The Ethical Imperative for Promoting a Culture of Civility Within Nursing

The International Council of Nurses’ (ICN) 2025 theme, Caring for Nurses Strengthens Economies, firmly places nurses at the center, as the global priority. ICN’s groundbreaking theme comprehensively encompasses nurses’ impact from creating health and longevity to their direct and indirect impact on the economic prosperity of the communities and countries, in which they practice. More significantly, nurses alone are not simply the priority, but more specifically, it is the “care of” nurses which is the imperative. The “care of the nurse” is the urgent and required focus of nurses’, hospitals’, and governments’ actions and strategic priorities. ICN’s 2025 call to action is that comprehensive tangible and outcome-oriented interventions be put in place to address the root cause that erode nurses’ well-being (ICN, 2025). Incivility, it can be argued, is one of the primary root causes, which erodes nurse well-being. Incivility is defined as low-intensity, deviant behavior (rude or discourteous) with or without the intent to harm the target in violation of workplace mutual norms of mutual respect; incivility can be a single incident (Andersson and Pearson, 1999; ANA, 2015). Another definition of incivility includes failing to act when action is warranted, failing to speak up when indicated, or refusing to assist or support a coworker (even when related to incivility) (“Principled Leadership,” 2016). Incivility, including the inaction of bystanders, is a violation of the ANS code (American Nurses Association) of ethics and an affront to the role/image of the professional nurse. Incivility is endemic within the nursing profession (Kile et al., 2019) no country, no sector, no hospital, and no unit is exempt from the incivility’s prevalence and negative outcomes. Eighty percent of nurses deem their workplace unsafe, with verbal and physical threats high (Shoorideh et al., 2021). Moreover, up to 79% of nurses experiencing (incivility) will leave their organization within 5 years (Bambi et al., 2018). Incivility has been referred to as the slow death of the nursing profession (cite), with nurses not only leaving units or organizations primarily because of incivility but also leaving the nursing profession altogether. The primary accountability of dismantling incivility and enculturating civility lies squarely with nurses and nurse leaders, as nurse-to-nurse incivility prevalence at 64% is the highest (Kile et al., 2019). Incivility has clear costs for an organization. Nurses who experience incivility contribute to organizational nonproductivity to a rate of 11,600 USD/44,000 USD per nurse per year (Kile et al., 2019). Up to 38% of adverse events are attributed to poor communication (Rosenstein and Naylor, 2012 as cited Smith, 2018). Disruptive behaviors contribute to unsafe work environments and adversely affect patient safety (JCI, 2008). Nurses dealing with the effects of an uncivil work environment are less likely to respond fully to the needs of their patients and to Speak Up! If there are safety concerns (Kile et al., 2019). Problematic interpersonal communication results in 60% of medication errors and 80% of medical errors (Benner, 2007). The cost of incivility for the nurse, while more difficult to quantify, is no no less significant is scope and depth. Through incivility, nurses’ physical, mental, emotional, and ethical well-being is fractured. Nurses experiencing incivility suffer more from stress-related illnesses, job dissatisfaction – Disengagement, low morale, excessive sick time (1.5 times higher than nurses not experiencing incivility), loss of productivity, lack of trust, decreased self-esteem, and a lack of passion for their profession (cite). There are also specific physical (add) and emotional/mental (add) symptoms that nurses often experience. In 2022, IHI outlined five pillars of any program on workplace safety (2022). Number one was that workplace safety and civility be the organization strategic priority with KPIs (add more on this as the 1st step). Furthermore, on International Nurses' Day 2025, ICN released its 76-page publication entitled, Caring for Nurses Strengthens Economies, which provides a roadmap to promote nurse well being and systematically address incivility through evidenced based practice, tangible interventions. It is clear that addressing incivility and enculturating civility requires concentrated organizational focus, structures, processes, and measurable outcomes. ICN_IND2025_report_EN_A4_FINAL_0.pdf. Conclusion In conclusion, each nurse and every organization has an ethical responsibility to comprehensively address the endemic of incivility which permeates throughout its patient care areas. Incivility negatively impacts our ability to expertly care for our patients safely. It negatively affects the financial bottom line of every hospital, specifically in loss of productivity and the cost of adverse events, but more so, thecosts of nurse turnover and nurse replacement. The highest cost of all is the negative effects on nurse well-being, in terms of physical, emotional and mental well-being. The ethical imperative is that the care of the nurse must begin by nurses.