Nurses: Resetting the Civility Conversation

Cynthia M. Clark, PhD, RN; Sara M. Ahten, MSN, RN


August 19, 2011

In This Article

Exposing Nurse Incivility

When we were interviewed for the article The Downward Spiral: Incivility in Nursing , we must admit that we did not anticipate the volume and passionate intensity of the responses from Medscape readers. When we learned how many individuals had read the article in the first few weeks after publication, the huge numbers were a surprise, but the stories were regrettably familiar.

Our intent in participating in the original interview was to initiate thoughtful conversation about civility and incivility in nursing. We believe that the end goal of this conversation should be the creation of a safe, respectful place for nurses to practice. We completely agreed with Susan Yox, RN, EdD, Editor, and many readers who see a need to focus on creating positive, proactive organizational changes in both the workplace and the academic setting. (See Incivility in Nursing -- Is That All There Is to Talk About?)

Civility: Putting a Name to It

In this article, we hope to raise awareness of the existence and consequences of incivility, which we view as a necessary first step in resetting the conversation to the topic of civility. The essential empowering activities for us as nurses are to define, encourage, model, and embed the desired behaviors into our organizations.

We believe that nursing must amplify the national dialogue on creating civil work and learning environments. Nurses can be ambassadors and leaders for change. With more than 3 million nurses in the United States, no other licensed healthcare profession has the potential power that nurses hold as a group. If we could agree upon and unite behind common expectations for how we are treated and how we treat others, we have the ability to change school and workplace interactions.

Eradicating bullying behavior starts at the top because an organization "reflects the values, attitudes, and actions of its leaders."[1] It takes deliberate and conscious decision on the part of leadership to eliminate uncivil behaviors, create norms and expectations for schools and workplaces, and hold all participants -- including themselves -- accountable.

Change can only occur following public recognition of what behavior must be changed. Griffin[2] stated that nursing "cannot fix the problem until we put a name to it. Throughout history, nursing has condoned intimidating behavior that has now become an 'acculturated bad behavior' that we don't really talk about." After our interview was published, hundreds of readers on the article's discussion board put a name to -- and told a story about -- their experiences with condoned intimidating behaviors.

What we found most upsetting about these stories were the obvious feelings of fear, loneliness, intimidation, and self-doubt that persisted for the nurses who were targets of uncivil, bullying behaviors, even years after the incident. The profound and far-reaching effects of these experiences cannot be minimized or marginalized. Griffin said it best: "Bullying is allowed to occur for 3 reasons: because it can; because it is modeled; because it is left unchecked."[2]


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