AACN Position Statement: Bullying, Incivility, and Verbal Abuse

Jun 01, 2025

Added to Collection

This AACN Position Statement was first published November 1, 2019. It was reviewed and updated on June 1, 2025.


Background

Bullying, incivility, and verbal abuse impede the delivery of safe, quality care, and violate individuals' rights to dignity and well-being. These acts are often subtle and can include eye rolling, sarcasm, and sighing.1 Other examples include contemptuous tone of voice, hostile looks, grinning, interrupting, shouting, spreading rumors, taking advantage of others, ignoring authority and identity in front of colleagues, aggressive behaviors (such as angry outbursts, shunning, reluctance, or refusal to answer questions), and threatening body language.2,3 The National Institute for Occupational Safety and Health (NIOSH) includes verbal abuse in its definition of workplace violence4 and both the American Nurses Association and Press Ganey report that a workplace tolerant of incivility and bullying creates a culture that is also conducive to violence.5,6 See AACN Position Statement: Preventing Violence Against Healthcare Workers.

Abusive behavior leads to unhealthy work environments, which degrade the communication and collaboration necessary to maintain patient and clinician safety. Unfortunately, this is a widespread problem. In the American Association of Critical-Care Nurses' 2021 Critical Care Nurse Work Environment Study, 65% of the 7,399 registered nurses who answered the question about abuse incidents reported experiencing verbal abuse at least once during the past year.7

The effects of unprofessional behaviors are not isolated to the individuals involved. Patient safety is at risk when staff are distressed, fatigued, and experiencing mental exhaustion from working in a hostile environment.5 In addition, when nurses and other healthcare workers feel that their organization values their health and safety, job satisfaction and retention are improved,8 but when nurses begin to lose motivation and career satisfaction, poor quality of care and increased patient safety concerns ensue.9 Taking a proactive approach towards a healthy work environment with actions based on cultivating an organizational culture that values mutual respect, open communication, and the formation of strong interpersonal bonds is recommended.8

AACN's Position

Bullying, incivility, and verbal abuse in the workplace are unacceptable. All healthcare workers must be accountable for their behavior, and institutions must implement evidence-based 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, and thus, support patient care.10

Recommended Actions for Healthcare Institutions

  • Provide tools and resources for staff to complete a self-assessment of their own behavior.
  • Ensure widespread awareness of healthy communication and safety to mitigate distress.
  • Encourage employees to promptly report incidents and ensure that no employee who experiences and reports bullying experiences reprisal.
  • Take action to address 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.
  • 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.
  • Establish interprofessional evidence-based educational interventions to prevent and respond to abuse.

Recommended Actions for Nurses

  • Communicate respectfully—online and in person.
  • Hold yourself and others accountable for unacceptable behavior.
  • 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, providers, and others 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 that promote civility.

References

  1. Manning AP, Opperman C, Vegh M, Sutherland-Foggio M, Brammer JM, Skeens MA. Promoting a healthy work environment: Increasing staff confidence to address incivility. Nurs Manage. 2025;56(2):26-33. https://doi.org/10.1097/nmg.0000000000000216
  2. Nazari S, Nikpeyma N, Haghani S, Fakhuri F, Farokhnezhad Afshar P. Workplace incivility and the professional quality of life in nurses. Nurs Ethics. 2024;31(2-3):311-320. https://doi.org/10.1177/09697330231193852
  3. Atashzadeh Shoorideh F, Moosavi S, Balouchi A. Incivility toward nurses: a systematic review and meta-analysis. J Med Ethics Hist Med. 2021;14:15. Published 2021 Nov 3. https://doi.org/10.18502/jmehm.v14i15.7670
  4. National Institute for Occupational Safety and Health. About Workplace Violence. Centers for Disease Control & Prevention. December 3, 2024. Accessed May 7, 2025. https://www.cdc.gov/niosh/violence/about/index.html
  5. American Nurses Association. American Nurses Association Position Statement on Workplace Violence. March 13, 2025. Accessed May 7, 2025. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/
  6. Assi, MJ. Calling out bullying and incivility in healthcare. Press Ganey. June 14, 2023. Accessed May 7, 2025. https://info.pressganey.com/press-ganey-blog-healthcare-experience-insights/calling-out-bullying-and-incivility-in-healthcare
  7. Ulrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA. National Nurse Work Environments - October 2021: A Status Report. Crit Care Nurse. 2022;42(5):58-70. https://doi.org/10.4037/ccn2022798
  8. Almeida D, Figueiredo AR, Lucas P. Nurses' Well-Being at Work in a Hospital Setting: A Scoping Review. Healthcare (Basel). 2024;12(2):173. Published 2024 Jan 11. https://doi.org/10.3390/healthcare12020173
  9. Dadfar M, Lester D. Workplace violence (WPV) in healthcare systems. Nurs Open. 2021;8(2):527-528. https://doi.org/10.1002/nop2.713
  10. 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. Accessed May 7, 2025. https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments
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