From incivility to outcomes: tracing the effects of nursing incivility on nurse well-being, patient engagement, and health outcomes

Abstract

Background Nursing incivility, defined as disrespectful behaviour toward nurses, is increasingly recognized as a pressing issue that affects nurses’ well-being and quality of care. However, research on the pathways linking incivility to outcomes is limited, especially in Saudi hospitals. Methods: This cross-sectional study examined relationships between perceived nursing incivility, nurse stress, patient engagement, and health outcomes in four Saudi hospitals. Using validated scales, 289 nurses and 512 patients completed surveys on exposure to incivility, stress levels, activation, and medication adherence. The outcomes included readmissions at 30 days and satisfaction. Results: More than two-thirds of nurses reported experiencing moderate to severe workplace incivility. Correlation and regression analyzes revealed that nursing incivility was positively associated with nursing stress. An inverse relationship was found between stress and patient participation. Serial mediation analysis illuminated a detrimental cascade, incivility contributing to increased nurse stress, subsequently diminishing patient engagement, ultimately worsening care quality. Conclusions The findings present robust evidence that nursing incivility has adverse ripple effects, directly impacting nurse well-being while indirectly affecting patient outcomes through reduced care involvement. Practical implications advocate for systemic interventions focused on constructive nursing cultures and patient empowerment to improve both healthcare provider conditions and quality of care. This study provides compelling information to inform policies and strategies to mitigate workplace mistreatment and encourage participation among nurses and patients to improve health outcomes.

Toward disrupting normalized incivility in our nursing workplaces

“…We cannot allow incivility to remain a recognizable dynamic within our profession. To normalize that which should never be normalized is to perpetuate the kinds of harms our profession was designed to prevent (Alsadaan et al, 2024;Sherrod & Lewallen, 2021). And so I challenge us all, and in particular, those of us engaged with professional associations, workplace leadership teams, and schools of nursing, to put some effort into thinking about what it is we actually do believe in with respect to interpersonal conduct in this profession of ours, how we might shape those ideas into workable language and how we might share them among and across contexts.…”