Association Between Nurses’ Experiences of Workplace Incivility and Caring Responsibilities: A Cross-Sectional Study

Abstract

Study Aim

To examine the association between workplace incivility and caring responsibilities among hospital nurses.

Methods

A cross-sectional design was utilized. A convenience sampling technique was used, and 1,378 nurses from 10 hospitals in Jordan participated. Questionnaires on workplace incivility and Caring Dimensions Inventory were administered to the participants. Data were analyzed using descriptive statistics and a two-model multiple linear regression.

Results

Workplace incivility was significantly and negatively correlated with nurses’ caring responsibilities r (1,376) = .10, p =< .001. The total mean score of reported incivility was 23.92 (SD = 10.06), ranging between 12 and 60. The regression model showed that caring responsibilities significantly predicted lower experiences of workplace incivility among hospital nurses (β = −0.185, p < .00), holding the effect of nurses’ characteristics constant.

Conclusions

Nurses reported low incivility behaviors from coworkers or supervisors during the prior year at work. Nurses’ experience of workplace incivility was weakly associated with their caring responsibilities toward patients. Nursing management needs to address workplace incivility and caring responsibilities among nurses. Interventions to improve nursing care responsibilities could help reduce incivility among nurses, such as therapeutic communication skills.

Introduction

Incivility encompasses verbal or nonverbal actions that degrade, disregard, or exclude individuals, resulting in psychosocial or physiological distress for those involved (Patel & Chrisman, 2020). Clark (2013) further elaborates that non-civil behavior manifests as violent or destructive acts causing significant psychological or physiological suffering. The conceptual breadth of incivility includes various forms of psychological aggression, such as bullying, emotional abuse, and horizontal aggression (Campana & Hammoud, 2015). In recent years, the escalating incidence of incivility within healthcare settings has become an alarming concern, raising questions about its impact on both medical professionals and patient care. In the workplace context, incivility has become increasingly investigated over recent decades due to its pervasive adverse effects on organizational culture and employee well-being (Alshehry et al., 2019).

Review of Literature

Incivility within the nursing profession poses significant disadvantages from clinical efficacy to professional sustainability. According to Laschinger et al. (2013), incivility can precipitate medical errors, reduce patient safety, and negatively affect patient satisfaction, thus undermining the core objectives of healthcare provision. Furthermore, Oyeleye et al. (2013) highlight that such hostile work environments erode nurses’ sense of safety and job satisfaction, driving many to consider leaving the profession entirely. This attrition exacerbates staffing shortages and increases turnover rates, compounding stress among remaining staff members. Additionally, daily experiences of incivility have been linked to burnout symptoms by Campana and Hammoud (2015), indicating a vicious cycle where workplace hostility affects not only immediate job performance but also long-term mental health. Abdollahzadeh et al. (2017) corroborate this by illustrating how persistent uncivil behavior impacts nurses’ attitudes toward their roles and responsibilities in healthcare settings. Research confirms that incivility detrimentally influences the quality of nursing care across various dimensions, emphasizing its pervasive impact on overall healthcare outcomes (Alshehry et al., 2019). Importantly, the work environment significantly affects the prevalence of incivility; Smith et al. (2018) found an inverse correlation between a supportive work atmosphere and occurrences of coworker incivility. Malekyan et al. (2022) research in Iran reveals that interactions with patients and visitors are most commonly associated with uncivil behavior, while those with supervisors are least likely to be problematic, highlighting specific relational dynamics that necessitate targeted interventions for fostering civility within clinical settings.

