Purpose: To identify evidence-based strategies used in transformational leadership to create a nursing work culture where incivility is reduced.
Background: History repeats itself in nursing and continues to show “nurses eat their young”. Strategies, interventions, and prevention strategies can help break the cycle of incivility and build a culture of caring in workplace environments.
Methodology: The search included MEDLINE, Cochrane Collaboration’s systematic reviews, Cumulative Index to Nursing, Allied Health Literature (CINAHL), Education Sources, ERIC, SocINDEX, PsycINFO, and Google Scholar. Inclusion criteria included strategies to prevent incivility and articles within the past five years included in academic journals. Articles focused on coping strategies, conflict types, and strategies to identify uncivil tactics were excluded. Thirty-five articles were included in the integrative literature review
Conclusion: Evidence-based solutions and recommended strategies to break the cycle of incivility in nursing were discussed. Four major themes were identified within the research: a) causes of incivility, b) impacts of incivility, c) strategies against incivility, and d) organizational actions against incivility. Stress, power conflicts, and a lack of leadership support were noted as common causes of incivility. The impact on nursing includes burnout, increased workload due to absenteeism, or shortage of staff. The impact of incivility affects the nurse, organization, and patient outcomes. Even though there were limitations of the review and future research is needed, cognitive rehearsal, education, and communication when used consistently show promise in the reduction of incivility. Organizational support was discussed; however, additional research is needed to identify if incivility policies and the enforcement of policies is a strategy that deters incivility. The literature consistently identified the use of policies but was limited in quantitative data on the actual impact of incivility. Nurse leaders should help build a solid foundation for growth in nursing and improve patient and organizational outcomes