Stress and Coping in Nurse Managers: A Qualitative Description

Abstract

Objective: This study provided a qualitative description of stress and coping as perceived by today's nurse manager incumbents. Background: The healthcare work environment as a source of overwork and stress has been implicated in today's nursing shortage. Nurse managers play a pivotal role in creating work environments for staff nurses, but little is known about the nature of nurse manager work. Methods: This qualitative descriptive study determined what situations contribute to nurse manager stress, what coping strategies they utilize, what health outcomes they report, and what decision-making processes they follow to address stressful situations in their roles. A purposive sample of 21 nurse managers employed at three U.S. acute care hospitals participated in the study. Participants completed a demographic questionnaire and a 14-question interview incorporating components of the Critical Decision Method. Content analysis was completed and themes identified. Results: Difficult situations reported included feeling pressure to perform, interpersonal conflicts associated with organizational communication deficits, and issues of human resources and staffing. Nurse managers utilized a combination of emotion-focused and problem-focused coping strategies. When comparing novice nurse managers (3 years or less in role) with experienced nurse managers (greater than 3 years in role), the novices used predominantly emotion-focused coping strategies, a narrow repertoire of self-care strategies, and experienced negative psychological, physiological, and functional outcomes related to their coping efforts. Experienced nurse managers working as co-managers demonstrated mostly problem-focused coping strategies, a broad repertoire of self-care strategies, and reported no negative health outcomes. The study produced a cognitive model in the form of 10 questions that guide nurse manager decision-making related to stressful situations. The study generated four themes amenable to intervention. Conclusions: Performance expectations for nurse managers in acute care hospitals have increased since the 1990's making the role requirements unrealistic. Rising expectations increase nurse manager stress perceptions, making coping more difficult, and potentially harming nurse manager and work environment well-being. Findings from this study suggest that to address stress, coping, and complexity in the nurse manager role requires a combination of strategies that address individual factors as well as organizational culture, supportive structures, and systems that facilitate the role.