviors and incivility – for the health of our patients, ourselves, the nursing profession, healthcare organizations, and our communities. A large-scale call to action for civility is needed.

In 2022, a frontline nurse courageously brought forth a request to assess workplace culture specific to “lateral violence” to the workplace violence committee at a community hospital in Colorado. A voluntary, anonymous survey of all hospital employees revealed 30% of respondents reported experiencing violence from a team member or provider – most often incivility, bullying, and intimidation. The survey also indicated that more than half (58%) of the workplace violence experienced from team members and providers may go unreported. Furthermore, a review of reported occurrences in 2023 at this same hospital revealed five occurrences per month with a tone of blame, finger pointing, and/or opportunity for collegial respect/tones – some of which contributed to patient care errors.

A committee to address workplace violence within the workforce was proposed, approved, and put into action in 2023. Focused work over the last year has included the following successes:

Ongoing awareness and prevention strategies through assessments of culture, data, and stories; increased reporting and accountability; team member, provider, and leader engagement; and professional governance engagement.

Evidence-based tools/techniques provided for civility best practices such as cognitive rehearsed responses; self-reflection; development of professional confidence, respect, autonomy, and personal value; shared vision development; basic code of conduct and mutual respect expectation established for patients, visitors, and all team members; common communication strategies; and basic conflict negotiation and verbal de-escalation tips.

Developed civility content for RN Residency and Preceptor programming in partnership with the companywide education and training team.

Nursing can lead the call to a healthier society, profession, and work environment. We can strive to inform, educate, engage, encourage dialogue, and provide practical, actionable solutions to cultivate change for healthy and productive workplaces through acknowledgement, self-reflection, accountability, and a commitment to change.

References

Rosenstein, A. H., & O’Daniel, M. (2008). A survey of the impact of disruptive behaviors and communication defects on patient safety. The Joint Commission Journal on Quality and Patient Safety, 34(8), 464–471. https://www.jointcommissionjournal.com/article/S1553-7250(08)34058-6/abstract

Institute For Safe Medication Practices (ISMP). (2022, February 10). Survey suggests disrespectful behaviors persist in healthcare. https://www.ismp.org/acute-care/medication-safety-alert-february-10-2022

Porath, Christine. (2022, November 30). Frontline work when everyone is angry. Harvard Business Review. https://hbr.org/2022/11/frontline-work-when-everyone-is-angry