Magazine article American Nurse Today

Cognitive Rehearsal: Learn a Strategy for Addressing Incivility and Bullying in Nursing

Magazine article American Nurse Today

Cognitive Rehearsal: Learn a Strategy for Addressing Incivility and Bullying in Nursing

Article excerpt

August 2017 Vol. 12 No. 8


* Incivility and bullying among healthcare ( workers contribute additional stress to an already stressful environment and can jeopardize patient safety.

* Cognitive rehearsal is one way to mentally prepare to address threats from incivility or bullying.

* Learning approaches to address incivility, such as cognitive rehearsal, equip nurses with the skills to respond to situations and protect themselves and their patients.

Unprofessional behavior within healthcare ( organizations, in the form of incivility and bullying, adds more stress to an already stressful environment and also jeopardizes patient safety. Too often, nurses are on the receiving end of incivility. Promoting a civil work environment requires effort by both the organizational leadership, through policies and action, and individual team members. On an individual level, nurses can help tackle unprofessional behavior using techniques such as cognitive rehearsal that promote communication and respect.

This article discusses some of the reasons behind workplace incivility, how individuals typically respond to disrespectful behavior, and how to use cognitive rehearsal as a tool to address it.



Cognitive rehearsal. With preparation, you can confront bullying and incivility constructively. Click for a high-res image (

What's behind incivility?

Conflict often arises in stressful environments with competing priorities and values at stake. Every day, nurses are expected to deliver competent, comprehensive patient care but are often met with distractions and a lack of resources. And as part of a healthcare ( team that includes various disciplines, nurses must struggle to make their priorities known, while acknowledging other team members' priorities.


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Rather than recognizing each team member's unique contributions to patient care, coworkers may let conflicts develop and manifest as incivility and disrespect. When combined with technology that facilitates communication without face-to-face interaction, which makes saying things that would never be communicated directly to another person easier, professional encounters deteriorate and create a culture of incivility. (See Incivility defined.)

How do you respond to incivility?

When faced with unprofessional behavior, most people choose fight or flight. Some respond immediately as a form of defense, but reciprocating in a similar manner may perpetuate the problem. Others choose to ignore incivility in an attempt to minimize the situation, inadvertently sending a message that the behavior is acceptable. Some people, though, recognize the inappropriateness of the behavior, but they lack the knowledge and skills to respond accordingly.

Incivility defined

Andersson and Pearson define incivility as "low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect. Uncivil behaviors are characteristically rude and discourteous, displaying a lack of regard for others."

If not curtailed, incivility can escalate to more threatening behaviors such as bullying, which is defined as behaviors intended to degrade or humiliate another and that continue over a period of time. …

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