Incivility Within the Healthcare Metaparadigm


By definition, nursing is a career that requires kindness, compassion, and excellent behaviour toward clients, as it is the positive practices and mindset that are crucial in ensuring that the patient’s wellbeing is prioritized. As a result, nurses are required to conduct themselves civilly as part of their work description. However, just while nurses’ primary responsibility is to patients, who are frequently the client, this does not imply nurse practitioners should be solely kind and well-behaved with patients. Other individuals and personnel in the healthcare field should be treated with dignity and respect. Indeed, the work of nurses is contingent upon the accumulated politeness of all other healthcare personnel.

Incivility is defined as disruptive, inappropriate, and impolite behaviour in the workplace that causes psychological suffering and jeopardizes the working environment. The behaviour may be unintended, in which case the individual is unaware of the impact on others, or purposeful, in which case the individual shows the behaviour knowingly (American Nurses Association, 2015). Sarcastic comments, ridicule, and bullying are examples of low-risk incivility that can be annoying and disturbing. It encompasses aggressive behaviours that may be severe, such as extortion, ethnic or racial stereotypes, and physical abuse, on the high-risk spectrum.

From the healthcare perspective, nurses’ incivility endangers patient safety, affects the standards of nursing service, and decreases staff satisfaction, resulting in increased employee turnover. As a result, there is an increased demand for healthcare to treat the issue.

The Effects of Incivility on Nurses’ Ability to Use Level Clinical Judgment

Both spectators and targets of incivility suffer a variety of negative physical, behavioural, and psychological consequences in a therapeutic context. These cognitive, emotional, and behavioural distress caused by incivility impair nurses’ capacity to exercise the requisite level of clinical judgment properly. On the other hand, psychological stress caused by incivility in the clinical setting might cause nurses to lose their commitment to the organization and ultimately abandon the profession. Nurses who are consumers of uncivil behaviour have low self-esteem and self-confidence, manifest physically as insomnia and headaches (Brown, 2017).

More significant psychological stress, depressive symptoms, impatience, and anxiety are all associated with incivility. These issues inevitably impair nurses’ clinical judgment, resulting in substandard performance, medical blunders, and an increased risk of losing patience. The quality of treatment outcomes and patient welfare is harmed when the physicians and other care professionals lose their skills and confidence.

Consequences of Workplace or Clinical Site Incivility

Individuals are more productive when they work in a setting that supports their psychological and physical well-being. Cases of uncivil behaviour exacerbate the targeted group’s susceptibility and erode worker and patient trust. Verbal abuse, embarrassment, and physical assaults contribute to increased absenteeism, reduced morale, and decreased productivity. According to the American Nurses Association (2015), covert clinical incivility, such as hiding vital information and the board’s reluctance to intervene in the context of extreme incivility, has a detrimental effect on the entire corporation.

Incivility in the workplace increases due to the failure of formal institutions to manage workplace violence, racism, and bullying. Incivility in the workplace results in a decreased adherence to practice procedures and policies, lowering productivity.

As a result, the organization’s care expenses increase while patients ‘ satisfaction decreases. Indeed, incivility raises operating costs through costs associated with managing the problem, supervising uncivil employees, consulting legal counsel, interviewing witnesses, and employing and training new employees. Failure to handle uncivil behaviour exposes the organization to increasing disability compensation, lawsuits, a dwindling public reputation, and a strained connection between care workers and patients (American Nurses Association, 2015). As a result of stress and fatigue, the healthcare industry has lost several caring and talented healthcare service providers. The entire quality of health care suffers as a result of the loss of this highly-trained personnel.

Incivility’s Effect on Interaction at the Clinical Site

Incivility in a healthcare setting increases the risk of medical errors caused by a lack of efficient communication. One of the primary causes of disrespect is a lack of efficient and suitable interaction with attendants, coworkers, and patients. Intimidation and a hostile setting might contribute to poor communication. Nursing practice is contingent upon an efficient exchange of information between and among care practitioners. As a result, any interruption in this flow will result in drug mistakes, delayed surgery and medication delivery, and inadequate follow-up. According to the Joint Commission (2016), incivility results in under-reporting of health and reliability problems and an increase in disease, error, and patient harm. Inadequate communication may result in an increased workload for a few employees with limited time and resources in a healthcare setting.

Additionally, nurses may express dissatisfaction with patient and duty assignments, resulting in contentious confrontations. In some instances, a health care provider may be unable to provide adequate descriptions of routine procedures and duties associated with health care tasks. In both circumstances, the facility will see a decline in collaboration and cooperation among specialists and an increase in ambiguity and imprecise expectations. Conflicts, disputes, frustrations, and ambiguities that result jeopardize patients’ health.

Employee burnout, stress, absence, low job satisfaction, and mental health problems have all been associated with workplace harassment and incivility. Nursing students are likely to have similar experiences with incivility and burnout in the job, given that staff nurses and new nurse trainees are facing these issues in the workplace. A wide range of uncivil behaviour is encountered by nursing staff in both the classroom and clinical settings.

There was a high level of incivility in classrooms, followed by clinical environments. These researchers also conducted a study in which nursing students described being verbally and physically abused by their professors (Joint Commission, 2016). Some indicated that nursing students should look for another career path. As a result of being bullied and disrespected by health care workers, nursing students felt ostracized and inconsequential.

Initiatives to Reduce Clinical Organizational Incivility

Workplace incivility should be addressed and mitigated by organizations that employ comprehensive and integrated methods. There should be an emphasis on enhancing nurses’ abilities and expertise, establishing effective communication, ensuring that each nurse is responsible for their assigned tasks, and cultivating a corporate culture that supports nurses and decreases their workload. Code of Ethics for Nurses by the American Nurses Association (ANA) calls on nurses to study and operate in an ethical environment marked by civil actions such as empathy and treating people with dignity.

All healthcare facilities’ management is committed to creating an environment that promotes respect, dignity and integration to decrease or eliminate incidences of violence or bullying or incivility while also boosting the health of both nurses and other staff members. Effective inter-and interprofessional communication is essential for creating a culture of safety, tolerance or dignity. Human resource procedures should also incorporate diversity management techniques to prevent discrimination. Nurses should be encouraged to participate in healthcare relationships based on fairness, strong communication skills, support, and tolerance (American Nurses Association, 2015). There should be a focus on improving knowledge, promoting collegial comprehension and accountability, enhancing the workforce’s emotional intelligence, and training in conflict management and diversity planning as the primary goals of any strategy.


Incivility in the workplace suggests a threat to the safety and quality of healthcare. The primary strategy for preventing and eradicating these disruptive behaviours is to establish and maintain a culture of respect, solid relationships, effective interprofessional involvement, and diversity in the workplace. Additionally, nurses need to take ownership of their work in a clinical context. To address this growing threat, we should focus on developing nurses’ conflict and diversity leadership abilities, promoting frequent communication, creating task accountability, and maintaining an organizational culture of kindness and respect.


American Nurses Association. (2015). Incivility, bullying, and workplace violence: ANA position statement. Web.

Brown, T. J. (2017). The Ethical Dimensions of Incivility in Nursing Education. Nursing & Healthcare International Journal, 1(3), 1-10.

Joint Commission. (2016). Bullying has no place in health care: quick Safety, 24(2).

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