Running head: INCIVILITY, BULLYING, VIOLENCE, AND THE PROFESSIONAL 1

NURSE

Incivility, Bullying, and Violence and the Professional Nurse

Julianna Brauchle

Cedar Crest College

INCIVILITY, BULLYING, AND VIOLENCE AND THE PROFESSIONAL NURSE 2

Abstract

Incivility, bullying, and violence are defined as being rude, discourteous, disrespectful behaviors

that may or may not be negatively charged in nature, and are repeated in order to cause distress

in the recipient. These actions directly impact that professional nurse, who provides a multitude

of care to patients, such as the recording and observing of behaviors for health history and

physical exams, provide health promotion and education, administer medications and provide

wound care, and numerous other interventions, interpret patient information and make critical

decision about needed actions, coordinate care in collaboration with a wide array of healthcare

professionals, direct and supervise care delivered by other healthcare professionals, direct and

supervise care delivered by personnel, and conduct research in support of improved practice and

patient outcomes. Incivility, bullying, and violence are present in the nursing workforce and are

known problems without much in the form of a solution. There is no current federal regulations

of violence in the workforce, however the Joint Commission and AACN have become involved.
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Incivility, Bullying, Violence, and the Professional Nurse

Within the complexity of the nursing profession, there are many different roles,

functions, and responsibilities of a professional nurse. The professional nurse is one of the main

lines of care for a patient. Since this is the case, the nurses responsibilities and roles, according to

the American Nurses Association (2016), are as follows: nurses “perform physical exams and

health histories, provide health promotion along with counseling and education, administer

medications, provide wound care, and numerous other interventions, interpret patient

information and make critical decision about needed actions, coordinate care in collaboration

with a wide array of healthcare professionals, direct and supervise care delivered by other

healthcare professionals, direct and supervise care delivered by personnel, and conduct research

in support of improved practice and patient outcomes”. In essence, nurses are the first person a

patient interacts with, the person a patient learns from, and receives care from. Nurses, however,

not only give care directly, they collaborate with other specialties and are supervisors. Nurses

also are researchers and critical thinkers, as they need to possess the ability to make critical

decisions about necessary treatment options.

When looking a little more closely at the nurse’s role, one will find that a nurse not only

provides medical care that affects the patent physically, but also mentally. One of the most

important aspects to a nurse’s effective treatment is therapeutic communication. This is worth

mentioning because without the complete trust of the patient, the nurse will have an incredible

time convincing the patient of treatment and teaching them about such things. It is also important

for the nurse to provide “emotional, and also psychological support to the patients and their

families, so registered nurses create a harmonious environment” (Registered Nurse, 2015). It is

INCIVILITY, BULLYING, AND VIOLENCE AND THE PROFESSIONAL NURSE 4

important for the nurse to maintain a therapeutic relationship with their patient, since without this

good relationship the patient will not be a receptive to their treatment.

In order for the professional nurse to maintain an effective therapeutic relationship, the

nurse’s work environment should also reflect such a basis. This means that the nurse’s work

environment should be free of bullying, violence, and incivility. The actions of the nurse have a

direct impact on patient’s health and outcomes. For example, it has been found that “poor

communication and unprofessional relationships among health care workers have a direct impact

on patients’ outcomes and safety” (Luparell, 2011). It is not hard to imagine that a nurse who has

been a victim of verbal abuse or incivility would be affected by this treatment, however it is hard

to imagine a scenario where it is acceptable for this to impact a patient’s safety. When abuse and

incivility are occurring in such a setting, such as a nurse’s work environment, it is paramount that

this situation be dissolved as quickly as possible. This is such an important problem that the Joint

Commission “issued a sentinel alert and in 2010 implemented new standard that require health

care organizations to have mechanisms in place to deal with uncivil and disrespectful behavior”

(Luparell, 2011). If the Joint Commission becoming involved, AACN itself actually “developed

standards for healthy work environments, demonstrating its commitment to making this serious

issue a top priority” (Luparell, 2011).

The licensed professional nurse is not the only person subject to incivility and violence in

the nursing field. Student nurses and faculty are also both subject to these problems. Students

report “being on the receiving end of disrespect by faculty, fellow students, ad staff nurses. For

example, students note that faculty sometimes belittle or taunt them in public, are inflexible to

students’ needs, cancel class without warning, or are unprepared for class” (Luparell, 2011).

While this is not directly related to the professional nurse per se, the inappropriate behavior
INCIVILITY, BULLYING, AND VIOLENCE AND THE PROFESSIONAL NURSE 5

starting as a student nurse does impact the way the student nurse is shaped. Bad behavior that is

not corrected only perpetuates more bad behavior, and can in turn directly impact the

professional nurse down the road. The same can be said for the nursing faculty that endure abuse.

For example, nursing faculty “endure tardy, inattentive, and unprepared students in the

classroom who make rude, disrespectful, and sarcastic comments. More than a small number of

faculty have reported being yelled at by students, threatened with injury, stalked, or physically

assaulted” (Luparell, 2011). This inappropriate behavior should be grounds to kick a nursing

student out of the program, however if a student is not reprimanded or disciplined they may think

this behavior is acceptable and may spin out of control. While it may not seem like incivility in

nursing school would have a direct impact on the already licensed professional nurse, it does. If

the simple fact that incivility may begin in nursing school is not enough to prove this, than the

simple fact that student nurses that are rude and disrespectful may bring this behavior into their

clinical hours in the hospital, and they rude behaviors would directly impact the professional

staff at the hospital.

