Positive working relationships matter for better nurse and patient outcomes.

Positive working relationships are a key success factor in today s rapidly changing high paced health care environments. High quality patient care requires a team of health professionals who value each other s contributions to the patient care process and who work effectively with each other. Nonsupportive collegial relations interfere with optimal delivery of care and create stress among team members. Thus, positive working relationships among colleagues, both supervisors and co-workers, are fundamental to retaining satisfied and engaged nurses to ensure that high quality patient care continues to be available for patients and their families. This issue reports the results of recent research related to working relationships in nursing settings by scholars in both nursing and organizational psychology. The papers address a variety of aspects of working relationships in nursing settings that can be clustered into three categories: the impact of leadership in creating positive working relationships, the effects of working relationship quality within health care teams, and the impact of negative interactions at work, such as conflict and workplace incivility. Several studies in this issue investigated leadership influences on working relationships in clinical settings. Wong et al. s study showed that when leaders are authentic, nurses are more likely to trust them, to be more engaged at work, more comfortable about voicing concerns, and to rate patient care quality highly in their units. Similarly, Giallonardo et al. found preceptors authentic leadership behavior to be important for new graduate nurses work engagement and job satisfaction, and Spiers et al. found that resonant leadership style and fairness were important predictors of both nurse and patient outcomes. These studies provide evidence to support the importance of relational styles of leadership, as opposed to a command and control style, in creating positive work attitudes and behavior. On the other hand, Tourangeau et al. did not find a direct effect of transformational leadership practices on nurses job satisfaction and turnover intentions over and above other worklife predictors. They suspect that leadership may affect workplace outcomes more indirectly through a variety of factors not included in their study. However, they did find that leadership behaviours were positively correlated to group cohesion and work group communication. Two studies report the effects of leadership interventions designed to promote positive healthcare work environments. MacPhee et al. described a project designed to increase shared decision making between managers and staff members. They found that the critical factor for success was the quality of relationships between the unit leaders and their staff that developed during the process. Cummings et al. showed that a leadership development program had a positive impact on nurse managers self-reported use of leadership practices and resulted in a greater sense of community among the managers in the study. However, their qualitative results revealed that many manager participants became more cynical at the completion of the program. This is counterintuitive finding and suggests the need for further investigation. Leadership programs are costly and labor intensive initiatives and every effort should be made to ensure that participants are able to integrate leadership perspectives into their daily practice. Taken together, these studies highlight the importance of leadership in creating supportive work environment for nurses and suggest new ways of conceptualizing and developing leadership competencies in health care settings. The notion of authentic leadership is a promising area for development in today s resource constrained health care settings. Several papers in this issue report the effects of work relationships among groups or teams on a variety of organizational outcomes. Havens et al. examined Gittel s notion of relational coordination among health care teams, defined as, a combination of high quality relationships and communication among team members. They found that high levels of relational coordination were related to fewer adverse events, highlighting the importance of high quality team relationships for patient outcomes. Purdy et al. illustrated the importance of workplace empowerment structures Journal of Nursing Management, 2010, 18, 875–877