Caring is a core principle in nursing practice, with nurses being unparalleled caregivers who profoundly impact their patients’ lives (Akansel et al., 2021). The essence of nursing care behavior, the professional nurse's acts, attitudes, and mannerisms, convey genuine concern for patient safety and well-being (Kibret et al., 2022). This intrinsic focus on caring behaviors supports the importance of patient quality of care and anticipates patient satisfaction (Burtson & Stichler, 2010; Putra et al., 2021). Caring behavior is essential for meaningfully connecting nurses’ interactions with client experiences (Kasa & Gedamu, 2019; Oluma & Abadiga, 2020). In contemporary healthcare settings, workplace incivility among nurses has emerged as a pervasive issue with far-reaching consequences, particularly in hospital environments. Such incivility can significantly undermine workplace culture, affecting morale and efficiency and directly impairing patient care and outcomes (Kisner, 2018). Nurses who face consistent incivility experience substantial psychological stress, decreased job satisfaction, and burnout factors that critically inhibit their capacity to deliver optimal patient care (Saleh et al., 2023). These negative emotional states reduce the quality of interactions between nurses and lead to disrupted communication channels within healthcare teams. This breakdown in effective communication results in increased errors, reduced efficiency, and compromised patient safety (Carlson, 2020).

Despite the well-documented adverse effects on professional dynamics and clinical performance, there remains a noticeable gap in scholarly research linking workplace incivility specifically to the concept of caring within nursing. In a qualitative study among nurses in Iranian hospitals, researchers investigated how workplace incivility can be prevented from the nurses’ perspective. One of the important themes of the study was the nurses’ belief that their caring responsibilities formed an effective approach to preventing incivility. The nurses mentioned examples of these responsibilities, including proper communication skills, completing tasks, and improved knowledge, skills, and evidence-based capabilities (Abdollahzadeh et al., 2017). Recent quantitative research has not addressed whether nurses’ caring behaviors influence experiencing incivility in the workplace. Previous studies did not examine whether nurses who consider various aspects of their nursing practice to be caring would experience greater or lower levels of incivility from their coworkers and managers. It is important to examine whether nurses who demonstrate greater caring responsibility toward their patients, such as listening to, reassuring, cheerful, and sitting with them, would experience greater or less uncivil behaviors from their coworkers and managers. This relationship is significant to address as both concepts have persistent consequences on nursing staff and nursing administration, and significant outcomes on the patient population (Kisner, 2018). Understanding differences in incivility experiences is crucial for developing targeted interventions to improve nurse well-being and patient outcomes. While several important theories explained the detrimental effects of workplace incivility on employee performance and intention to turn over, such as the Affective Events Theory or the Organizational Justice Theory (Lilly, 2017; Mehmood et al., 2024), it is essential to address how poor employee performance (e.g., poor caring responsibility among nurses) would lead to workplace incivility. Thus, this study seeks to examine the possible effect of caring responsibilities among hospital nurses on workplace incivility as a critical step toward fostering a more supportive work environment that upholds both nurse integrity and high standards of patient care.

Methods

Design

This study employed a cross-sectional descriptive correlational design to examine the association between nurses’ workplace incivility and caring responsibilities while considering nurses’ characteristics and job conditions (e.g., job title, work shift).

Sample and Sampling

The study included hospitals from different sectors in Jordan. The selection of governmental, military, and private hospitals was based on bed capacity and the number of nurses. Three private and four governmental hospitals with the highest bed capacity were included. Two university-affiliated hospitals were selected, as they are the only teaching hospitals in Jordan. In addition, one military hospital was selected. The total number of selected hospitals was 10.

The sampling of this study was reported in a previous study (Allari & Hamdan, 2023). Participants were selected using convenience sampling. The single inclusion criterion was that participants must have worked as a hospital nurse for at least 3 months. The participants were registered nurses (RNs), and licensed practical nurses (LPNs), who worked in medical wards, surgical wards, pediatrics, oncology, and other different units. The sample size was calculated using a survey calculator (Taherdoost, 2017). This survey calculator used the standard formula for calculating sample size (n). n = N⋅Z²⋅p⋅(1 − p)/(N − 1)⋅E² + Z²⋅p⋅(1 − p). The size of the nursing population in Jordan was (N = 24,000 nurses), considering a 95% confidence interval (Z = 1.96 for 95% CI) with an estimated proportion of the population (p = .5) and 5% margin of error (E). Based on these parameters, a total number of 1,022 participants was required. As reported in the previous study, 1,500 nurses were invited to participate (Allari & Hamdan, 2023) to account for a potential lack of response. Finally, a total of 1,378 nurses participated in the current study to ensure sufficient analysis power.

