Incivility and Bullying in Classroom and Clinical Environments

Understanding Incivility and Bullying: Definitions, Distinctions, and Theoretical Foundations

During my first clinical rotation in a busy medical-surgical unit, I witnessed an interaction that would shape my understanding of nursing culture for years to come. A nursing student approached the charge nurse to ask about a patient’s medication schedule. Without looking up from her charting, the nurse snapped, “If you don’t know that by now, you shouldn’t be here. Figure it out yourself or ask your instructor—I don’t have time to babysit students.” The student’s face flushed red, and I watched her retreat to the medication room where she stood alone, visibly fighting tears, too embarrassed and intimidated to seek help elsewhere. That patient’s medication was delayed by over an hour because the student was too afraid to ask anyone else. In that moment, I understood viscerally how lateral violence doesn’t just hurt students—it compromises patient care and perpetuates a cycle of hostility that keeps nursing from reaching its full professional potential.

Incivility and bullying in healthcare education represent complex behavioral phenomena that exist on a continuum from subtle discourtesy to severe harassment, requiring clear definitions and theoretical understanding to effectively address their manifestations and impacts.

Defining Incivility, Bullying, and Related Concepts

Incivility: Rude, discourteous, or disrespectful behavior that demonstrates lack of regard for others, violating norms for mutual respect. Incivility is characterized by behaviors that may be unintentional or situational rather than deliberately malicious, typically involving low-intensity deviant behavior that may be ambiguous in intent, occurring as single incidents or occasional lapses rather than sustained patterns, and potentially caused by stress, lack of awareness, or poor social skills rather than deliberate malice. Examples include interrupting others, making sarcastic comments, ignoring communications, arriving late without apology, or displaying dismissive body language.

Bullying: Repeated, intentional harmful behavior directed at specific individuals who have difficulty defending themselves, involving an imbalance of power between perpetrator and target. Bullying is distinguished by persistent behavior occurring over time, clear intent to harm, intimidate, or exert control, systematic targeting of specific individuals or groups, escalation in severity without intervention, and significant psychological impact on targets. Examples include repeated public humiliation, deliberate exclusion, spreading malicious rumors, threatening academic or professional standing, and consistent undermining of confidence or competence.

Lateral violence: Also called horizontal violence, this refers to covert or overt behaviors directed toward peers perceived as threatening due to their knowledge, skills, or professional advancement. In nursing, lateral violence specifically describes nurses directing hostility toward other nurses at the same hierarchical level, though in educational contexts it encompasses experienced nurses directing aggression toward nursing students. The term emphasizes the horizontal rather than vertical direction of aggression, highlighting how oppressed groups may redirect anger at peers rather than at higher-status oppressors.

Horizontal hostility: Essentially synonymous with lateral violence, describing aggressive behaviors among members of the same group or hierarchical level, rooted in group dynamics of oppressed populations who internalize negative stereotypes and redirect frustration laterally.

Workplace bullying: When bullying occurs in professional settings including clinical environments, characterized by abuse of power, creation of hostile work or learning environments, and significant impact on targets’ wellbeing and performance.

Academic incivility: Uncivil behaviors specifically in educational settings, encompassing student-to-faculty, faculty-to-student, and student-to-student incivility that disrupts learning environments and violates academic community norms.

Theoretical Foundations of Bullying and Lateral Violence

Oppressed group theory: Originally developed by Paolo Freire, this theory explains how groups experiencing systematic oppression internalize the oppressor’s values and beliefs, developing low self-esteem and negative self-image. Unable to direct anger upward at the oppressor due to fear of retaliation or powerlessness, oppressed groups redirect aggression horizontally at peers, creating lateral violence. In nursing’s historical context as a female-dominated, physician-subordinate profession with limited autonomy, this theory explains how nurses may internalize feelings of powerlessness and redirect frustration at vulnerable nursing students and new nurses rather than challenging hierarchical systems.