It is an important topic to be addressed, incivility in nursing. Incivility, violence, and

bullying is a notion that is spiraling out of control in more professions than just nursing, however

it is an important current problem that needs to be addressed. When nurses do not address

incivility or bullying, they are perpetuating the bad behavior. According to an article by

Felbinger (2008), “some nurses are accustomed to tolerating behaviors that are outside of the

realm of considerate conduct and are unaware that they are doing so”. It is disturbing that some

nurses are treated so poorly for so long that they are no longer aware that they are being treated

poorly. It is unfortunate that this has gotten to this point, and since the nurses are no longer aware

of the behavior, they are not changing it in any way, and “these behaviors affect the
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organizational climate, and their negative effects multiply if left unchecked” (Felbinger, 2008).

The simple fact that nurses are unaware of the behavior means that, to a certain extent, the nurses

are ignoring the behavior. Now, if a nurse ignored a patient’s warning signs of a worsening

problem, that would be unacceptable. The same should apply here. A nurse who ignores poor

behavior, who ignores bullying and incivility is a nurse that is doing more harm than good. It

may seem easier to just let it happen and deal with it, however the coworker who is making one

nurse feel bad is more than likely doing it to others, and this can have an impact on patient

outcomes.

Violence in the nursing workplace is another aspect of the problems in nursing. A study

done by Camerino, Behar, Conway, Hejiden, and Hasselhorn (2008) found that “higher levels of

adverse work-related factors were significantly associated with higher frequency of distinguished

types of violence”. So, it was found that there is an increased risk of adverse work-related factors

when there is violence present in the workplace. This is just one reason as to why it is paramount

that interventions take place in order to avoid conditions that perpetuate violence and violent

behaviors. It is not out of the realm of possibility that a victim of violence would not be acting or

performing as effectively as a non-victim of violence, however it does not make it acceptable

that some places do not feel the necessity to protect their employees from abusive coworkers.

Violence can come in an assortment of manners, including but not limited to physical and verbal.

Once violence is seen and noted, it is important for these issues to be problems with violence to

be addressed and taken care of so that they do not spiral out of control and contribute to bad

patient outcomes.

A nurse is a crucial part of a patient care team. Nurses are a patient advocate and a patient

caretaker. Nurses provide direct medical care to the patient, while also providing the patient with
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other types of services, such as emotional and psychological support, which also extends to the

family of the patient. A nurse is not only a caregiver, the nurse is also a collaborator, researcher,

and critical thinker. It is important that healthcare practices protect their nurses from incivility,

bullying, and violence. As defined by the American Nurses Association (2016), incivility is one

or more rude, discourteous, or disrespectful actions that may or may not have a negative intent

behind them. Bullying is defined as “repeated, unwanted, harmful actions intended to humiliate,

offend and cause distress in the recipient, which is a very serious issue that threatens patient

safety, RN safety, and the nursing professional as a whole” (ANA, 2016). According to the

American Nurses Association (ANA), there is not currently a federal standard that requires

workplace violence protections, however there is a small number of states that have enacted

legislation and regulations that are aimed at preventing workplace violence.

Incivility, bullying, and violence are important and worthy topics of discussion. It is

important that nurses are protected from these issues, as these problems can directly impact

patients and other nurses alike. When unacceptable behavior is not disciplined and stopped, it is

essentially allowed and perpetuated. Since there is not currently any federal standard, it is

important that going forward there is change in this aspect of the workplace. There should be

necessary standards and precautions set forth to protect our public and workforce from the

potentially dangerous and devastating effects of bullying, incivility, and violence, as these

harmful actions can be devastating to not only the nurse, but also to the general public as patients

in the hospital are now subject to the adverse problems that come from nurses being bullied and

treated poorly.
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References

American Nurses Association. (2016). What Nurses Do. Retrieved November 27, 2016, from
http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-
Need/RNsAPNs.html

Camerino, D., Estryn-Behar, M., Conway, P. M., Beatrice Isabella Johanna Maria Van Der
Heijden, & Hasselhorn, H. (2008, January). Work-related factors and violence among
nursing staff in the European NEXT study: A longitudinal cohort study. International
Journal of Nursing Studies, 45(1), 35-50. doi:10.1016/j.ijnurstu.2007.01.013

Felblinger, D. M. (2008, March 11). Incivility and Bullying in the Workplace and Nurses’
Shame Responses [Abstract]. Journal of Obstetric, Gynecologic & Neonatal Nursing,
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Luparell, S. (2011). Incivility in Nursing: The Connection Between Academia and Clinical
Settings. Critical Care Nurse, 31(2), 92-95. doi:10.4037/ccn2011171

Registered Nurse Responsibilities, Duties and Job Prospects. (2015). Retrieved November 27,
2016, from http://www.topregisterednurse.com/registered-nurse-job-description-and-
duties/