Workplace Incivility in Healthcare A growing Concern

By Carolyn Hoffman-Kaminski

Workplace incivility may not be a topic openly discussed in healthcare, but it should be. Currently nurses are often working in hostile environments and in many instances it has become the accepted norm. Incivility behaviors such as demeaning remarks, refusing to help, and exclusion by peers or supervisors can lead to rising rates of burnout, turnover, lower job satisfaction and depression. In addition, the annual financial burden due to workplace incivility is estimated to be $23.8 billion (Laschinger, Wong, Cummings, & Grau, 2014).

Don't let one bad apple spoil the bunch!

Bullying in the nursing profession has been occurring as far back as the Crimean War. Florence Nightingale, who worked with women of lower socioeconomic status was known to be intimidating, demanding, critical and disrespectful to the nurses who worked for her (Lim & Bernstein, 2014). Unfortunately, even today, workplace bullying continues to be a growing problem. Fostering an environment of empowerment is one strategy utilized to tackle workplace incivility. However, more active attention and policy intervention is imperative to conquering lateral and horizontal violence. Some organizations have tried other approaches such as Civility, Respect and Engagement in the Workplace (CREW) training, role playing or education type workshops (Laschinger, Leiter, Day, Gillin-Oore, & Mackinnon 2012) with some success.


Workplace incivility can produce stress, burnout, and increased turnover as well as physical illness. Many individuals and departments within a hospital are affected. The same stakeholders that may be impacted negatively from the "bully" are the same individuals who can also benefit from being part of the solution. These include nurses, physicians, hospital leadership, other clinical staff, patients, family members, and the Human Resource and Finance Department.

More needs to be done to address and prevent bullying in the hospital. Leaders within an organization play a pivotal role in creating a positive work environment where collegial relationships are created, collaborative teams are formed and hostile atmospheres are eliminated. Skilled communication and authentic leadership, standards one and six of the American Association of Critical Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments, speak to a nurse leader’s obligation to create a healthy work environment which includes respect, integrity and collaboration (Barden, 2016). it is not only the individual hospitals responsibility to implement a zero tolerance policy but nursing and hospital associations are also responsible. Connecticut hospitals should work closely with the Connecticut Hospital Association and American Nurses Association to drive statewide initiatives to address workplace incivility and to create a Just Culture.

Needed Resources to Address Workplace Incivility

Nurse leaders must be provided with resources to address nurse bullying within the healthcare environment. "Research shows that when managers are ill-equipped for addressing workplace incivility conflicts, the tendency to ignore those conflicts is high" (Oyeleye, Hanson, O'Connor, & Dunn). Regulation needs to be enacted to address the growing problem in the shrinking nursing workforce. Hospitals need to incorporate Just Culture Training funds into their annual strategic plan in addition to implementing a Zero Tolerance Policy to combat workplace incivility.

From the Classroom to the Boardroom

DNP graduates can influence the future of nursing relationships beginning in the classroom. Advocating for workplace incivility prevention to be integrated into the nursing curriculum is a first step. DNP graduates can facilitate change through mentoring, educating, and conducting anti-bullying train-the-trainer programs. Further, DNP graduates as leaders in the organization, need to ensure hospital managers, executives, and boards are highly educated on the issue of workplace incivility and that funding for training is allocated in the annual budget.



Barden, C. (Ed.). (2016). AACN standards for establishing and sustaining healthy work environments: A journey to excellence. Retrieved October 31, 2017,

Laschinger, H. K., Leiter, M. P., Day, A., Gilin-Oore, D., & Mackinnon, S. P. (2012). Building empowering work environments that foster incivility and organizational trust. Nursing Research, 61, 316-325.

Laschinger, H. K., Wong, C. A., Cummings, G. G., & Grau, A. L. (2014). Resonant leadership and workplace empowerment: The value of positive organizational cultures in reducing workplace incivility. Nursing Economics$, 32, 5-15.

Lim, F. A., & Bernstein, I. (2014). Civility and workplace bullying: Resonance of Nightingale’s persona and current best practice. Nursing Forum, 49, 124-129.

Oyeleye, O., Hanson, P., O'Connor, N., & Dunn, D. (2013). Relationship of workplace incivility, stress, and burnout on nurses' turnover intentions and psychological empowerment. JONA, 43, 536- 542.

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