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Workplace incivility and its impact on care delivery

May 17, 2021
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Seniors Care: Workplace incivility and its impact on care delivery

By Dr. Heather Cooke, research associate in the School of Nursing and instructor for the MHLP in Seniors Care

We speak at length about physical safety in long-term care homes, for staff and residents. My experience and research in the field of dementia care and long-term care over the past 25 years suggests we need to bring a comparable focus to psychological safety.

As part of my post-doctoral research work with Jennifer Baumbusch, I explored workplace relationships amongst health care aides and the potential impact on care delivery when those relationships were marked by incivility or bullying.

This research interest came about from witnessing an episode of verbal abuse in which a witness care aide pleaded with me not to report the episode as the perpetrator was likely to make her work life unbearable. For this care aide, who was kind, compassionate and gentle in her interactions with residents, fear of repercussion from her colleague overrode the safety of the residents in her care.

My ethnographic research study – conducted before COVID-19 – included 100 hours of participant observation and over 30 interviews in two non-profit long-term care homes.

This research revealed the pervasiveness of uncivil behaviours such as social exclusion, gossip, rumour-mongering, blame and criticism. These are behaviours that would not necessarily be identified as bullying or harassment (which are expressly addressed in workplace policies) and this makes it easier for people to normalize them or brush them off as unimportant.

Staff may feel uncomfortable voicing concerns to HR for fear of not being taken seriously, or because of fear of reprisal from colleagues.

Yet these behaviours have a significant impact on workplace culture. Staff may hesitate to ask for help from other aides or decline to work certain shifts depending on who will be working with them.

Left unaddressed, tensions and power imbalances can lead to a toxic work environment – and from talking with colleagues in long-term care homes, these tensions have only been exacerbated by the impacts of COVID-19.

Staffing levels or how many people are on shift are essential to care quality; however, who is on shift appears just as important. Quality care is difficult to achieve when staff do not routinely engage with one another in a positive manner.

There are solutions to explore. This work fits into a larger piece around the importance of workplace culture in long-term care homes and how we value our staff.

We talk in health care about patient-centred care. But if we do not take care of our staff, they simply won’t be able to take care of residents in the way they deserve.

A positive workplace culture really does start at the top, and that means ensuring that all levels of leadership have the support and ongoing professional development opportunities they need to manage teams, instil a positive culture and be equipped to have some of those difficult conversations to address these underlying issues.

The Master of Health Leadership & Policy in Seniors Care is uniquely positioned to equip health-care professionals with the knowledge and skills needed to make a difference in this area.

The curriculum is balanced between courses through both the School of Nursing and UBC Sauder’s Robert H. Lee Graduate School, exposing graduates to the latest evidence-based research in seniors care, complemented by foundations in business and leadership. This enables our graduates to lead by example to set a positive culture and tone for organizations across the sector.

Read Dr. Cooke’s research article: Not just how many but who is on shift: the impact of workplace incivility and bullying on care delivery in nursing homes.”

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