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Background <p>Nurses, as the largest and most patient-facing group in healthcare systems, play a vital role in delivering high-quality care. However, they constantly work in high-risk and high-stress environments. Workplace incivility, a subtle yet pervasive stressor, may cause persistent harm to nurses’ health. Identifying how different sources of incivility affect nurses’ suboptimal health status and examining whether adverse childhood experiences moderate this relationship are essential for developing targeted health promotion strategies.</p> Methods <p>This cross-sectional study was conducted in a tertiary hospital in Shandong Province, China, from October 2024 to April 2025, involving 481 registered nurses. The Extreme Gradient Boosting (XGBoost) was applied to determine the relative impact of different dimensions of workplace incivility on suboptimal health status. Hierarchical regression models were used to explore the moderating role of adverse childhood experiences in the relationship between workplace incivility and suboptimal health status. Additionally, an interactive tool was used to visually present the results.</p> Results <p>XGBoost results indicated that supervisor incivility had the strongest association with suboptimal health status, followed by patient incivility, physician incivility, nurse incivility and general incivility. Hierarchical regression revealed that adverse childhood experiences significantly moderated the relationship between workplace incivility and suboptimal health status. The pattern of moderation aligned with the stress inoculation model, suggesting that higher levels of early adversity weakened the negative impact of workplace incivility on suboptimal health.</p> Conclusion <p>Workplace incivility is an important factor influencing nurses’ suboptimal health status, with incivility from supervisors exerting the most pronounced effects. Adverse childhood experiences play a protective moderating role, implying that moderate early-life adversity may enhance psychological resilience. Management strategies should prioritize addressing high-risk sources of incivility and incorporate individual differences in early-life experiences to design more tailored health support programs.</p>

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The moderating role of adverse childhood experiences in the relationship between workplace incivility and suboptimal health status among nurses

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月8日

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  • Xue Zhang,
  • Xiaona Zhang

摘要

Background

Nurses, as the largest and most patient-facing group in healthcare systems, play a vital role in delivering high-quality care. However, they constantly work in high-risk and high-stress environments. Workplace incivility, a subtle yet pervasive stressor, may cause persistent harm to nurses’ health. Identifying how different sources of incivility affect nurses’ suboptimal health status and examining whether adverse childhood experiences moderate this relationship are essential for developing targeted health promotion strategies.

Methods

This cross-sectional study was conducted in a tertiary hospital in Shandong Province, China, from October 2024 to April 2025, involving 481 registered nurses. The Extreme Gradient Boosting (XGBoost) was applied to determine the relative impact of different dimensions of workplace incivility on suboptimal health status. Hierarchical regression models were used to explore the moderating role of adverse childhood experiences in the relationship between workplace incivility and suboptimal health status. Additionally, an interactive tool was used to visually present the results.

Results

XGBoost results indicated that supervisor incivility had the strongest association with suboptimal health status, followed by patient incivility, physician incivility, nurse incivility and general incivility. Hierarchical regression revealed that adverse childhood experiences significantly moderated the relationship between workplace incivility and suboptimal health status. The pattern of moderation aligned with the stress inoculation model, suggesting that higher levels of early adversity weakened the negative impact of workplace incivility on suboptimal health.

Conclusion

Workplace incivility is an important factor influencing nurses’ suboptimal health status, with incivility from supervisors exerting the most pronounced effects. Adverse childhood experiences play a protective moderating role, implying that moderate early-life adversity may enhance psychological resilience. Management strategies should prioritize addressing high-risk sources of incivility and incorporate individual differences in early-life experiences to design more tailored health support programs.