Ethical Consideration

The study proposal was reviewed and approved by the Institutional Review Board (IRB) of the participating university. The participants received pertinent information about the study in a cover letter to ensure their anonymity. The survey started with a consent statement that must be verified before the participants could answer the questionnaire. Regarding the Workplace Incivility Scale (WIS), it was freely available online (Cortina et al., 2001). Emails were sent to the Developers of the Caring Dimensions Inventory (CDI-35); they permitted the tool's use.

Data Collection

Data collection began after obtaining the required ethical approvals. As the study was conducted during the COVID-19 pandemic lockdown, web-based CDI and WIS questionnaires were administered through Google Forms. Data were collected between the periods of January 2020 to April 2020. The link for the questionnaire was sent to a facilitator in each participating hospital (nursing managers). The facilitator invited nurses to participate in the study at different duty shifts and sent them the questionnaire link. These facilitators met nurses in their departments at different times to ensure that all working nurses in the department were invited to participate. At the end of each questionnaire, the principal researcher's email and phone number were displayed for the participants if they had any questions. Several steps reduced response bias; participating nurses were informed that their answers were confidential and anonymous. The survey questions were answered using a variety of responses (5-point Likert scales). In addition, the facilitators followed up with nurses at different times to reduce non-respondents’ bias.

Measures

The three parts of the online survey were the demographic data questionnaire, which was developed by the study authors, the WIS (Cortina et al., 2001), and the CDI-35 (Watson & Hoogbruin, 2001) (Supplemental Material). Nurses' demographics included information about age, gender, total years of experience, job labels, hospital sector, and the shift type they were mostly assigned.

Workplace Incivility

It was measured using WIS. It is a reliable and valid tool that measures the occurrence of a personal experience of uncivil behavior (Cortina et al., 2001). Each item on the scale had a 5-point Likert scale answer that ranged from 0 (never) to 4 (many times). The questionnaire included questions about experiencing uncivil behaviors from coworkers and supervisors during the past year. The Cronbach alpha reliability reported in a previous study was .89 (Cortina et al., 2001).

Caring Behaviors

It was measured using the CDI-35, which is a previously validated and reliable questionnaire about caring perception (Watson & Hoogbruin, 2001). The stem question, “Do you consider the following aspects of your nursing practice to be caring?” is followed by 35 items (e.g., listening to a patient and measuring the patient's vital signs). The answer for each item is a 5-point Likert scale ranging from “strongly agree” to “strongly disagree.” Permission to use the instrument was sought from the CDI developer. The content validity and Cronbach's alpha reliability were tested in a previous study, and levels were higher than .90 (Watson & Lea, 1997). Cronbach's alpha reliability was .94 in this study.

Translation Procedure

The forward-backward translation strategy was employed in the study (Yu et al., 2004). First, a forward translation was conducted from the English language to the Arabic language by a certified translator after meeting with the principal investigator to explain the purpose of the study, the research questions, and the sample for the study. Second, a back translation was conducted from Arabic to English by a different certified translator who also received information about the study aims and sampling by the principal investigator. Finally, a panel included three nursing research professors, the translators, and the principal investigator reviewed and compared the two copies of the questionnaires with the original version. Inaccuracies in the Arabic language were identified and adjusted (Wang et al., 2006). A sample of 20 nurses in a pilot test answered the final version of the three questionnaires. They did not find any difficulties understanding the questions and confirmed that the Arabic version was coherent and easy to complete.

Data Analysis

The statistical analysis of the data in this study was conducted using SPSS version 21 (Corporation., 2012). Descriptive statistics, such as frequency, mean, percentage, and standard deviation, were computed to elucidate the demographic information and responses on the WIS and CDI items. Pearson's correlation coefficient (r) was used to assess the association of levels of workplace incivility experienced by nurses with their caregiving responsibilities. A two-model multiple linear regression was performed to examine the effect of caring responsibilities and several explanatory variables in the study (nurses’ characteristics and job conditions) on predicting workplace incivility. Based on clustering the hospitals, multilevel analysis was not performed as the intraclass correlation coefficient (ICC) value was very low (less than 5%).

