The document discusses incivility, or lateral violence, in public safety professions like EMS and nursing. It is defined as rude, disrespectful, aggressive, or hostile behavior towards colleagues. Examples include gossiping about coworkers, questioning their competence, and intentionally sour attitudes. Some see hazing and belittling of new employees as a way to "earn respect" but research shows this creates a negative learning environment. The document argues for transformational leadership styles that empower and inspire employees rather than exert authoritarian power over them. This can help reduce incivility and create a more positive work culture.

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Incivility in Public Safety Professions
Edward D. Struzinski
RN, CEN, CCRN, NR/CCEMT-P
August, 2014

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Who have we become? Why all this banter about one another and schoolgirl gossip while
relaxing at the station? Is it me? Or is there a whole lot more negative conversation going on,
talking about each other, rather than focusing positively about how we can be learning from our
mistakes? Let’s be better than we ever expected we could. Let’s be kind and considerate toward
one another. Give each other time to talk; listen to our extended family members – our brothers
and sisters of the public safety network, a large and socially diverse group of talented folks. As a
member of the public safety network, we are part of a special family of unique individuals. We
all work together under the most stressful of times. We strive for independence. As we age and
draw closer to retirement, we might actually become more dependent on others, in an ironic and
coincidental fashion to how we first started our careers. We evolve. And throughout our career in
public safety there is interaction among other humans: the building of relationships and
application of personal skills that helps us to generally get along, or be civil, with each other.
There are times, however, that we in the EMS field – providers of all levels – behave quite the
opposite, showing aggression, or otherwise acting in an uncivil manner toward each other. Call it
what you will. Some call it “giving someone what they deserve”. Still others call it “getting
disrespected”. But the bottom line is that the behavior is unbecoming of a true professional. It is
simply unnecessary to act in such a manner, and it is also unlawful to incite an atmosphere of
hostility. What is it? It is incivility. The subject has many sister names, varying in degrees and
along the spectrum from simple discourtesy to outright intimidation.
Incivility, more commonly known as lateral violence, is a major problem in the
healthcare field, especially in EMS and Nursing. In fact, it is reported that violence and other
forms of workplace aggression are increasingly being identified as an epidemic in the workplace;
with it being so great in the healthcare field that many providers, if not all, will experience it at

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some point in their career (Marquis & Huston, 2012). It is so particularly prominent in health
care occupations that some estimates indicate as many as nine out of ten people reported
experiencing it at work (Guidroz, Burnfield-Geimer, Clark, Schwetschenau, & Jex, 2010).
What exactly is incivility?
Incivility can be defined in several ways or take on multiple forms. For example,
pertaining to the field of education, it is defined as any disruptive classroom behavior that is
showing disrespect or disregard to the instructor or classmates (Michigan State University,
2014). Another definition, as noted by sociologists who studied over five hundred events of bitter
behaviors, is that it is seen as the everyday rudeness and inconsiderate behavior of people
(Smith, Philips, and King, 2010). In business, it is described as general rudeness and impolite
behavior of not saying “thank you” or “please”; even questioning the competence of another
individual (Clay, 2013). The Joint Commission of Accreditation addressed the nature and cost of
incivility in a 2009 Sentinel Event Alert, reporting it as reluctance or refusal to answer questions,
not returning phone calls, condescending communication, uncooperative attitudes, and threats
being made (The Christ Hospital Health Network, 2014). Incivility has even managed to weave
itself into the World Wide Web. A study performed and discussing online behavior defines it as
that which ranges from name-calling and rude critiques or commentary to outrageous claims and
“flaming” discussion posts (Anderson, Brossard, Scheufele, Xenos, and Ladwig, 2013). This is
seen all of the time on the social media sites, is it not? And are we not all guilty of it at some
point in our net-surfing time on the job, too?
Finally, we come to the realm of public safety encompassing the triad of Police, Fire, and
EMS disciplines. Incivility is all too common, and extends to our international family as well.
Are we not guilty of any of these descriptions and/or actions that relate to workplace hostility?

