ANA Issues New Position Statement on Incivility and Bullying in Nursing

The American Nurses Association (ANA) has released a new position statement on incivility and bullying in nursing that frames civility as a professional norm and assigns distinct, shared responsibilities to individual nurses, employers, and academic programs for preventing and addressing harmful behaviors.

The statement, effective September 10, 2026, and announced October 16, 2026, also calls on organizations to reconsider zero-tolerance policies in favor of restorative, tiered approaches, a shift with practical implications for oncology nurses working in high-acuity, emotionally demanding settings.

What does the new ANA position statement say?

Titled "Fostering Civility and Respect in Nursing: Empowering Nurses to Prevent Incivility and Bullying," the document was originated by the ANA Incivility & Bullying Position Committee and adopted by the ANA Board of Directors. It is a new statement rather than a revision. It is grounded in the 2025 Code of Ethics for Nurses, which obligates nurses to foster an ethical environment and a culture of civility.

According to ANA, the statement is intended to clarify expectations for preventing and responding to incivility and bullying across practice, academic, research, and clinical learning environments. It identifies civility as a requisite for safe and effective practice, emphasizes respectful communication across verbal, nonverbal, and electronic channels, and calls for transformational leadership, supportive policies, and organizational cultures built on psychological safety.

The committee that developed the statement included 2 oncology-certified nurses, Karen Kinsley, MSN, RN, OCN, and Wendy Pritchett, MSN, RN, OCN, NEA-BC.

ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, said nurses deserve "workplaces where respect is the standard and harmful behaviors are addressed, not normalized." She added that meeting that goal depends on clear communication in every setting and on each nurse supporting colleagues who experience incivility or bullying and taking an active role in resolving conflict.

How does ANA define incivility and bullying?

The statement draws a distinction between the 2 behaviors.

• Incivility: low-intensity, disrespectful behavior that violates norms of mutual respect, is often ambiguous, and may or may not carry negative intent. Examples include eye rolling, exclusion from conversations, and dismissive behavior.
• Bullying: repeated, intentional acts of hostility or aggression over time, marked by a perceived or imposed power imbalance. Examples include gossiping, scapegoating, withholding support, and sabotage. ANA classifies bullying as a form of type 3, worker-on-worker violence.

How common is incivility and bullying in nursing?

The statement acknowledges variability in measurement across studies but reports consistently high prevalence. Cited estimates include:

• 3.9% to 86.5% in a systematic review of bullying in health care workplaces
• 17% to 94% in a meta-analysis using the Negative Acts Questionnaire
• 40% in a large sample of US nurses
• 9% to 96% among nursing students

At the system level, the statement cites national workforce data linking incivility to reduced productivity (66%) and morale (59%), and a nurse leader survey in which more than 70% reported negative effects on psychological safety. It also notes that secondary traumatic stress affects 64% to 76% of nurses and can function as both a consequence of and a contributor to bullying. The document links incivility to miscommunication, clinical errors, and turnover.

What does ANA recommend nurses do?

Recommendations for individual nurses center on upholding the Code, building respectful relationships, and establishing team agreements on collaboration and constructive feedback. Nurses are asked to know their workplace incivility and bullying policies and, where none exists, to help develop one.

Two recommendations are framed as anticipatory guidance. ANA suggests that units agree on, and practice using, a predetermined word or phrase to signal an uncivil or bullying event. It also asks nurses to actively support affected colleagues and help resolve conflict at the individual level before involving a supervisor or filing a formal report. Nurses are further encouraged to engage professional associations and lawmakers on state and federal policy.

What are employers and educators expected to do?

The largest set of recommendations is directed at employers and leaders. These include:

• Elevating a healthy work environment to a strategic priority and providing leaders with coaching on addressing disruptive conduct
• Offering accessible, confidential, psychologically safe reporting mechanisms
• Designating internal champions, such as "Civility Ambassadors"
• Providing restorative resources, including mediation, employee assistance programs, ombuds, and peer support
• Embedding behavioral expectations in codes of conduct, handbooks, and performance evaluations, and screening job applicants for civility and teamwork
• Integrating civility education into curricula, nurse residency programs, preceptor development, and continuing education, including cognitive rehearsal and upstander training

Notably, the statement says zero-tolerance policies, although widely adopted, may discourage reporting, overlook context, and prioritize punishment over change. It instead recommends a restorative, tiered approach that weighs the context and severity of each behavior and issues proportionate responses.

