Running head: Civility in Nursing

Civility in Nursing
Shawnee Cuthbert
Cedar Crest College

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Abstract

A major problem in nursing is civility in nursing, or more precisely, the lack of civility in
nursing. The effects of rude and discourteous behavior, being disrespectful to your co-workers
and outright bullying in the workplace are felt throughout the entire healthcare system. When
nurses cannot work as a cohesive group, patient care diminishes, the staff experiences
psychological and physical stress and the entire profession of nursing suffers. A program was
developed in 2005, called CREW, which gives nurses a voice and helps create a positive,
productive workplace for nurses. The need is great for this type of program, or other programs
like this, and each hospital needs to be responsible to ensure its employees are happy. In order to
retain quality nurses and make the workplace a safe environment, all nurses must take
responsibility and make the changes necessary.

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Nursing is not immune to workplace incivility. Incivility thrives in nursing where there
are personality conflicts in peer relationships, ineffective communication, weak leadership and
improperly trained nurses. There is a trickle-down effect that interferes with providing good
patient care, financial difficulties for the healthcare facility which can result in a poor reputation
in the community and incivility is one of the reasons for a high attrition rate of new nurses.
Nursing Implications
There are significant implications regarding incivility in the nursing workplace. When
nurses are not civil, and the working atmosphere is cold, distant or at worst, hostile, the entire
system can break down and fail as a profession. Nursing is already a high-stress profession with
stressors such as a heavy workload, the patients acuity, of which a nurse has no control, and also
little say over the job itself and what it brings each shift. Incivility adds to these and can bring
about depression, anxiety, and other psychological and physical strains on the entire unit.
(Oore et al., 2010)
One of these considerations is the impact on nursing relationships. Peer relationships
thrive in a climate of camaraderie. The feeling that we are a team, we are in this together, we will
conquer this crazy shift and pull together to deliver the best nursing care for our patients, can
only succeed in a very civil climate. A nurse will be much less likely to approach a peer nurse for
opinions, reassurance, or for trying a new method of a nursing skill in a hostile environment. The
interactions with other nurses are unsatisfying, or even demeaning in truly uncivil situations.
Looking for validation, support or offering these kinds of things will greatly diminish. Effective
communication is critical for a nursing environment. Much of this communication is via informal
talk, mentioning things as a busy nurse is running through her shift, and tells another nurse of a
subtle change in a patients demeanor, pain level, appetite or sleep pattern. Although official

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nursing documentation will still take place, informal communication will be stunted. This can
lead to less than optimal patient care. The relaxed, civil working environment is far more
beneficial to ensure that this important, informal communication exists.
Furthermore, this lack of communication and poor work relationship issue, will greatly
impact new nurses. Nurses are trained via orientation, but much of the real learning is ongoing,
and can extend for months, after the orientation is long gone. If incivility of the workplace is the
norm, these new nurses will not have the comfort level to ask for what they need, or to ask that
dumb question that crops up. Incivility will lead to new nurses growth being stunted where
again, the patients suffer. A study by Leiter, Price and Laschinger (2010), found that young, new
nurses suffer more from the effects of incivility, than their baby boomer counterparts, which is
surprising in a field where there is a shortage of prospects and the shortage is expected to
continue.
The nurse-to-nurse relationship is not the only area in which incivility will impact the
unit. It will overflow into the relationships with nurse techs, respiratory therapists, social
workers, unit clerks, and in fact, even interactions with families of the patients. With incivility,
morale in general declines. This overflows into patient interactions and patient care, as well as
the care of family members of the patients. This will ultimately cause a decline in the reputation
of that hospital or facility, which is bad for the financial bottom line. To take this idea to the
extreme, you could even see hospitals getting a bad reputation, and therefore patients seeking
care elsewhere.
Personal Professional Implications
It is part of the role, as a professional nurse, to help maintain civility in the nursing
workplace. I very strongly feel that communication is key component in nursing and we must
foster a comfort level in which one is free to offer an opinion, question things, or lend support.

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Center (2010) says, . . . incivility survives and often thrives in many work environments due to
secrecy, shame and silent witness. Professionally, I would much rather work in a civil
environment, where myself and fellow nurses feel comfortable communicating in an informal
manner, where we all feel the camaraderie which should be a part of nursing.
I am leaning towards the critical care setting or emergency care for my future in nursing.
I do understand that both of these can be stressful, intense environments and civility could be
strained in both settings. Tolerance for mistakes or imperfection will be low, as it should be, yet I
feel this should not prevent nurses from maintaining a level of workplace civility. This leads
back to the concept of nurses being professionals. We must be able to maintain that sense of
civility and professionalism, even in high stress medical situations.
CREW, which stands for Civility, Respect and Engagement in the Workplace, is a
program that has been implemented in some hospitals since 2005. CREW is very successful in
lowering job dissatisfaction, raising patient and employee satisfaction, and complaints and
excessive sick days have diminished. It begins with the hospital administration and various
support people and also give the nursing staff a voice in what is happening in the unit. CREW
doesnt directly go after the bullies and intimidators, but instead, establishes a solid base that can
be built upon and creates an atmosphere where employees know they have the power to stop the
incivility. (Joining the CREW, 2010) My hope is that the hospital where I will work employs this
program, if not, I will introduce CREW and work on establishing it.
Nursing leadership roles play a major part in maintaining a safe and healthy environment;
but, ultimately we are responsible for ourselves and creating such an environment should begin
with the individual. Each nurse must recognize the incivility and be honest that maybe he or she
plays a part in it whether by actively bullying or inactively by standing by and letting the

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bullying happen. We cannot expect the problem to go away, until we all take responsibility and
recognize the problem, incivility will continue. (Center, 2010)

Conclusion
The effects of incivility may not be apparent at first when addressing the issue in the
nursing workplace. It extends past nurses, onto other health professionals and unit staff. It affects
patients and their families. It can affect the institution financially. Incivility can have an impact
on how nurses are seen by the general public. A unit of nurses with bad attitude can contribute to
how nurses are seen by the local community, and then by the public in general. Nurses want to be
seen as professionals, and incivility is very unprofessional. Frankly, it gives nurses, and the
profession of nursing, a bad name. There needs to be strong leadership with group participation
to control and eventually eliminate incivility. It is up to the entire staff, as individuals and then as
a team, to create and maintain a positive workplace.

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References

Oore, D., Leblanc, D., Day, A., Leiter, M., Laschinger, H., Price, S., & Latimer, M. (2010). When
respect deteriorates: Incivility as a moderator of the stressor-strain relationship among
hospital workers. Journal of Nursing Management, 18(8), 878-888. doi:10.1111/j.13652834.2010.01139.x
Leiter, M., Price, S., Laschinger, H., Price, S. (2010). General differences in distress, attitudes
and incivility among nurses. Journal of Nursing Management, 18(8), 970-980.
doi:10.1111/j.1365-2834.2010.01139.x
Center, D. (2010). Three As of civility: Acknowledgment, authentic conversations, and action.
Journal of Continuing Education In Nursing, 41(11), 488-489. doi:10.3928/0022012420101026-04
Joining the CREW builds civility at VA. (2010). Hospital Employee Health, 29(3), 30-31.