Incivility in nursing refers to rude, disrespectful, or discourteous behavior between healthcare workers that falls short of outright bullying but still damages working relationships, personal well-being, and patient care. It includes behaviors like gossiping, refusing to help a coworker, using a condescending tone, publicly criticizing a colleague, and name-calling. While these actions might seem minor in isolation, they carry serious consequences: research links nursing incivility to medical errors, surgical complications, and even patient deaths.
How Incivility Differs From Bullying
Incivility and bullying overlap but aren’t the same thing. Bullying involves repeated, targeted actions meant to humiliate, undermine, or harm someone, often through a misuse of power. It’s deliberate and sustained. Incivility, by contrast, can be a one-off eye roll, a snippy email, or a dismissive comment during a handoff. The intent may not even be conscious. Someone under stress may snap at a colleague without meaning to cause harm.
That distinction matters because incivility is often treated as trivial, something people should just shrug off. But the CDC’s National Institute for Occupational Safety and Health warns that incivility left unaddressed tends to escalate into bullying and even violence. A condescending remark that goes unchecked today sets the tone for worse behavior tomorrow. Incivility also isn’t limited to face-to-face interactions. It happens over the phone, in emails, during web-based meetings, and in online communication.
Common Forms of Incivility
Uncivil behavior in nursing takes many forms, some obvious and some easy to miss:
- Verbal behaviors: condescending tone, name-calling, sarcastic remarks, public criticism that undermines a colleague’s dignity
- Social behaviors: gossiping, spreading rumors, excluding coworkers from conversations or decisions
- Withholding behaviors: refusing to assist a coworker, ignoring questions, deliberately not sharing information needed for patient care
- Nonverbal behaviors: eye-rolling, sighing, turning away when someone is speaking
These behaviors can flow in any direction. Nurses experience incivility from physicians, supervisors, peers, and patients. It can come from someone with more authority or from a colleague at the same level.
Why It Happens: Systemic Triggers
Incivility isn’t just a personality problem. Research at academic medical centers has identified organizational factors that create fertile ground for uncivil behavior. One major driver is the physical and structural separation between departments. When colleagues rarely interact, they form assumptions and prejudices about one another. Brief, impersonal encounters are more likely to start from a place of conflict rather than cooperation.
Leadership plays a central role. When leaders model or tolerate divisiveness and competition, that behavior filters down. A “culture of silence,” where no one addresses rude behavior because it feels too minor or too risky to call out, allows incivility to become normalized. Over time, this silence institutionalizes the problem. Power cliques can also form: small groups of influential individuals who band together and exclude anyone they see as a threat, reinforcing an environment where disrespect goes unchallenged.
Heavy workloads and chronic understaffing add fuel. Nurses working under constant pressure are more prone to short tempers, less likely to offer help, and more likely to interpret neutral interactions as hostile. The stress doesn’t excuse the behavior, but it explains why incivility clusters in high-pressure units.
The Toll on Patient Safety
This is where incivility stops being an interpersonal nuisance and becomes a clinical danger. A systematic review published in Future Healthcare Journal found that incivility is associated with medical errors, adverse events, surgical complications, and patient mortality. The mechanism is straightforward: rude behavior impairs the cognitive function of the person on the receiving end. Concentration drops, decision-making suffers, communication breaks down, and critical steps get missed.
The numbers are striking. In one study of emergency departments, 57% of participants reported witnessing disruptive behavior from physicians and 52% from nurses. Among those witnesses, roughly a third linked the behavior to medical errors and poor quality of care. About 18% were aware of a specific adverse event that happened as a direct result of disruptive behavior. In another study, 71% of respondents agreed that disruptive behaviors were linked to medical errors, and 27% connected them to patient mortality.
A particularly revealing investigation tracked 13,653 surgical patients and 202 surgeons. Patients whose surgeons had more coworker reports of unprofessional behavior over the previous three years faced a higher risk of both surgical and medical complications. In other words, a surgeon’s reputation for rudeness predicted worse outcomes for their patients.
In high-acuity settings like intensive care units, the effects are amplified. Incivility has been shown to reduce vigilance, impair teamwork, and cause diagnostic errors. Team members who have been treated rudely become less willing to speak up, less likely to offer help, and more anxious, which is exactly the opposite of what critically ill patients need from their care teams.
How Incivility Affects Nurses
Beyond patient harm, incivility takes a measurable toll on the nurses themselves. Research shows it directly increases burnout and turnover intention while decreasing job satisfaction and organizational commitment. One study found that workplace incivility significantly reduced both job satisfaction and commitment to the organization, while increasing the likelihood that nurses would leave their jobs. These aren’t small effects. In a profession already facing staffing shortages, incivility accelerates the cycle: fewer nurses means heavier workloads, which means more stress, which means more uncivil interactions, which drives more nurses to quit.
At the team level, incivility disrupts group dynamics. Trust erodes. Collaboration suffers. The overall culture of a unit shifts from supportive to defensive, where self-preservation replaces teamwork.
Regulatory Standards for Hospitals
The Joint Commission, which accredits most U.S. hospitals, now holds organizations accountable for addressing these behaviors. Its workplace violence prevention standards use a broad definition that includes not just physical violence but verbal aggression, threats, intimidation, harassment, bullying, and sabotage.
Under these standards, hospitals must conduct an annual worksite analysis to identify risks and document the actions taken to address them. They must continuously monitor and report violent or disruptive events. Staff must receive education and training. And each hospital must establish a formal workplace violence prevention program led by a designated individual and supported by a multidisciplinary team. Simply acknowledging the problem isn’t enough; hospitals must show they are actively working to fix it.
What Actually Works to Reduce It
One of the most studied interventions is cognitive rehearsal training, where nurses practice scripted responses to common uncivil behaviors before they encounter them in real life. Think of it as role-playing difficult conversations in a safe setting so you have the words ready when a colleague is condescending or dismissive. An integrative review of 22 studies found that this training can build the skills and confidence nurses need to address incivility in the moment, which in turn decreases its occurrence.
But training alone isn’t sufficient. The review identified four core components that make cognitive rehearsal effective, and emphasized that the broader work culture has to support the effort. If a nurse learns to speak up but returns to a unit where leadership ignores complaints, the training won’t stick. Sustainable change requires a combination of individual skill-building, leadership accountability, clear reporting pathways, and organizational policies that treat incivility as a safety issue rather than a personality conflict.