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Incivility in the Emergency Department
Authors: Nicki Credland, Dan Darbyshire, Rhea Saldanha / Editor: Liz Herrieven, Adam Dalby / Reviewer: Daniel Darbyshire / Codes: / Published: 23/08/2022 / Reviewed: 07/04/2026
This is one of three RCEMLearning Blogs on Bullying, Undermining and Incivility in the Emergency Department (ED). Originally published in 2022, these have been updated for 2026.
Why this matters
If youve worked even a handful of shifts in the ED, youve probably seen it – or felt it.
A curt comment at handover.
An eyeroll when you ask for help.
A specialty colleague brushing you off midsentence.
These moments might seem insignificant at the time, but the growing body of evidence tells us otherwise: incivility affects how we think, how we work, and how safely we care for patients.
What is incivility
Incivility can be defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.1 In healthcare, incivility means behaving in a rude or disrespectful way for example, ignoring, interrupting or speaking down to someone. These actions can damage professionalism and make communication, teamwork and patient care less safe.
Incivility is often subtle, unlike overt aggression. It can include eye-rolling, sarcasm, dismissive comments, exclusion, or abrupt communication. These behaviours can undermine dignity and can negatively affect communication, teamwork and patient safety.2
Why is the ED especially vulnerable to incivility?
Up to 90% of healthcare staff encounter incivility at work.3,4 The ED, of course, is uniquely vulnerable.
Think about a standard shift: High acuity, relentless pace, crowding, staffing variation, time pressure, plus emotionally charged interactions with patients and teams.1,5,6 Its a tinderbox for brief, reactive moments that land badlyeven when no harm is intended.
UK EMTA survey 2024: new data on Incivility
The Emergency Medicine Trainees Association (EMTA) 2024 Survey gives us a clearer picture of how widespread this really is.
From 1,045 trainee respondents:
Hierarchy mattered too:
And perhaps the most striking:
62.5% of those who experienced incivility said it directly affected the care they felt able to provide.
Previous EMTA surveys have not specifically asked about incivility. However, the free-text responses to the questions about bullying and harassment provide plenty of examples of clear incivility.7
Standard for the course. Always has been at this Trust, it is an unfriendly place to work. EMTA Survey Respondent
If I had worked in this department as my first EM job I would never have applied to EM training. EMTA Survey Respondent.
How incivility can change behaviour
Incivility has been shown to have adverse consequences on clinical decision-making, as well as diagnostic and procedural performance. Rudeness from patients and relatives leads to poorer performance from medical teams.4 Porath & Pearson suggest that 38% of employees reduce the quality of their work when faced with incivility.8 Spence Laschinger & Nosko found that incivility and quality of nursing care were directly related, reporting that nurses felt that incivility caused them to make more clinical errors,9 while paramedics suggested that incivility created feelings of vulnerability, which undermined their confidence in their own practice, potentially impacting the quality of the care provided.10
Impact on Wellbeing
Incivility has a well-established negative impact on staff well-being, with recent evidence showing clear associations with burnout, psychological distress, reduced job satisfaction and decreased retention of staff.5,11 Research published since 2023 shows that even seemingly minor but repeated uncivil behaviours can lead to emotional exhaustion and moral injury, especially in high-pressure settings such as emergency departments. Ongoing exposure to incivility has also been associated with sleep problems, anxiety, and reduced resilience, with effects that can build up over time rather than being limited to single incidents.12
Final thought
Incivility in healthcare is not a minor interpersonal issue but a significant patient safety concern. Evidence shows that even subtle disrespectful behaviours can impair communication, teamwork and clinical performance. Addressing incivility through individual awareness, supportive leadership and system-level change is essential to protect staff wellbeing and deliver safe, high-quality patient care.
Infographics courtesy of Dan Darbyshire
Further resource: Civility Save Lives
References