Before conducting the regression analysis, the following assumptions were tested and met. Linearity between the independent variables and workplace incivility, absence of multicollinearity using the variance inflation factor, and independent and normally distributed residuals. Appropriate approaches controlled potential confounding variables. For example, the study included different hospitals in Jordan from various settings, including nurses of both genders and nurses from different backgrounds with various levels of experience. In addition, a two-model multivariable regression was used to control for the covariates (age, gender, hospital type, years of experience, job title, work unit, and work shift).

Results

A total of 1,378 nurses participated in this study. The mean age of the participants was 32.4 years (SD = 6.42). More than half of the participants were females, 56.2% (n = 774). Most of the sample were RNs, 86.5% (n = 1,192). Most nurses were working in governmental hospitals, 50.1% (n = 691). For other sample characteristics, see Table 1.

Table 1.

Participants’ Demographic Data (N = 1,378).

Item	n (%)	Mean	SD	Range
Age		32.4	6.42	20–57
Gender
Male	604 (43.8)
Female	774 (56.2)
Total years of experience
Less than 1 year	79 (5.7)
1–5 years	399 (29)
6–10 years	398 (28.9)
11–15 years	286 (20.8)
16–20 years	151 (11)
More than 20 years	65 (4.7)
Job title
RN	1,192 (86.5)
LPN	186 (13.5)
Hospital type
Governmental	691 (50.1)
Private	354 (25.7)
Military	134 (9.7)
Educational	199 (14.4)
Work unit new collections
Medical	369 (26.8)
Surgical	363 (26.3)
Pediatric	114 (8.3)
Oncology	28 (2)
Different units	504 (36.6)
Most often work shift.
Day	468 (34)
Afternoon	67 (4.9)
Night	80 (5.8)
Shift rotation	763 (55.4)

Nurses’ Experience of Workplace Incivility

The total mean score of reported incivility was 23.92 (SD = 10.06), ranging between 12 and 60, indicating a low level of exposure to incivility from supervisors and coworkers in the previous year. However, most incivility levels were relatively low (means = 0.99, SD = 0.84). The highest mean scores reported by nurses were for the items “paid little attention to your statements or showed little interest in your opinions” (m = 1.49, SD = 1.21) and “rated you lower than you deserved on an evaluation” (m = 1.36, SD = 1.27). On the other hand, the lowest mean score reported by nurses was for the item “made jokes at your expense” (m = 0.61, SD = 0.97). See Table 2.

Table 2.

Nurses Reported Experience of Incivility (N = 1,378).

Item	Never	Once or Twice	Sometimes	Often	Many times
	N (%)	N (%)	N (%)	N (%)	N (%)	m (SD)
“Paid little attention to your statements or showed little interest in your opinions”	392 (28.4)	296 (21.5)	392 (28.4)	222 (16.1)	76 (5.5)	1.49 (1.21)
“Doubted your judgment on a matter over which you had a responsibility”	445 (32.3)	308 (22.4)	402 (29.2)	166 (12)	57 (4.1)	1.33 (1.17)
“Gave you hostile looks, stares, or sneers”	616 (44.7)	282 (20.5)	316 (22.9)	119 (8.6)	45 (3.3)	1.05 (1.15)
“Addressed you in unprofessional terms, either publicly or privately”	706 (51.2)	280 (20.3)	250 (18.1)	107 (7.8)	35 (2.5)	0.9 (1.11)
“Interrupted or ‘spoke over’ you”	457 (33.2)	369(26.8)	368 (26.7)	131 (9.5)	53 (3.8)	1.24 (1.13)
“Rated you lower than you deserved on an evaluation”	476 (34.5)	296 (21.5)	334 (24.2)	172 (12.5)	100 (7.3)	1.36 (1.27)
“Yelled, shouted, or swore at you”	843 (61.2)	243 (17.6)	176 (12.8)	96 (7)	20 (1.5)	0.7 (1.02)
“Made insulting or disrespectful remarks about you”	844 (61.2)	226 (16.4)	210 (15.2)	69 (5)	29 (2.1)	0.7 (1.03)
“Ignored you or failed to speak to you (e.g., gave you ‘the silent treatment’)”	717 (52)	279 (20.2)	262 (19)	83 (6)	37 (2.7)	0.87 (1.09)
“Accused you of incompetence”	769 (55.8)	276 (20)	221 (16)	81 (5.9)	31 (2.2)	0.79 (1.05)
“Targeted you with anger outbursts or temper tantrums”	701 (50.9)	314 (22.8)	235 (17.1)	89 (6.5)	39 (2.8)	0.88 (1.09)
“Made jokes at your expense”	900 (65.3)	226 (16.4)	165 (12)	66 (4.8)	21 (1.5)	0.61 (0.97)

