Bullying and incivility in healthcare do more than cause pain to the individuals experiencing them (although that pain alone is a significant issue).

These disruptive behaviors have been linked to medical error by 71% of physicians and nurses surveyed, and to patient death by 27% of those professionals surveyed (Lewis, 2023).

Using effective conflict resolution skills is a great way to resolve conflict IF all parties are invested in resolution.

But sometimes you may be facing a situation in which you are being treated rudely or disrespectfully. In those situations, the incivility needs to be addressed first. Having a process in place to manage these incidents will help you control your emotions and attain the best possible outcome:

1. Practice emotional self-regulation. Emotional self-regulation is not about denying our emotions, but about downgrading their intensity to an adaptive level. It is an essential foundation for difficult or disruptive interpersonal interactions. You can try:
   1. Deep breathing. If you are using deep breathing in a conflictual situation, do use caution that the breathing itself does not escalate the situation by coming across as heavy sighing or another disrespectful behavior.
   2. Imagery. Call a peaceful image to mind (family, vacation spot, whatever works for you) and hold it for a few seconds. The more you use this technique, the more powerful it will become. With repetition, it becomes an immediate cue for relaxation.
2. Have a plan for what to say. Renee Thompson and the Healthy Workforce Institute are dedicated to reducing incivility in nursing and in healthcare more broadly. They have a number of scripts readily available, including such statements as:
   1. “You are yelling and screaming at me in front of patients and their families.” 
   2. “I am willing to discuss this with you as long as you are willing to speak to me in a respectful manner.” 

Notice that these examples involve labeling the behavior, not the person. “You’re being a jerk” is inflammatory (no matter how true it feels or is). “You’re yelling and screaming at me” keeps the focus on the behavior that needs to change. 

Similarly, expressing your willingness to continue having a discussion under certain circumstances is an example of setting a boundary. Boundary-setting is consistent with conflict resolution, although it may cause some tension in the moment.

But what if the bullying or rude behaviors are persistent? HWI has scripts for that, too, including: “I’m not sure you realize this, but sometimes you can come across as being _________ (intimidating, aggressive, unapproachable, etc.).”

You are still not labeling the person, but describing the way that their behaviors come across. You are acknowledging the role of your perceptions in the situation, while keeping the focus on the disruptive behaviors that are occurring.

It is critically important to emphasize that you are not to blame for bullying and incivility directed against you. Talking about tools and strategies to address these behaviors is intended to give you power, but it does not give you responsibility.

It is also critically important to acknowledge the roles of racism, intolerance, and anti-LGBT bias in workplace incivility and workplace abuse. These intolerant behaviors are often accompanied by gaslighting efforts that may leave those affected questioning their perceptions. Institutional support is crucial, but may be lacking.

If support is not available in your organization, there are options.

Heliana Ramirez of Hostile Workplace Recovery offers online support and resources in an anti-racist and LGBT-affirming recovery space by and for workplace abuse survivors (not limited to healthcare). Hostile Workplace Recovery offers on-demand webinars, group coaching, and private peer support discussions in addition to a comprehensive resource guide.

You may also benefit from using more generally applicable coping strategies. You might consider:

• Meditating;
• Journaling, writing poetry, or trying other forms of written expression;
• Attending to the basics (to the extent that you are able, getting enough rest, ensuring proper hydration and nutrition, and engaging in regular exercise);
• Connecting with spirituality (if applicable).

Lastly, I encourage you to hold space for your feelings. Bullying and incivility hurt. They hurt regardless of age, education, professional status, or general life satisfaction. There is nothing deficient or wrong or weak about being hurt by something hurtful.

Take care. 

Additional Resources:

Healthy Workforce Institute https://healthyworkforceinstitute.com/

Hostile Workplace Recovery https://www.hostileworkplacerecovery.com/

References:

Lewis C. (2023). The impact of interprofessional incivility on medical performance, service and patient care: a systematic review. Future Healthcare Journal, 10(1):69-77. 

Ramirez, H. (2024). BIPOC and LGBTQ+Toxic Job Survivor Suicide Prevention Resource Guide.