Addressing nursing incivility: A faculty development initiative

This quality improvement (QI) project aimed to explore faculty perspectives on incivility and evaluate the effects of a multi-faceted educational intervention in reducing nursing faculty-perceived frequency of student incivility behaviors at a nursing college. Changes in faculty-perceived incivility will be measured quantitatively using the Incivility in Nursing Education-Revised (INE-R) tool, both before and after the intervention. The project objective relates to the following PICOT question: In nursing faculty (P), how does an educational intervention on nursing incivility (I), compared to no intervention (C), affect faculty-reported occurrences and perceptions of nursing incivility (O) 3 months after implementation (T)? The objectives of this project included: (a) a 5% reduction in the mean score of faculty-perceived frequency of student-incivility behaviors, as measured by the INE-R tool, comparing within two weeks prior to the intervention and two months post-intervention, and b) a 75% participation rate among full-time nursing faculty for the entirety of the educational intervention.

An extensive literature review revealed three themes: barriers/risk factors to nursing incivility, nursing faculty perceptions, and effective interventions to decrease nursing incivility.

1.2.1Barriers and risk factors

1.2.2Nursing faculty perceptions

1.2.3Effective interventions

This QI project aimed to evaluate nursing faculty perceptions and experiences of incivility and the impact of a multi-component educational intervention on faculty-perceived frequency of student incivility behaviors. A descriptive, pre–post design was used to assess changes in faculty-reported incivility using the INE-R survey. Data were collected at two time points: within two weeks prior to the intervention (Time 1) and two months following the intervention (Time 2). This QI project followed the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines to ensure a structured reporting of quality improvement processes and outcomes.^[21]

The intervention was a two-day educational program scheduled for August 2025, prior to the start of the fall 2025 school semester. It consisted of three integrated components: (a) Awareness and policy review: An online lecture introducing the concept of incivility in nursing education, including definitions, statistics, risk factors, and consequences. This session also reviewed specific campus policies related to professional conduct, emphasizing fostering a civil academic environment; (b) Cognitive rehearsal and role-playing: A live, interactive session incorporating evidence-based cognitive rehearsal techniques. Faculty will be engaged in scenario-based role-playing to practice responding to uncivil behaviors in academic settings; (c) Reflective Practice: A facilitated peer and individual reflection session utilizing the Clark Workplace Civility Index to promote critical thinking and self-awareness regarding civility in the workplace. Each component lasted about 1-2 hours. This multi-modal intervention addressed incivility by combining increased awareness, cognitive rehearsal, and reflective practice, aligning with recommendations for multi-component strategies.

This QI project was conducted at a private nursing college in Midwestern Idaho. The target population comprised a purposive convenience sample of full-time nursing faculty teaching in the LPN, BSN, or Master’s Entry Program in Nursing (MEPN). At the time of the project, the college employed 10 BSN/MEPN and 6 LPN faculty (N = 16). Although the two-day educational intervention was offered to all faculty, including part-time and per-diem instructors, only full-time faculty who met the study criteria were included in data collection and analysis. Inclusion criteria were: (1) full-time employment status; (2) active teaching in the LPN, BSN, or MEPN programs during the intervention period; and (3) completion of both the intervention and pre-/post-surveys. Exclusion criteria included: (1) individuals who did not meet the above inclusion criteria (e.g., non-nursing or general education faculty, or faculty at other campuses); and (2) eligible faculty who did not complete the full intervention and both surveys. Contextual factors at the project site included chronic faculty shortages, high turnover, general faculty burnout, and social/cultural differences between faculty and students.

An a priori power analysis conducted in G*Power using an effect size of .50, α = .05, power = .80, and df = 1 indicated that a minimum of 32 participants were required.^[22] However, because the institution employed only 16 full-time nursing faculty, a census of the eligible full-time faculty (purposive convenience sample) was used. All full-time faculty meeting the inclusion criteria were invited to participate in data collection and outcome analysis. Demographic data collected included years of academic teaching experience (categorized), highest degree earned, age range, race, and gender identity. Sex was self-reported as male, female, or other. These variables were analyzed descriptively and explored in relation to faculty-reported levels of incivility.

The INE-R instrument was used to measure faculty perceptions of the severity and frequency of student incivility behaviors. The INE-R Survey was selected for this project due to its strong psychometric properties, including demonstrated validity and reliability in nursing education settings.^[19] Clark et al. (2015) reported high internal consistency with Cronbach’s a ≥ .94 for lower and higher-level incivility subscales and total a of ≥ .96 for student behaviors and ≥ .98 for faculty behaviors.^[19] Validity was supported through exploratory factor analysis, which revealed a two-factor structure (lower-level and higher-level incivility) with a good model fit.

