The “Ugly Secret” of a Caring Profession
In 2026, as the world looks to Africa to help bridge the global health workforce gap, the internal culture of African nursing is under intense scrutiny. While nursing is fundamentally built on the principles of empathy and care, a silent pathogen is currently “sickening” teams across the continent: Nurse-to-Nurse Incivility.
Often described as an “ugly secret,” incivility in nursing, also known as lateral or horizontal violence, refers to low-intensity deviant behavior with an ambiguous intent to harm. Research published in the Africa Journal of Nursing and Midwifery (2025/2026) reveals that between 27% and 42% of nurses in countries like Nigeria, South Africa, and Ghana have personally experienced bullying, while a staggering 83% to 85% have witnessed it. This is not merely “workplace drama”; it is a systemic failure that compromises patient safety, fuels the “brain drain,” and leads to profound mental health distress among the nursing cadre.
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Identifying the “Invisible” Bully: Overt vs. Covert Acts
In 2026, incivility has moved beyond simple shouting. It often manifests as subtle psychological warfare that is difficult for management to track but devastating for the victim.
Overt Incivility (Visible & Direct)
- Public Criticism: Belittling a junior nurse’s clinical judgment in front of patients or during ward rounds.
- Verbal Aggression: Using a hostile tone, shouting, or using condescending nicknames (e.g., “The University Girl”).
- Physical Threats: While less common, “intimidating acts” still account for nearly 60% of reported bullying in some high-stress Nigerian hospitals.
Covert Incivility (Hidden & Passive)
- The “Silent Treatment”: Purposefully ignoring a colleague during handovers or leaving them out of ward discussions.
- Information Hoarding: Failing to share vital patient status updates, essentially “setting up” a colleague to fail.
- Backstabbing and Gossip: Spreading rumours about a colleague’s personal life or professional competence to undermine their reputation.
- Sarcastic Eye-Rolling: Non-verbal gestures that signal disrespect and unreliability.
The Root Causes of Nurse-to-Nurse Incivility in African Healthcare
To fix the problem in 2026, we must understand the “why.” Researchers (Clark, 2025; Tetteh, 2025) identify several unique drivers in the African context:
- The “Oppressed Group” Mentality: When nurses feel powerless within the hospital hierarchy (relative to doctors or administration), they often take out their frustrations on their own peers.
- Generational Clashes: The “Diploma vs. Degree” divide is still sharp in 2026. Veteran nurses who trained via the traditional hospital-based model may feel threatened by, or resentful of, new “Gen Z” graduates who arrive with high-level theoretical knowledge and tech skills.
- Resource Insecurity Stress: Working in an environment with constant electricity outages, drug stock-outs, and a 1:30 nurse-to-patient ratio creates “organizational chaos” where patience is thin, and tempers are hot.
- Hierarchical Rigidity: In many African institutions, a “command and control” style of management is still the norm. Superiors targeting subordinates account for over 83% of bullying incidents in some regional studies.
The Patient Safety Crisis: When Incivility Kills
The most dangerous consequence of nurse-to-nurse incivility is its impact on the patient.
- Communication Breakdowns: If a junior nurse is afraid to ask a senior colleague for help or clarification because they fear being mocked, a medication error or a missed vital sign change is almost inevitable.
- Reduced Clinical Judgment: Victims of incivility experience “cognitive narrowing.” The stress of being bullied uses up mental energy, leaving less room for the critical thinking required to spot a deteriorating patient.
- The Pathogen Effect: Like a common cold, incivility is contagious. A ward with a toxic culture sees a 30% higher rate of complications and patient dissatisfaction.
Strategies for a Respectful Workplace
In 2026, “hope” is not a strategy. We are moving toward evidence-based interventions that have been proven to work in high-pressure environments.
A. Cognitive Rehearsal (Mental Scripting)
This is the most effective tool for an individual nurse. It involves practicing specific, non-emotional responses to common uncivil behaviors before they happen.
- Scenario: A colleague rolls their eyes during your handover.
- Rehearsed Response: “I see you are rolling your eyes. I’m concerned that you might have a question or concern about my report. Let’s discuss it professionally.”
- Why it works: It stops the “incivility spiral” by making the behavior visible without reacting with equal aggression.
B. The CREW Program (Civility, Respect, and Engagement in the Workplace)
In 2026, leading private hospital groups are adopting the CREW model. This involves:
- Weekly 15-minute “Civility Briefs”: Brief team-building exercises focused on respect.
- Peer Mentoring: Pairing new graduates with “Civility Champions”—senior nurses who are vetted for their positive mentorship skills, not just their clinical seniority.
C. Institutional “Zero Tolerance”
Management must move beyond the “culture of silence.”
- Transparent Reporting: Hospitals in 2026 are implementing anonymous digital reporting systems where nurses can report lateral violence without fear of retaliation from their supervisors.
- Modelling by Leadership: Managers must lead by example. A “hot-tempered” matron cannot expect a civil ward if they themselves lead through intimidation.
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Breaking the Cycle: A Guide for the New Graduate
If you are entering the workforce in 2026, you are the most vulnerable group. Protect yourself with these steps:
- Seek a Mentor Early: Find a senior nurse whose values align with yours.
- Document Everything: If you are being targeted, keep a “shadow log” of dates, times, and specific behaviors. This is your evidence if you ever need to involve HR or your union (NANNM/DENOSA).
- Prioritize Self-Care: Victims of incivility are 50% more likely to experience burnout. Don’t let a toxic colleague steal your joy for nursing.
FAQ: Navigating Ward Bullying As A Nurse
Q: Is “teasing” the new nurses’ just part of the culture?
A: No. In 2026, we distinguish between “humorous banter” and “incivility.” If the behavior makes a colleague feel small, incompetent, or excluded, it is incivility and it is harmful.
Q: Can I get fired for reporting a senior nurse?
A: Under the 2026 labor laws in most African countries (and hospital policies), you are protected from “victimization” for reporting misconduct. However, always use official channels (HR/Union) to ensure you have a paper trail.
Q: What is “Lateral Violence”?
A: It is “horizontal” abuse between people at the same level (nurse-to-nurse). This is different from “Vertical Violence” (manager-to-nurse or doctor-to-nurse).
Q: Can incivility be unintentional?
A: Yes. A nurse may be so stressed and overworked that they snap at a colleague without intending to “bully.” However, the impact is still negative. This is why “Cognitive Rehearsal” focuses on the behavior, not the intent.
Research References & Links
- Clark, C. M. (2025). A Respectful Workplace Culture to Address Nurse-to-Nurse Incivility. Africa Journal of Nursing and Midwifery
- Tetteh, J. (2025). “We Are Our Own Worst Enemies”: Workplace Bullying Among Nurses in Northern Ghana. ResearchGate
- RSIS International (2025). Nursing Incivility and its Impact on Professional Quality of Life. IJRSIDigital Library
- WHO Health Workforce (2026). Preventing Occupational Violence in Healthcare Settings. WHO Publication
