Title : Collapsing into darkness: An exploratory qualitative thematic analysis of the experience of workplace reintegration among nurses with operational stress injuries
Nurses work in unique, challenging, fast paced and unpredictable environments in which they are exposed to potentially psychologically traumatic events. During the COVID-19 pandemic, healthcare professionals (HCPs) across the globe have faced an influx of patients, resource limitations, system overload, policy changes, secondment, societal, and political stigma, family needs, exposure to mass death and dying, as well as personal elevated exposure risk for COVID-19. As a result, more HCPs, including nurses, have been exposed to traumatic and morally injurious events. This can lead to increased rates of operational stress injury (OSI) which can result in HCPs needing time off work. It can be challenging for HCPs to reintegrate into their unique workplaces after an OSI, especially with repeated exposure to potentially psychologically injurious situations and the physically and mentally demanding nature of the workplace. An unsuccessful workplace reintegration process can be career ending for HCPs which may affect the individual, their family, and wider community while contributing to the HCP shortages within healthcare systems. Research regarding HCPs and OSIs have largely focused on clinical interventions and treatments, but neglect to address the important step after clinical interventions when workers are redeployed and expected to perform their occupational duties as before in an adverse environment. There is a paucity of research on workplace reintegration after psychological injury in nurses which makes it difficult to develop evidence-based policies, procedures, and initiatives to assist with the return-to-work and retention of nurses who have experienced an OSI. Prior to the conceptualization and implementation of policies, procedures, and initiatives to address workplace reintegration after OSI, it is imperative that the perspective of nurses are considered. The purpose of this study was to explore the perspectives of Canadian nurses who experienced a return-to-work process after experiencing an OSI. This qualitative study included nurses (N=7) who work or have worked in emergency rooms (ER) or intensive care/critical care units (ICU/CCU) settings within the province of Alberta, Canada. Data collection included an online demographic questionnaire and recorded interviews conducted via Zoom. Reflexive thematic analysis was utilized to createthemes from the data using an inductive and deductive approach. The results showed that cumulative events caused or contributed to psychological distress which required participants to take leave from work. Participants had varied experiences in their return-to-work process, with only two participants engaged in a formalized workplace reintegration. The resulting themes included: (1) Heroes to zero (2) Changing the status Quo (3) Connection is key and, (4) Post traumatic Growth: Advocacy and Altruism. The themes highlighted the current realities that may impede returning to work after an OSI and emphasized the importance of acknowledging the presence of potentially psychologically injurious events, the need for education on mental health at micro, meso, and macro levels, the desire for improved and formalized work reintegration programs and processes, and the importance of connection with close relations, peers, and the workplace. Participants were able to recognize personal strengths, engage in new opportunities, and had a new appreciation for life both professionally and personally. It is imperative that the profession of nursing, healthcare organizations, governments, and the public at large acknowledge that nurses experience trauma in the workplace. Exploration of evidence-based processes, policies, and initiatives may provide additional support to nurses affected by OSIs. Further research is needed regarding understanding the experiences of nurses and healthcare professionals in their workplace reintegration as this may have a profound impact on the entire professions, systems and communities.