Conceptualising doctors' and nurses' experience of formal and informal solidarity: A Meta-Ethnography Protocol

Negative healthcare professional experiences of work can undermine health system stability by contributing to shortages, burnout and poor retention. Research into doctors' and nurses' working conditions indicates the important role of 'solidarity' to their working experience. There is limited understanding of formal (trade unions, industrial action) and informal (peer-support, camaraderie) solidarity in shaping doctors' and nurses' working experience. This study aims to conceptualise both forms of solidarity as perceived by doctors and nurses to understand its potential on their working experience. This qualitative evidence synthesis (QES) protocol is reported following PRISMA-P recommendations. A search strategy has been developed using controlled vocabulary and free terms (MEDLINE, CINAHL, Scopus Embase, PubMed databases), following the Peer Review of Electronic Search Strategies (PRESS) process. English language articles will be included if they report primary, conceptually rich and contextually thick qualitative data, exploring the perceptions of informal and formal solidarity as experienced by qualified doctors and/or nurses. Its influence on the working experience, as reported by included studies, will be explored. Initial title and abstract screening, followed by full-text screening of included articles, will be completed independently by two reviewers. A grey literature search will be employed, including a targeted, domain-specific Google search of doctor and nurse national unions within ten countries with highest union density, and websites of intergovernmental organisations/agencies. Piloted data extraction forms will be used to extract study characteristics and qualitative data. The CASP (Critical Appraisals Skills Programme) tool will be used to assess the quality of included studies by two reviewers, independently. Confidence in cumulative findings will be assessed using GRADE-CERQual guidelines. The QES will be reported using eMERGe guidelines and will follow the Noblit and Hare meta-ethnography approach. Registration Number: This protocol has been registered via the PROSPERO database, the International Prospective Register of Systematic Reviews. The protocol can be found on the register under the following number: CRD420251150676. Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251150676. PROSPERO Registration: CRD420251150676.