On This Episode:
Incivility doesn’t always announce itself loudly—it often creeps in quietly, becoming normalized in high-stress clinical environments. In this episode, Lynn and Garry are joined by leadership veteran Meri Gilman-Mays, CRNA, DNP to continue a candid conversation on addressing incivility in nurse anesthesia.
Part two of this conversation shifts from recognizing incivility to actively addressing it through leadership. We’ll challenge the notion that leadership requires a title, highlighting how CRNAs lead daily at the bedside, in the operating room, and through committee work. Listeners are invited to consider the impact of silence versus intervention and how modeling professionalism under pressure influences team culture.
After listening to this episode, participants will be able to:
- Identify leadership behaviors that CRNAs can demonstrate regardless of formal title or position.
- Apply real-time de-escalation strategies to address incivility while maintaining professionalism and authority.
- Utilize a structured framework for conducting difficult follow-up conversations and ensuring accountability.
- Describe strategies for fostering a culture of respect and psychological safety within anesthesia and perioperative teams.
Important Links:
- The 1099 CRNA Institute
- Earn MAC Dev Credit
- Now you can watch the show on YouTube!
"Normalization of disrespect is not normal—and it should never be accepted.”
- Lynn & Garry
References
Addressing Workplace Incivility Among Perioperative Nursing Team Members. (2023). AORN Journal, 117(5), 273–273. https://doi.org/10.1002/aorn.13921
Arakelian, E., & Rudolfsson, G. (2021). Reaching a tipping point: Perioperative nurse managers’ narratives about reasons for leaving their employment—A qualitative study. Journal of Nursing Management, 29(4), 664–671. https://doi.org/10.1111/jonm.13202
Aunger, J., Maben, J., & Westbrook, J. I. (2025). How unprofessional behaviours between healthcare staff threaten patient care and safety. Expert Review of Pharmacoeconomics & Outcomes Research, 25(5), 635–638. https://doi.org/10.1080/14737167.2025.2460518
Blackler, L., Scharf, A. E., Chin, M., & Voigt, L. P. (2022). Is there a role for ethics in addressing healthcare incivility? Nursing Ethics, 29(6), 1466–1475. https://doi.org/10.1177/09697330221105630
Bradley, B. H., Baur, J. E., Stewart, G. L., & Banford, C. G. (2014). The No Asshole Rule Revisited: How Interdependence and Emotional Stability Buffer Team Performance. Academy of Management Annual Meeting Proceedings, 2014(1), 17208. https://doi.org/10.5465/ambpp.2014.17208abstract
Bump, G. M., & Cladis, F. P. (2025). Psychological Safety in Medical Education, Another Challenge to Tackle? Journal of General Internal Medicine : JGIM, 40(1), 41–45. https://doi.org/10.1007/s11606-024-09166-y
Burns, K. E. A., Fox-Robichaud, A., Lorens, E., & Martin, C. M. (2019). Gender differences in career satisfaction, moral distress, and incivility: a national, cross-sectional survey of Canadian critical care physicians. Canadian Journal of Anesthesia, 66(5), 503–511. https://doi.org/10.1007/s12630-019-01321-y
Clark, C. M., & Dunham, M. (2020). Civility Mentor: A Virtual Learning Experience. Nurse Educator, 45(4), 189–192. https://doi.org/10.1097/NNE.0000000000000757
De Clercq, D., Azeem, M. U., & Haq, I. U. (2023). Supervisor incivility, ruminations and insubordination: catalytic effects of supervisor task conflict. Management Decision, 61(11), 3385–3407. https://doi.org/10.1108/MD-11-2022-1522
Dwyer, P., Engstrand, S., & Dyer, A. (2025). The Influence of Workplace Sense of Belonging and Structural Empowerment on Perioperative Nurses’ Turnover Intent. AORN Journal, 121(4), 267–279. https://doi.org/10.1002/aorn.14317
Franklin, A. D., Serdiuk, A. A., Tsai, M. H., Urman, R. D., & Engwall, S. (2021). Designing reliable healthcare teams - Proceedings of the Association of Anesthesia Clinical Directors (AACD) 2021 annual perioperative leadership summit. Journal of Clinical Anesthesia, 74, Article 110411. https://doi.org/10.1016/j.jclinane.2021.110411
Fryburg, D. A. (2023). Kindness Isn’t Just about Being Nice: The Value Proposition of Kindness as Viewed through the Lens of Incivility in the Healthcare Workplace. Behavioral Sciences, 13(6), 457. https://doi.org/10.3390/bs13060457
Huseynova, G., & İslamoğlu, M. (2024). Mind over matter: mindfulness as a buffer against workplace incivility. Frontiers in Psychology, 15, 1409326. https://doi.org/10.3389/fpsyg.2024.1409326
Homaei, A., Nemati-Vakilabad, R., Ebadi, E., Hosseini, M., & Mirzaei, A. (2025). Evaluating Workplace Incivility and Its Relationship With Patient Safety Culture Among EMS Staff: A Cross‐Sectional Analytical Study in Iran. Journal of Nursing Management, 2025(1), 8846297. https://doi.org/10.1155/jonm/8846297
Freed, P. E., Frost, E., & Simmons, K. (2021). Crucial Conversations: Virtual Instruction, Sensitive Topics, and Safety in Groups. Nurse Educator, 46(6), E143–E144. https://doi.org/10.1097/NNE.0000000000001087
Jawahar, I. M., & Schreurs, B. (2018). Supervisor incivility and how it affects subordinates’ performance: a matter of trust. Personnel Review, 47(3), 709–726. https://doi.org/10.1108/PR-01-2017-0022
Kamolo, E. K., & Njung’e, W. W. (2021). Interventions for Addressing Incivility among Undergraduate Nursing Students: A Mixed Study Review. International Journal of Caring Sciences, 14(1), 476–486.