The Association Between Workplace Incivility and Caring Responsibilities

The average total of caring was 139.24 (SD = 20.85), ranging from 35 to 175, demonstrating a high level of care. Workplace incivility was significantly and negatively correlated with nurses’ caring responsibilities r (1,376) = .10, p < .001.

Predictors of Workplace Incivility Among Hospital Nurses

Table 3 presents the results of multiple regression in two models. In the first model, nurses’ characteristics were examined as covariates, including their age, gender, hospital type (governmental/private/military/educational), years of experience, job title (RN/LPN), work unit (medical/surgical/pediatric/oncology/different units), and work shift (day/afternoon/night/rotations). This model showed that younger nurses reported significantly higher levels of experiencing workplace incivility than older nurses (β = −0.095, p = .041), controlling for other covariates. RNs reported significantly higher levels of experiencing workplace incivility compared to practical nurses (LPN) (β = −0.067, p = .013), controlling for other covariates. On the unit level, nurses who worked in medical units (the reference group) reported significantly higher levels of incivility than nurses who worked in oncology (β = −0.071, p = .010). On the other hand, the medical group reported significantly lower levels of incivility than nurses who worked in rotations of different departments (β = 0.124, p ˂ .00). This indicated that nurses who worked in different units reported the highest level of workplace incivility. Lastly, this model showed that nurses who worked on the day shift reported experiencing higher incivility levels than nurses who worked different shift types (β = −0.094, p = .002). In the second model, caring was entered and showed a significant negative difference; the increase in total caring responsibility significantly decreased workplace incivility (β = −0.185, p ˂ .00). The effect of nurses’ age became nonsignificant in the presence of caring in the model. Similarly, RNs working in the medical unit compared to oncology, working in different units compared to the medical unit, and working day shifts compared to different rotations showed significantly higher levels of reporting workplace incivility among these nurses (β = −0.074, p = .006; β = −0.064, p = .017; β = −0.111, p = .001; β = −0.074, p = .013, respectively). Both regression models were statistically significant with F = 4.76 and 7.80, p ˂ .01, respectively. The percentage of explained variance of the models was 3.7% and 6.9%, respectively. See Figure 1.

Table 3.

Predictors of Workplace Incivility (N = 1,378).