The document also endorses a trauma-informed approach, noting that trauma and stress can impair self-regulation and problem-solving, and outlines how incivility affects direct care clinicians, school nurses, nursing students, nurse leaders, and faculty. In its summary, ANA calls on employers to make "psychological safety, trauma-informed practice, and restorative approaches the standard, not the exception."

Why does this matter in oncology settings?

Oncology nurses manage complex regimens, high symptom burden, and frequent exposure to patient suffering and loss, conditions that overlap with the stressors the statement identifies as drivers of incivility. Previous Oncology Nursing News coverage described a survey at an academic oncology center in which bullying was more prevalent in the outpatient oncology clinic than on inpatient units, and in which many nurses said they were hesitant to report it. Separate coverage has reported that oncology nurses who experience workplace violence describe low sleep quality, burnout, and depression.

The statement does not report oncology-specific prevalence data, and its prevalence estimates come from studies with differing definitions and instruments. The document discloses that generative artificial intelligence was used to help draft portions, with all content reviewed and approved by humans.

What are the key takeaways for oncology nurses?

• Review the facility's incivility and bullying policy; if none exists, the statement asks nurses to help create one.
• Consider proposing a unit-wide signal word or phrase for flagging uncivil behavior in real time, and rehearse using it.
• Act as an upstander: support colleagues who are targeted and attempt to resolve conflict directly before escalating, when safe to do so.
• Watch for secondary traumatic stress in self and colleagues, given its link to bullying.
• Model civility for new graduates, students, and orientees in preceptor roles, where power imbalances can sustain uncivil behavior.
• Advocate for confidential reporting channels and restorative resources such as mediation and peer support.

References

1. American Nurses Association releases new position statement on incivility and bullying in nursing. News release. American Nurses Association. October 16, 2026. Accessed October 19, 2026. https://www.nursingworld.org/news/news-releases/2026-news-releases/american-nurses-association-releases-new-position-statement-on-incivility-and-bullying-in-nursing/

2. American Nurses Association. Fostering civility and respect in nursing: empowering nurses to prevent incivility and bullying. Position statement. Effective September 10, 2026. Accessed October 19, 2026. https://www.nursingworld.org/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/nursing-practice/incivility-and-bullying-position.pdf

3. Lever I, Dyball D, Greenberg N, Stevelink SAM. Health consequences of bullying in the healthcare workplace: a systematic review. J Adv Nurs. 2019;75(12):3195-3209. doi:10.1111/jan.13986

4. Serafin L, Sak-Dankosky N, Czarkowska-Pączek B. Bullying in nursing evaluated by the Negative Acts Questionnaire-Revised: a systematic review and meta-analysis. J Adv Nurs. 2020;76(6):1320-1333. doi:10.1111/jan.14331

5. Pogue CA, Li P, Swiger P, et al. Associations among the nursing work environment, nurse-reported workplace bullying, and patient outcomes. Nurs Forum. 2022;57(6):1059-1068. doi:10.1111/nuf.12781

6. Camarda A, McAndrew NS, Wolf L, Bishop-Royse J. A scoping review of workplace bullying in emergency and intensive care settings. J Nurs Adm. 2025;55(5):252-258. doi:10.1097/NNA.0000000000001572

7. Childers L. Creating a safe space: preventing bullying and violence among oncology nurses. Oncology Nursing News. August 19, 2021. Accessed October 19, 2026. https://www.oncnursingnews.com/view/creating-a-safe-space-preventing-bullying-and-violence-among-oncology-nurses

8. Fischer L. The rate of workplace violence in oncology remains high. Oncology Nursing News. November 16, 2023. Accessed October 19, 2026. https://www.oncnursingnews.com/view/the-rate-of-workplace-violence-in-oncology-remains-high