Incivility in Nursing & Horizontal Violence
When you think of the nurse community, you don’t necessarily think of nurse incivility or horizontal violence. Many people have asked, what is incivility in nursing? Isn’t nursing the most caring profession in the world? Believe us, nobody wants to believe that there are examples of incivility in nursing. Nursing has always been a trusted position in healthcare, and the goal is to keep it that way through education on these types of wrinkles in the healthcare system. Nurses have a unique heart to serve patients and the healthcare community in a selfless way, however, just like any other community, there’s still acts of violence and nurse incivility that occur. Unfortunately, with nurse incivility occurring, the only way to address it is to discuss it, educate other healthcare professionals on the warning signs, and commit to removing it from our culture.
By definition, we can take a closer look at what is considered nurse incivility or horizontal violence and then share some examples of incivility in nursing:
Nurse Incivility:
A form of psychological harassment and emotional aggression that violates the ideal workplace norm of mutual respect.
Horizontal Violence:
Harmful behavior, via attitudes, actions, words, and other behaviors that is directed towards us by another colleague. Horizontal violence controls humiliates, denigrates or injures the dignity of another. Horizontal violence indicates a lack of mutual respect and value for the worth of the individual and denies another’s fundamental human rights.
In order to be as accurate as possible, we gathered examples of incivility in nursing from actual nurses responding to “What is incivility in nursing? Have you encountered it? How can we fix it?”
Recently, we invited nurses to speak up about it and we got to hear what they had to say:
“In 24+ years, I can’t begin to quantify an answer for how often I see nurse incivility. I’ve seen charts flung across a room (nearly took my head off, one time). Countless verbal assaults. Leaving a coworker in a dangerous position (I work in psychiatry). Maybe I should write all this up one day – a chapter or three for the memoirs endured this from coworkers, doctors and managers over the past 36 years. The worst has been from my own nurse colleagues and is the main reason I quit nursing 8 yrs ago. Although I returned to nursing 2 yrs ago in the same specialty the emotional and verbal abuse continues and is getting more intense and chronic.”
“How about when the ER Director called a staff meeting and the topic is triage. She announced that every triage nurse should give exactly the same ESI level if they were presented with the same patient. When we explained that a lot of triage was subjective and patients don’t always give accurate information, she stated that a monkey could do triage. She then continued this example of nurse incivility and went around the room pointing at each nurse and said: “I expect monkey 1 (point) to do the same as monkey 2 (point) to do the same as monkey 3 (point), etc.”
“Radiology Technologist 20 years- I’ll have to keep it short as I can… 1st few years 1994 on- worked in Florida. A lot of Radiologists were sexist and racist which I think took nurse incivility to a more cruel and unacceptable level. Even if the department manager was a woman- the male tech’s got opportunities in Cath Lab, MRI and CT. A lot of sexual harassment too. No one reported it- cause management cared only to keep the doctors. Mostly it was humiliation- and it was done very publicly. Sometimes female techs were stalked as well- I’d had enough of one radiologist cornering me and threatening me- he did it on nights when no one was there to witness- so I told him that we could finish this in the parking lot- he never did it again.”
“What is nurse incivility? What happens to us all- yes it is/was wrong. And we have more legal protections than ever. But, I do think about how bad people have it in other countries and I think about what Caucasian’s have done to non-whites. We still have it good- let’s just get better.”
“Endured this from co-workers, doctors, and managers over the past 36 years. The worst nurse incivility has been from my own nurse colleagues and it’s the main reason I quit nursing 8 years ago. Although I returned to nursing 2 years ago in the same specialty, the emotional and verbal abuse continues and is getting more intense and chronic.”
These examples of nurse incivility are responses to a Facebook question we posted asking nurses if they’ve experienced this personally. It’s almost shocking to hear that this is the reality some have faced. We believe it’s important to allow stories to be heard, understand the nature of why these acts of violence occur, and what we can do to end it.
If you’ve been a target of nurse incivility & horizontal violence, here are a few best practices to remember:
- Ask for help and alert someone right away, find a superior and report these types of behaviors so they do not continue. You also want all of the actions and verbal exchanges documented.
- Practice responses with a trusted friend
- Be a mirror and speak up regarding your boundaries
- Treat others with respect
- Avoid gossip and spreading of rumors
- Be the change you wish to see
All cultural changes start with you. Do not get us wrong; nurse incivility is not your fault or your responsibility to fix. We just mean that it is important that you stand up for yourself, stand up for your profession, and take action when you witness examples of nurse incivility. We want to see a thriving healthcare community starting with our nurses and how they’re treated. If you or somebody you work with makes a medical mistake, read here about appropriate courses of action.