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PATIENT SAFETY FIRST
Incivility in Nursing: Unsafe Nurse, Unsafe Patients
SHARON A. McNAMARA, MS, BSN, RN, CNOR
Websters dictionary describes incivility as the quality or condition of being uncivil; discourteous behavior or treat
ment, an uncivil act,1(p966) and the word uncivil as without good manners, unmannerly, rude, impolite, and discourteous.1(p2056) As a nurse who has observed and been on the receiving end of incivility from other nurses, this seems to me to be a very tame description. The nursing literature is rich with descriptions of various types of incivility, the most common being lateral (eg, nurse to nurse) and hierarchical (eg, nurse administrator or manager to nurse, nurse to student, faculty member to student, physician to nurse). The incivility described is usually directed from someone in a position of power toward a coworker who has less power, and it can be devastating to the targeted person, unsafe for patients, and costly for the facility.
In July of 2008, The Joint Commission issueda Sentinel Event Alert that discussed intimidating and disruptive behavior that undermines a culture of safety.2 In January 2009, The Joint Commission implemented leadership standards that require hospital leaders to create and maintain a culture of safety and quality in the hope that recognition that behavior that intimidates others and affects morale or staff turnover can be harmful to patient care.3 In the standards to be published in spring of 2012, The Joint Commission will drop
the term disruptive behavior, used in two of the elements of performance, because of the negative connotation to some health care providers.4 Instead, the standards will identify behavior or behaviors that undermine a culture of safety and call attention to the fact that behavior that intimidates others can create an environment of hostility and disrespect that affects morale, and increases staff turnover, and can lead to distractions and errors, all of which are detrimental to patient care.3,5,6
Nurses must raise their awareness and the awareness of others about these behaviors; recognize behavior that undermines a culture of safety when it occurs; and become empowered to address, confront, and move beyond bullying.Awareness requires nurses to examine their own behavior and seriously consider what actions they can take or how they can respond to inappropriate behavior. Nurses must recognize when...