The Impact of Hostile Nurse-Nurse Relationships Upon Clinical Outcomes: Implications of a Mixed-Methods Systematic Review

Wednesday, 1 August 2012: 4:10 PM

Marie Hutchinson, RN, RM, PhD
School of Health and Human Sciences, Southern Cross University, Lismore, Australia
Debra Jackson, RN, PhD
Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Sydney, Australia

Learning Objective 1: The learner will understand the relationship between hostile professional behaviours and clinical outcomes

Learning Objective 2: The learner will recognise hostile behaviours that may impact upon clinical outcomes


To date attention has largely focused upon hostile physician behaviours and their relationship to clinical outcomes. Drawing upon the findings from a mixed-method systematic review the implications of nurse-nurse HPR will be presented.


 Examining the relationship between hostile professional relationships (HPR), patient care, and clinical outcomes a broad search strategy for the period 1990-2011 examined 8 electronic databases for the terms bullying, incivility, violence, horizontal violence, lateral violence, disruptive behaviour, aggression, with nurs*, patient care, clinical outcomes, patient safety, and quality. Standardised critical appraisal instruments from the Joanna Briggs Institute assessed the quality of retrieved quantitative and qualitative studies. 21 publications were retained for review. The outcomes of the quantitative studies were grouped into broad categories and content analysis was used to develop a taxonomy from the qualitative findings (Sandelowski and Barrosso, 2003).


 The analysis provided a conceptual summary of the data in three broad domains - Implicating clinical care in hostility, Directly involving patients in hostility, and Reduced performance relating to exposure to HPR.


The taxonomy derived from this review identifies features of HPR not currently included in measurement instruments. The implications of HPR upon patient care and clinical outcomes are more profound and extensive than often understood. Further research is required to explore the impact of nurse-nurse HPR on patient care and clinical outcomes and determine appropriate intervention strategies.

  Sandelowski, M. and J. Barroso (2003). "Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women." Research in Nursing and Health 2003(26).