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Archive Diversity in Surgery 2019

Fighting the Incivility War

Teaching and requiring respectful behavior improve staff morale, patient safety and the bottom line.

Rebecca Gilbert

Rebecca Gilbert, DNP, RN, CCRN



An older nurse rolls her eyes at a younger one and calls her an "idiot" behind her back. A frustrated eye surgeon pushes a female nurse and sends her flying. A frustrated nurse slaps a colleague. Sound familiar? Most of us know that we have an incivility problem in health care.

The journal Academic Medicine recently reported that 100% of the physicians interviewed in their study had witnessed or been personally affected by incivility. A Joint Commission survey in 2008 nurses found that 90% of nurses had witnessed workplace bullying — and 50% had been bullied themselves.

Friction between staffers and staffers and surgeons costs us big — in absenteeism, loss of productivity and turnover. Estimates are that nurse-on-nurse and surgeon-on-nurse bullying costs healthcare facilities upwards of $14,000 per employee per year — a staggering $4 billion annually in the aggregate. Worse, bullying affects outcomes. Incivility in health care has been linked to an alarming 71% of medical errors and to increased mortality in 27% of cases, according to a report in The Joint Commission Journal on Quality and Patient Safety. The OR is a particularly high-stress, high-risk environment, and the one place in health care where physician-on-nurse bullying is more common than the nurse-to-nurse variety.

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