Some of the conflict centred on the work, and who was responsible for it. Nurses had a high workload and felt a pressure to perform. If nurses on a previous shift did not complete all of their work, this left more for the nurses on the next shift, and fostered conflict. As one Canadian-born RN explained:
You are a night nurse coming around; feels like the day nurses didn’t finish their case work that day. They get very upset with them and can’t reason. I can’t think of a reason why you couldn’t have enough time to finish your work. They are very upset because they have more work on their plate for themselves, [especially] if it is blood work or if a consultant has to be notified [CEN, RN, 7.5 years, Psychiatry, White]
Getting the work done typically required teamwork. Conflict also arose when colleagues focused on their own work, and seemed unwilling to provide a helping hand to others:
You have to pick up the slack; you have to do the quick thinking…There are certain people, when you work with them, they care for their own and just their own. They do not offer any helping hand yet still they want help. There are other people that get talked about a lot. People don’t like working with them. Anything that will cause your fellow nurse to pick up your slack will cause them to dislike you [CEN, RN, 7 years, Sub-acute medicine, Black]
While inter-professional conflict often revolves around which groups get to perform which tasks, conflicts around the task within a profession are more about insufficient teamwork and lack of support by colleagues.
Nonetheless, there is evidence that conflicts around expertise, knowledge and performance can emerge across segments within the nursing profession. If a nurse is not seen to have the requisite knowledge, colleagues can turn against her:
A few nurses ask I did this, I did that, what do you think? There are instances you can do that, it is ok to ask for a second opinion. But you don’t want a nurse to come to you always asking... Once that happens, they form an alliance against you. You become the incompetent nurse now. Everybody does not want to get close to you because they think they have to do your work for you and your thinking for you and they have their fair share of their business and they don’t want to care about somebody’s business [CEN, RN, 7 years, Sub-acute medicine, Black]
In such cases, race and immigration status may exacerbate the situation. Nurses might feel the foreign-born (or trained) nurse does not know her business and close ranks against her.
Further, study participants spoke of conflicts between RN’s and RPN’s, and between members of these groups and PSW’s. Expertise differences, status differences, and heavy workloads combine to foster conflict:
And there is a little bit of RPN and RN thing. Because the job is the same and there is no difference and the pay difference is huge and sometimes the RNs get frustrated when they are expected to take on a more difficult patient that day. That’s what they are getting pay for and that’s what their extra education caters for. Some RNs don’t think RPN can do medication which is totally within our scope of training. Some RNs just don’t like RPN period. I have heard of one RN in front of the whole unit yelled at an RPN and said ‘don’t bother coming back unless you have learnt how do your job’ because he had a different approach. Not because he wasn’t capable of doing it but because he didn’t want to do it the way she was doing it. She screamed at him in front of everybody which was humiliating [CEN, RPN, 3 years, Psychiatric unit, White]
If [PSWs] are told by RNs saying that Mr. A and B need to be changed, no question is asked. The PSWs are not going [to do it] especially if you the RN, according to them, have nothing doing. It is your patient and I am going to do something else. It is a conflict between RNs and PSWs. RNs want PSWs to do all their work, they are so lazy and so forth…it is a constant battle…it has occurred even today...right now and the respect is gone. Not all RNs and not all PSWs, but for the most part it is one of those things I think about because it happens a lot everyday on our floor. Where PSW is quarrelling about something and RN is complaining about something [CEN, RN, 29 years, Neurosciences, Black]
Such conflicts are very similar to those reported by scholars studying inter-professional conflict as some groups seek to claim higher-status tasks for themselves while delegating the lower-status, less-expert tasks to subordinate groups. Through these day-to-day activities, RNs delegate some of the less-skilled tasks to their lesser-trained counterparts; RPNs and PSWs may respond with resentment. Note, however, that these conflicts take place in a context where RNs clearly express being overworked. Indeed our respondents (9 out of 66) suggest that these types of conflicts are worse in some work contexts than others.
There is absolutely a big difference between Hospital A and Hospital B. Hospital A, I find as a unit, … as a team, they are very strong. They work very well together as far as communication. They are very open to having our support workers, the PSWs and the RPNs. They are very supportive of each other as far as learning….staff will back each other up; everyone is really good about that, every one eats together…there are no problems over there. Over here [in hospital B], it is very different … nobody eats in the staff room apart from the RNs. Other floors are … extremely rude to them [RPNs and PSWs]. They don’t acknowledge their existence. I find nurses are extremely rude to them here, they don’t recognise them as part of the team [CEN, RPN, 4 years, Sub-acute medicine, White]
In ---- hospital, the mental health unit is a total dysfunctional place. The staffs are constantly at each other. There are fights, there are threats; it is unbelievable. Sometimes you think this is a professional work environment, the way the people treat each other up there is bizarre. You would not think that it is possible to not get fired for the things that these people say to each other [CEN, RN, 12 years, General Surgery, White]
Thus, as the literature has shown, organizational context and workload appear to condition and influence these types of conflicts significantly.
Overall, nurses report considerable conflict around who does what and how things are done. RNs and RPNs (and PSWs) conflict over who should be doing what. Nurses at the same level are more likely to conflict when they feel that colleagues are not pulling their weight, not supporting each other, or when they suspect their colleagues do not have sufficient knowledge to do their jobs.