How 'Rudeness' in Healthcare Setting Affects Nurses

Rudeness is not just unpleasant. In a clinical setting it degrades performance, and degraded performance puts patients at risk.

Think back to the last time someone was sharp with you. You probably cycled through shock, anger, looking for reasons, maybe even how to retaliate. For that stretch your attention was locked on the incident and pulled off everything around you, and the moment kept resurfacing for the rest of the day. That same distraction, dropped into a complex clinical task, is where errors start.

A randomized trial in Pediatrics put this to the test. Researchers had NICU teams run a simulation of a deteriorating preterm infant while an observer made either neutral comments or mildly rude ones unrelated to the team's work. The teams exposed to rudeness performed measurably worse at both diagnosis and procedures. Rudeness alone accounted for roughly 12 percent of the variance in how well teams performed, and most of that effect ran through breakdowns in information-sharing and help-seeking: insulted people stop talking to each other and stop asking for help. The authors concluded that in a real resuscitation, that gap could be the difference between a patient living and dying.

What rudeness is

Rudeness is treating someone in a disrespectful, uncivil, or judgmental way that runs against accepted social behavior. It signals a lack of regard for another person's rights and feelings.

Severe aggression and violence are easy to name. Rudeness is quieter, which is exactly why its damage slips past us. It ranges from the merely impolite, skipping a greeting or interrupting, to verbal put-downs and deliberate offensiveness. Sometimes what we read as rudeness was never intended; sometimes it is calculated. It tends to arrive out of nowhere and from any direction, whether authority figures, coworkers, subordinates, or outsiders.

It also spreads like a contagion. One person is rude, the receiver retaliates or takes it out on the next person, and witnesses change their behavior too. Left alone, it becomes the baseline of a unit without anyone noticing.

How it affects you

Experience rudeness, or even just witness it, and you immediately drop into negative emotion and start a round of mental gymnastics: replaying the moment, decoding why it happened, weighing how to respond. Without realizing it, your limited working memory fills with the incident and you cannot focus on the task in front of you. It hijacks your attention and undercuts your ability to reason, decide, learn, and recall. The body and mind are doing so much with the negative emotion that you physically cannot think past the moment.

In a separate set of experiments, even low-intensity rudeness sharply hurt performance on thinking tasks, including when the rude party was an outsider encountered on the way to the test. The effect also lowered creativity, raised aggressive thinking, and reduced people's willingness to help others, and it showed up in both the targets and the bystanders.

We have half-accepted incivility as part of a stressful healthcare environment, and most of us will say it is not really a problem while missing what it does to us. Reduced thinking, blunted creativity, aggressive thoughts that can boil into conflict, and a lower drive to help all hit teamwork directly, and they carry straight through to patient safety and quality of care.

How to deal with it

Naming your reaction is what stops rudeness before it takes over your thinking and behavior.

When you need to, step back and list the thoughts that just fired, then mark each one true, false, or unknown. For "he didn't even greet me, he doesn't like me, I don't matter here," the only true part is "he didn't greet me." Whether he dislikes you is unknown, and "I don't matter here" is plainly false. Sorting it that way keeps you from taking it personally and from spiraling into anger and resentment.

Most rudeness is unintentional or pointless, and once you see that, it is easier to let go. Respond with composure instead of striking back, which breaks the cycle and drains the power out of a deliberate jab. The same objective look often surfaces a real problem underneath the behavior, and you can address that root cause instead of the incivility masking it.

If it has crossed into harassment or bullying, decide to handle it directly, face-to-face or with management, at the right time. You always control how you respond, and with rudeness the best move every time, for you, the unit, and your patients, is to hold your composure and defuse it.