Conflicting Working Relationships Among Nurses: The Intersection of Should Nursing, Double Domination, and the Big Picture

BACKGROUND: Research conducted on conflict between Registered Nurses (RNs) has established that it happens regularly within the hospital setting, that it adversely affects the health and well-being of RNs, impacts the effective functioning of the health care organization, and compromises quality patient care. In this article, the phrase conflicting working relationships (CWRs) is used to represent working relationships between RN peers that are non-collegial, uncaring, and non- supportive, and inclusive of the behaviours associated with incivility, horizontal violence, and bullying, among others. PURPOSE: To examine how nursing, including nursing knowledge and practice, is socially organized within the hospital setting and how this organization is linked to CWRs between RN peers. METHODS: Interviews were conducted with 17 RNs, followed by text analysis and mapping guided by institutional ethnography (IE) as the research methodology. RESULTS: The intersections between should nursing, double domination, and the big picture threads shows work environments where RNs struggle to provide appropriate care and conflict has become institutionalized. The intersection between threads can be used as caution areas for RNs and individuals in leadership positions to reflect on nursing practice when conflict is being experienced. CONCLUSIONS: The contextual variables surrounding professional nursing practice are very influential with respect to how RNs relate to each other. A new type of dialogue about the organization of nursing practice in the hospital setting is needed to support more relational practices between RNs.