Incivility in Nursing: The Experience of Registered Nurses in the Emergency Department

The American Association of Colleges of Nursing (AACN) predicts that due to the anticipated retirement of the “baby boomer” generation coupled with an expanded need for medical care across the United States, the need for nurses will expand 6% by 2032 (AACN, 2024). This need will be impeded by nurses leaving the profession due to feelings of a poor work environment, burnout and job dissatisfaction. Incivility in nursing has been shown to be a contributor to nurses leaving their current work environments or the profession of nursing entirely. Incivility in nursing has roots in organizational psychology and has been shown to be prevalent in nursing academia. There are limited studies set in the Emergency Department for what the experience of incivility is like from the ED nurses’ perspective. The question asked of participants is “What is the registered nurses’ experience of incivility working in the emergency department?” An interpretive descriptive approach was used to gain insight into the emergency department nurses experience of incivility in their work environment. An anonymous survey was completed by 32 registered nurses who worked or had worked in the past five years of the collected data in the ED. Participants were asked how they define incivility, experiences of incivility they had both witnessed and were a part of, if they had ever felt their own behavior to be uncivil, and to describe their work environment in relationship to incivility. They were asked to pick an emoji that best described how they felt about incivility in their work environment. An “expert” nurse was interviewed by phone to triangulate data obtained anonymously. The survey was completed on survey monkey, was transcribed by participants and analyzed using qualitative techniques. Almost all participants were able to recall uncivil events they had either witnessed or had been a part of. Incivility came from peers, but also patients themselves and their families. Definitions of incivility by participants included rude behaviors, racism, verbal outbursts and a violation of not only workplace norms but also social norms. Many nurses included violence as a part of incivility. Some participants admitted their own behavior had been uncivil at times, and those who did not suggest it is due to attributions of emotional self-regulation. Participants further concluded the impact the work environment has on incivility; purporting that a negative environment impacts patient care, morale and attrition. Emojis showed most participants felt angered and saddened by incidences of incivility in their work environment. Conclusion: The work environment significantly shapes the nurses’ experiences of incivility. When there is a lack of moral, communication, support and teamwork, patient care is compromised. Emotional self-regulation and a supportive work environment can contribute to a positive experience for nurses with less instances of incivility and therefore can contribute to increased morale and better patient care. Keywords: incivility*, incivility in nursing, incivility in the emergency department, incivility in clinical nursing, and incivility in nursing education