A Descriptive Phenomenology of Workplace Incivility Among Operating Room Nurses During the COVID-19 Pandemic

Abstract

Workplace incivility (WPI) and other forms of workplace mistreatment in healthcare are associated with medical errors, increased costs, preventable adverse events, and issues with retention of qualified clinicians. The operating room (OR) can be an exceptionally toxic environment for nurses, and as many as 97% of OR clinicians are exposed to WPI and other disruptive behaviors. Additionally, there is evidence that incivility among registered nurses has increased since the beginning of the COVID-19 pandemic. Major professional and healthcare organizations are calling on healthcare institutions to address the problem. Despite quantitative evidence on the existence and consequences of WPI in the OR, the problem has continued to persist, and there are critical gaps in the literature. There is minimal qualitative research on the topic, and there are no current data on the efficacy of interventions for addressing WPI in the OR. Of utmost importance is the need to understand how the COVID-19 pandemic has influenced WPI among OR nurses. Thus, there is a need for a qualitative study exploring WPI among this population during the COVID-19 pandemic. The purpose of the study was to describe the essential structure of the lived experience of WPI among registered nurses practicing in the circulator role in ORs within hospitals in the southeastern United States during the COVID-19 pandemic. I conducted the study utilizing Colaizzi’s descriptive phenomenological methods. A total of 15 OR nurses from five different sites participated, and each participating nurse completed up to two semi-structured interviews. Based on data analysis, three themes were revealed: (a) Enduring incivility as an individualized test of one’s mettle, (b) COVID-19 as an accelerant for WPI, and (c) Addressing WPI through accountability, communication, and education. While participants experienced WPI in a variety of ways, certain similarities were threaded throughout their descriptions of the phenomenon. The experience was primarily described as unpleasant and complex, especially for those who were the target of WPI. Additionally, the experience was influenced by a number of factors, some of which were unique to each individual and some which were unique to the OR itself. COVID-19 seems to have exacerbated the problem of WPI in the OR, creating an environment characterized by greater stress, tension, and frustration. There is an urgent need to address WPI in the OR, especially through accountability, communication, and education. OR managers and leaders can use the findings of this study to enhance the overall health of the environment and begin to foster a culture of civility. Specifically, managers can use the findings to improve the experience of being new in the OR, as well as the experience of reporting WPI in the OR. There is a need for additional knowledge development related to new graduate nurses in the OR, as well as the impact of sociodemographic factors on WPI in the OR. In addition, there is a need for research on targeted interventions for addressing WPI in the OR.