Variables	Workplace Incivility First Model				Workplace Incivility Second Model
	B	S.E.	p-Value	Confidence Interval	B	S.E.	p-Value	Confidence Interval
(Constant)	18.43	2.71	.00	13.12–23.75	30.923	3.214	.000	24.62–37.23
Age	−0.15	0.07	.041	−0.29 to −0.01	−0.131	0.071	.066	−0.27 to 0.01
Gender	−1.10	0.57	.079	−2.14 to 0.12	−0.738	0.566	.192	−1.85 to 0.37
Years of experience	0.565	0.484	.243	−0.38 to 1.51	0.604	0.476	.204	−0.33 to 1.54
Job title	−1.981	0.799	.013	−3.55 to −0.42	−2.162	0.786	.006	−3.70 to −0.62
Hospital type	−0.133	0.257	.605	−0.64 to 0.73	−0.323	0.254	.205	−.82 to 0.18
Work unit
Surgical	−.32	.738	.665	−1.7 to –1.23	−0.767	0.729	.293	−2.20 to 0.66
Pediatric	−.447	1.095	.663	−2.63 to 1.67	−0.926	1.078	.391	−3.04 to 1.19
Oncology	−5.067	1.957	.010	−8.91 to −1.23	−4.590	1.926	.017	−8.37 to −0.81
Different units	2.586	.696	.000	1.22–3.95	2.319	0.686	.001	0.97–3.66
Work shift
Afternoon	−1.933	1.314	.142	−4.51 to 0.65	−2.034	1.292	.116	−4.57 to 0.50
Night	1.824	1.227	.137	−0.58 to 4.23	1.465	1.208	.225	−0.90 to 3.83
Rotation	−1.901	.607	.002	−3.09 to −0.71	−1.498	0.600	.013	−2.67 to −0.32
Caring responsibilities total score					−0.125	0.018	.000	−0.16 to −0.09

Figure 1.

Significant Predictors of Incivillity.

Discussion

This study investigated the perceptions of workplace incivility among nurses from their coworkers or supervisors and examined how these experiences could be influenced by their levels of caring responsibilities. The results demonstrated that there was a low incidence of incivility coupled with the high levels of caring activities reported by the nurses. However, some instances of incivility were highlighted, particularly in areas where supervisors or coworkers failed to pay adequate attention to nurses’ opinions and consistently undervalued their performance evaluations. The study results revealed a significant and negative weak correlation between perceived levels of caring and incivility; as perceived incivility increased, the reported levels of caring behavior decreased correspondingly.

The prevalence of incivility among nurses in the workplace is alarmingly high, with recent statistics indicating rates exceeding 55%, particularly more pronounced in developing countries (Shoorideh et al., 2021). Such uncivil behaviors undermine nurses’ contributions and can significantly impact their job satisfaction and motivation to improve. Compared to the global rate, the current study highlights that the level of incivility manifested through neglecting nurses’ opinions was notably higher than that reported among RNs in U.S. hospitals (Smith et al., 2018), suggesting a systemic issue that crosses international borders. This outcome was similar to Shoorideh's et al. (2021) study that indicated the damaging effects of incivility on the nursing environment. Furthermore, one of the most egregious forms of incivility identified was unfair evaluations—rating nurses lower than deserved adds to their sense of undervaluation and injustice within their professional environment. Supporting this finding, El Ghaziri et al. (2022) reported that 40% of nurses indicated their supervisors as primary sources of uncivil behavior. Similarly, a qualitative study by Serapelwane and Manyedi (2022) found that South African nurses faced discrimination, favoritism, and unfair performance ratings from managers as prevalent forms of unfair labor practices. These studies collectively underscore the urgent need for interventions aimed at fostering respect and fairness in nursing environments to enhance both nursing well-being and patient care outcomes.

Incivility among nurses is increasingly recognized as a critical occupational hazard that can jeopardize nurse well-being and patient care quality. A comprehensive retrospective study by El Ghaziri et al. (2022) involving 526 nurses revealed that the vast majority experienced incivility from various sources, including physicians, fellow nursing and non-nursing coworkers, patients, and their families. These findings further support that incivility is a prevalent concern to nurses and nursing management as it impacts the entire healthcare workforce, not just nurses.

