The American Nurses Association is urging employers to move away from zero-tolerance policies on nurse bullying and incivility in favor of a tiered, restorative approach that weighs context and severity.
The recommendation appears in a new position statement on civility in nursing, which ANA’s board of directors adopted effective Sept. 10.
Zero-tolerance policies are widely adopted, but they “may discourage reporting, overlook context, and prioritize punishment over change and accountability,” the statement said. ANA recommends that organizations instead judge each behavior on its merits and respond in ways that are “fair, proportionate and constructive.”
The statement separates incivility from bullying. It defines incivility as low-intensity disrespect, such as eye-rolling or excluding someone from conversations. Bullying is repeated, intentional hostility involving a power imbalance. Bullying is classified as Type 3 worker-on-worker violence under the National Institute for Occupational Safety and Health’s framework.
ANA’s recommendations for employers and leaders include:
- Screening job applicants for civility, teamwork and collegiality during hiring
- Building civility and respectful communication into performance evaluations, employee handbooks and culture surveys
- Offering confidential, psychologically safe ways to report incidents
- Naming internal champions, such as “Civility Ambassadors,” to lead healthy work environment efforts
- Providing coaching so leaders can handle disruptive conduct and difficult conversations
- Making psychological safety and “Just Culture” part of strategic plans and mission statements
For front-line nurses, ANA recommends that units agree on a code word or phrase that signals an uncivil or bullying moment, and practice using it. The statement also asks nurses to resolve conflicts with colleagues one-on-one, when they can, before going to a supervisor or filing a formal report.
To make the case for acting, the statement cites a 2025 American Organization for Nursing Leadership study. In it, more than 70% of nurse leaders reported that incivility and bullying harm psychological safety. It also cites Society for Human Resource Management research linking incivility to lower productivity (66%) and morale (59%).
ANA acknowledged that prevalence is hard to pin down. Global estimates range from 3.9% to 86.5% depending on how bullying is measured. One large U.S. sample put the rate at 40%.
The statement calls for trauma-informed approaches across clinical and academic settings. It ties secondary traumatic stress, which it says affects 64% to 76% of nurses, to bullying as both a cause and a consequence.
ANA also urges nurses to push for state and federal legislation addressing incivility and bullying.
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