The INE-R asked respondents to rate the frequency of 24 uncivil student behaviors over the past two months using a four-point Likert scale: Never, Rarely, Sometimes, and Often. For analysis, responses were assigned to ordinal values (Never = 1 to Often = 4), and a composite incivility frequency score was calculated for each participant by summing responses across the student behavior items. These scores were then compared between pre-intervention (T1) and post-intervention (T2) time points. To evaluate the primary objective, a 5% reduction in the mean score of faculty-perceived frequency of student-incivility behaviors, the percentage change in the mean incivility score was calculated to assess practical significance and evaluate whether the reduction goal was met. To evaluate the secondary objective, achieving a 75% participation rate among full-time nursing faculty, attendance data were collected through sign-in sheets. The participation rate was calculated and interpreted descriptively.

The second part of the INE-R asked respondents to rate the level of incivility or severity for each of the same 24 behaviors using a four-point Likert scale: Not uncivil, Somewhat uncivil, Moderately uncivil, and Highly uncivil. In addition to the frequency and severity scales, the INE-R contains nine supplementary items in the third section, comprising Likert, categorical, and open-ended questions that explore the perceived prevalence, impact, and context of incivility. These items will be examined with descriptive statistics to broaden the picture of faculty views. Three project-specific open-ended questions were added: (1) faculty preparedness and confidence in addressing incivility (collected at both time points); (2) perceived usefulness of the intervention (post-intervention only); and (3) perceptions of when student incivility is most likely to occur in the school year (collected at both time points). INE-R responses, added questions, and demographic data were collected electronically and entered into SPSS v. 31 for statistical analysis. Descriptive statistics summarized the sample; ratio-level variables were evaluated with paired t-tests, nominal data with McNemar’s test, and ordinal data with the Wilcoxon signed-rank test. Statistical significance was set at p ≤ .05.

This project was reviewed by the University of Missouri Institutional Review Board (Project #2128801) and was determined not to constitute human subjects research. The activity was classified as a quality improvement initiative and did not require further IRB oversight. Additional approval was obtained from the project site organization prior to implementation. Participation was voluntary, and informed consent was obtained prior to completing the survey. Survey data were collected via Google Forms and exported into Microsoft Excel, where they were saved on an encrypted, password-protected laptop accessible only to the principal investigator. Data was then analyzed through SPSS. Data will be retained for five years after the intervention and then permanently deleted.

The nursing faculty completed the first INE-R survey in July 2025, and the two-day educational intervention was conducted in mid-August 2025. The post INE-R survey was conducted in the first two weeks of October 2025. This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.

Of the 16 full-time nursing faculty employed at the institution, 12 faculty members completed the survey at T1. Of these, eight participants attended the entire QI intervention and completed both surveys. Only those eight who attended the intervention and completed both surveys at T1 and T2 were included in the analysis. The age range of the eight faculty was 31 to 61+ years, with a mean score of 50.4 years (SD = 6.1) and a predominant age category of 41-50 years (50%, n = 4). Years of nursing academic teaching experience ranged from < 1 year to 10+ years, with a mean categorical score of 3.1 years (SD = 1.1), indicating that most participants had between 2 and 10 years of experience. The highest degree earned was predominantly a master’s degree (87.5%, n = 7), followed by a bachelor’s degree (12.5%, n = 1). The predominant race was White/Caucasian (75%, n = 6), with the remaining participants identifying as members of other racial or ethnic groups (25%, n = 2). The sample consisted of 62.5% females (n = 5) and 37.5% males (n = 3). Table 1 presents a summary of the demographic characteristics of the nursing faculty participants.

For the post-intervention analysis, Mann-Whitney U tests revealed no statistically significant associations between faculty perceptions of the severity of incivility and the highest degree earned (p ≥ .25) or gender (p ≥ .07). There were also no significant associations between faculty-perceived frequency of incivility and the highest degree earned (p ≥ .25). However, Mann-Whitney U tests did reveal a significant association between faculty-perceived frequency of incivility and gender for two individual items: “Making rude gestures or other inappropriate non-verbal behaviors toward others” (p = .036) and “Skipping class or other scheduled activities” (p = .036). Kruskal-Wallis tests indicated no significant associations between faculty perceptions of the severity of incivility and years of teaching experience (p ≥ .292), age (p ≥ .25), or race (p ≥ .130). Likewise, there were also no significant associations between faculty-perceived frequency of incivility and years of teaching experience (p ≥ .145), age (p ≥ .072), and race (p ≥ .185).

