Experiences and Coping Strategies of Emergency Department Nurses Regarding Unethical Pro-Organizational Behavior: A Descriptive Qualitative Study.

BACKGROUND

Emergency nurses' unethical pro-organizational behaviors (UPBs) exert detrimental effects on individual well-being, professional performance, and clinical workplace atmosphere; nevertheless, qualitative evidence systematically exploring the underlying mechanisms and coping strategies of such behaviors in the Chinese nursing context remains scarce.

AIM: This study aimed to qualitatively explore the sources, perceived impacts, and coping strategies of UPBs among emergency department nurses in China.

DESIGN

Descriptive qualitative study.

METHODS

This study was conducted in the emergency department nurses of five hospitals in China between February and March 2026. A total of 21 registered nurses aged ≥ 18 years who were currently in practice were recruited using purposive sampling. Data were collected using semistructured interviews until thematic saturation was achieved. Data analysis was performed using qualitative content analysis.

RESULTS

Three main themes emerged-sources, impacts, and coping-highlighting that UPBs arose from high-pressure environments and distorted loyalty, led to moral distress and normalization, and was managed with adaptive and self-rationalizing strategies.

CONCLUSIONS

UPBs among emergency nurses constitute a vicious cycle fueled by workplace stressors, implicit cues, and coping strategies, which profoundly affects individual well-being and organizational ethics. These findings suggest that source-oriented humanistic interventions, including environmental optimization, ethical support, competence enhancement, and cultural reshaping, are essential for practice.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should target systemic and cultural drivers of UPBs, clarify ambiguous expectations, establish ethical support (e.g., confidential reporting and debriefings), model integrity-based leadership, and decouple loyalty from unethical compliance. These actions are designed to alleviate ethical distress, reduce rule-bending, and break the vicious cycle in emergency settings.

REPORTING METHOD: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contributions.