Across the UK, incivility is becoming increasingly common and, for nursing, its implications are especially harmful. There are many ways in which incivility in the workplace raises its head. Behaviours that can be seen as uncivil range from lack of support to rude, ill-mannered or humiliating comments. It can also include verbal threats. As incivility often goes unrecognised and under-reported, these apparently insignificant behaviours can have far-reaching negative consequences. Andersson and Pearson (1999) defined incivility as actions that violate norms of respect, but whose intent to harm is ambiguous. The intimidating behaviour that comes with incivility affects morale, staff turnover and patient care.
Health and care professionals who are subjected to incivility, even when it is not directed at them, are at risk of being harmed. In complex organisations, such as the hospital environment, incivility can be perpetuated by underlying erroneous beliefs, such as, ‘we work in a high-pressure environment; therefore, it is acceptable to skip the subtleties, the minutiae’. Confronting these beliefs is central to addressing workplace incivility.
Small et al (2015) state that 85% of nurses reported having personally experienced incivility in the past year, this highlights the significance of the issue. When a nurse experiences an act of incivility, it impacts their performance, mental health and wellbeing, as well as their desire to remain with an organisation or even the profession. While the effects on nurses and healthcare organisations are detrimental (the organisation, for example, will incur increased costs related to staff turnover, absenteeism and poor work performance), a more serious and potentially life-threatening consequence of incivility is its risk to patient safety as a result of unsafe nursing practices directly related to cases of incivility.
Given the reported prevalence in the workplace, it is essential that efforts are made (particularly by managers) to recognise the phenomena and to devise interventions that reduce its effect on individuals and organisations. Efforts are required to understand the predictors and triggers associated with incivility in teams and in so doing reduce frequency and impact. All nurses must act in line with the Code (Nursing and Midwifery Council, 2018). Nurses who fail to address unprofessional behaviour are indirectly promoting such conduct. Uncivil behaviour undermines the healthcare team's effectiveness and can lead to errors and preventable adverse patient outcomes. Interventions aimed at reducing incivility in the workplace are beneficial to nurses, healthcare organisations and patients.
In those organisations that exhibit intimidating, bullying or disruptive behaviours, with inappropriate hierarchies, disruptions in teamwork along with loss of trust, decreased morale and increased turnover, then patients and staff can expect to be harmed as a result of this. Poor teamwork as well as disrespectful, rude and insulting behaviours have no place in contemporary health and social care organisations. Incivility can generate an atmosphere where staff will not, for fear of being humiliated, raise concerns or question managers, resulting in poor communication and patient outcomes. None of us can afford to be onlookers when situations such as these arise. Incivility can be contagious and we must never normalise this abnormal behaviour or poor care. We are less when we engage with incivility. Civility can save lives, it can be the difference between a member of staff being indifferent and great. Irwin (2018) notes that civility, kindness and empathy is not simply the domain of patient care, it must also be bestowed on each other.