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Previous research has demonstrated that social-relational factors are instrumental to employee voice. An essential aspect of this relates to notions of respect or disrespect. Although nurses commonly report experiencing professional disrespect in their interaction with doctors, earlier studies have focused on how the professional status hierarchy and power imbalance between doctors and nurses hinder speaking up without considering the role of professional disrespect. Addressing this gap, we explore how professional disrespect in the doctor–nurse relationship in surgical teams influences the willingness of nurses to voice legitimate concerns about threats to patient safety.

Fifty-seven semi-structured interviews with nurses drawn from a range of specialities, ranks and surgical teams in three hospitals in a West African Country. In addition, two interviews with senior representatives from the National Registered Nurses and Midwifery Association (NRNMA) of the country were undertaken and analysed thematically with the aid of NVivo.

Disrespect is expressed in doctors’ condescending attitude towards nurses and under-valuing their contribution to care. This leads to safety concerns raised by nurses being ignored, downplayed or dismissed, with deleterious consequences for patient safety. Feeling disrespected further motivates nurses to consciously disguise silence amidst speech and engage in punitive silence aimed at making clinical practice difficult for doctors.

We draw attention to the detrimental effect of professional disrespect on patient safety in surgical environments. We contribute to employee voice and silence by showing how professional disrespect affects voice independently of hierarchy and conceptualise the notion of punitive silence.