When the Patient Is Uncivil: A Rural Nursing Perspective
Jennifer Werthman, PhD, RN
Rural nurses are known for building strong relationships with patients, families, and communities they serve. In many rural settings, nurses do not simply care for strangers who pass through the healthcare system. They often care for neighbors, church members, coworkers, parents of their friends, and people they may see long after clinical encounters.
While close community ties are a great strength of rural nursing, they can make difficult interactions more complicated when discussions lead to incivility. While discussions about civility in healthcare often focus on health professionals, another important source of stress deserves attention: uncivil comments and behaviors from patients and families.
Patient incivility may include dismissive remarks, interruptions, insults, or demands that are delivered in a disrespectful way (Atashzadeh Shoorideh et al., 2021). These behaviors can occur in any healthcare setting, but rural nurses may experience them differently due to overlapping personal, professional, and community relationships.
Imagine a nurse working in a small rural clinic. A patient who has waited longer than expected says, “No one around here knows what they’re doing.” The comment stings. The nurse knows the patient personally. In a larger system, the interaction might remain confined to the workplace. In rural communities, the encounter can feel personal. The nursing patient relationship may extend beyond the exam room, emergency department, home health visit, or hospital bedside (Szumer & Arnold, 2023).
Nurses may worry about preserving trust,maintaining confidentiality, protecting professional reputation, and continuing to participate ncomfortably in community life. Resource limitations can also intensify these encounters. Rural healthcare settings often operate with smaller teams, fewer layers of support, and limited access to specialty services. When a patient becomes upset, another nurse may not be available to help de-escalate a situation.
A nurse may need to remain calm, continue the plan of care, and manage other patients at the same time. This emotional labor is often invisible. Patients and families in rural communities may also bring understandable frustrations into the clinical setting. They may have traveled a long distance, taken time off from work, struggled with transportation, referrals, or cost of services. They may feel anxious about delays in accessing specialty care or concerned that local resources are disappearing. These stressors do not excuse disrespectful behavior, but they can help nurses better understand a situation.
Responding with compassion, however, does not mean accepting incivility. Nurses can acknowledge distress while still setting clear expectations for respectful communication. For example, a nurse might say, “I can hear that you’re frustrated, and I want to help. I need us to speak respectfully so we can focus on your care.” Another response might be, “I understand waiting is difficult. Let me explain where we are in the process and what will happen next.”
These responses do three things: they recognize the patient’s emotion, redirect the conversation toward care, and establish a professional boundary. It is also important for rural nurses to distinguish between frustration and unsafe behavior. A worried patient who snaps or complains may need information, reassurance, or a moment to regain composure. A patient who threatens staff, uses discriminatory language, intimidates others, or repeatedly refuses respectful communication is unacceptable (National Institute for
Occupational Safety and Health [NIOSH], 2024). Nurses should know their organization’s policies for reporting, escalation, and safety support (Jones et al., 2023). Civility should never depend on nurses silently absorbing harmful behavior (Feruglio et al., 2025). Team support is important in rural environments. Because staffing may be lean, nurses may hesitate to ask for help or may minimize the impact of an encounter. Yet a check-in from a colleague matters. Asking, “Are you okay?” or “Do you need me to take over?” communicates nurses are not expected to manage incivility alone. Leaders can strengthen this culture by normalizing debriefing, reinforcing communication standards, and responding consistently when behavior becomes unsafe.
At its heart, civility in rural healthcare is not about avoiding every difficult conversation. It is about navigating hard moments with dignity, honesty, and mutual respect. Rural nurses can hold space for fear, frustration, and suffering while protecting their own well-being and the care environment. A calm, respectful response may help preserve the therapeutic relationship while making clear that disrespect is not acceptable. When nurses are supported in setting healthy boundaries, patients benefit too. Respectful communication improves trust, reduces tension, and helps everyone stay focused on what matters most: safe, compassionate care close to home.
References
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Feruglio, L., Bressan, V., & Cadorin, L. (2025). Violence against nurses during care: A
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https://doi.org/10.1111/jocn.17424
Jones, C. B., Sousane, Z., & Mossburg, S. E. (2023). Addressing workplace violence and
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https://psnet.ahrq.gov/perspective/addressing-workplace-violence-and-creating-safer-
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Szumer, R. T. O., & Arnold, M. (2023). The ethics of overlapping relationships in rural and
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https://doi.org/10.1007/s11673-023-10243-w
