281 The Impact of Incivility on Well-Being of Emergency Department Staff

Abstract

In non-medical studies, incivility (rudeness) negatively impacts job satisfaction, wellbeing and workplace culture. While anecdotally, emergency department (ED) staff feel patients and coworkers frequently behave incivilly towards them, no studies have used incivility scales to measure frequency and impact of exposure to incivility in the ED. We aimed to validate an adapted customer incivility scale for use with patients; assess rates of patient and coworker incivility experienced by ED staff in a typical week; and assess the differential impact of the two sources of incivility on emergency physician (EP) well-being, while controlling for two predictors of emotional exhaustion, trait fatigue and trait optimism. We recruited 45 randomly selected ED staff (15 each of physicians, nurses and care techs) to both rate how well an adapted version of a previously validated customer incivility scale measured patient incivility and to complete frequency measures of patient and coworker incivility. Reliability analyses were used to assess the validity of the adapted scale. Then, we recruited a convenience sample EPs via a Facebook group to complete a survey at two time points (to reduce the effects of common method bias). Participants first completed measures for two control variables, trait fatigue and trait optimism, and coworker and patient incivility scales. Next, participants completed an emotional exhaustion measure. Hierarchical linear regression was used to compare the impact of incivility on emotional exhaustion. Twenty-eight staff rated the adapted customer incivility scale and indicated this scale as highly representative of patient incivility. Reliability analyses revealed that this adapted measure showed strong internal consistency and reliability (α=0.95). Of this sample, 93% reported experiencing at least one episode of patient incivility weekly, while 40% reported experiencing at least one episode of coworker incivility weekly. Study two had 159 physicians complete the survey at both time points. These respondents reported similar rates of patient and coworker incivility. Hierarchical linear regression analyses revealed that, controlling for trait fatigue and trait optimism, exposure to patient incivility did not significantly predict emotional exhaustion. However, coworker incivility positively predicted emotional exhaustion, accounting for an additional 4% of the variance in emotional exhaustion above and beyond patient incivility, trait optimism, and trait fatigue. ED staff experience incivility daily. While patient incivility is more frequent than coworker incivility, coworker incivility has a more detrimental effect on ED staff well-being. In this study, patient incivility had no impact on emotional exhaustion after controlling for trait optimism and fatigue, while more exposure to coworker incivility led to higher rates of emotional exhaustion. Results from this study show that accounting for the source of incivility is important, and, while emergency physicians may be more inoculated from incivility from patients, interventions are needed to reduce the rates and impact of coworker incivility in EM. As emotional exhaustion is linked to poorer patient care outcomes, future research should address ways to mitigate the negative effects of incivility, which may include negative patient care outcomes.