When evaluating the INE-R, the Wilcoxon Signed-Rank Test was used to determine the effect of the intervention on faculty perceptions of student incivility, specifically the severity and frequency of uncivil student behaviors. For the severity subscale, results revealed a small-to-moderate but nonsignificant decrease in faculty-perceived severity of student incivility behaviors following the educational intervention. The median severity score decreased from Mdn = 2.98, IQR = 2.23-3.65 at pretest to Mdn = 2.44, IQR = 1.85-3.46 at posttest, suggesting that faculty perceived student incivility as less severe after the intervention. However, the Wilcoxon Signed-Rank Test comparing the median of the differences between pre- and post-composite scores was not statistically significant (Z = -1.18, p = .23).

For the frequency subscale, the Wilcoxon Signed-Rank Test revealed a large statistically significant decrease in faculty-perceived frequency associated with several individual items, including: “Sleeping or doing work unrelated to class activities” (p = .034, A = 0.81), “Using a computer, phone, or other media device during class, meetings, activities for unrelated purposes” (p = .023, A = 0.88), “Arriving late for class or other scheduled activities” (p = .011, A = 0.94), and “Skipping class or other scheduled activities” (p = .024, A = 0.88). The median frequency score decreased from Mdn = 2.17, IQR = 1.98-2.69 at the pretest to Mdn = 1.77, IQR = 1.58-2.08 at posttest, indicating that faculty perceived these behaviors as occurring less often after the intervention. The Wilcoxon Signed-Rank test comparing the median of the differences between pre- and post-composite scores revealed a statistically significant reduction in frequency (Z = -2.10, p = .03). The mean INE-R frequency scores also decreased from 2.3 (SD = 2.3) pre-intervention to 1.9 (SD = 1.9) post-intervention, reflecting a 17.4% reduction in the perceived frequency of student incivility. Table 2 presents the pre- and post-intervention INE-R composite scores for the severity and frequency subscales.

To complement these quantitative findings, faculty’s responses to the nine supplemental INE-R items provided additional insight into their experiences and perceptions of incivility. Faculty were asked to rate the extent to which incivility was a problem within their department or program. A Wilcoxon signed-rank test was conducted to evaluate changes in faculty perceptions of the overall extent of incivility from pre- to post-intervention. Faculty ratings showed a downward trend following the intervention. The median score decreased from Mdn = 3.00 (moderate problem) at the pretest to Mdn = 2.00 (mild problem) at the posttest, with the mode also shifting from 3.00 to 2.00. Three participants (37.5%) reported lower post-test scores, five (62.5%) reported no change, and none reported higher scores. Although the change was not statistically significant (Z = -1.60, p = .25, r = .57), the moderate effect size suggests meaningful directional improvement in perceived civility.

Faculty were asked to indicate whether they believed students or faculty members were more likely to engage in uncivil behavior within their program at both the pre- and post-intervention periods. At pretest, 62.5% (n = 5) reported that students are much more likely to engage in incivility, 12.5% (n = 1) selected students are a little more likely, and 25% (n = 2) viewed both groups as about equally likely. Following the intervention, 50% (n = 4) reported that students are much more likely, 25% (n = 2) that students are a little more likely, and 25% (n = 2) again selected about equal. No participants indicated that faculty were more likely to engage in incivility at either time point.

Faculty were asked to rate the overall level of civility within their nursing program on a scale of 0 (absence of civility) to 100 (completely civil) at both pre- and post-intervention. The mean civility rating decreased from M = 66.25 (SD = 19.04) at pretest to M = 59.75 (SD = 30.53) at posttest, reflecting a 9.8% decrease. Four participants (50%) reported lower civility ratings at posttest, three (37.5%) reported higher ratings, and one (12.5%) reported no change. The Wilcoxon signed-rank test indicated that this difference was not statistically significant (Z = -0.17, p = .91).

Faculty were asked to identify their top three strategies for improving the level of civility in nursing education at both pre- and post-intervention. Ten predefined options were provided from a list, with an opportunity to include additional strategies not listed. Before the intervention, most faculty (87.5%, n = 7) selected “role-modeling professionalism and civility” as the most effective strategy. After the intervention, three strategies tied as the most frequently selected: “role-modeling professionalism and civility,” “raising awareness & providing civility education,” and “providing training for effective communication and conflict negotiation” (50% each). These findings suggest that the intervention reinforced many of the evidence-based strategies incorporated into the faculty development program, highlighting the perceived importance of professional role-modeling, civility education, and communication/conflict training for sustaining a culture of civility in nursing education.

