Escape from the diffusion of responsibility: A review and guide for nurses
Open accessAbstract
AIMS: This review aims to help nurse leaders and professionals to understand, recognize, and mitigate the phenomenon known as the diffusion of responsibility, while also bridging a gap in nursing literature by highlighting Milgram's and Zimbardo's research. BACKGROUND: Nurses are uninformed of how responsibility is diffused when obeying authority figures, fulfilling roles, and conforming in groups. It is important to recognize and address this potential for unethical practices, given the high risk for these behaviours to occur in health care settings. EVALUATION: Sources discussing the diffusion of responsibility were identified through databases using terms such as: "Diffusion of Responsibility," "Nursing," "Ethics," "Obedience," "Groupthink," "Bully," "Milgram," and "Zimbardo." KEY ISSUES: Social psychology examples of diffused responsibility from Milgram, Zimbardo, and Janis are explored, applied to the field of nursing, and leadership implications are discussed. CONCLUSION: Nurses can unintentionally ascribe accountability for personal action to others. It is therefore essential for nurses to escape the cycle of diffused responsibility. IMPLICATIONS FOR NURSING MANAGEMENT: Examples in this review provide important clues for addressing the negative effects of diffused responsibility. The onus is on nurses to personally enhance the ethics of their practice by surveying, pondering, and applying these concepts.
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Cites
Behavioral Study of obedience.
Milgram, S. (1963) · The Journal of Abnormal and Social Psychology · doi:10.1037/h0040525 · Cited by 4,918 · see citing works
Moral Disengagement in the Perpetration of Inhumanities
Bandura, A. (1999) · Personality and Social Psychology Review · doi:10.1207/s15327957pspr0303_3 · Cited by 4,228 · see citing works
Group inhibition of bystander intervention in emergencies.
Latane, B., & Darley, J. M. (1968) · Journal of Personality and Social Psychology · doi:10.1037/h0026570 · Cited by 1,252 · see citing works
A Study of Prisoners and Guards in a Simulated Prison
Haney, C. W., Banks, C., & Zimbardo, P. G. (2004) · Intellect Books · doi:10.2307/j.ctv36xvxrb.6 · Cited by 452 · see citing works
Twenty-Five Years of Groupthink Theory and Research: Lessons from the Evaluation of a Theory.
Turner, M., & Pratkanis, A. R. (1998) · Organizational Behavior and Human Decision Processes · doi:10.1006/obhd.1998.2756 · Cited by 297 · see citing works
Zimbardo, P. (1973) · Cognition · doi:10.1016/0010-0277(72)90014-5 · Cited by 232 · see citing works
AN EXPERIMENTAL STUDY IN NURSE-PHYSICIAN RELATIONSHIPS
Hofling, C. K., Brotzman, E., DALRYMPLE, S., GRAVES, N., & Pierce, C. M. (1966) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-196608000-00008 · Cited by 210 · see citing works
‘Don’t rock the boat’: Nursing students’ experiences of conformity and compliance
Levett-Jones, T. L., & Lathlean, J. (2008) · Nurse Education Today · doi:10.1016/j.nedt.2008.10.009 · Cited by 175 · see citing works
The Life of Florence Nightingale
Cook, E. T. (1914) · AJN American Journal of Nursing · doi:10.2307/3404885 · Cited by 142 · see citing works
Meta-Milgram: An Empirical Synthesis of the Obedience Experiments
Haslam, N., Loughnan, S., & Perry, G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0093927 · Cited by 83 · see citing works
Systematic biases in group decision-making: implications for patient safety
Mannion, R., & Thompson, C. (2014) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzu083 · Cited by 79 · see citing works
Moral Disengagement Through Displacement of Responsibility: The Role of Leadership Beliefs
Hinrichs, K. T., Wang, L., Hinrichs, A. T., & Romero, E. J. (2012) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.2011.00869.x · Cited by 61 · see citing works
The Stanford Prison Experiment
Onishi, S. L., & Hebert, R. S. (2014) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909114552126 · Cited by 57 · see citing works
Revisiting the Stanford Prison Experiment: A Case Study in Organized Skepticism
Kulig, T. C., Pratt, T. C., & Cullen, F. T. (2016) · Journal of Criminal Justice Education · doi:10.1080/10511253.2016.1165855 · Cited by 33 · see citing works
Longo, J. (2013) · Journal of Nursing Management · doi:10.1111/jonm.12173 · Cited by 33 · see citing works
Tolich, M. (2014) · Research Ethics · doi:10.1177/1747016114523771 · Cited by 32 · see citing works
When managers pressure employees to behave badly: Toward a comprehensive response
Tepper, B. J. (2010) · Business Horizons · doi:10.1016/j.bushor.2010.07.002 · Cited by 26 · see citing works
The Bully Within and Without: Strategies to Address Horizontal Violence in Nursing
Egues, A. L., & Leinung, E. Z. (2013) · Nursing Forum · doi:10.1111/nuf.12028 · Cited by 25 · see citing works
Hoyk, R., & Hersey, P. W. (2008) · Stanford University Press eBooks · doi:10.1515/9780804776134 · Cited by 25 · see citing works
From obedience to contagion: Discourses of power in Milgram, Zimbardo, and the Facebook experiment
Recuber, T. (2015) · Research Ethics · doi:10.1177/1747016115579533 · Cited by 15 · see citing works
Are theoretical perspectives useful to explain nurses' tolerance of suboptimal care?