Social learning theory: Bandura’s theory proposes that people learn behaviors through observation, imitation, and modeling. In nursing environments where incivility and lateral violence are common and go unaddressed, students and new nurses observe these behaviors as “normal” or acceptable, learning through modeling that this is how nurses treat each other. Without intervention, victims of lateral violence may become perpetrators themselves, having learned that this behavior is part of nursing culture, perpetuating an intergenerational cycle.

Power imbalance theory: Bullying fundamentally involves abuse of power, whether formal (based on position, authority, or role) or informal (based on knowledge, experience, social status, or personality). In educational and clinical settings, multiple power imbalances exist—faculty over students, experienced nurses over novices, preceptors over students they’re evaluating. When individuals abuse these power differentials through bullying, targets have limited ability to defend themselves or report without fear of retaliation affecting grades or evaluations.

Systems theory: Incivility and bullying don’t occur in isolation but within systems that either enable or prevent these behaviors. Organizational cultures that tolerate uncivil behavior, lack clear policies and consequences, fail to support targets, or prioritize other concerns over respectful treatment create systems where incivility flourishes. Conversely, systems with strong civility cultures, clear accountability, and consistent enforcement can prevent and address incivility effectively according to the American Nurses Association position statement on incivility, bullying and workplace violence.

Stress and strain theory: Healthcare environments involve high stress from high-acuity patients, staffing shortages, time pressures, emotional demands, and life-or-death stakes. Under conditions of chronic stress and burnout, individuals may lack emotional resources for patience, mentoring, or civil interaction, leading to snapping at students, refusing to teach, or displaying other uncivil behaviors as maladaptive coping mechanisms. While stress doesn’t excuse incivility, understanding it as a contributing factor helps develop systemic interventions.

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Incivility in Classroom Environments: Forms, Perpetrators, and Dynamics

Academic incivility in nursing education classrooms takes multiple forms depending on whether it flows from students toward faculty, faculty toward students, or between students, each pattern creating distinct challenges for learning environments and requiring tailored interventions.

Student-to-Faculty Incivility

Student incivility directed toward faculty represents one of the most commonly documented forms of academic incivility, encompassing behaviors that disrupt teaching, undermine faculty authority, and create hostile classroom environments:

Disruptive behaviors during instruction: Talking to peers during lectures or presentations, arriving late or leaving early without legitimate reason and disrupting class in the process, packing up belongings noisily before class ends, using phones or laptops for non-class activities (social media, texting, shopping, watching videos), eating noisily during class when not permitted, sleeping during instruction, and creating other distractions that interfere with teaching and others’ learning.

Disrespectful communication: Making sarcastic or hostile comments in class, challenging instructor competence or credentials publicly rather than privately, arguing about grades or policies in front of the class, interrupting faculty or talking over them, using disrespectful tone or language, rolling eyes or displaying dismissive body language, and making inappropriate jokes at faculty expense.

Resistance and non-compliance: Refusing to participate in class discussions or activities, submitting poor quality work without effort, ignoring course policies on attendance, deadlines, or academic integrity, demanding special accommodations without legitimate need, and generally demonstrating lack of engagement or respect for course requirements.

Intimidation and threats: Making veiled or explicit threats related to grades or evaluations, threatening complaints to administrators without attempting direct resolution, implying faculty discrimination or unfair treatment, using social media to complain about or disparage faculty, and in extreme cases, making threats to faculty members’ safety.

Boundary violations: Contacting faculty excessively outside appropriate channels, expecting immediate responses to emails sent at all hours, demanding personal time and attention beyond what’s reasonable, and failing to respect faculty privacy or personal boundaries.

Faculty-to-Student Incivility

While less frequently discussed, faculty incivility toward students creates particularly harmful dynamics given faculty power over grades, progression, and professional references:

Disrespectful treatment: Making demeaning, sarcastic, or belittling comments about student intelligence or abilities, publicly embarrassing students for mistakes or questions, using hostile tone or body language, showing impatience or irritation with legitimate questions, and generally creating intimidating classroom atmospheres that inhibit student participation.

