Addressing nursing incivility: A faculty development initiative

Abstract

Background/objective: Nursing incivility is a widespread issue experienced by more than 85% of nurses in the U.S. Approximately 30%-71% of nursing faculty consider incivility a moderate to severe problem. Incivility is commonly known as “horizontal violence” or “bullying” and can include behaviors such as minor annoyances, distractions, or acts of violence. Incivility has negative effects on faculty well-being, including physical/emotional distress, reduced job satisfaction, and increased turnover. This quality improvement (QI) project aimed to explore faculty perspectives on incivility and evaluate the effects of a multifaceted educational intervention in reducing nursing faculty-perceived frequency of student incivility behaviors.

Methods A descriptive, pre-post design was used to assess changes in faculty-reported incivility using the Incivility in Nursing Education-Revised (INE-R) survey. Multifaceted interventions, incorporating multiple strategies such as increasing awareness, cognitive rehearsal, and reflective learning, were integrated into the educational intervention. The intervention was completed with nursing faculty, and the INE-R survey was utilized to measure faculty perceptions of the severity/frequency of student incivility behaviors before and after the intervention. Pre- and post-intervention data were collected and evaluated using the Wilcoxon Signed Rank Test and other descriptive statistics.

Results The Wilcoxon Signed-Rank test comparing the median of the differences between pre- and post-composite scores revealed a statistically significant reduction in frequency (Z = -2.10, p =.03). The mean INE-R frequency scores decreased from 2.3 (SD = 2.3) pre-intervention to 1.9 (SD = 1.9) post-intervention, reflecting a 17.4% reduction in the perceived frequency of student incivility.

Conclusions Nursing programs should sustain civility initiatives through ongoing multifaceted educational interventions integrated into faculty development and institutional policies. Expanding these interventions across programs and institutions can strengthen the culture of civility and promote positive change in nursing education.

Keywords

Faculty development / Incivility in nursing education / Nursing academia / Nursing incivility

AUTHORS CONTRIBUTIONS

Dr. Sherman, committee chair, provided overall project leadership, including guidance on study design, statistical analysis, and manuscript drafting and revisions. Dr. Ulbrich contributed to project oversight and manuscript revisions. Kerrie Downing provided guidance on study design and institutional implementation and assisted with the coordination of the scholarly project at the campus level. All authors reviewed and approved the final manuscript.

FUNDING

Not applicable.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

INFORMED CONSENT

Obtained.

ETHICS APPROVAL

The Publication Ethics Committee of the Association for Health Sciences and Education. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

DATA SHARING STATEMENT

No additional data are available.

ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to my husband, Alex, for his unwavering support and encouragement throughout my doctoral program. His support was instrumental from the beginning to the completion of this work. I also thank my committee members for their guidance and expertise throughout the project. Finally, I am grateful to the participants who contributed to this study and for their time and encouragement.

References

[1] Alsadaan N, Ramadan OM, Alqahtani M. From incivility to out-comes: tracing the effects of nursing incivility on nurse well-being, patient engagement, and health outcomes. BMC Nurs. 2024 May; 23: 325. PMid:38741096 https://doi.org/10.1186/s12912-024-01996-9

[2] Aul K. Who’s uncivil to who? Perceptions of incivility in prelicensure nursing programs. Nurse Educ Pract. 2017 Nov; 27: 36-44. PMid:28843175 https://doi.org/10.1016/j.nepr.2017.08.016

[3] Clark D. Creating & sustaining civility in nursing education. 2nd ed. Indianapolis (IN): Sigma Theta Tau International; 2017.

[4] Griffin M, Clark CM. Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. Journal of Continuing Education in Nursing. 2014 Nov; 45(12): 535-542. PMid:25406637 https://doi.org/10.3928/00220124-20141122-02

[5] Park E, Kang H. Faculty-to-faculty incivility in nursing academia: a qualitative systematic review. Journal of Professional Nursing. 2023 Sept-Oct; 48: 1-14. PMid:37775223 https://doi.org/10.1016/j.profnurs.2023.05.006

[6] American Nurses Association. Incivility, bullying, and workplace violence. Silver Spring (MD): American Nurses Association; 2015 Jul [cited 2025 Dec 16]. Available from: https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/

