Managerial dynamics influencing doctor–nurse conflicts in two Nigerian hospitals

BACKGROUND: In the hospital, authority does not usually comes from a single person nor is it exercised in a single chain of command as is obtainable in most formal organizations. Doctors exercise substantial authority within the organizational structure of the hospital and therefore enjoy high autonomy in the hospital setting. This nature of autonomy within the medical and its allied professions has the propensity to incite conflicts within the hospital settings. The study thus sought to examine how the relationship of authority and influence between doctors and nurses within the hospital organization generates conflicts and to evaluate the effectiveness of managerial procedures utilized to resolve doctor–nurse conflict in the selected hospitals. METHODS: Semi-structured questionnaires were self-administered to 323 health workers who were sampled from one secondary and the only one tertiary hospital in the state at the time. Focus group discussions (FGDs) were conducted with three groups each of doctors and nurses in the selected hospitals. The organograms of both organizations were also reviewed to evaluate structural relationships of authority between doctors and nurses. Data were analyzed using unadjusted odd ratios at 95% level of significance. RESULTS: Respondents were also twice likely to attest that the command structure and its ability to resolve conflicts was below average in assessment (odds ratio [OR] – 2.05; 95% confidence interval [CI] – 1.27–3.29). Undue advantage (partisan approach) for a particular group by management to conflict resolution was thrice likely to be practiced in both hospitals but more in state hospital compared to the federal medical center (OR – 2.93; 95% CI – 1.54–5.58). Some findings from respondents in the FGDs revealed lackadaisical approach by the management in tackling conflicts among health workers. CONCLUSION: Doctor–nurse conflict is caused by several organizational and managerial factors. Hospital management must understand the interplay of these factors and institute appropriate managerial policies to tackle the problem appropriately.