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Next time you arrive for your shift, take a moment to clear your brain of all those ACLS
algorithms and make room for that which you probably have automatically tuned out. Pay close
attention. Does the morning ritual not seem to be discussing each other? People bashing the
reputations of others behind their backs (sometimes even straight to them), critically questioning
a colleague’s competence or slamming someone over the way they handled a crash scene or
medical call? What about your co-workers intentionally showing a generally sour attitude to
someone, causing more unrest between each other? According to the U.S. Department of Labor
(2014), workplace hostility is any conduct rendering the atmosphere as intimidating, hostile, or
offensive. Examples include threatening behavior, crude language, forms of sabotage, and
demeaning or belittling other employees (U.S. Dept. of Labor, 2014).
Hazing rituals and “traditional” learning
For those of us with significant longevity in public safety, consider the “early” ways of
teaching new EMTs and rookie firefighters the ropes of the job. Do you recall using, or
receiving, the tactics of intimidation during scenarios and belittling of efforts? How often is this
still experienced among EMS workers as a form of hazing or other way of “earning respect
within the group”, “earning your stripes in EMS”? Or to validate the usual statement “if you
cannot take it here, then what good are you going to be on a scene?” … as if psychologically
beating someone into submission is somehow a valid indicator of their skill level and predicator
of proficiency to perform tasks, such as applying Oxygen, inserting an IV, immobilizing a
patient on a backboard, or wrestling with a confused diabetic to provide an amp of D50.
Time after time these statements are spoken from educated and often very experienced
veterans of the field, yet the ignorance of their words somehow blinds them to only see the EMS
of the past and not moving it forward to the brighter future lying ahead for our newest members.

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Somehow some of these folks feel they are better providers in the field because of the demeaning
nature of how they were trained back in the day, and that everyone needs to go through it as a
form of basic training to the profession. This delusional idea for molding new and
impressionable EMTs is damaging to the individual, the profession, and ultimately patient care.
It is well known and supported today that these forms of aggressive behavior (incivility, hostility,
bullying, hazing, etc.) creates a hostile environment built on fear and disrespect that has a
negative impact on learning. It undermines the learning environment that green EMTs need in
order to achieve their maximum potential and be successful (National Association of State
Boards of Education, 2014). Research shows this sort of behavior only serves to be destructive,
not constructive, to individuals and learning. Continuing to perform these actions only breeds
more ancient philosophy for “learning”. As the department training officer or other preceptor
position, ask yourself to honestly answer the following question: to whose benefit it is when you
demand that new team member to wash the station floor over and over again because it does not
meet your satisfaction criteria? Is it to their benefit to empower them? Or is it to serve your own
selfish desire to express your “power” over them?
On the other hand, these techniques are a determining factor for causing employees to
frequently use their sick time unnecessarily, have habitual lateness habits, feel distressed, express
negativity, or suddenly need to leave work due to an “illness” or “back injury” sustained on the
job. These incidents raise the frequency of being held at work, further inciting negativity and
ultimately breaks the budget with overtime costs. We see this in the EMS field every day.
So, have you ever asked yourself why you think it’s okay to perform your inconsiderate
actions and spread this disease of unprofessional behavior? To the very people whom you entrust
with your life while driving to the call, or to the hospital, but you refuse to extend a genuine

