A faulty shield of armor: An exploration of callousness in health care workers

BACKGROUND: Callousness-behaving in an impersonal, insensitive, and cynical demeanor toward others-is increasing among health care workers and associated with harm to patient care. Yet, there has been little study of its predictors and effects on workers and workplace functioning. PURPOSE: This exploratory study aims to develop the theoretical premise for callousness as a distinct construct and examine possible contextual predictors and outcomes of health care workers' callousness to motivate further study and inform organizations' response to this behavior. METHODOLOGY/APPROACH: We reviewed the literature to illuminate the distinctiveness of callousness, surveyed 557 workers in 20 hospital intensive care units (ICUs) and then used multilevel generalized structural equation modelling to assess: (1) callousness's link to two hypothesized contextual predictors (work-life balance and psychological safety), (2) whether type of work unit moderates the effect of hypothesized predictors, and (3) callousness's relationship to two workforce-related organizational concerns, that is, intent to stay and proactive behavior. RESULTS: Self-reported callousness is significantly higher when workers report lower work-life balance and psychological safety. This relationship varies with the type of unit in which workers are situated (medical, surgical, or mixed). Callousness is negatively associated with intent to stay in one's job and proactive behavior, and it mediates their relationship with work-life balance and psychological safety. CONCLUSION: Callousness is associated with elevated threat to workforce stability and quality improvement efforts. Work-life balance and psychological safety may help to mitigate callousness, more so in some work units. PRACTICE IMPLICATIONS: Health care managers should act to reduce callousness to thwart staff turnover and retain workers' improvement motivation; both affect care. Fostering psychological safety and work-life balance may aid their efforts.