Cultivating Healthful Environments


While it sometimes might be viewed as minor, the problem of incivility in the workplace can have serious negative consequences for most if not all parties involved. This paper considers the issue of incivility in more detail. The definition of incivility is provided; the importance of this problem is discussed; an example of the consequences of uncivil behaviors is supplied; some strategies to address incivility are described, and the manner in which such strategies can be implemented while working as a family nurse practitioner are discussed.

The Issue of Incivility

The term “incivility” refers to the property of behaviors of being bad-mannered, crude, severe, discourteous, and impolite (McNamara, 2012). Incivility can be lateral (e.g., coming from nurse to nurse) or hierarchical (e.g., a manager to a subordinate); it is typically targeted at someone with less power McNamara, 2012). It may include such elements as verbal or nonverbal abuse, bullying, sexual harassment, or passive-aggressive behaviors (McNamara, 2012). While incivility might appear to be a minor issue, it is stressed that it may have profound adverse consequences for most parties involved (McNamara, 2012).

The Importance of the Issue of Incivility in Nursing

The problem of incivility is paramount in nursing due to the potential negative consequences that it may have for nurses, for the patients and their safety, and for the health care organization in which it occurs. As has been noted, incivility is practiced by those who have some power over their victim; thus, it is difficult for the latter to retaliate, and they remain vulnerable.

If incivility is aimed at an individual, it may cause that person to develop or exacerbate inferiority complexes. If subjected to severe bullying, young individuals are at a greater risk of suicide (Stanley, Horowitz, Bridge, Wharff, & Teach, 2016); this may also be true for people of other ages subjected to severe incivility (Steele, Thrower, Noroian, & Saleh, 2017). In work environments, when employees face incivility coming from their colleagues or administrators, this has a detrimental effect not only on the victims, but also on the atmosphere at the workplace in general; workers accumulate disrespect and/or resentment towards one another, and cannot effectively engage in collaboration; victims may suffer from weight loss or gain, headaches, increased blood pressure, fatigue, sleep disorders, etc. (McNamara, 2012). Incivility is also highly detrimental for nursing because the additional stress and health issues experienced by nurses at the workplace endangers patients. Also, nurses subjected to incivility frequently experience burnouts (McNamara, 2012).

An Example Scenario

A new female nurse employee becomes a target of derogatory remarks combined with mild sexual harassment from her male nurse administrator. The nurse fears to lose her job, so she does not report it. She has always considered herself overweight and non-attractive, and the derogatory remarks exacerbate her inferiority complexes, also further making her more afraid of losing the job. She constantly experiences stress, and fears to accidentally run into the administrator while at work. Her stress causes her to gain even more weight (McNamara, 2012); she also loses focus and is unable to care well for the patients. Her colleagues start believing that she is clumsy and incompetent, which also affects the relationships between the nurses. All of this negatively impacts the work environment, where one nurse is constantly anxious, the rest consider her incompetent, no effective collaboration is possible, and patients get lower-quality care.

Strategies to Create a Healthful Environment

Given the potential fallout of the incivility in nursing, it is pivotal to take actions aimed at eliminating such incivility and creating a healthful environment in the nursing workplace. A number of strategies may be utilized with this purpose. For instance, one of the strategies is related to nurse education: educators should disseminate information on addressing incivility to nursing learners and nurse practitioners in order to help them face and eradicate it; and create educational programs aimed at helping individuals to identify and deal with non-civil behavioral patterns so as to eliminate them and prevent their further emergence (Clark, Ahten, & Macy, 2013).

Another strategy is that of cognitive rehearsal, which can be implemented in the workplace (Griffin & Clark, 2014). It consists of three main phases: gaining didactic instruction; creating specific responses that could be used to react to non-civil behaviors (these should be neutral, acknowledge the existing problems, and invite further collaboration); and rehearsing them while preparing to face the uncivil behaviors in the real-life (Griffin & Clark, 2014).

In addition, yet another strategy could be employed to address uncivil behaviors. Its crux is facing the person practicing uncivil behavior in the presence of an effectual and competent leader, who can also supply a positive role model for the members of the conflicting situation (Clark, 2013). This strategy is stated to be among the most effective strategies for dealing with incivility and, consequently, creating a healthful environment (Clark, 2013).

Strategies to Be Implemented By a Family Nurse Practitioner

Generally speaking, family nurse practitioners may often work autonomously, in which cases they might not often face incivility in the workplace. Nevertheless, when collaborating with other professionals, the problem of uncivil behavior may still occur. To cultivate a healthy environment in the workplace, it is possible to disseminate information pertaining to incivility among colleagues so as to warn them about the dangers of this phenomenon and help them become aware if they unintentionally practice such behaviors. Another strategy that can be employed with this purpose is implementing the method of cognitive rehearsal, and teaching colleagues to use it (Griffin & Clark, 2014), in order to enable them to better address the problem of uncivil behavior should it arise in the workplace.


All in all, incivility can be defined as the property of behaviors of being cruel, bad-mannered, rude and impolite; these behaviors may be rather severe and may include abuse (verbal and non-verbal), bullying, sexual harassment, etc. Incivility has profoundly adverse consequences for its victims, as well as for the patients (if it occurs in health care setting), and for the working environment on the whole. To create healthful environments, nurses should be educated in college about the negative impacts of incivility and about the ways to address it. Also, it is possible for individual nurses to utilize such methods as the cognitive rehearsal, or confronting the perpetrator in the presence of an effectual and competent leader. Nursing leaders, in turn, should disseminate information about incivility, and about the methods for addressing it.


Clark, C. M., Ahten, S. M., & Macy, R. (2013). Using problem-based learning scenarios to prepare nursing students to address incivility. Clinical Simulation in Nursing, 9(3), e75-e83.

Clark, C. M. (2013). National study on faculty-to-faculty incivility: Strategies to foster collegiality and civility. Nurse Educator, 38(3), 98-102.

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. The Journal of Continuing Education in Nursing, 45(12), 535-542.

McNamara, S. A. (2012). Incivility in nursing: Unsafe nurse, unsafe patients. AORN Journal, 95(4), 535-540.

Stanley, I. H., Horowitz, L. M., Bridge, J. A., Wharff, E. A., & Teach, S. J. (2016). Bullying and suicide risk among pediatric emergency department patients. Pediatric Emergency Care, 32(6), 347-351.

Steele, I. H., Thrower, N., Noroian, P., & Saleh, F. M. (2017). Understanding suicide across the lifespan: A United States perspective of suicide risk factors, assessment & management. Journal of Forensic Sciences, 2017, 1-10. Web.