Incivility Between Nursing Students in the Classroom: A Review of the Literature

Sunday, 30 July 2017

Abby Grammer Horton, MSN
Norma Graciela Cuellar, PhD, DSN
Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA


Nearly 62% of students and faculty in nursing education have reported incivility in an academic setting (Clark & Springer, 2007). In a national survey, 24.8% of faculty have been physically assaulted and 42.8% had experienced verbal abuse while in the clinical setting (Lashley & de Menese, 2001). Vertical incivility/violence may occur between faculty:students, nurse:students, and administration:employees. Horizontal incivility/violence may occur between nurse:nurse, faculty:faculty, and student:student. However, there is very little evidence of incivility reported between student:student.


The purpose of this review of the literature was to identify the evidence of incivility between student and student in the classroom in undergraduate nursing education. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to guide the review of the literature.


A comprehensive review of the literature was conducted in Medline, Pubmed, CINAHL, ERIC, and PsycInfo. Inclusion criteria included 1) peer-review journals, 2) original publications, 3) no limitation to time, 4) quantitative or qualitative designs, and 5) studies identifying student to student incivility. Exclusion criteria was any vertical incivility in nursing education (faculty:student, clinical nurse:student, administrator:student/faculty). Terms used in the search included nursing, nursing education, nursing students, incivility, bullying, and micro-aggressions utilizing Boolean terms. The search was conducted in June/July 2016 and in several phases.


We found six articles on incivility between students. These included two articles that were qualitative and one article that was quantitative. Additionally, three articles were listed as mixed- methods studies. Five of the studies were conducted in the USA and one study was conducted in Egypt. Incivility exists between students in nursing programs. Incivility in undergraduate programs is reported as a problem both in the classroom and in clinical settings. Incivility can results in poor performance in the classroom and higher attrition rates in nursing programs. As well, incivility experienced by nursing students may impact the role of professional behavior in those that are both the perpetrators and the victims of incivility.


The negative consequences of incivility to students will impact attitudes towards the profession after graduation resulting in uncivil nurses. During the nurse education experience, students must learn how to be civil to each other to be prepared to work with other nurses and health care providers in their professional careers. There is a lack of knowledge in faculty on how to address incivility. Faculty must be able to identify incivility and stop it when it occurs. As well, further research is needed to examine the psychological and social consequences of incivility in undergraduate nursing students which may include coping, self-efficacy, stress, anxiety, depression, health and wellness.