A mixed methods analysis of predictors of a toxic culture among nurses

Abstract

Objective: The three-year Workforce Engagement for Compassionate Advocacy, Resiliency, and Empowerment (WE CARE) project targets well-being and resilience of post-pandemic nurses in a hospital environment as part of a 2020 grant-funded collaborative agreement with the Health Resources and Services Administration. This project aims to examine extrinsic factors associated with the perception of a toxic work environment among post-pandemic nursing personnel and further describe the toxicity present at work.

Methods: A mixed methods design was conducted at an academic medical center in the Southeastern United States to assess nursing well-being. An open-ended question to explore nurses’ perceptions of toxic work environment was added to an annual email survey on well-being topics. All nursing personnel were solicited and 1,359 responded. 

Results: A total of 366 individuals (27%) selected toxic work environment as a stressor and 50 respondents commented contributing 218 instances of themes. Lack of leadership was the most frequent theme identified (63/218, 28.9%) but others included, in descending order, relational aggression, negative attitudes, lack of job accountability, gossip, favoritism, lack of teamwork, attitudes/bullying, negative work environment, cliques, and lack of trust. The respondents who perceived a toxic culture also reported significantly lower perceived organizational support (M = 7.22) than who did not (M = 9.21) (p < .001, Cohen’s D = 0.64); and other significantly worse outcomes including burnout (60.9% versus 33.5%, Cramer’s V = 0.22), and moral distress (34.4% versus 16.8%, Cramer’s V = 0.17).

Conclusions: Although this was a single site study and cannot be generalized, the findings of 27% of nursing personnel experiencing a toxic work environment is notable.  Perceived lack of leadership was the most prominent theme. Those reporting a toxic culture also reported lower indicators of well-being. This project should provide an impetus for others to investigate this phenomenon among their respective workforces.