Nurse Manager Stress and Work

¶ … Nurse Manager Stress and Work Complexity:

Factors That Make a Difference"

More than ever, there is a need for nurses. In fact, the nursing shortage could reach up to 500,000 by 2025 (Buerhas, Staiger & Auerbach, 2009.) A potential cause for this shortage is a stressful and draining work environment (Institute of Medicine, 2004.) In an article by The Journal of Nursing Administration (Shirey, McDaniel, Ebright, Fisher, & Doebbeling, 2010), researchers conducted a qualitative study to gain a greater understanding of the types of stress faced and coping mechanisms used by nurse managers. Because nurse managers are a critical component of the healthcare environment and help provide the foundation needed to build a secure and healthy workplace and retain quality staff, they were the focus and main participants of this study (Institute of Medicine, 2004 and American Association of Critical-Care Nurses, 2005.) This paper offers a critique of the article, including study details and findings, and is based on the required guidelines.

The phenomenon of this study focuses on the human experience in a stressful work environment, which is not necessarily a "natural" setting. In addition, the phenomenon is relevant to both nursing and health, and is in fact focused on the interconnection between the two -- how different types of stress affect the health of nurse managers.

For this study, a qualitative descriptive design was used and the findings reported in the article were based on three research questions. The research questions did not specify a distinct process to be studied, but instead provided a basis for understanding the situations that cause stress, the coping strategies used by nurse managers to combat these stressful situations, and the stress-related effects on health. It appears that the study was fairly objective, with no real biases reported by the researchers. Additionally, there was no structure of ideas provided that reflected the researchers' personal beliefs.

The research questions identify the context by referring to nurse managers. While the terms "nursing environment" are not specifically stated, one can assume that the context of the study is the nursing environment because the study is focusing on nurse managers in their work environment. The specific qualitative method used is the Critical Decision Method (CDM) and it fits with the research questions because it uses unusual incidents to understand how workers make decisions and judgments in the work setting (Crandall, Klein, & Hoffman, 2006.) This makes sense for the nursing environment because nurses must face many new and different challenges and make decisions on a daily basis.

It is clear that the selected sample is living the phenomenon of interest, however, the sample size seemed somewhat limited in scope. In the article, it was stated, "The limitations to the study included use of purposive sampling, which limited generalizability, and the use of cross-sectional measures, which provided only a snapshot of the phenomenon of interest," (Shirey, McDaniel, Ebright, Fisher, & Doebbeling, 2010.) Regardless, the researchers expressed that the 21 nurse managers studied from three different facilities represented a good sampling of varying levels of experience and diverse organizational cultures. The data sources and methods used to collect data were specified and included a demographic questionnaire and face-to-face interview that incorporated the components of the CDM.

In the article, it was not indicated if participant consent was an integral part of the data gathering process. However, there was evidence that consent was provided as the procedures were approved by all three institutional review boards and particularly because the nurses actively participated in the study. By participating, one can presume that each person's participation signified her consent. That said, the study could have been required by each employer, but since neither fact was stated, there is no real confirmation that each participant provided her personal consent.

The data analysis dimensions can be identified and logically followed. There was a definitive method used to gather the data, summarize the themes, and synthesize the data across the cases. Interviews were taped and analyzed when generating each case study. Collaboration with the research team helped with the overall qualitative content analysis. Overall, it appeared that the data analysis was based on a formal structure with direct quotes to support each key theme, and collaboration between researchers helped assess the qualitative content.

Because the interview process was built on the participant's self-identified situation, the researchers were able to provide a clear picture of each participant's reality. Much of the evidence used to capture the participant's meaning was through direct quotes.

Although it is not indicated that other professionals confirmed the researcher's interpretation, the findings from the study resonated with a smaller pilot study (Shirey, Ebright & McDaniel, 2008.)

Examples were provided to help guide the reader from the raw data to the researcher's synthesis. These examples included three major themes that were derived from the interview questions and 10 subthemes that were derived from the data analysis. With the themes and subthemes, researchers were able to categorize data across cases.

The study findings can be linked to an earlier pilot study, and the general need to create healthier work environments for nurses can be linked to existing studies and literature. Prior to the pilot study, there have been no other studies done on this subject matter targeting nurse managers. In the article, the findings more or less support the initial study purpose.

The ability to apply the study findings to other settings was not covered, as this study was specifically focused on the nursing environment. However, it is possible to glean some beneficial information about stress and its affect on health and job satisfaction, and thus to apply that knowledge to different work environments.

The study structure, findings, and recommendations make logical sense, yet it seems that there is still some room for interpretation. While the data analysis was very structured, researchers analyzed the qualitative content of the data through collaboration and discussion, which could have unintentionally influenced some of the results. Furthermore, each participant offered a self-identified situation, which might make it difficult to generalize each response. Yet, it does appear that the methods used were appropriate and that there were enough similarities in participant responses to adequately assess the data and provide recommendations. As stated in the article, "The data were provided by self-report; however, structured interviews like those used here are routinely used in leadership and management research," (Shirey, McDaniel, Ebright, Fisher, & Doebbeling, 2010.)

Above all, the authors did a good job of making the connection between the data gathered in the study, the tools used to assess that data, and the application to practice. The study findings also helped to provide a greater understanding of the challenges nurse managers face and the recommended areas that must be focused on to help improve staff retention and the overall nursing work environment going forward.

In the future, it might be helpful to build on this research by interviewing additional nurses and nurse managers and comparing the findings from this study with the results of future studies to further dissect and understand this complex subject.

Annotated Bibliography

Buerhas, P., Staiger, D., & Auerbach, D. (2009.) The Future of the Nursing Workforce in the United States: Data, Trends and Implications. Sudbury, MA: Jones & Bartlett Publishers. This book provides an extensive, integrated body of data on the forces shaping the United States' nursing workforce. The book also identifies and illustrates the major changes in the existing nursing workforce as well as provides forecasts and insights for the future.

Crandall B., Klein G., & Hoffman R. (2006.) Working Minds: A Practitioners Guide to Cognitive Task Analysis. London, UK; MIT Press. Somewhat of a handbook, this book provides a set of tools for performing Cognitive Task Analysis (CTA.) CTA helps provide researchers with an understanding of the cognitive skills and strategies people use to act effectively and accomplish tasks. Essentially, the book covers all the details of CTA methods, from examples and guidance to directions on how to study cognition in real-world settings and face the difficulties associated with rapidly evolving technology.