Wayne State nursing faculty lead national effort to address incivility and bullying in nursing education

The American Nurses Association (ANA) Membership Assembly has adopted a national framework developed and presented by Wayne State University College of Nursing faculty to strengthen protections for nursing students in clinical learning environments.

Wayne State College of Nursing faculty members Erik V. Carter, PhD, MS, APRN-ACNS, CCRN-A, PHN, Nicole Demeter, DNP, CNM, FACNM, CNE and Stefan Smolenski, DNP, APRN-AGPCNP-BC, helped bring a United States nursing education issue to the floor of the American Nurses Association Membership Assembly in Washington, D.C., on June 28, 2026.

Their work centered on incivility and bullying directed at nursing students during clinical education, a challenge that can affect student confidence, well-being, academic progress and retention in the profession. The framework they presented was adopted by the Assembly with 92% of voting representatives in support, directing ANA to advance the recommendations through its established process.

Dr. Carter, clinical associate professor and director of undergraduate programs in the WSU College of Nursing, authored the original proposal in response to ANA's call for proposals. He was joined in presenting the framework by Drs. Demeter and Smolenski, both Wayne State clinical assistant professors whose work connects to nursing education, clinical learning environments and academic incivility.

"Nursing students should be able to learn in clinical environments where they feel safe, supported and respected," Dr. Carter said. "This framework gives nursing education and clinical partners a clearer path for addressing incivility and bullying before it harms students' well-being, confidence or decision to remain in the profession."

The framework addresses a problem that can arise during one of the most formative periods of a nursing student's education. Students who experience mistreatment in clinical settings may struggle to report concerns safely, fear academic consequences, or lack access to confidential support. These barriers can make it harder for students to learn, ask questions, build confidence and see a future for themselves in nursing.

In developing the proposal, Drs. Carter, Demeter, and Smolenski documented the scope and consequences of the issue, including a pooled global prevalence of bullying among nursing students during clinical practice of nearly 66%. They also cited rates of burnout, depression, and anxiety well above those of the general college population, along with evidence linking unaddressed incivility to workforce attrition and patient safety concerns.

At a time when the country continues to face nursing workforce needs, improving the clinical learning environment is also a workforce issue. By addressing incivility and bullying during clinical education, the framework aims to help nursing students develop in settings that support learning, accountability and professional growth.

"Clinical education is where students begin to see themselves as nurses," Dr. Demeter said. "When those environments are harmful or dismissive, it affects learning, belonging and professional identity. This work helps move the profession toward clearer expectations and stronger support for students."

The adopted recommendations focus on three core areas.

The first asks ANA to consider student-focused provisions within its Position Statement on Workplace Violence, including confidential reporting channels, clear investigation pathways within academic-clinical partnerships, clinical-site agreements that define behavioral expectations, safeguards against academic retaliation and access to appropriate mental health supports for student reporters.

The second recommendation urges ANA to develop resources and implementation guidance, such as educational content, guidelines, standards, model clinical-site partnership agreements or a toolkit to help schools of nursing and clinical partners respond more consistently.

The third recommendation calls for tracking the impact of incivility on nursing students, through an outcome-monitoring infrastructure that tracks student mental health metrics, transition-to-practice retention and longitudinal career outcomes, disaggregated by demographic group.

"This is about accountability across academic and practice settings," Dr. Smolenski said. "Students need reporting pathways, mental health support and protection from retaliation so they can speak up without risking their academic progress. Clear expectations help schools and clinical partners respond before harm continues."

The Assembly's vote directs ANA to advance the framework. It does not, on its own, create a finalized ANA policy position or amend an existing position statement.

For Wayne State University College of Nursing, the outcome reflects faculty leadership that connects scholarship, clinical expertise and policy engagement. Drs. Carter, Demeter and Smolenski identified a problem affecting nursing students nationwide, translated that concern into a national framework and helped bring it before nursing representatives from across the country.

Their work also aligns with the College of Nursing's commitment to preparing nurses who are ready to lead in complex health care environments. Strengthening the clinical learning environment supports student success, workforce readiness and the future of patient care.

The faculty members plan to continue supporting the framework through scholarship, dissemination and collaboration with academic and clinical partners. Their goal is to help schools of nursing and health care organizations build learning environments where students can develop as nurses without fear of mistreatment or retaliation.

"This is a national win for the College of Nursing, but more importantly, it is a step forward for nursing students," Dr. Carter said. "Our students deserve systems that protect them, listen to them and help them become the nurses our communities need."

Media contact:

Erik V. Carter, PhD, MS, APRN-ACNS, CCRN-A, PHN
Wayne State University College of Nursing
313-577-4144
[email protected]