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Nurs Adm Q. 2019 Apr/Jun;43(2):138-156. doi: 10.1097/NAQ.0000000000000338.

An Integrative Review of Nurse-to-Nurse Incivility, Hostility, and Workplace Violence: A GPS for Nurse Leaders.

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Academy of Evidence-Based Practice, Kaiser Permanente Southern California Patient Care Services, Regional Nursing Research Program, Pasadena (Dr Crawford); Gonzaga University, Foley Center Library, Spokane, Washington (Ms Chu); California State University, Los Angeles, Chin Family Institute for Nursing, Los Angeles (Dr Judson); University of California, Los Angeles, School of Nursing, Los Angeles (Dr Cuenca); School of Nursing, California State University, Long Beach (Dr Jadalla); Kaiser Permanente Woodland Hills Medical Center, Medical-Surgical/Oncology Unit, Woodland Hills, California (Ms Tze-Polo); Kaiser Permanente Southern California Patient Care Services, Regional Nursing Research Program, Kaiser Permanente, Pasadena (Dr Kawar); Health Science/Medical Library, Southern California Permanente Medical Group, Downey (Ms Runnels); and Kaiser Permanente Panorama City Medical Center, Nursing Administration, Panorama City, California (Mr Garvida Jr).


Bullying, lateral violence, and incivility are real phenomena in the nursing workplace and remain widespread across all care settings. The American Nurses Association recommends zero tolerance for any form of violence from any source and adopting evidence-based strategies to mitigate incivility and bullying. This integrative review examined the evidence regarding nurse-to-nurse incivility, bullying, and workplace violence for 4 nurse populations-student, new graduate, experienced, and academic faculty. Ganong and Cooper's review methodology structured the evidence synthesis. Twenty-one articles pertained to the clinical inquiry. The evidence consistently described the incidents, instigators, and targets of incivility/bullying, which contributes to 84 negative academic, organizational, work unit, and personal outcomes. A safe and just organizational culture demands a comprehensive systems-level approach to create civil environments. The evidence-based structures, processes, and recommendations serve as a Global Positioning System for practice and academic leaders to use in creating a healthy work environment where nurses are encouraged and empowered. The critical choices by nurse leaders will determine not only the future of 21st century professional nursing practice but how the public views the nursing profession for many years to come.

[Indexed for MEDLINE]

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