Nurse Manager Stress, Coping, and Work Environment Research

Introduction

More than ever, there is a critical need for nurses. The nursing shortage could reach up to 500,000 by 2025 (Buerhas, Staiger & Auerbach, 2009). A potential cause of this shortage is a stressful and draining work environment (Institute of Medicine, 2004). In an article published in The Journal of Nursing Administration, Shirey, McDaniel, Ebright, Fisher, and Doebbeling (2010) conducted a qualitative study to gain a greater understanding of the types of stress faced by nurse managers and the coping mechanisms they employ. Because nurse managers are a critical component of the healthcare environment, helping 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; American Association of Critical-Care Nurses, 2005). This paper offers a critique of that article, including study details and findings.

Study Phenomenon and Research Design

The phenomenon of this study focuses on the human experience in a stressful work environment, which is not necessarily a "natural" setting. The phenomenon is relevant to both nursing and health, and is focused on the interconnection between the two — specifically, 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; instead, they provided a basis for understanding the situations that cause stress, the coping strategies used by nurse managers to combat those situations, and the stress-related effects on health. The study appeared fairly objective, with no real biases reported by the researchers and no framework of ideas that reflected the researchers' personal beliefs.

The research questions identify the context by referring to nurse managers. While the term "nursing environment" is not explicitly stated, one can reasonably assume that the context is the nursing work environment. The specific qualitative method used is the Critical Decision Method (CDM), which fits 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 is particularly appropriate for the nursing environment, where nurses must face many new and different challenges and make decisions on a daily basis.

Sample Selection and Data Collection

It is clear that the selected sample is living the phenomenon of interest; however, the sample size seemed somewhat limited in scope. As stated in the article, "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 noted 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 interviews that incorporated the components of the CDM.

Data Analysis and Findings

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 cases. Interviews were recorded and analyzed when generating each case study. Collaboration among the research team aided the overall qualitative content analysis. Overall, the data analysis appeared to be based on a formal structure, with direct quotes supporting each key theme, and researcher collaboration helping to assess the qualitative content.

Because the interview process was built on each 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 participant meaning was conveyed through direct quotes.

Although it is not indicated that other professionals independently confirmed the researchers' interpretations, the findings resonated with a smaller pilot study (Shirey, Ebright & McDaniel, 2008). Examples were provided to guide the reader from raw data to the researchers' synthesis. These examples included three major themes derived from the interview questions and ten subthemes derived from the data analysis. With these 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 connected to existing studies and literature. Prior to the pilot study, no other studies had been conducted on this subject matter specifically targeting nurse managers. The findings in the article largely support the initial study purpose.

The ability to apply the study findings to other settings was not addressed, as the study was specifically focused on the nursing environment. However, it is possible to draw some beneficial insights about stress and its effect on health and job satisfaction, and to apply that knowledge to different work environments.