Letter to the Editor by Jason Roy to “Nurses Need Not Be Guilty Bystanders: Caring for Vulnerable Immigrant Populations”

Moral Courage Amid Moral Distress: Strategies for Action

October 20, 2018

Response by Jason Roy to “Nurses Need Not Be Guilty Bystanders: Caring for Vulnerable Immigrant Populations,” by Fitzgerald, Myers, and Clark (December 1, 2016)

With Reply from Authors

Dear Editor:

I am writing in response to the article “Nurses Need Not Be Guilty Bystanders: Caring for Vulnerable Immigrant Populations,” by Fitzgerald, Myers, and Clark (2016).  I believe you have identified an issue facing nurses by addressing the need for civility and integrity in communication.  It is difficult to confront a peer, particularly when hearing inappropriate conversation about a patient’s ethnic background.  It may be easier to ignore others’ comments and not respond, but the integrity of the nursing profession hinges on our ability to assert professional behavior and hold each other accountable.  I appreciate the authors’ discussion of the principles of quiet leadership and the strategies offered for resolving incivility directed both at our patients and peers. Nurses must always defend civility and behave professionally regardless of the background of a patient or peer.  The principles described by the author are the empowering tools needed to become defenders of civility.

I experienced incivility in my workplace in the form of bullying when I started as a new nurse in intensive care.  While I chose not to tolerate this behavior, I did not yet possess the skills to communicate my message immediately.  I now will use Merton’s principles of quiet leadership as described by the authors to affect change as conflict happens.  I have gained a new skill that will allow me to address incivility directly and professionally.  Not all nurses feel empowered.  As such, I encourage them to read this article.  Developing a program to train and implement quiet leadership skills organization-wide will empower all nurses and staff.  The authors focused their discussion on the individual nurse and nurse leaders using quiet leadership to resolve issues case-by-case, but I recommend introduction of this strategy to an entire organization.  Teaching this effective strategy to all nurses and staff in an organization would create shared responsibility for professional communication.  A shared understanding of professional expectations and possessing tools for handling fall outs will result in empowered staff who are equipped to address conflict directly.

The authors discuss a difficult topic that has potential to damage the professional image of nursing.  I have gained a new tool for assuring professionalism and combatting incivility as it happens.  Whether toward patients or peers, incivility is never acceptable, posing a threat to the public’s perception of nurses as professionals.  Case-by case strategies for using quiet leadership are offered, but I encourage organization-wide training for and implementation of quiet leadership skills to empower staff.  Being equipped to address incivility in real time is necessary across any health care organization.  Incivility can be insidious, thus tools to stop it must be applied organization-wide to empower all staff.


Jason Roy, BS, RN, CFRN
Wilmington, NC


Fitzgerald, E.M., Myers, J.G., & Clark, P., (2016). Nurses need not be guilty bystanders: Caring for vulnerable immigrant populations. OJIN: The Online Journal of Issues in Nursing, 22(1). doi: 10.3912/OJIN.Vol22No01PPT43