Unfair or inconsistent treatment: Showing favoritism toward certain students, applying policies inconsistently across students, providing unclear or changing expectations, grading subjectively or punitively, and treating students differently based on characteristics like age, race, gender, or native language.

Unavailability and unresponsiveness: Being unavailable during posted office hours, not responding to emails within reasonable timeframes, canceling classes frequently without adequate notice, refusing to provide clarification when students are confused, and generally failing to fulfill basic teaching responsibilities.

Rigid or punitive approaches: Refusing reasonable accommodation requests, being inflexible about policies even when circumstances warrant exceptions, focusing on punishment rather than learning from mistakes, and creating cultures of fear rather than supportive learning environments.

Undermining confidence: Consistently focusing on what students do wrong rather than recognizing progress, making statements that discourage students from nursing (“Maybe nursing isn’t for you”), comparing students unfavorably to others, and generally creating environments where students feel inadequate or unwelcome.

Student-to-Student Incivility

Peer incivility among nursing students creates toxic learning environments affecting both academic performance and professional development:

Social exclusion and cliques: Forming exclusive social groups that deliberately exclude certain students, refusing to work with particular peers in group projects, withholding information about assignments or changes from certain classmates, and creating “in-groups” and “out-groups” within cohorts.

Gossip and rumor-spreading: Talking negatively about peers behind their backs, spreading rumors about students’ personal lives, academic abilities, or clinical performance, sharing private information students disclosed in confidence, and generally creating cultures of distrust.

Competition and sabotage: Refusing to share study materials or resources, sabotaging group projects by not completing assigned portions, taking credit for others’ work, and viewing peers as competitors rather than colleagues despite nursing’s emphasis on teamwork and collaboration.

Discrimination and microaggressions: Making comments based on race, ethnicity, age, gender, sexual orientation, or other characteristics, excluding or treating differently students from marginalized groups, and creating unwelcoming environments for students who don’t fit dominant group norms.

Disrespectful group work dynamics: Dominating group discussions without allowing others input, dismissing or criticizing others’ contributions, not pulling weight in group projects while expecting good grades, and creating conflicts within study or project groups.

Bullying in Clinical Environments: Lateral Violence and Its Devastating Effects

While classroom incivility disrupts learning, clinical environment bullying—particularly lateral violence directed at nursing students by staff nurses and preceptors—represents one of the most damaging phenomena in nursing education, affecting not only student wellbeing and learning but ultimately patient care and the nursing profession’s culture.

Understanding Lateral Violence in Nursing

Lateral violence, also called horizontal violence or nurse-to-nurse aggression, refers to hostile, aggressive, or harmful behaviors directed by nurses toward their peers or toward nursing students. In clinical education contexts, it specifically describes experienced nurses targeting nursing students through behaviors ranging from subtle undermining to overt bullying.

Historical and cultural roots: Lateral violence in nursing has deep historical roots in the profession’s development as female-dominated, physician-subordinate, with limited autonomy and professional recognition. According to oppressed group theory, nurses internalized feelings of powerlessness from this subordinate status, and unable to challenge those with more power (physicians, administrators), redirected anger horizontally at vulnerable peers and students. The tradition of “nurses eating their young” became so ingrained that many experienced nurses view it as a normal rite of passage, believing “I went through it, so they should too” rather than recognizing it as harmful hazing that should be eliminated.

Power dynamics: In clinical settings, staff nurses and preceptors hold significant power over students through control of learning opportunities, clinical evaluations that affect grades, and influence over whether students feel welcomed or excluded. Students depend on nurses for teaching, guidance, patient assignments, and positive evaluations, creating profound vulnerability to lateral violence when nurses abuse this power.

Environmental stressors: Clinical environments involve intense stressors including high-acuity patients where mistakes can cause harm or death, inadequate staffing creating overwhelming workloads, time pressures with multiple competing demands, emotional strain from suffering and death, and constant vigilance requirements. Under these conditions, burned-out nurses may lack patience for teaching, view students as additional burdens, or displace stress onto vulnerable students.