The high level of care demonstrated by nurses in this study, as evidenced by a mean caring total score of 139.24, points to dedicated healthcare providers committed to their roles despite significant challenges. The study results revealed a significant and negative weak correlation between perceived levels of caring and incivility. While this relationship is statistically significant, the strength of the association is weak. This would indicate that despite the significant chance of their association, there is a minimal effect on either one with the other. This weak association might have different aspects and explanations. For instance, nurses who demonstrate greater levels of caring responsibilities develop greater means of confidence in communication and professionalism, which can prevent incivility. In a recent study in Iran, nurses reported that higher evidence-based care effectively prevented incivility (Abdollahzadeh et al., 2017). In the prediction model, caring was a significant predictor of workplace incivility, considering the effect of other variables. This finding aligns with the results of a study by Alshehry et al. (2019) as they found a significant correlation between workplace incivility and diminished quality of nursing care. Caring is an essential aspect of nursing care and the focal of the nursing profession (Adams, 2016), and it is one of the indicators of quality of care (Kol et al., 2018). In a systematic review of incivility among nurses, Shoorideh et al. (2021) indicated that incivility decreases nurses’ job satisfaction, leading to decreased nurses’ commitment. In addition, incivility reduces workplace productivity and increases absenteeism. It can affect nurses’ mental health and lead to potential safety hazards and medication errors (Phillips et al., 2018).

Being an RN was a significant predictor of experiencing workplace incivility compared to LPNs. This finding is consistent with the previous two studies in Jordan and the United States (Jaber et al., 2023; Layne et al., 2024). Several plausible explanations could explain this finding. RNs could be more aware and sensitive to identifying signs of uncivil behaviors from their coworkers and managers (Layne et al., 2024). Their ability to recognize these behaviors would increase reporting incivility among RNs. In addition, RNs have greater responsibility and accountability than LPNs; this would introduce them to stressful situations that increase tension with their coworkers and managers, which ultimately produce more risk for incivility. Another possible explanation is that RNs’ roles include interdisciplinary interactions with several other specialties in the healthcare setting, possibly leading to conflicts with others and increasing the risk of incivility (Laschinger et al., 2013).

The regression analysis also showed that nurses who work in medical units reported higher levels of perceived incivility than nurses who work in oncology units but lower than nurses who work in different rotations of departments. While this outcome was not discussed in previous research (Keller et al., 2020), it could be explained that nurses who work in different departments might be unable to maintain consistent and continuous collegiality with other nurses and managers. These nurses could be treated as “outsiders” in the department where they are assigned, and this would increase the risk of incivility. This finding also supports what previous research indicated: the lack of support and cohesion in the healthcare work environment can bring feelings of isolation, stress, and burnout among nurses (Laschinger et al., 2013).

Nurses on the day shift reported higher incivility compared to nurses in different shift rotations. While this finding was inconsistent with what was reported in previous studies on incivility and bullying among nurses and medical staff in Spain and Jordan (Al-Ghabeesh & Qattom, 2019; Ariza-Montes et al., 2013), it suggests that time and situational factors might exacerbate negative workplace dynamics that lead to incivility. It is well known that day shifts are more dynamic as most administrative and assignment work, patients’ admission, patients’ care prescriptions and orders, and patients’ visits occur during the day shift. These greater demands and stressful tasks create a risk of experiencing poor interactions and incivility. A previous study indicated that hospital nurses reported experiencing more psychological and physical problems on the day shift rather than the night shift (Silva et al., 2022).

Study Limitations

The recent study represents a pioneering effort to explore the relationship between workplace incivility experienced by nurses and their perceptions of patient care, thereby filling a critical gap in healthcare research. However, the study has some limitations. One limitation is the potential exclusion of nurses lacking internet access, which could result in an unrepresentative sample. This limitation affected the external validity of the study. The study's reliance on self-administered questionnaires introduced a risk of response bias. As nurses read and responded to the questionnaires without the researcher's presence, there could be a lack of explanation or clarification of some questionnaire areas that might affect the answers. In addition, using a self-administered questionnaire with Likert scale items might limit the depth of the information received from the study participants. Several strategies can be implemented in future research to enhance the external validity and reliability of the study. First, a mixed-methods approach could be beneficial. Expanding the study design to include quantitative and qualitative data collection might provide a more comprehensive understanding of the issue. For instance, conducting focus group discussions alongside the self-administered questionnaires could facilitate deeper insight into the nurses’ experiences with workplace incivility. Qualitative methods, such as interviews, would allow for clarification of questions and richer data collection, thus minimizing the limitations stemming from response bias (Maghsoud et al., 2022). Second, improving accessibility for participants who may lack internet access is crucial for enhancing the representativeness of the sample. This could involve distributing paper-based questionnaires in clinical settings or utilizing mobile data collection methods where researchers are present to administer surveys directly. This approach not only broadens participation but also minimizes the likelihood of misunderstandings or misinterpretations of the questionnaire items (Krel et al., 2023). Additionally, implementing strategies to reach underserved populations, such as engaging with community health workers, can ensure that a more diverse sample of nurses is included (Aguilera et al., 2023).