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suggestion to drive safely after work? Incivility is a malignant tumor on the profession of EMS
and society in general; one that requires daily and continuous treatments to suppress it, in the
form of polite behavior, showing concern, smiling, handshake greetings, saying “please” and
“I appreciate it” at every opportunity of every day, and performing random acts of kindness, like
maybe surprising your EMS partner with their coffee or treating them to lunch.
Transformational-style leadership and empowerment
Instead of applying power over an individual, as found in authoritarian-style leadership
(dictators who command and demand), it is best to provide power to the individual, so they may
grow into being a true leader for the next generation. This can be achieved by being a
transformational-type leader, one who inspires others. Developed by James MacGregor Burns in
1978, this style of leadership focuses on motivation and enhancing performance by connecting
with an individual’s identity and self-goals, and challenging the individuals to take greater
ownership of their work and efforts (Langston University, 2014). This is an effective means of
leadership that drives productivity by empowering others, the most important action we can
make toward each other in the public safety field. Empowerment is a process. It challenges our
ideas and views about the way things are now and how they can be later (Page & Czuba, 1999)
and challenges us to achieve and succeed. Empowerment strengthens relationships and
encourages us to work as a unified team and employ a collaborative-style approach to
performing patient care and handling confusion on scenes. Collaboration between EMS
providers and all of public safety is essential to team performance and effectiveness on every call
and in every situation. It is also co-dependent on having and expressing the concept of mutual
respect, something we all want to receive and nothing short of it. Research shows that teams
using a collaborative approach have advantages over the ones who do not (Northouse, 2010).

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Conclusion
Incivility, more commonly known as lateral violence, is a growing problem in every
workplace and in every career interest. The effects from incivility are as widespread as the
problem itself. With time, effort, and continued education spotlighting the issue, hopefully this
cancer that causes a hostile work environment will be eradicated from EMS. What we need in
our field is for all of us to join together in union for the creation of a powerfully motivating and
constructive environment that fosters good will and good times. We need to not allow or stand
for others who use destructive power and negativity, for it is only associated with promoting a
hostile environment through actions of incivility, intimidation, bullying, etc. Support each other.
Take care and be kind to each other. Be generous and spontaneous to your fellow EMS partners.
Offer instead of demand, especially toward our newest family members, as they are the most
impressionable and will be more likely to demonstrate that same behavior in their future.
We’re all in this together, and should be for the same purpose: patient care.

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References
Anderson, A., Brossard, D., Scheufele, D.A., Xenos, M.A., & Ladwig, P. (2013). The “nasty
effect”: Online incivility and risk perceptions of emerging technologies. Journal of
Computer-Mediated Communication, 19(3). doi:10.1111/jcc4.12009
Clay, R. (2013). That’s just rude. American Psychological Association, 44(10). Retrieved from
http://www.apa.org/monitor/2013/11/rude.aspx
Guidroz, A. M., Burnfield-Geimer, J.L., Clark, O., Schwetschenau, H.M., & Jex, S. M. (2010).
The Nursing Incivility Scale: Development and validation of an occupation-specific
measure. Journal of Nursing Measurement, 18(3), 176-200.
doi: 10.1891/1061-3749.18.3.176
Langston University. (2014). Transformational leadership. Retrieved from
http://www.langston.edu/sites/default/files/basic-content-files/
TransformationalLeadership.pdf
Marquis, B., Huston, C. (2012). Leadership roles and management functions in nursing (7th
ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Michigan State University. (2014). Civility/incivility in the college classroom. Retrieved from
http://fod.msu.edu/oir/civilityincivility-college-classroom
National Association of State Boards of Education. (2014). Bullying, harassment, and hazing.
Rhode Island Statewide Bullying Policy, 2011. Retrieved from
http://www.nasbe.org/healthy_schools/hs/bytopics.php?topicid=3131
Northhouse, P. (2010) Leadership theory and practice (5th ed.). Thousand Oaks, CA:
Sage.

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Page, N., Czuba, C. (1999). Empowerment: What is it? Journal of Extension, 37(5). Retrieved
from http://www.joe.org/joe/1999october/comm1.php
Smith, P., Philips, T., King, R. (2010). Incivility, the rude stranger in everyday life.
Cambridge, UK: Cambridge University Press. doi: 10.1017/CBO9780511781803
The Christ Hospital Health Network. (2014). Incivility in the workplace. Examiner, A
Physician’s Publication. April/May, 2013. Retrieved from
http://www.thechristhospital.com/?id=2443&sid=1
U.S. Department of Labor. (2014). Hostile work environment harassment. Retrieved from
http://www.dol.gov/oasam/programs/crc/2011-workplace-harassment.htm

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