[7] Olsen JM, Aschenbrenner A, Merkel R, et al. A mixed-methods systematic review of interventions to address incivility in nursing. Journal of Nursing Education. 2020 May 20; 59( 6): 319-326. PMid:32497233 https://doi.org/10.3928/01484834-20200520-04

[8] Opsahl AG, Embree JL, Howard MS, et al. Adapting civility education in an academic-practice partnership. The Journal of Continuing Education in Nursing. 2021 Dec 1; 52(12): 575-580. PMid:34870530 https://doi.org/10.3928/00220124-20211108-09

[9] Rawlins L. Faculty and student incivility in undergraduate nursing education: an integrative review. Journal of Nursing Education. 2017 Nov 20; 56(12): 709-716. PMid:29206260 https://doi.org/10.3928/01484834-20171120-02

[10] Sherrod JT, Lewallen LP. Workplace incivility and its effects on the physical and psychological health of nursing faculty. Nursing Education Perspectives. 2021 Sept; 42(5): 278-284. PMid:34149012 https://doi.org/10.1097/01.NEP.0000000000000839

[11] Small SP, Cashin G, English D, et al. “It is essentially about treating each other well”: insights from faculty on incivility in nursing education. Can J Nurs Res. 2023 Oct 3; 56(1): 81-94. PMid:37788344 https://doi.org/10.1177/08445621231204985

[12] Moore W, Palerino A, Pawloski K. The relationship between faculty diversity and workplace civility in nursing education: a correlational analysis. Nurse Education in Practice. 2024 May; 77: 103975. PMid:38657338 https://doi.org/10.1016/j.nepr.2024.103975

[13] Christensen M, Craft J, White S. Nurse academics’ experience of contra-power harassment from under-graduate nursing students in Australia. Nurse Education Today. 2020 Jan; 84: 104220. PMid:31715473 https://doi.org/10.1016/j.nedt.2019.104220

[14] Hyun M, Kang H, Gagne JC, et al. Nursing faculty experiences with student incivility in South Korea: a qualitative study. BMC Medical Education. 2022 Feb 18; 22(105): 1-10. PMid:35177057 https://doi.org/10.1186/s12909-022-03170-8

[15] Abedini Z, Maryam S, Khalajinia Z, et al. Developing a culture of civility in nursing students. Nursing Education Perspectives. 2023 March; 44(2): 119-120. PMid:34974504 https://doi.org/10.1097/01.NEP.0000000000000927

[16] Merkel R, Olsen J, Pehler S, et al. An innovative civility intervention created by a faculty and student action research team. Journal of Nursing Education. 2020 March 23; 59(4): 214-217. PMid:32243553 https://doi.org/10.3928/01484834-20200323-07

[17] Clark CM. Using Cognitive rehearsal to address faculty incivility in nursing academe. Nurse Educator. 2024 Sept-Oct; 49(5): 250-255. PMid:38857476 https://doi.org/10.1097/NNE.0000000000001661

[18] Cole KA. Exploring relationships and reflections on nurse educator civility behaviors. Teaching and Learning in Nursing. 2024 April; 19(2): 133-138. https://doi.org/10.1016/j.teln.2023.09.014

[19] Clark CM, Barbosa-Leiker C, Larecia MG, et al. Revision and psychometric testing of the Incivility in Nursing Education (INE-R) survey: introducing the INE-R. J Nurs Educ. 2015 May 15; 54( 6): 306-315. PMid:26057424 https://doi.org/10.3928/01484834-20150515-01

[20] Clark CM, Sattler VP, Barbosa-Leiker C. Development and psychometric testing of the Workplace Civility Index: a reliable tool to assess workplace civility. Journal of Continuing Education in Nursing. 2018 Aug 13; 49(9): 400-406. PMid:30148537 https://doi.org/10.3928/00220124-20180813-05

[21] Ogrinc G, Davies L, Goodman D, et al. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2015 Sept; 25: 986-992. PMid:26369893 https://doi.org/10.1136/bmjqs-2015-004411

[22] Faul F, Erdfelder E, Lang A, et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007 May; 39(2): 175-191. PMid:17695343 https://doi.org/10.3758/BF03193146