Values at work: Comparing affirming and challenging narratives of nurses and physicians in a large health system

Tensions between nurses and physicians have been linked to differences in power, hierarchy, education, compensation and gender. Less attention has been paid to the underlying values on which these differences are predicated. Likewise, little is known about how frequently values conflicts are resolved, and the threats to patient safety unresolved conflicts pose. Our aim was to compare the values embedded in affirming and challenging narratives elicited using Appreciative Inquiry and the Critical Incident Technique in interviews with 55 nurses and 50 physicians from a large health system in the USA. We used thematic analysis and descriptive statistics to assess goodness-of-fit of observed differences in themes. Narratives were coded into eight values categories: nurses felt affirmed by emotional investment, altruism, humanism and being of service, while for physicians affirmation came from humanism and teamwork. For nurses, the challenges involved respect, altruism/kindness and emotional investment; respect was also a challenge for physicians, along with professionalism, being of service, humanism and teamwork. Some values-affirming narratives, e.g., humanism, were indistinguishable, while for some values-challenging narratives, e.g., respect, there was virtually no overlap in narrative content. Participant narratives provide important insights into work-life satisfaction and tensions arising from differences in the underlying values of close working professional groups. Unresolved values conflicts are a potential threat to quality, safety and effective relationships.