Healthy Workforce

Creating Thoughtful Zones

Keeping conflicts away from patient care areas

A nurse belittling another nurse while other nurses watch

If you’ve been a nurse for awhile, you are familiar with the ways some of us mistreat each other. The old eat their young; nurses get thrown under the bus in front of others; the day shift battles with the night shift; and nurses dread hearing that they have been floated to another unit (where they’ll be tormented as newcomers).

These experiences certainly don’t cultivate the culture of caring so many of us expect to find in healthcare. The good news is that simple steps can make a real difference.

Bad Behavior: Yelling, gossiping and arguing in patient care areas
Culture of Caring Solution: Create “thoughtful zones”

According to our research, one of the most common forms of uncivil behavior healthcare employees report is being yelled at or openly criticized in front of others. Unfortunately, many times this happens in front of patients. I frequently hear nurses say things like these:

No matter how hard I try, Jackie always finds fault with how I leave my patients at the end of my shift. What makes it worse is that she berates me in front of my patients during report. It’s so embarrassing!

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Patients frequently witnessed interactions between me and other nurses and asked with concern, “Are you okay after what she said to you?” or, “Sounds like she is having a really bad day.” One patient told me, “I felt really uncomfortable seeing that interaction, but most of all, I feel bad for you!”

I don’t have to tell you how behaviors like these negatively impact nursing performance, employee wellbeing, patient satisfaction and outcomes.

They Can Hear Us

Sometimes, we forget that patients and their families can hear everything we say, not only in their rooms, but also at the nurses’ station and in the hallways. One simple solution is to establish “thoughtful zones” in all areas where patients and family members can hear us.

Within these areas, we commit as a healthcare team to avoid criticizing, yelling, cursing or gossiping. In this way, we can not only protect patients from negativity, but also create a kinder environment for nurses and staff.

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A Gentle Reminder

As a reminder to everyone to communicate respectfully in those areas, you can create a distinctive “thoughtful zone” motif or symbol and post it in each area.

Alternatively, you can hang a sign that says “Shhh,” “Be Thoughtful” or whatever works for you. The motif or sign can be temporary until everyone has formed a new habit, and you can put the signs back up (or create new ones) later if people need a reminder.

We get so caught up in our work that we sometimes forget that healthcare is a profession where we are called to serve the public and each other. By being thoughtful and careful about what we say in the spaces where we care for our patients, we elevate the morale and professionalism of the entire unit.

RENEE THOMPSON, RN, DNP, CMSRN, is the CEO and founder of the Healthy Workforce Institute. As a speaker, author and consultant, her goal is to eradicate nurse bullying and incivility.


JASMIN MORA is a Los Angeles-based illustrator. Reach her at

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