AACN Position Statement: Zero Tolerance for Bullying, Incivility, and Verbal Abuse

Nov 01, 2019

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Bullying, incivility, and verbal abuse impede the delivery of safe, quality care, and violate individuals’ rights to dignity and well-being. Bullying can take the form of intimidating behaviors such as, angry outbursts, shunning, reluctance or refusal to answer questions, and threatening body language. Incivility takes the form of rudeness, gossip, and condescending language and body language. Verbal abuse can be blatant or subtle and may consist of word choice, facial expressions, or a tone or manner that disparages, intimidates, patronizes, threatens, accuses, or disrespects another.

Abusive behavior leads to unhealthy work environments, which degrade the communication and collaboration necessary to maintain patient and clinician safety. In addition, this behavior may cause recipients to experience psychological trauma, including depression and anxiety.1,2 The damage can be even more long-lasting when these behaviors occur online.3

Unfortunately, bullying, incivility, and verbal abuse are widespread. AACN’s 2018 Critical Care Nurse Work Environment Study4 reported that 80% of the 8,080 respondents had experienced verbal abuse at least once during the past year. Among this group, 73% experienced abuse from patients, 64% from patients’ families, 41% from physicians, 34% from other RNs, 15% from non-RN/nonphysician healthcare personnel, and 14% from a nurse manager.

The effects of unprofessional behaviors are not isolated to the individuals involved. Verbal abuse and disrespectful behavior significantly impact the workplace by decreasing morale, increasing job dissatisfaction, and creating a hostile work climate.5,6 Zero-abuse policies make a difference. According to AACN’s 2018 study,4 respondents who worked at institutions with zero-abuse policies reported fewer negative incidents than did those who worked at institutions without such policies.

AACN’s Position:

The American Association of Critical-Care Nurses (AACN) calls for all institutions and healthcare workers to take a zero-tolerance stance on bullying, incivility, and verbal abuse in the workplace. In addition, institutions must implement enforceable policies and culture changing programs to prevent and eliminate abusive, disrespectful, and noncollaborative behaviors in the workplace. AACN is committed to the creation and maintenance of healthy work environments that are free from intimidation, threats, and abuse.7

Recommended Actions for Healthcare Institutions:

  • Adopt and implement clear zero-tolerance policies and procedures for all abusive behavior, including cyberbullying, with guidelines on how to report violations, enforce disciplinary actions, counsel victims, and track institutional progress.
  • Ensure widespread awareness of zero-tolerance policies.
  • Always take action when an incident of abusive behavior occurs: discipline offenders, counsel victims and other employees, perform follow-up analyses of incidents, and impose corrective measures to prevent recurrence.
  • Encourage employees to promptly report incidents and ensure that no employee who experiences and reports workplace abuse experiences reprisal.
  • Establish interprofessional evidence-based educational interventions to prevent and respond to abuse.

Recommended Actions for Nurses:

  • Communicate respectfully, online and in person.
  • Hold self and others accountable for unacceptable behavior.8
  • Seek solutions as a team – investigate and analyze occurrences of abuse in the same manner as other incidents, such as medication errors.
  • Develop a mentoring system among peers, supervisors, physicians and other providers to build on strengths and enhance personal skills.
  • Contribute to building healthy work environments—establish norms of true collaboration and skilled communication in the unit, develop strategies and skills, and share best practices.
  • Participate in interprofessional committees to develop organizational policies and strategies for abuse prevention.

Helpful Resources:

  1. Unresolved disrespectful behavior in healthcare—practitioners speak up again (part I). Institute for Safe Medication Practices website. https://www.ismp.org/resources/unresolved-disrespectful-behavior-healthcare-practitioners-speak-again-part-i. Published October 3, 2013. Accessed August 27, 2019.
  2. Disrespectful behaviors: their impact, why they arise and persist, and how to address them (part II). Institute for Safe Medication Practices website. https://www.ismp.org/resources/disrespectful-behaviors-their-impact-why-they-arise-and-persist-and-how-address-them-part. Published April 24, 2014. Accessed August 27, 2019.
  3. D’Souza N, Forsyth D, Tappin D, Catley B. Conceptualizing workplace cyberbullying: toward a definition for research and practice in nursing. J Nurs Manag. 2018;26:842-850.
  4. Ulrich B, Barden C, Cassidy L, Varn-Davis N. Critical care nurse work environments 2018: findings and implications. Crit Care Nurse. 2019;39(2):67-84.
  5. National Institute for Occupational Safety and Health. Workplace violence prevention for nurses (unit 4: risk factors for type 3 violence). Centers for Disease Control website. https://wwwn.cdc.gov/WPVHC/Course.aspx/Slide/Intro_1. Updated August 12, 2013; reviewed January 27, 2016. Accessed September 27, 2019.
  6. U.S. Department of Labor. Caring for Our Caregivers. Preventing Workplace Violence: A Road Map for Healthcare Facilities. Washington, DC: Occupational Safety and Health Administration; 2015. https://www.osha.gov/Publications/OSHA3827.pdf. Accessed August 27, 2019.
  7. Barden C, Cassidy L, Cardin S, eds. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. 2nd ed. Aliso Viejo, CA: American Association of Critical-Care Nurses; 2016. https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments. Accessed August 27, 2019.
  8. Thompson R. What if you’re the bully? American Nurse Today. 2019;14(1)22-25. https://www.americannursetoday.com/what-if-youre-the-bully. Accessed September 27, 2019.
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