Price, L., Duffy, K., McCallum, J., & Ness, V. (2014) · Journal of Nursing Management · doi:10.1111/jonm.12239 · Cited by 14 · see citing works
Bullying in nursing and ways of dealing with it.
Lowenstein, L. F. (2013) · PubMed · Cited by 11 · see citing works
Avoiding "groupthink" A manager's challenge
MacLeod, L. (2011) · Nursing Management · doi:10.1097/01.numa.0000394953.94337.b4 · Cited by 7 · see citing works
Groupthink as Social Identity Maintenance
Turner, M. E., Pratkanis, A. R., & Struckman, C. K. (2011) · Psychology Press eBooks · doi:10.4324/9780203818565-9 · Cited by 7 · see citing works
Rosenblum, E. H. (1982) · JONA The Journal of Nursing Administration · doi:10.1097/00005110-198204000-00007 · Cited by 5 · see citing works
The Root Causes of Unethical Behavior
Hoyk, R., & Hersey, P. W. (2010) · Cited by 5 · see citing works
The Ethics of Medical Experiments: Have We Learned the Lessons of Tuskegee and the Holocaust?
Starck, P. L., & Holeman, D. S. (2014) · Springer eBooks · doi:10.1007/978-3-319-05702-6_15 · Cited by 1 · see citing works
Blumenreich, G. A. (2004) · PubMed · Cited by 1 · see citing works
Flagged first, then by citations
1 of the 29 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Czech, H., Hildebrandt, S., Reis, S. P., Chelouche, T., Fox, M. A., López, E. G., Lepicard, É., Ley, A., Offer, M., Ohry, A., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)01845-7 · Cited by 81 · see citing works
Westbrook, J. I., Li, L., Raban, M. Z., Woods, A. J., Koyama, A. K., Baysari, M. T., Day, R. O., McCullagh, C., Prgomet, M., Mumford, V., et al. (2020) · BMJ Quality & Safety · doi:10.1136/bmjqs-2020-011473 · Cited by 77 · see citing works
Groupthink among health professional teams in patient care: A scoping review
DiPierro, K., Lee, H., Pain, K. J., Durning, S. J., & Choi, J. J. (2022) · Medical Teacher · doi:10.1080/0142159x.2021.1987404 · Cited by 48 · see citing works
Generational diversity in nursing practice environments – scoping review
Sanches, D. M. M., Pereira, S. C. D. A., de Castro, S. F. M., Mendes, M., Santos, E. J. F., & Ribeiro, O. M. P. L. (2024) · BMC Nursing · doi:10.1186/s12912-024-02607-3 · Cited by 35 · see citing works
Quiet quitting: Obedience a minima as a form of nursing resistance
Domingue, J., Lauzier, K., & Foth, T. (2024) · Nursing Philosophy · doi:10.1111/nup.12493 · Cited by 28 · see citing works
Bushuven, S., Dettenkofer, M., Sippel, S., Koenig, S., Bushuven, S., & Schneider‐Brachert, W. (2020) · PLoS ONE · doi:10.1371/journal.pone.0239444 · Cited by 20 · see citing works
Castrellón, L. E. (2021) · Educational Studies · doi:10.1080/00131946.2021.1892680 · Cited by 17 · see citing works
Black, S. A., Capdeville, M. J., Augoustides, J. G., Nelson, E. W., Patel, P. A., Feinman, J. W., Gordon, E. K. B., Lockman, J. L., & Yanofsky, S. D. (2019) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2019.01.001 · Cited by 14 · see citing works
Teti, S. L. (2023) · Metamedicine · doi:10.1007/s11017-023-09608-4 · Cited by 7 · see citing works
Gorjian, Z., Asadizaker, M., Zarea, K., Irajpour, A., Ahmadi, F., & Rokhafroz, D. (2024) · BMC Medical Education · doi:10.1186/s12909-024-05633-6 · Cited by 7 · see citing works
Basir, M. F. M., Ibrahim, M. I., Mohammad, W. M. Z. W., Fuzi, N. M. H. M., Rosli, A. S., Rahman, M. S. A., Rosedi, A., & Hairon, S. M. (2025) · One Health Outlook · doi:10.1186/s42522-025-00137-9 · Cited by 7 · see citing works
Luo, Y., Ran, H., Deng, Y., Li, H., Zhang, M., & Zhao, L. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.973827 · Cited by 7 · see citing works
Changes of Causal Attribution by a Co-actor in Situations of Obvious Causality
Hayashida, K., Miyawaki, Y., Nishi, Y., & Morioka, S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.588089 · Cited by 6 · see citing works
Ethical Decision-Making in School Mental Health
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.001.0001 · Cited by 4 · see citing works
The Role of Students’ Moral Identity, Mood and Intelligence in the Mechanisms of Moral Disengagement
Azimpour, A., Karimian, N., Khajavi, Y., & Mohammadi, N. (2024) · Psychological Studies · doi:10.1007/s12646-024-00812-3 · Cited by 3 · see citing works
Haff, N., Horn, D. M., Bhatkhande, G., Sung, M., Colling, C., Wood, W., Robertson, T., Gaposchkin, D. P., Simmons, L. H., Yang, J., et al. (2025) · American Heart Journal · doi:10.1016/j.ahj.2025.02.007 · Cited by 2 · see citing works
Schwinn, T., Hirschmiller, J., Wiltink, J., Zwerenz, R., Brähler, E., Beutel, M. E., & Ernst, M. (2025) · Archives of Suicide Research · doi:10.1080/13811118.2025.2533195 · Cited by 1 · see citing works
