A 360-degree view of unprofessional behaviours between nurses and between nurses and medical colleagues: a secondary analysis of a mixed-method evaluation

Background: Unprofessional behaviour negatively affects staff and patient safety and wellbeing and organisational culture. It typically involves one perpetrator and target/s, as well as staff who may witness, report or respond to the incident, while positive behaviours may buffer experiences. Understanding nurses’ experiences across these roles may support reducing unprofessional behaviour. This is the first 360° view of the roles that nurses play in unprofessional behaviour.

Aims: To examine the frequency, type, severity and impact of unprofessional behaviours between nurses and between nurses and medical personnel; the experiences of reporting and responding unprofessional behaviours; and if nurses acknowledge or exhibit positive behaviours.

Method: Secondary analysis of a mixed-method study evaluating an all-staff professional accountability program (Ethos) implemented in eight Australian hospitals. Data included (i) cross-sectional surveys administered pre- and postimplementation (longitudinal investigation of negative behaviour surveys: n = 5178 baseline [n = 2248 nurses] and n = 3975 follow-up [n = 637 nurses] surveys), (ii) interviews with middle managers n = 30 (n = 12 nurses), (iii) 1310 reports of coworker unprofessional behaviours (n = 799 submitted by nurses, n = 538 about nurses) and 1194 reports of coworker positive behaviours (n = 787 by nurses, n = 595 about nurses), and (iv) Ethos messenger surveys n = 60 (n = 17 nurses). Analyses undertaken varied by data type: descriptive analysis for quantitative data and content or thematic analysis for qualitative data.

Results: Nurses exhibited unprofessional behaviours (perpetrators), most commonly towards other nurses (62%–90%) and were the targets of nurses (47%–70%) and medical colleagues (4%–34%). Nurses frequently observed unprofessional behaviour, with 51% witnessed it at least weekly. Many (46%) were not comfortable responding, with 44% believing they would not be considered seriously (reporters). Nurses indicated having the skills (83%) and training (87%) to respond to unprofessional incidents. However, they frequently used workarounds (interview theme) or reported insufficient time. Nurses frequently acknowledged others’ positive behaviours (n = 1930, 67%), received positive feedback from nurses (1235 behaviours, 83%) and medical colleagues (94 behaviours, 6%).

Conclusion: Nurses’ roles in unprofessional behaviour may include perpetrator, target, observer, reporter, responder and buffer. Individual and organisational-wide approaches are required to confidently address unprofessional behaviours. Multifaceted culture change programs are needed.