Common Forms of Lateral Violence Toward Nursing Students

Withholding information: One of the most dangerous forms, experienced nurses refuse to share information students need for safe patient care—medication administration guidelines, patient histories, changes in condition, unit protocols, location of supplies, or who to contact with questions. This not only impairs student learning but compromises patient safety when students lack critical information.

Belittling and demeaning comments: Nurses make comments undermining student confidence like “That’s a stupid question,” “Didn’t they teach you anything in school?” “You’re going to kill someone if you don’t know that,” “Why are you even here?” or “Nursing school must be easier than when I went.” These comments, especially when delivered publicly, devastate student confidence and create fear of asking necessary questions.

Refusing to teach or answer questions: When students approach nurses with legitimate questions, nurses respond with “Figure it out yourself,” “Look it up,” “I don’t have time for this,” or simply ignore the student. While developing independent problem-solving is important, refusing to guide students when they genuinely need help impairs learning and potentially patient safety.

Assigning inappropriate tasks: Nurses assign students tasks far beyond their skill level without adequate supervision, setting them up for failure, or conversely, assign only menial tasks (stocking supplies, getting coffee) that prevent actual learning. Both extremes demonstrate lack of commitment to student education.

Public humiliation and criticism: Nurses criticize students in front of patients, families, or other staff rather than providing private feedback, creating embarrassment and shame that inhibits learning. Comments like “The student messed up your IV” to patients or “Watch out, the student is practicing on you today” undermine patient confidence in students and humiliate learners.

Exclusion from learning opportunities: Nurses exclude students from procedures, patient interactions, or educational experiences, giving opportunities to other students they prefer or keeping them for staff. Students may be told to “stay out of the way” or assigned to sit at the nurses’ station rather than being integrated into care.

Threatening comments about grades: Nurses make statements like “I’m going to tell your instructor you’re not ready,” “You’re going to fail clinical,” or “I don’t think you should be a nurse,” using their evaluation power as intimidation rather than providing constructive feedback aimed at improvement.

Undermining confidence through constant negativity: Rather than balanced feedback acknowledging strengths and areas for growth, nurses focus exclusively on mistakes, communicate low expectations (“I knew you’d mess that up”), and generally create atmospheres where students feel they can’t do anything right, leading to learned helplessness and decreased performance.

Gossip and talking about students: Nurses discuss students’ mistakes, weaknesses, or personal information with other staff rather than maintaining professional confidentiality, creating hostile environments where students know they’re being talked about negatively.

Sabotage: In extreme cases, nurses deliberately set students up for failure by providing wrong information, failing to notify them of patient changes, or making false statements in evaluations, going beyond neglect to active sabotage of student success.

Why Lateral Violence Is Particularly Damaging

Lateral violence in clinical settings causes particularly severe harm for several reasons:

Occurs during vulnerable learning periods: Clinical experiences represent students’ first opportunities to apply theoretical knowledge in real patient care with real consequences. Students are already anxious, uncertain, and vulnerable. Lateral violence during these formative experiences creates trauma that can affect their entire nursing careers.

Comes from role models: Students look to experienced nurses as professional role models demonstrating what it means to be a nurse. When these role models demonstrate hostility rather than support, students internalize negative perceptions of nursing culture and may either leave the profession or perpetuate the cycle by modeling the hostile behaviors they experienced.

Affects patient safety: When students fear asking questions or seeking help due to expected hostile responses, they may proceed without adequate information or guidance, potentially making errors that harm patients. Lateral violence doesn’t just hurt students—it compromises the safety of patients under their care.

Involves power imbalances: Students cannot easily defend themselves against or report lateral violence from staff nurses without fear that it will negatively affect their clinical evaluations, grades, or references. This power imbalance makes students particularly vulnerable and less able to address mistreatment.

