Edinburgh Napier University

  Negative interactions and bullying in the workplace are commonplace and can cause nurses to experience harmful emotions, burnout and increased intention to leave. It is likely that this impacts on nurses’ relationships with patients. This paper explores how power plays, passive aggression and incivility affect nurses’ ability to deliver person centred care. We defined person centredness as the extent to which nurses included patients as equal partners in planning, developing and monitoring care. The therapeutic relationship is an integral part of person-centredness and the basis for equality and inclusivity. Carspecken’s critical qualitative research was selected as the philosophical and methodological basis for this study that investigated the culture of care in an acute surgical ward in regional Queensland, Australia. Participant observation, individual and focus group interviews were utilised to collect data. Hermeneutic data analysis led the researchers to the concept of team-centred care whereby nurses delivered task-focused care to meet team goals whilst espousing patient inclusion and person- centredness. It was the informal leaders within this nursing team who controlled and directed patient care through power plays and passive aggression meted out to nurses who were considered inefficient. Examples included, eye rolling, pointed silences and social isolation. Nurses were faced with the choice of compliance or exclusion and mostly chose the former. Passive aggression was used to ensure the team complied with the expectations of managerialism and audit that prioritised measurable outcomes and efficiency above person-centredness. In joining the team nurses lost their ability to practice according to their values.