Faculty members described examples of uncivil encounters they had experienced or witnessed within the previous two months, both before and after the intervention. At pre-intervention, faculty frequently cited student behaviors involving attendance and accountability issues, such as arriving late, leaving early, or skipping class, as well as failing to take responsibility. Other examples included excessive complaining, doing work unrelated to class, disrupting class, sending rude or demanding emails, being unresponsive to faculty communication, cheating, bullying or gossiping toward colleagues, and making implied or actual threats of harm. Faculty-to-faculty examples included unprofessional behaviors and unfair grading practices.

At post-intervention, faculty frequently identified behaviors related to being unprepared for class or failing to listen to feedback. Other examples included reports of class disruption, sending rude or demanding emails, threats of harm, bullying, gossiping, general disrespect, challenging faculty authority, using electronics unrelated to class, and requesting grade changes. The only faculty-to-faculty behavior reported was backstabbing.

Faculty were asked to identify the primary reason or cause of incivility in nursing education at both pre- and post-intervention periods. At pre-intervention, faculty frequently identified a lack of accountability or discipline as the cause. Other examples included stress/anxiety, high-stakes student environment, entitlement, social media normalizing incivility as acceptable behaviors, lack of resources/support, inability to balance work/school/personal, and power imbalances between faculty and students. At post-intervention, faculty frequently identified stress/anxiety and a high-stakes student environment as causes. Other examples included burnout/overload, a lack of accountability, entitlement, and social media normalizing incivility as acceptable behaviors.

Faculty were asked to identify the most significant consequence of incivility in nursing education. At pre-intervention, faculty frequently identified burnout or leaving the nursing profession as significant consequences. Other examples included violence/harm (physical/emotional) to individuals or patients, a decrease in respect for the nursing profession, hindering the student learning environment, and creating a toxic work environment. Post-intervention, faculty frequently identified violence/harm (physical/emotional) to individuals or patients. Other examples included burnout or leaving the nursing profession, a decline in respect for the profession, course failure, and a failure to hold individuals accountable for their actions.

Faculty were asked to identify the most effective way to promote academic civility. At pre-intervention, faculty frequently identified education and raising awareness as effective strategies. Other examples included providing coping resources for students, conducting curriculum audits for quality improvement, utilizing both positive and negative reinforcements, enforcing policies and setting clear early expectations, and role-modeling. At the post-intervention stage, faculty frequently identified role-modeling as an effective strategy, followed by the use of positive and negative reinforcement, enforcing policies, setting clear expectations early on, and educating or raising awareness.

3.10.1Program/department strengths

3.10.2Confidence, effectiveness & timing

Based on the findings of this QI project, several recommendations are proposed to sustain and expand civility initiatives within nursing education. Nursing programs should continue implementing structured, multifaceted interventions that focus on civility education and training as a recurring component of professional development. Integrating civility education into new faculty orientation and annual development programs will reinforce expectations, strengthen professional accountability, and foster a culture of civility. Institutional leaders should incorporate civility standards and clear reporting processes into policies and procedures to ensure consistency and transparency when addressing uncivil behaviors. Strengthening leadership visibility, reinforcement, and recognition of civility efforts will further promote engagement and sustainability. Faculty should be encouraged to serve as exemplars for students and colleagues by modeling professionalism, accountability, and effective communication. Programs are encouraged to expand, evaluate, and replicate civility interventions across programs and campuses to determine scalability and impact. Including both faculty and students in future training programs can foster a sense of shared ownership. Finally, findings should be disseminated and shared within other sister institutions and nursing programs to encourage collaboration and promote widespread adoption of evidence-based strategies for fostering civility in nursing education.

This quality improvement project was subject to several limitations that may affect the interpretation and generalizability of the findings. The small sample size, inherent to the limited number of full-time nursing faculty, resulted in an underpowered, convenience sample of eight participants, which restricts statistical power and the ability to detect smaller effect sizes. The short project time interval, constrained by the academic semester and program timeline requirements, also limited the ability to capture long-term outcomes or the sustainability of intervention effects. Although the PICOT question and supporting literature review referenced a three-month follow-up period, the outcome evaluation was conducted two months post-intervention due to these time constraints. Additionally, faculty workload, competing priorities, burnout, and recent turnover impacted participation and engagement in both the intervention and survey completion. Several newly hired faculty members had limited rapport and less exposure to the project or institutional culture, which may have influenced their level of participation.