Occurs in high-stress environments: The combination of learning new skills, managing anxious patients and families, navigating complex care environments, and experiencing lateral violence creates overwhelming stress that affects students’ ability to learn and perform, their mental health, and their decisions about continuing in nursing.

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Impacts and Consequences: Understanding the Profound Effects of Incivility and Bullying

The effects of incivility and bullying extend far beyond momentary discomfort, creating cascading consequences that affect students’ psychological wellbeing, academic performance, professional development, physical health, and career trajectories, while also impacting educational institutions and ultimately the nursing profession and patient care.

Psychological and Emotional Impacts on Students

Anxiety and fear: Students experiencing incivility or bullying develop significant anxiety about attending class or clinical, interacting with faculty or preceptors, asking questions even when necessary for patient safety, and being evaluated or observed. This constant state of heightened anxiety impairs cognitive function, making it harder to learn and retain information, and can develop into clinical anxiety disorders requiring treatment.

Depression and emotional distress: Persistent experiences with incivility and bullying contribute to depressive symptoms including sadness, hopelessness, loss of interest in activities previously enjoyed, and feelings of worthlessness. Students may develop clinical depression requiring medication and therapy, with some experiencing suicidal ideation in severe cases.

Decreased self-esteem and confidence: Constant criticism, belittling, and undermining devastate students’ confidence in their abilities, knowledge, and potential as future nurses. Students internalize negative messages, developing beliefs that they’re not smart enough, competent enough, or suitable for nursing, creating self-fulfilling prophecies where decreased confidence leads to poorer performance, confirming their negative self-perceptions.

Imposter syndrome: Many nursing students already experience imposter syndrome—feeling like frauds who don’t belong in nursing school despite evidence of their capabilities. Incivility and bullying exacerbate these feelings, making students believe they truly don’t belong and that the mistreatment is justified by their inadequacy rather than being inappropriate behavior by perpetrators.

Emotional exhaustion and burnout: Constantly being on guard against incivility, managing emotional responses to bullying, and navigating hostile environments creates emotional exhaustion that depletes students’ psychological resources. Students may develop burnout characterized by emotional exhaustion, cynicism, and reduced sense of personal accomplishment even before graduating.

Sleep disturbances: Anxiety, rumination about experiences, and stress from hostile environments disrupt students’ sleep through difficulty falling asleep, frequent waking, poor sleep quality, and nightmares about incivility experiences. Sleep deprivation further impairs learning, emotional regulation, and physical health.

Post-traumatic stress symptoms: In severe cases of bullying, students develop PTSD-like symptoms including intrusive memories of traumatic incidents, hypervigilance in triggering environments, avoidance of situations or people associated with the trauma, and persistent negative emotional state. Some students experience lasting psychological trauma requiring long-term treatment.

Academic Performance Consequences

Decreased learning and retention: High anxiety and stress impair cognitive processes required for learning including attention, working memory, encoding of information into long-term memory, and retrieval. Students experiencing incivility demonstrate poorer retention of course material, lower performance on exams, and difficulty integrating theoretical knowledge with clinical practice.

Lower grades: The combined effects of decreased learning, impaired concentration, increased absenteeism, and poor performance in hostile clinical environments result in lower grades across didactic and clinical courses, potentially affecting GPA, honors eligibility, and competitiveness for desired positions.

Increased absenteeism: Students avoid class or clinical when anticipating incivility or bullying, calling in sick or missing sessions to avoid hostile faculty, preceptors, or peers. Increased absences further impair learning, create patterns that may violate attendance policies, and in clinical courses, may prevent students from meeting required hours.

Consideration of program withdrawal: A significant percentage of nursing students experiencing severe incivility or bullying consider leaving their programs entirely, with some following through on these considerations. This represents loss of talented individuals from the profession, wasted educational investments, and personal costs of abandoning career goals due to hostile environments rather than lack of capability.

