Resilience, Dysfunctional Behavior, and Sensemaking: The Experiences of Emergency Medicine Physician Assistants Encountering Workplace Incivility

Abstract

Existing literature examining workplace incivility in the healthcare setting does not address the experiences of emergency medicine physician assistants (EMPAs) as separate and unique from the experiences of other non-physician members of the emergency medicine healthcare team. The physician assistant profession is one of the fastest growing professions in the healthcare industry and many emergency departments are employing EMPAs to address issues of overcrowding. Within the healthcare setting, the emergency department is the area where employees most frequently encounter workplace incivility. Workplace incivility has been demonstrated to negatively impact employee well-being as well as organizational performance. Within healthcare, it is linked to employee burnout and decreased patient safety.

Unfortunately, little is known about the lived work experience specific to EMPAs. A qualitative study was undertaken to examine their adaptive responses as a result of their experience with workplace incivility. Interviews with eleven participants provided the researcher with a rich understanding of how they made sense of their experiences and how they manifested their adaptive responses. Participants experienced WI as a threat to their sense of belonging. This threat was associated with experiences of emotional distress. Positive adaptations to this emotional distress included accessing their social capital and improving their clinical competence. Negative adaptations to this emotional distress included avoidance behaviors and engaging in acts of retribution. Participants exercised personal agency through direct confrontation with the source of their WI encounter and through organizational and career exit.

Three conclusions resulted from this study. The first addresses the negative emotions experienced by EMPAs who encounter WI. The second reveals the role of social capital in the EMPAs development of resilience. The third highlights the risk of patient harm that results from their negative adaptive responses. These conclusions offer insight that directly addresses the culture of emergency medicine and the impact of that culture on the lived experiences of EMPAs, their well-being, and the safety of the patients they serve.