Keller, S., Tschan, F., Semmer, N. K., Timm-Holzer, E., Zimmermann, J., Candinas, D., Demartines, N., Hübner, M., & Beldi, G. (2019). “Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams. PloS One, 14(12), e0226437. https://doi.org/10.1371/journal.pone.0226437
Keller, S., Yule, S., Zagarese, V., & Henrickson Parker, S. (2020). Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open, 10(6), e035471. https://doi.org/10.1136/bmjopen-2019-035471
Keller, S., Jelsma, J. G. M., Tschan, F., Sevdalis, N., Löllgen, R. M., Creutzfeldt, J., Kennedy-Metz, L. R., Eppich, W., Semmer, N. K., Van Herzeele, I., Härenstam, K. P., & de Bruijne, M. C. (2024). Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Services Research, 24(1), Article 71. https://doi.org/10.1186/s12913-024-10555-6
Kolbe, M., Eppich, W., Rudolph, J., Meguerdichian, M., Catena, H., Cripps, A., Grant, V., & Cheng, A. (2020). Managing psychological safety in debriefings: a dynamic balancing act. BMJ Simulation & Technology Enhanced Learning, 6(3), 164–171. https://doi.org/10.1136/bmjstel-2019-000470
Kumar, P., Kainth, R., & Mellanby, E. (2026). Psychological safety in the operating theatre environment. BJA Education, 26(1), 1–9. https://doi.org/10.1016/j.bjae.2025.10.004
Lama, A., Nwamu, H., & Kim, Y. (2025). Interventions to Address Clinical Incivility in Nursing: A Systematic Review. Nursing Reports (Pavia, Italy), 15(6), 199. https://doi.org/10.3390/nursrep15060199
Layne, D., Hudgins, T., Kusch, C. E., & Lounsbury, K. (2024). An Imperative Responsibility in Professional Role Socialization: Addressing Incivility. Journal of Academic Ethics, 22(4), 715–733. https://doi.org/10.1007/s10805-024-09524-9
Lee, H., Woodward-Kron, R., Merry, A., & Weller, J. (2023). Emotions and team communication in the operating room: a scoping review. Medical Education Online, 28(1), 2194508. https://doi.org/10.1080/10872981.2023.2194508
Lim, S., Goh, E.-Y., Tay, E., Tong, Y. K., Chung, D., Devi, K., Tan, C. H., & Indran, I. R. (2022). Disruptive behavior in a high-power distance culture and a three-dimensional framework for curbing it. Health Care Management Review, 47(2), 133–143. https://doi.org/10.1097/HMR.0000000000000315
LÖGDE, A., RUDOLFSSON, G., BROBERG, R. R., RASK-ANDERSEN, A., WÅLINDER, R., & ARAKELIAN, E. (2018). I am quitting my job. Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job. International Journal for Quality in Health Care, 30(4), 313–320. https://doi.org/10.1093/intqhc/mzy023
Luca, C. E., Sartorio, A., Bonetti, L., & Bianchi, M. (2024). Interventions for Preventing and Resolving Bullying in Nursing: A Scoping Review. Healthcare (Basel), 12(2), 280. https://doi.org/10.3390/healthcare12020280
Major, K., Abderrahman, E. A., & Sweeney, J. I. (2013). ‘Crucial Conversations’ in the Workplace. The American Journal of Nursing, 113(4), 66–70. https://doi.org/10.1097/01.NAJ.0000428750.94169.f3
Mantone, J. (2006). The cost of bad behavior in OR. Docs’ nurses’ actions linked to adverse events: study. Modern Healthcare, 36(28), 18–18.