Poor clinical performance evaluations: In clinical settings, anxiety and fear impair students’ ability to demonstrate competence, think critically under pressure, or perform skills smoothly. Additionally, biased evaluations from hostile preceptors may not accurately reflect student capabilities, yet these evaluations affect grades and progression.

Reluctance to ask questions: Perhaps most dangerously, students experiencing incivility become reluctant to ask questions even when they genuinely need information for safe patient care, fearing hostile responses or appearing incompetent. This reluctance creates knowledge gaps that affect both learning and patient safety.

Professional Development and Career Impacts

Impaired professional socialization: Professional socialization—the process of internalizing professional values, norms, and behaviors—is fundamentally disrupted when students experience incivility and lateral violence. Rather than being socialized into nursing’s caring ethos, students learn that nursing culture includes hostility, lack of support, and tolerance of bullying.

Negative perceptions of nursing: Experiencing lateral violence shapes students’ perceptions of nursing as a profession, creating beliefs that nursing culture is inherently toxic, that nurses don’t support each other, and that hostility is inevitable in nursing work. These negative perceptions affect career satisfaction and may lead students to leave nursing.

Career decision impacts: Students may choose career paths based on avoiding settings where they experienced lateral violence rather than following their interests or where they’d be most effective. For example, students interested in acute care may choose less demanding settings to avoid perceived toxicity, depriving those settings of talented nurses.

Consideration of leaving nursing: Research documents that significant percentages of nursing students experiencing severe bullying consider leaving nursing entirely, either before graduation or shortly after starting their first positions. Given nursing shortages and the profession’s investment in education, this represents tremendous loss.

Perpetuation of lateral violence cycle: Troublingly, students who experience lateral violence may perpetuate the cycle by modeling these learned behaviors when they become experienced nurses, believing this treatment is normal or justified, creating intergenerational transmission of toxic culture.

Physical Health Effects

Stress-related physical symptoms: Chronic stress from incivility manifests physically through tension headaches, gastrointestinal problems including nausea, stomach pain, irritable bowel symptoms, changes in appetite (decreased appetite or stress eating), muscle tension and pain particularly in neck and shoulders, and fatigue unrelieved by rest.

Weakened immune function: Chronic psychological stress suppresses immune function, making students more susceptible to infections and illnesses, slower to recover from illnesses, and potentially exacerbating chronic health conditions.

Cardiovascular effects: Persistent stress and anxiety elevate blood pressure and heart rate, potentially contributing to cardiovascular problems even in young, otherwise healthy students.

Prevention and Intervention Strategies: Creating Cultures of Respect

Effectively addressing incivility and bullying requires comprehensive, multi-level strategies operating at institutional, program, and individual levels, combining prevention efforts that stop incivility before it starts with intervention approaches that address ongoing situations and provide support for those affected.

Institutional-Level Prevention Strategies

Policy development and implementation: Institutions must create clear, comprehensive policies defining unacceptable behaviors for students, faculty, and clinical partners, establishing reporting mechanisms that are accessible, confidential, and protect against retaliation, specifying consequences for policy violations with consistent enforcement, implementing zero-tolerance approaches for severe bullying or harassment, and including civility expectations in strategic planning and accreditation self-studies. Policies work only when consistently enforced—inconsistent application undermines credibility and enables continuing incivility.

Education and training programs: Mandatory civility and professionalism training for all stakeholders including incoming students during orientation, faculty during onboarding and annually, and clinical partners who precept students teaches what constitutes civil versus uncivil behavior, develops skills in conflict resolution and professional communication, trains faculty and preceptors in effective mentoring and constructive feedback delivery, provides bystander intervention training empowering witnesses to safely intervene, and emphasizes shared responsibility for maintaining respectful cultures.

Culture transformation initiatives: Creating lasting change requires transforming organizational cultures through visible leadership commitment with administrators modeling civil behavior consistently, celebrating and rewarding individuals who demonstrate exceptional civility and mentoring, addressing uncivil behavior promptly and consistently regardless of perpetrator status, creating forums for open dialogue about climate concerns, conducting regular climate surveys assessing learning environment quality, and transparently communicating efforts and progress on civility initiatives.

