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Oct 17, 2018, 17:26 PM
<7-min. read> In your gut, you may know that teaching students about civility is the right thing to do. But if you need convincing, consider the following noteworthy reasons. Their totality will ensure civility plays a central role in your curricula.

The negative impacts of civility are probably more far-reaching that you can imagine. They — in and of themselves — are crucial reasons to ensure students learn communication skills that will help them foster healthy work environments. But other reasons underscore the importance of teaching civility.


In her paper, “An Evidence-Based Approach to Integrate Civility, Professionalism, and Ethical Practice Into Nursing Curricula” (published in the May/June 2017 issue of Nurse Educator), Cynthia M. Clark, PhD, RN, ANEF, FAAN, ATI Strategic Nursing Advisor, writes, “All nurses regardless of setting or position have an ethical obligation to create and sustain healthy workplaces and to foster an atmosphere of dignity, professionalism, and respect.”

Cynthia Clark, PhD, RN, ANEF, FAAN, is a world-renowned expert on the topic of civility.

More specifically, the International Code of Ethics for Nurses, created by the International Council of Nurses, states in its preamble: “Inherent in nursing is a respect for human rights, … to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status.”

That organization isn’t the only one pointing out nurses’ responsibilities toward supporting civility. The American Nurses Association Code of Ethics for Nurses With Interpretive Statements expresses the belief that all nurses have the obligation to foster safe, ethical, civil workplaces.

One example that Dr. Clark points out in her research is a provision requiring nurses ‘‘to create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect and that any form of bullying, harassment, intimidation, manipulation, threats or violence will not be tolerated.” Another section requires educators to “ensure that all graduates possess the knowledge, skills, and moral dispositions that are essential to nursing.”


Nurse helping senior with caneTo underscore the emphasis on civility in the codes cited above, the world’s most respected nursing and healthcare organizations also place great importance on the topic.

Many have foundational documents or have published reports that support the need for all nurses to continuously demonstrate professional and civil actions. Consider:

  • National League for Nursing
    ✔ Refers to core values of caring, integrity, diversity, and excellence. In September 2018, the NLN published a statement highlighting the importance of creating community to build a civil and healthy academic work environment stressing that faculty play an important role in co-creating and maintaining academic and practice environments that foster civility.
  • The Tri-Council for Nursing (American Association of Colleges of Nursing, American Nurses Association, American Association of Nurse Executives, and National League for Nursing)
    ✔ Issued a joint proclamation declaring that civility is key to promoting healthy, inclusive work environments to safeguard patient safety.
  • American Association of Colleges of Nursing (AACN) Essential VIII: Professionalism and Professional Values
    ✔ Discusses nurses being accountable/responsible for individual actions and ensuring civility is always present.
  • 2011 Institute of Medicine Report
    ✔ Counsels nurses to collaborate toward improved work environments and healthcare systems.
  • Center for American Nurses (now a part of ANA)
    ✔Recommends nurses and nursing students receive information specifically addressing conflict and providing ways to recognize, address, and change disruptive behavior in the workplace
    ✔ Advocates developing/implementing teaching strategies and curricula on the incidence and prevalence of disruptive behaviors and how to eradicate uncivil behavior.


2 Female students talkingWhen Dr. Clark was a novice researcher on the topic of civility, she says she was surprised to discover the lack of self-awareness among individuals.

In some cases, people didn’t have a clue how they were coming across to other people, she says. When individuals were asked to self-reflect, she explains, “It wasn't really part of their DNA.”

The issue is the same today, Dr. Clark adds. “Sometimes students come to us without a clear realization of how their behaviors might impact other people,” she says. They don’t know what’s expected of a professional nurse; what it means to advocate for patients; or what it even means to communicate within the healthcare setting and the patient-care environment, she adds.

The problem with this lack of self-awareness is, of course, that if you can’t accurately assess yourself, you can unconsciously contribute to incivility problems. Thus, Dr. Clark realized she needed to help people become better able to recognize how others were interpreting their actions, words, and behaviors. She eventually developed a set of self-reflection tools that, ultimately, have proven to be valid and reliable (recently published in the Journal of Continuing Nursing Education.)


From a nursing perspective, the negative impact of incivility can be broken out into students, professional nurses and patients.


Students experience incivility on multiple levels, with peers and with faculty. While it may seem innocuous, such simple acts as not saying hello to a student in the hallway can have very detrimental effects. Dr. Clark describes talking to students all over the United States and Canada, who will say to her, “You know, Dr. Clark? I’m walking down the hall, and the faculty will pass me and say nothing. What am I? Am I invisible? Do I not matter?”

“Those kinds of microaggressions,” Dr. Clark says, “can have a real impact on people over time.”

In extreme situations, students can experience psychological and physiological distress. Sometimes, incivility can progress into unsafe or threatening situations. As a whole, of course, it degrades the overall learning environment.Patient in surgery with 2 medical staff


Similar to students, incivility can negatively affect professional nurses. Aggressions can be verbal — being disrespectful, making demeaning comments, or calling someone names — or nonverbal — ignoring someone, rolling the eyes, or turning and walking away.

And while these actions may seem minor, they can have major consequences. In August 2018, for example, a nurse committed suicide after being bullied by the nurses with whom she worked — ironically at a psychiatric hospital.

The issue, unfortunately, is widespread. Up to 85 percent of nurses say they’ve been bullied at work.

But incivility isn’t just a problem for nurses’ morale and well-being. It’s also an extremely serious issue for public health.


Putting patient safety at risk is the most critical outcome of incivility in the healthcare workplace. Patients can be put at risk when stress from an unhealthy work environment causes nurses to make mistakes. Worse is when one nurse tries to make another look bad by withholding valuable information.

“Some people believe that, if they are the keeper of that information, then they’re kind of the hero in their story,” Dr. Clark explains. “So a nurse may think, ‘I’m not going to tell [another nurse] about a patient condition because, you know what? ‘Figure it out. Check the chart. I'm tired. I'm going home.’”

When incivility occurs in healthcare settings, the result can be patients who experience life-threatening mistakes, preventable complications, harm, and even death.


While incivility’s detrimental impact on individuals is obviously the most significant reason you should incorporate the topic into your curricula, one more reason may not have occurred to you: its impact on your school’s reputation — and the nursing profession as a whole.

Today, social media can spread negative news in a nanosecond. That means a student’s or faculty’s adverse experience can spread quickly among prospective students, impacting your application rates — and your reputation. Similarly, websites where students review faculty can significantly influence students.

Incorporating civility training into every aspect of your school’s program, then, can have far-reaching impacts.

Not only can you pre-empt problems before they arise, but you also prepare students for a future in which they can positively redirect negative situations. They’ll not only help make their jobs more enjoyable but help save lives as well.

For more than a year, Dr. Clark led a team of instructional designers, psychometricians, and computer programmers at ATI to address the issue of civility. Their goal? To create an interactive and engaging learning solution that gives nursing students the skills to:

  • Engage in difficult conversations with colleagues and preceptors
  • Foster civility and healthy work environments.

The result of their efforts is Civility Mentor, a series of virtual simulations that allow students to engage in client conversations in a safe learning environment before entering a clinical setting.

Learn more about Civility Mentor.

Read more articles about civility:

civility mentor