Using non-probability convenience sampling in the study also affected the external validity and limited the generalizability of the findings to a greater population in the healthcare setting. Lastly, the observed relationship between caregiving duties and incivility is minimal, with the regression model accounting for merely 6.9% of the variation in incivility experiences. This limited predictive capability diminishes the practical relevance of the results and highlights the potential impact of additional factors influencing incivility that were not addressed in this research. So, as a recommendation for future studies, addressing the issues related to convenience sampling requires careful planning regarding participant selection. Future research could employ stratified sampling techniques to ensure that the sample reflects the demographics of the entire nurse population more accurately (Yang et al., 2023). This would enhance the generalizability of the findings and allow for more robust conclusions that can be applicable to diverse healthcare settings. Furthermore, acknowledging the limited predictive capability noted in regression models can be remedied by broadening the scope of factors examined in relation to incivility. Future studies could explore additional variables such as workplace culture, organizational support, and individual resilience, which may contribute to experiences of incivility (Hu et al., 2022). By doing so, a more complex and accurate regression model could be developed, capturing a higher percentage of variance and providing more actionable insights for nursing management and policy development (Hassan et al., 2021). Future researchers should prioritize rigorous statistical analysis and utilize appropriate sample size calculations to better support their findings. Clear reporting of the statistical power, effect sizes, and CIs can enhance the credibility of the research and allow for better interpretation of the results (Bae, 2024). All previously mentioned strategies addressing this study's limitations will strengthen the theoretical framework that was suggested in the study.

Implications for Nursing Management and Health Policy

While the incidence of workplace incivility was not high, part of the sample reported experiencing incivility, especially as supervisors or coworkers failed to appreciate the nurses’ performance. This indicates that nursing managers need to improve the work environment where nurses feel more valued. In addition, nursing managers need to develop and implement continuous education and training programs that enhance professionalism and mutual respect among nurses. Effective leadership training is also an important approach that helps nursing supervisors listen to nurses, distinguish their contributions, and value their work loyalty. Nursing managers should also prioritize strategies to mitigate uncivil behaviors among nurses, particularly during day shifts, as such behavior can significantly impact nurse well-being and patient care. Increasing awareness of workplace incivility and its detrimental effects on individual nurses is crucial; educating staff about the harmful consequences of incivility can foster a more supportive and respectful work environment. Nursing managers must address areas with high levels of workplace incivility. RNs have high job demands and responsibilities that might create a stressful work environment between nurses, their managers, and nursing colleagues. Hospital administrations need to develop interventions that help improve nursing care responsibilities, which will eventually reduce the incidence of incivility. Programs and incentives encouraging nurses to focus on improving their caring behaviors might help reduce incivility, eventually improving patient outcomes. Additionally, further research is imperative to validate these findings and explore other potential sources of incivility that nurses face, including interactions with patients and their families. Nursing managers may focus on improving nurses’ abilities to address and take action toward incivility through continuous education and quality improvement.

Conclusions

Nurses reported experiencing relatively low levels of uncivil behaviors from coworkers and supervisors. Nurses demonstrated high levels of caring towards their patients, reflecting a strong professional commitment and ethical standards ingrained in the nursing profession. The relationship between a decline in caregiving responsibilities and experiences of incivility reveals critical nuances about workplace dynamics, emphasizing the significance of cultivating an environment rooted in professionalism and respect. The minimal strength of this observed connection suggests that other unexamined factors play a role in influencing such interactions. Finally, registered nursing, lower caring responsibilities, working in medical departments, and working on day shifts appeared to be significant factors linked to increased incivility among hospital nurses.