Theresa Parker, BS, Univ. of Connecticut, Janet Barnes-Farrell, PhD, Univ. of Connecticut, Martin Cherniack, MD, MPH, UConn Health, Mazen El Ghaziri, PhD, Univ. of Massachusetts-Lowell, Declan Gilmer, MS, Univ. of Connecticut, Ethan Gossett, BS, Univ. of Connecticut, Hossein Hamidi Shishivan, MS, Yuan Zhang, PhD, Univ. of Massachusetts-Lowell

The purpose of this work is to further explore experiences of incivility, harassment, and other stressors faced by the nursing population through utilization of experience sampling methods (ESM).

Nurses are known to experience repeated exposure to stressors including workplace incivility and violence, and are in a unique position to experience these stressors from both their colleagues and the patients they serve. Thus, nurses? experiences with these stressors are likely distinct from other working populations and are of interest to understand. These stressors are associated with a multitude of negative outcomes. An estimated 98 percent of workers report having experienced incivility, a prevalence that holds in the nursing population (Porath & Pearson, 2013; Spiri, Brantley, & McGuire, 2016). Similarly, about fifty percent of nurses report having experienced some type of workplace violence during their five most recent shifts (Phillips, 2016). Incivility and harassment experiences have been shown to directly affect nurses through their association with anxiety, exhaustion, and sleeplessness (Holm, Torkelson & Backstrom, 2015; Najafi, Fallahi, Ahmadi, Dalvandi, & Rahgozar, 2018), and indirectly effect patients through their association with decreased patient satisfaction, nursing care organization, and overall quality of nursing care (Alshehry, Alquwez, Almazan, Namis, & Cruz, 2019). Previous methodologies investigating these stressors typically required participants to retroactively report on prior incidents and stress levels, yielding data subject to recall bias. This study utilizes ESM to capture stress at the incident and daily level to provide a more holistic view of the nursing experience and to inform workplace interventions to address these stressors.

This study utilized ESM to examine nurses? workplace experiences. To date, thirteen participants have been recruited from a university-affiliated hospital in the Northeastern USA. Two surveys were used for seven consecutive days, including work and non-work days. The ?Incident Survey? is composed of a series of ten questions designed to capture incident characteristics and incident-level stress, and was completed as close to the time of an incident as possible. The daily diary assessed day-level stress and qualities of the past 24 hours. Participants completed the daily diary at the end of each day or work shift, whichever came later. Surveys were administered using ?PIEL Survey,? a mobile device application designed for ESM and survey administration, that participants downloaded onto their device. Upon survey completion, data is automatically sent from the device to an email address which only researchers have access to.

To date, a total of ninety-two daily diaries and seventy-one incident surveys have been completed. Preliminary findings indicate that days with incidents were slightly more common than days without (59%). Of these incidents, the majority were perpetrated by patients (62%) and other staff (28.2%), and most commonly characterized as uncivil (35%) and intentional (47.9%). Across all incidents, participants reported an average stress level of 2.28 (1=Not at all stressed to 3=Very stressed, N=71, SD=0.45) at the time of occurrence. Incidents perpetrated by other staff members (N=20) were more often rated as ?very stressful? as compared to those perpetrated by patients (N=44, 20%). On days where an incident(s) was reported, participants? average rated stress over the previous twenty-four hours was 2.60 (1=No stress to 5=Extreme stress, N=55, SD=0.91), as compared to 1.78 on non-incident days (N=37, SD=0.67). Similarly, on work-days, participants? average rated stress was 2.44 (N=52, SD=0.95), as compared to 2.05 on non-work days (N=40, SD=0.81). In addition to these quantitative analyses, qualitative descriptions of incidents will be classified and included in findings upon completion of data collection for a small number of remaining participants this summer.

Current data confirm previous research, in that nurses are subject to repeated exposure to workplace stressors including incivility and harassment. Data show that participants are more likely to give higher stress ratings on work days and on days where incidents occurred. Incidents are most commonly characterized as uncivil and perpetrated by patients and other staff. While it currently appears that incidents perpetrated by other staff members are rated as more stressful than those perpetrated by patients, future analyses will further investigate the relationship between perpetrator and immediate and retrospective stress levels. A strength of this research is its methodology. It appears that participants might accurately recall stress levels at the time of the incident and again within twenty-four hours. While participants most commonly reported experiencing ?a little stress? on both work and non-work days, higher ratings of stress do appear to coincide with ?incident days?. Future analyses will further investigate this relationship.

Together, these data confirm the extremity of the workplace violence and incivility experienced by nurses and will continue to expand on the unique experiences of the nursing population with stressors to inform appropriate training and interventions for this workforce. This study followed individual-level responses to incidences of workplace incivility and harassment. Future studies might consider investigating dyad- or group-level responses to incidents.

Tags: Basic research, Case studies; single study; informal field studies; or similar reports and findings, Empirical study, Health care and social assistance, Workplace Mistreatment; Threats; and Violence, Workplace Stress; Outcomes; and Recovery