Bullying and general incivility are “pervasive threats” to the nursing workforce and health systems, and require employers to develop comprehensive policies that encourage accountability and “restorative” responses.
The warning and recommendations are among several outlined in the American Nurses Association’s newly released position statement on the issues, which was adopted by its board of directors and made effective last month. The statement describes the issues as threatening to the delivery of high-quality care, affected clinicians and long-term workforce stability.
Incivility is defined in the statement as “low intensity, yet disrespectful behaviors” that may not necessarily have negative intent—for instance, “eye rolling or a vacant expression in response, exclusion from activities or conversations, and dismissive behavior.”
Bullying, meanwhile, “involves repeated, intentional acts of hostility or aggression over time” and are intended to cause harm and distress, examples of which include “blank stares, gossiping, taunts, scapegoating, the withholding of support and sabotage.”
The position statement describes these practices as “a widespread occupational hazard,” citing published data placing global incivility and bullying incidence estimates anywhere from 3.9% to 86.5% depending on how it is measured and reported. One “large sample of U.S. nurses” cited by the ANA estimated 40% prevalence, while another focused on nursing students specifically outlined a similarly broad range of 9% to 96%.
While broadly advocating stakeholders take a “trauma-informed approach” to the issue, the ANA’s statement outlines a slew of recommendations targeted at nurses and employers.
For the former group, ANA encouraged the clinicians to take a proactive approach by participating in the development of healthy work environment policies, or by “providing anticipatory guidance” by either helping to resolve conflicts among colleagues before they reach management or establishing a predetermined word or phrase that can be used to signal the behaviors to others in the moment.
For employers and other leadership, ANA called for healthy work environments to be elevated as a key strategic priority. Doing so would include cultural initiatives such as regular assessments, a clearly defined code of conduct, designation of internal champions and the availability of “accessible, confidential and psychologically safe reporting mechanisms.”
Notably, ANA’s position statement outlined a step away from “widely adopted” zero-tolerance policies the organization said “may discourage reporting, overlook context and prioritize punishment over change and accountability. In contrast, a restorative and tiered approach evaluates the merits of each behavior, considers its context and severity, and issues fair, proportionate and constructive responses.”
ANA’s other recommendations extend into the hiring phase, with calls to evaluate applicants for their civility, and into professional development programs where organizations should integrate relevant education on incivility and bullying into education materials.
“Nurses deserve workplaces where respect is the standard and harmful behaviors are addressed, not normalized,” Jennifer Mensik Kennedy, Ph.D., president of the ANA, said in a statement. “That requires clear, respectful communication across all settings and through every channel. It also requires each of us to support colleagues who experience incivility or bullying and to take an active role in resolving conflict.”