This is largely due to nurses leaving their jobs and/or medical incidents involving patients. A nurse working in an environment lacking courtesy can create stress and anxiety for the nurse. This in turn will lead to poor attitudes, lower productivity, increased absences, and higher turnover rates (Kerber, 2015). Although working in uncivil environments is unhealthy for healthcare professionals, it has also been shown to greatly affect patient care. A nurse working in a hostile environment may feel stressed and overwhelmed, which can lead to an altered emotional state. Blevins (2015) reports in Impact of Incivility in Nursing that nurses working in this type of environment may “suffer from stress-related disorders and physical illnesses” that can decrease work attendance. A nurse or health care provider providing care to a patient in this emotional state may turn their negative feelings into uncivil behavior toward the patient or miss something essential to the patient's care, resulting in harm or death of the patient. For example, if a nurse is upset by a lack of respect from a fellow healthcare professional, she may transform her emotions by not asking the right assessment questions or by overriding a critical detail reported by the patient . Incivility can also reach the patient level when a nurse is afraid to ask questions regarding the patient's care to the charge nurse following recent harassment. The opposite is also true; If a patient is discourteous to a nurse who is courteous and helpful, this could make the nurse indifferent to the satisfaction of the patient's care. This can escalate into a cycle of incivility that is difficult to manage.