Power and collegial relations among nurses on wards adopting primary nursing and hierarchical ward management structures.

Power and collegial relations among nurses on a number of hospital wards were analysed using a mixed methodology. Half the wards had adopted primary nursing whilst the rest continued with hierarchical management structures. Nurses' interactions were recorded as they worked, as were those that occurred during the shift handover period. The nurses' own perceptions of their collegial relations were measured using a 'Likert scale' type of questionnaire. Qualitative analysis of the observational data suggested that genuine differences in the nature of the power relations existed between the laterally and hierarchically managed wards. Some of the nurses on the primary nursing wards were observed to identify and discuss solutions to their patients' nursing problems, whereas these were either not followed-up or referred to other health care workers on the traditionally managed wards. Statistical analysis of the questionnaires suggested that nurses on the primary nursing wards found their collegial communication to be significantly more collaborative than that of the nurses on the hierarchical wards. Comparison between specialties did not reveal a statistical difference.