Three Explorative Studies on Responsibility and Escape from Responsibility: A Facet Theory Approach
Bar-Haim, A. (2025) · Journal of Human Resource and Sustainability Studies · doi:10.4236/jhrss.2025.134026 · Cited by 1 · see citing works
Sembiring, A., Yustina, I., Zulfendri, Z., Setiawan, S., & Nasution, S. S. (2022) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2022.9219 · Cited by 1 · see citing works
Relational Responsibility: Bringing the Wider Social Environment into the Analysis
Ong, S. A. K., & Savulescu, J. (2025) · Asian Bioethics Review · doi:10.1007/s41649-025-00379-9 · Cited by 1 · see citing works
Sato, T. (2025) · Journal of Japan Academy of Nursing Science · doi:10.5630/jans.45.392 · Cited by 1 · see citing works
General palliative hospital care – a Danish nationwide survey of organization and clinical practice
Bergenholtz, H., Ikander, T., Refer, I. F., Mikkelsen, T. B., & Benthien, K. S. (2026) · BMC Palliative Care · doi:10.1186/s12904-026-02005-3 · Cited by 1 · see citing works
Was Pflichtfortbildung mit „Pflicht“ und „Fortbildung“ zu tun hat
Bushuven, S., Strametz, R., & Arn, C. (2020) · Krankenhaushygiene up2date · doi:10.1055/a-1033-6896 · Cited by 1 · see citing works
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.002.0006 · Cited by 1 · see citing works
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0005
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0004
Know Yourself and Your Responsibilities
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0001
Review and Document the Process
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0007
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0006
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0002
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0008
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0003
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.003.0009
طه, س. إ. ج., أحمد, ط. ط., & عبدالعزیز, أ. ع. ز. (2022) · المجلة العلمية للدراسات التجارية والبيئية · doi:10.21608/jces.2022.248175
Verantwortungsdiffusion in der Hämodialyseshuntpflege
Griesau, L. (2022) · Dialyse aktuell · doi:10.1055/a-1873-7192
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.002.0004
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.002.0009
Raines, J. Z. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.005.0001
Raines, J. C., & Dibble, N. T. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197506820.002.0008
Innovations in Older Adult Care and Health Service Management: A Focus on China
(2024) · Frontiers research topics · doi:10.3389/978-2-8325-4917-9
Nursing Education and Public Health Campaigns in Reducing Communicable Disease Transmission
Alanazi, D. H. S., Almutairi, A. M. D., Alanazi, E. K. G., Alhazmi, L. M. S., Altarfawi, D. S. B., Aljabbab, A. A., Alsulimi, H. S. M., Alraddadi, M. A., Qarah, B. B., & Alrashdi, F. H. A. (2024) · International Journal of Computational and Experimental Science and Engineering · doi:10.22399/ijcesen.4187
Zeid, M. A. G. A., Al-Sabeely, A. A., & Ibrahim, I. A. (2025) · Journal of Nursing Management · doi:10.1155/jonm/6932401
Meelarp, N., Singjaroen, P., Suasamserm, S., Chaijittiprasert, P., & Wongtanasarasin, W. (2026) · Journal of Patient Safety · doi:10.1097/pts.0000000000001493
AI-Assisted Simulations to Explore Responsibility and Escape from Responsibility
Bar-Haim, A. (2026) · Journal of Human Resource and Sustainability Studies · doi:10.4236/jhrss.2026.143019
- Authors
- Christensen, S. S.
- Affiliations
- University of Utah (US)
- Corresponding author
- Christensen, Scott S.
- Venue
- Journal of Nursing Management
- Publisher
- Wiley
- Published
- 2018-09-04
- Volume
- 27
- Issue
- 2
- Pages
- 264-270
- ISSN
- 0966-0429 (ISSN-L)
- OpenAlex
- W2891023874
- Cited by
- 44
- References
- 29
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 18 · 2020: 3 · 2019: 1
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Nursing Management (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Psychology of Social Influence
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Social Sciences › Decision Sciences › Information Systems and Management › Ethics in Business and Education
- Keywords
- diffusion of responsibility, Milgram obedience experiments, groupthink, bullying, nursing ethics, nursing leadership, accountability, social psychology
- MeSH terms
- Cooperative Behavior, Ethics, Nursing, Humans, Nurses, Social Behavior, Social Responsibility, Nurse's Role
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