Exploring group conflict between doctors and nurses in a Nigerian health care setting: a social identity theory perspective

Intergroup conflict between doctors and nurses is common and impacts negatively on health service delivery. Most often, causes are psychosocial in nature. Yet most studies conducted on intergroup conflicts in health care settings do not have a theoretical framework that is needed to explore and understand the psychosocial issues in intergroup relations. Social Identity Theory (SIT) is a psychosocial lens that can be used to explore and understand intergroup conflicts. To the author‘s knowledge, studies that have used SIT to explore intergroup conflicts in health care settings are scant and all based in developed contexts. There was a need to conduct a study in Nigeria, a developing context. The aim was to explore factors that cause doctor-nurse conflicts in a public hospital setting and propose interventions that will manage intergroup conflicts and improve health service delivery. An interpretive qualitative design with a single case study research method was adopted. Data was collected using a semi-structured interview with 15 doctors and 15 nurses and a focus group discussion with three doctors and three nurses. Respondent validation was employed to ensure the credibility of the data collected. Thematic data analysis revealed that four deductive themes (ingroup favouritism, group competition, ingroup prestige and professional group norms) from SIT and one inductive theme (cultural norms) underpinned conflicts between doctors and nurses. Under the deductive theme of professional group norms, two inductive sub-themes: professional indoctrinations and taking medical decisions without doctors‘ knowledge or consent, were revealed. Multiple social identities resulted in both constructive and destructive outcomes. Discrimination was a dominant sub-theme under ingroup favouritism. Discriminatory behaviours among professionals were experienced not only against the ‗professional group‘ but also the ‗ethnic group‘. Group competition between professionals occurred in a manner that revealed the behaviour of the ‗winner gets it all‘. Ingroup prestige, when intertwined with differences in professional group norms, posed a threat to patient care. General findings reflected the characteristics of the Nigerian context, a context that is predisposed to particular intergroup relations due to ethnic, cultural and religious diversity. Cultural norm with regards to this finding is described as certain cultural values and normative behaviours common in the Nigerian context that come in the way of doctors‘ and nurses‘ professional standards resulting in iii unprofessional behaviours that cause conflicts between them. The most dominant sub-theme under cultural norms was age difference/seniority. The cultural value of respect for elders in Nigeria influenced nursing and medical ethics. Some nurses imposed the cultural values inherent in the Nigerian context into the health care setting, giving way to unprofessional acts that caused conflicts. Strategies underpinned by SIT proposed by participants to manage conflicts included adopting a system of hospital administrators and distributive justice in allocating leadership positions that aimed at managing ingroup favouritism. Strategies proposed to manage group competition included partnering government hospitals with the private sector and paying health care professionals based on hourly remunerations. Adopting reforms in nursing schools and university admission policies to discourage students who go into nursing as a last resort was aimed at managing conflicts associated with ingroup prestige. Adopting patient-centred care through training on interprofessional relationships was proposed to manage conflicts arising from differences in professional group norms. Strategies proposed to manage the influence of cultural norms are reflected in public-private partnerships and hourly remunerations. Exploring doctor-nurse conflicts through the lens of SIT was worthwhile in proffering strategies for managing intergroup conflicts in Nigeria.