Moran, R. (2016). Thing About Work : Showing Up and Other Important Matters [A Worker’s Manual](1st ed.). Routledge. https://doi.org/10.4324/9781315213149
Murray, H., Gillies, C., & Aalamian, A. (2024). Physician incivility in the health care workplace. Canadian Medical Association Journal (CMAJ), 196(9), E295–E295. https://doi.org/10.1503/cmaj.231377
Newstrom, J., & Pierce, J. (2013). The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t. In Manager’s Bookshelf: Pearson New International Edition. Pearson Education UK.
Nguyen, B., Mai, D., Venegas, M. G., Omo-Sowho, P., Han, L., Natarajan, A., Chima-Melton, C., & Dermenchyan, A. (2025). Exploring Physician-Nurse Relations Through the Lens of Intersectionality: A Scoping Review. Curēus (Palo Alto, CA), 17(5), e83685. https://doi.org/10.7759/cureus.83685
Ota, M., Lam, L., Gilbert, J., & Hills, D. (2022). Nurse leadership in promoting and supporting civility in health care settings: A scoping review. Journal of Nursing Management, 30(8), 4221–4233. https://doi.org/10.1111/jonm.13883
Patterson, K. (2002). Crucial conversations : tools for talking when stakes are high. McGraw-Hill.
Pearson, C., & Porath, C. (2010). Zero tolerance: business leaders who understand the cost of incivility in their organizations make eliminating bad behavior a priority. American Executive, 8(5), 14.
Pearson, C. (2010). The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What to Do about It. Human Resource Management International Digest, 18(6). https://doi.org/10.1108/hrmid.2010.04418fae.002
Raft, J., Lamotte, A.-S., Richebé, P., & Bouaziz, H. (2025). Incivility in the operating room: A French anesthesia survey. Journal of Clinical Anesthesia, 106, Article 111983. https://doi.org/10.1016/j.jclinane.2025.111983
Smith, A. F., & Plunkett, E. (2019). People, systems and safety: resilience and excellence in healthcare practice. Anaesthesia, 74(4), 508–517. https://doi.org/10.1111/anae.14519
Sutton, R. I. (2007). The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t: Vol. February 2009 (1st ed.). Grand Central Publishing.
Vasconcelos, A. F. (2023). Organizational incivility: a conceptual framework. Society and Business Review, 18(3), 484–503. https://doi.org/10.1108/SBR-08-2022-0209
Vauk, S., Seelandt, J. C., Huber, K., Grande, B., & Kolbe, M. (2022). Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study. British Journal of Anaesthesia : BJA, 129(5), 776–787. https://doi.org/10.1016/j.bja.2022.07.050
Villafranca, A., Hamlin, C., Enns, S., & Jacobsohn, E. (2017). Disruptive behaviour in the perioperative setting: a contemporary review. Canadian Journal of Anesthesia, 64(2), 128–140. https://doi.org/10.1007/s12630-016-0784-x
Villafranca, A., Magid, K., Young, A., Fast, I., & Jacobsohn, E. (2019). Abusive behaviour in Canadian and US operating rooms. Canadian Journal of Anesthesia, 66(7), 795–802. https://doi.org/10.1007/s12630-019-01334-7
Villafranca, A., Hiebert, B., Hamlin, C., Young, A., Parveen, D., Arora, R. C., Avidan, M., & Jacobsohn, E. (2019). Prevalence and predictors of exposure to disruptive behaviour in the operating room. Canadian Journal of Anesthesia, 66(7), 781–794. https://doi.org/10.1007/s12630-019-01333-8
Villafranca, A., Fast, I., Turick, M., & Jacobsohn, E. (2024). Clinician responses to disruptive intraoperative behaviour: patterns and norms identified from a multinational survey. Canadian Journal of Anesthesia, 71(4), 490–502. https://doi.org/10.1007/s12630-023-02670-5
Wright, M. I. (2026). Managing Conflict to Promote Patient Safety. AORN Journal, 123(1), 101–103. https://doi.org/10.1002/aorn.70014
Zhong, R., & Robinson, S. L. (2021). What Happens to Bad Actors in Organizations? A Review of Actor-Centric Outcomes of Negative Behavior. Journal of Management, 47(6), 1430–1467. https://doi.org/10.1177/0149206320976808
