The social organization of nursing practice in the hospital setting and the influence on the development of conflicting working relationships between registered nurse peers

Abstract

The term conflicting working relationships (CWRs) is used in this research to represent working relationships between nurse peers that are non-collegial, uncaring, and non-supportive. These types of relationships have been reported in the research literature using many different labels including incivility, horizontal violence, and bullying and are known to be a source of job dissatisfaction, disengagement, and burnout. Despite efforts to limit the occurrences of CWRs between nurse peers, incidents of CWRs continue to occur. Using institutional ethnography, this research explored and made visible the relationship between the social organization of professional nursing practice in the hospital setting and the development of CWRs between Registered Nurse (RN) peers. Three aspects of the social organization of professional nursing practice, should nursing, double domination, and the big picture were revealed as creating disjunctures, frustrations, and tensions for nurses that were significant in the development of CWRs. The findings of this research further illuminate how conflict has become institutionalized and how there is a need for strong nursing leadership to advocate for workplace processes and contexts that support healthy and productive working relationships between nurse peers. The results of this study offer important insights into the ways CWRs between RN peers are influenced by the extra-level processes and relations of ruling that govern professional nursing practice. Through increased clarity of these factors, it is hoped that this research can be used to open a dialogue for leaders to discuss how nursing practice could be organized in a way that supports more collegial practices between RNs.