title: Professional collegiality and peer monitoring among nursing staff: an ethnographic study.
abstract: BACKGROUND
  Patient safety and professional self-regulation systems both rely on professional colleagues to hold each other accountable for quality of care.
  
  
  OBJECTIVE
  To understand how staff nurses manage variations in practices within the group, and negotiate the rules-in-use for quality of care, collegiality, and accountability.
  
  
  METHODS
  Ethnographic case study; participant-observation, semi-structured interviews, policy analysis.
  
  
  METHODS
  In-patient unit in an urban US teaching hospital.
  
  
  RESULTS
  Explicit acknowledgment of conflicts and practice variations was perceived as risky to group cohesion. The dependence of staff on mutual assistance, and the absence of a system of group practice, led to the practice of "mutual deference", a strategy of reciprocal tolerance and non-interference that gave wide discretion to each nurse's decisions about care.
  
  
  CONCLUSIONS
  Efforts to improve professional accountability will need to address material constraints and the organization of nursing work, as well as communication and leadership skills.
authors: School of Nursing, University of Washington, Seattle, United States. spadgett@u.washington.edu
authors: Stephen M
authors: SM
authors: Padgett
mesh_terms: D000884:Anthropology, Cultural; D006801:Humans; D007400:Interprofessional Relations; D017008:Negotiating; D009740:Nursing Staff; D010379:Peer Group
keywords: Accountability; Nursing practice; Professional regulation; Professionalism; Work environment