Support system development: Institutions must provide accessible mental health and counseling services for students experiencing incivility impacts, peer support programs connecting students for mutual support, formal faculty mentoring programs creating positive relationships, ombudsperson or student advocate positions providing confidential support and guidance, and structured debriefing opportunities after difficult clinical experiences allowing processing of emotional responses.

Clinical site partnership approaches: Since much lateral violence occurs at clinical sites, institutions must collaborate with clinical partners establishing shared expectations for student treatment, requiring preceptor training on effective student supervision and teaching, creating processes for addressing clinical site incivility promptly, regularly evaluating clinical sites on learning environment quality not just patient acuity, and being willing to discontinue relationships with sites demonstrating persistent toxicity despite intervention attempts.

Program and Faculty-Level Strategies

Curriculum integration: Programs should integrate professionalism, therapeutic communication, conflict resolution, and civility content throughout curricula rather than treating them as separate topics, include case studies and role-plays practicing responses to incivility, require reflection on professional behaviors and experiences, and use simulation to practice difficult conversations and bystander intervention.

Classroom management: Faculty must establish clear behavioral expectations in course syllabi and at course beginning, address disruptive or disrespectful behavior promptly and consistently, model respectful communication in all interactions with students, create inclusive environments where all students feel valued, provide multiple channels for student feedback and concerns, and use active learning strategies promoting engagement and reducing opportunities for off-task behavior.

Clinical supervision approaches: Clinical faculty should prepare students for potential incivility during clinical orientation, maintain regular communication with students about their experiences, intervene promptly when students report lateral violence, provide debriefing opportunities after difficult interactions, advocate for students with clinical staff when appropriate, and carefully evaluate preceptors’ teaching approaches not just their clinical competence.

Evaluation and accountability: Programs must include civility in student evaluation criteria across courses, provide clear rubrics defining expected professional behaviors, document concerning behaviors and implement improvement plans, but also evaluate faculty and clinical instructors on creating positive learning environments, and use teaching evaluations to identify faculty whose approaches create hostile environments.

Individual Student Strategies for Responding to Incivility

Immediate response approaches: When experiencing incivility, students can use assertive communication by calmly but firmly stating the behavior is unacceptable using “I” statements (“I feel disrespected when you roll your eyes while I’m speaking”), set boundaries about acceptable treatment, remove themselves from situations when safe to do so, avoid escalating through defensive or aggressive responses, and focus on the behavior rather than attacking the person.

Documentation practices: Students should keep detailed records of incidents including dates, times, locations, witnesses present, specific behaviors or statements with quotes when possible, and their responses, save emails, text messages, or other written communications demonstrating incivility, document impacts on their wellbeing or academic performance, and maintain this documentation in secure locations in case formal reporting becomes necessary.

Seeking support: Students should not suffer alone but should reach out to trusted faculty members, academic advisors, or program administrators, utilize student support services including counseling centers, connect with peers who can provide emotional support and validation, involve family or friends outside the program for perspective, and consider whether support groups for nursing students dealing with incivility would be helpful.

Utilizing formal mechanisms: Students should review student handbooks for policies on incivility and bullying, understand reporting procedures and available resources, file formal complaints when appropriate following institutional procedures, document all steps taken in addressing situations, and understand protections against retaliation for making good-faith reports.

Self-care and resilience: Managing incivility impacts requires maintaining physical health through adequate sleep, nutrition, and exercise, practicing stress management through mindfulness, meditation, breathing exercises, or other techniques, engaging in activities outside nursing school that provide joy and balance, setting boundaries around study time and personal time, and seeking professional counseling when psychological impacts are significant or persistent.

Skill development: Students should work on developing professional skills that serve throughout careers including assertive communication without aggression, conflict resolution and de-escalation techniques, emotional intelligence and regulation, resilience and adaptability, and separating others’ problematic behavior from their own worth and competence.