The iceberg of a healthy work environment: Understanding the spiral of incivility and silence in nursing and midwifery faculties - a qualitative study

Abstract

Incivility within academic nursing and midwifery settings has become a pervasive yet normalized dysfunction. While its psychological and professional consequences are recognized, little is known about how such experiences perpetuate organizational silence and weaken psychological safety. This study explores how academics in nursing and midwifery faculties experience incivility and how these experiences sustain silence within institutions. Methods A qualitative exploratory multi-case design grounded in Critical Realism was employed. 20 academics from seven higher education institutions were recruited through maximum variation sampling. Semi-structured interviews were analyzed using Braun and Clarke's thematic analysis. Psychological Safety Theory, the Job Demands–Resources Model, and the Spiral of Silence Theory informed coding to interpret how individual experiences reflected broader cultural and structural mechanisms. Results Four themes and ten subthemes emerged, illustrating the psychological, organizational, and cultural mechanisms that reinforce incivility and silence. Theme 1: psychological impacts and coping mechanisms described burnout, anxiety, and silence as self-protection. Theme 2: hierarchical incivility and power asymmetry revealed fear of retaliation and loss of voice within rigid hierarchies. Theme 3: institutionalized silence and the normalization of incivility demonstrated how silence becomes an adaptive academic norm. Theme 4: the spiral of incivility and silence depicted their cyclical, mutually reinforcing nature. Conclusion Findings show that incivility in nursing and midwifery academia extends beyond interpersonal tensions, reflecting institutional hierarchies and weak accountability. Silence functions as both a coping and a cultural response, normalizing inequity and hindering professional growth. Addressing this issue requires educational and structural reforms that foster ethical leadership, transparency, and psychological safety. As academic environments shape future professionals' values, embedding restorative communication and moral courage within nursing and midwifery education is crucial. Institutional policies should advance learning environments that identify and mitigate incivility and silence as systemic barriers to collaboration, integrity, and educational excellence.