Values at work

Comparing affirming and challenging narratives of nurses and physicians in a large health system


  • Richard M. Frankel Indiana University School of Medicine
  • Thomas S. Inui Indiana University School of Medicine
  • Orit Karnieli-Miller Tel-Aviv University



communication, interprofessional relationships, language, professional education, social values


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 from nurses and physicians from a large health system. 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; for physicians, it was humanism and teamwork. Nurse challenges involved respect, altruism/kindness and emotional investment. For physicians it was also respect and, in addition, 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. 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.

Author Biographies

Richard M. Frankel, Indiana University School of Medicine

Richard Frankel is professor of medicine and geriatrics at Indiana University School of Medicine and currently the director of the ASPIRE (Advanced Scholars Program for Internists in Research and Education) Fellowship. He is also a senior health services research scientist at the Regenstrief Institute and a staff member in the Education Institute at the Cleveland Clinic, where he co-leads the Civility, Professionalism and Resilience program. He has published more than 275 scientific articles and authored or edited seven books.

Thomas S. Inui, Indiana University School of Medicine

Thomas S. Inui received his MD from Johns Hopkins School of Medicine. A retired academic physician and active community service volunteer, his emphasis in teaching and research has included physician–patient communication, chronic disease management, health promotion and disease prevention, the social context of medicine and medical humanities. He has published more than 335 peer-reviewed articles and authored or edited eight monographs and books.

Orit Karnieli-Miller, Tel-Aviv University

Orit Karnieli-Miller has a PhD in social work from the University of Haifa, focused on communication in healthcare. She is currently Associate Professor at the Sackler School of Medicine at Tel Aviv University.Her emphasis in teaching and research is on physician–patient communication, breaking bad news, shared decision making, triadic (doctor–patient– companion) communication and professionalism.


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How to Cite

Frankel, R. M., Inui, T. S., & Karnieli-Miller, O. (2020). Values at work: Comparing affirming and challenging narratives of nurses and physicians in a large health system. Communication and Medicine, 15(3), 268–281.