Toward disrupting normalized incivility in our nursing workplaces

The rapidly expanding volume of writing about racism and bias within nursing and health care makes it clear that the idea of all nurses being nice people is unsupportable. While most nurses may harbor a deeply ingrained sense of themselves as being in service to humanity, giving of themselves for those in need, the reality of our workplaces makes it clear that we too are subject to the nastier aspects of what seem to be the human condition in this world of ours (Hutchinson & Jackson, 2015). Under that public cloak of being seen as heroes and angels, giving of ourselves without expectation of reward, being totally “there” for others, we too have elements that are self-centred, competitive, and small minded. The extensive body of research on bullying within nursing confirms that this is and has likely always been far too prevalent and also that, despite best intentions, we still do not know how to fix it. We have tended to assume that, if nursing includes bullies, then that is an understandable response within a profession that has historically been subservient to another (i.e., medicine), has too little control over its own destiny in matters of governance and regulation, and possesses no particular hold on the power that shapes its practice conditions. However, it is also arguable that nursing is a fine profession, well respected and trusted by the wider society, and at this point in its history constitutes an entirely reasonable way to make a good living. The varied and various experiences nurses have in the course of their work bring them into intimate engagement with real life stories, action, intervention and even making a meaningful difference to the lives of those who are in need of nursing. And so, the explanation that the nursing profession is sufficiently oppressed and nursing work is sufficiently difficult to justify the existence of bullying is misguided and misleading (Hutchinson et al., 2006). Incivility exists in our profession, and takes its shape in many forms (Clark et al., 2021; Craft et al., 2020; Phillips et al., 2018; Taşkaya & Aksoy, 2021). We treat one another in ways we would never wish to be treated, and we normalize incivility as an inevitable product of the complex systems in which we work and the inherent challenges of our roles. When we try to disrupt incivility—to blow the whistle on a colleague or raise concerns about the behaviors we see around us—we run into barriers (such as lines of authority, unions, weak regulatory frameworks) that make it difficult to envision a favorable outcome. And so we become passive, reasoning that this is just an unfortunate reality of human nature, that we are simply being over-sensitive, that there is nothing we can do to change the status quo. If we have learned anything from our collective critical reflection on racism in nursing and health care, it is that these entrenched patterns of human behavior do not resolve themselves without intervention and without explicit commitment to enacting change. And although racism is the focal emphasis for much of what has recently been written, it seems fair to suggest that intolerable incivility can cross all boundaries of gender, ethnicity, and heritage. So I do believe that finding ways to tackle it squarely—to name it, challenge it, protect those affected against its harms, and to make it increasingly difficult for people to get away with it—will ultimately benefit us all. My own university administration introduced a “Respectful Environment Statement” several years ago.1 It was not positioned as a formal university policy as there was wide recognition that debates around its details would inevitably become contentious, but rather as a “Statement”—something that the various academic policy bodies, administrations and unions could generally agree upon as giving a sense of where the boundaries of acceptable behavior reside and what actions could be justifiably taken if they were violated. That document pre-empted the most predictable lines of critique that university folk might be inclined to counter with, ensuring it recognized power differentials, made space for lively debate and respected academic freedom as well as the value of articulating a diversity of opinions. However, it also made it unequivocally clear that the idea of freedom of expression also creates the possibility of tangible harms, and it named many of those foreseeable harms directly. It further confirmed the university's right to challenge disrespectful behaviors and take appropriate action. And although this document theoretically holds no official “teeth” in the sense of being legally enforceable, it has served the community exceptionally well over these years as a meaningful guide to addressing disrespectful conduct, including persuasive guidance and disciplinary action where needed. It articulates what the community has come to understand as a shared agreement on what a workplace can actually do to assure its members that they will be treated fairly and respectfully. If an organization as complex as a university can manage to take a stand on incivility, then I believe that nursing can do the same. For the most part, our codes of ethics have focused on our role in protecting patients from various harms, and we have made significant inroads with concepts such as cultural safety to try to integrate shared understandings into our ways of doing business. But as we focus on nurses as agents of action in support of protecting patients from these unacceptable harms, we have not often considered ourselves to be worthy of similar protections. And I believe we ought to. There is much within our discipline that sets a foundation for what we could collectively agree upon. Readers will recognize that many of these ideas have turned up in editorials in this journal over the years. For example, we have a strong historical tradition of shared values (Thorne, 2017a), we recognize that the building of a professional inherently requires the generosity and good will of others within the discipline to pave the way (Thorne, 2013, 2023), we understand that the overt and covert racism that we have allowed to creep into our professional practices are morally wrong (Thorne, 2017b, 2018), and we understand that there must be a collective commitment toward dismantling such patterns (Thorne, 2022). Having worked among nurses for over 50 years now, across many different settings, contexts and cultures, I know that the vast majority of nurses would sincerely commit to a workplace environment characterized by civility, even if it required a bit of support and retraining to get them there. Nurses can envision the idea of causing harms, even if they are more comfortable ignoring the part they may be playing in causing them. And communities of nursing can usually clearly articulate what it is they mean by the kind of work environment within which all members, from the most junior learners to the most senior leaders, flourish and thrive. Although formal healthcare administrations may not have an appetite for wrangling with professional associations and bargaining units to formalize disciplinary mechanisms for what are often nuanced behaviors and communications, communities of nurses can begin to build their own “statements”—perhaps drawing on the language and expression of other institutions of various kinds that have attempted to do the same. And over time, if we propose ideas for inclusion, discuss them, refine the expression of our arguments, and learn to understand the implications of what we have written, these kinds of documents can become shared commitments with sufficient strength and durability to become the established community standards against which direct action can be taken where needed. Once we have a firm grasp on what our collective mandate entails as regards civility and incivility, we have ample skills to be able to integrate those elements into basic and continuing education, workplace orientation and support, and our evolving workforce research initiatives (Padgett, 2015). We cannot allow incivility to remain a recognizable dynamic within our profession. To normalize that which should never be normalized is to perpetuate the kinds of harms our profession was designed to prevent (Alsadaan et al., 2024; Sherrod & Lewallen, 2021). And so I challenge us all, and in particular, those of us engaged with professional associations, workplace leadership teams, and schools of nursing, to put some effort into thinking about what it is we actually do believe in with respect to interpersonal conduct in this profession of ours, how we might shape those ideas into workable language and how we might share them among and across contexts. This is important work, aspirational work and work that can make a real difference for the lives of individual nurses and the collective effectiveness of our profession on behalf of society.

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