ANA: 'Zero Tolerance' for Workplace Violence, Bullying

Troy Brown, RN

September 02, 2015

The American Nurses Association (ANA) will no longer tolerate violence of any kind against nurses in the workplace, according to a new position statement developed by its Professional Issues Panel on Incivility, Bullying, and Workplace Violence.

"Taking this clear and strong position is critical to ensure the safety of patients, nurses and other health care workers," ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, said in a news release. "Enduring physical or verbal abuse must no longer be accepted as part of a nurse's job."

"[Registered nurses (RNs)] and employers across the health care continuum, including academia, have an ethical, moral, and legal responsibility to create a healthy and safe work environment for RNs and all members of the health care team, health care consumers, families, and communities," the position statement explains.

In a recent survey of 3765 registered nurses, almost one quarter of respondents said they had been physically assaulted at work by a patient or a patient's family member, and almost half of respondents had been bullied in some way, either by a peer (50%) or by someone with authority over them (42%).

Incivility can include rude or discourteous actions, gossiping and spreading rumors, and refusing to help a coworker.

The statement defines bullying as "repeated, unwanted harmful actions intended to humiliate, offend and cause distress," and includes hostile remarks, verbal attacks, taunts, threats, intimidation, and withholding support.

Workplace violence includes direct physical assaults (with or without weapons), written or verbal threats, physical or verbal harassment, and homicide.

Incivility, bullying, and workplace violence result in decreased job satisfaction, reduced organizational commitment, and decreased personal health, as well as additional direct and indirect costs to employers and RNs, according to the statement. One study calculated lost productivity related to workplace incivility at $11,581 per nurse annually.

RNs and employers share responsibility for creating a culture of respect and implementing evidence-based prevention strategies, the statement explains.

RNs should:

  • commit to "promoting healthy interpersonal relationships" and become "cognizant of their own interactions, including actions taken and not taken";

  • participate in training on effective communication, diversity and inclusiveness, and conflict negotiation and resolution training;

  • establish an agreed-upon code word or signal to let others know they feel threatened. "This outreach may involve the targeted individual or a bystander using a predetermined phrase that signals all available nurses to move toward the target both to provide nonverbal support and to witness the harmful actions taking place";

  • after an incident of incivility or bullying, report the incident through appropriate channels, according to their institution's policies;

  • after an incident of incivility or bullying, keep a detailed written record of what happened, relevant names, dates, and any witnesses;

  • support coworkers who experience incivility or bullying, which can include offering emotional support and validation as well as helping the targeted employee document and record the incident.

Employers should:

  • develop a comprehensive violence-prevention program that is in line with federal health and safety guidelines, with RNs' input;

  • offer education on incivility and bullying, including evidence-based strategies for prevention;

  • encourage RNs to take part in educational programs, learn their organization's policies and procedures, and be aware of what is going on around them to anticipate the potential for violence;

  • provide a way for RNs to seek support when feeling threatened;

  • encourage employees to report violent incidents, and not blame employees for violence committed by nonemployees;

  • establish a "zero tolerance" policy against incivility and bullying that "treats all cases in the same manner, regardless of who is involved”;

  • inform employees about available conflict resolution strategies and respectful communication.

Additional resources for RNs and employers are available at


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.