Objective: The purpose of this study was to gain insight into nurse managers’ stress experiences and coping strategies in order to better support them. Design: A qualitative exploratory descriptive research design was used in this study. Subject: Fifteen nurse managers participated in this study. Results: Three descriptive themes related to nurse managers’ occupational stress were identified: role overload, loneliness, and role conflict. We also identified three descriptive themes that contributed to their stress management: sufficient support and advice, taking mental breaks while off duty, and individual coping strategies. Conclusions: Our study proposes two recommendations to reduce nurse managers’ stress. First, for nurse managers who experience work overload, hospitals should support them in learning how to work efficiently and how to manage their response to work demands. Second, nurse managers’ primary stressors were loneliness and role conflict. Nurse managers are known to juggle multiple demands from the hospital nursing director and staff nurses. Although it is difficult to eliminate the role conflict, nurse managers should be guided on how to manage conflicting demands, the hospital nursing director and staff nurses.
Over the last decade, management in nursing has become increasingly demanding [
The research questions were as follows:
1) What are nurse managers’ occupational stressors?
2) How do nurse managers cope with their stress?
The aim of this study was to gain insight into nurse managers’ perceptions of stress and to learn their coping strategies.
Work-related mental health results primarily from increased workplace satisfaction and from mitigating work- related stress. Among nurses, specific environmental stressors have been identified, including unpredictable staffing and scheduling, lack of role clarity, little involvement in decision-making, poor status, and poor support [
A qualitative exploratory descriptive research design was used to gain an in-depth understanding of nurse managers’ stress and coping strategies using semi-structured interviews.
Data were collected from July to August 2012. All face to face interviews were conducted by researcher. The study was completed when the data has been saturated. Interview topic guide designed by researchers and experts from the faculty of psychology. The questions on the interview guide focused on the views of the job-stress of nurses [
1) What are the major occupational stressors that you face as a nurse manager?
2) How do you deal with your concerns?
3) Does your hospital offer any support?
4) Can you cope with your stress positively?
5) What do you do when you feel tired or stressed?
6) What do you think is the effect of your mental health on your staff?
All interviews lasted for 30 to 60minutes and were audio recorded in a private room at each hospital.
Fifteen nurse managers participated in this study. They were selected from five hospitals with 200 beds or more in the Kanto, Kansai, and Kyushu regions of Japan. Criterion sampling was used for intentional sampling, and each person had at least one year of experience as a nurse
The study was approved by the Ethics Committee of the Kyoto University Graduate School and the Faculty of Medicine. Additionally, research permission was given by the nursing department directors of all five hospitals. After receiving approval from each hospital, we explained the project and procedures to the nurse managers.
Data analysis was done simultaneously with data collection. The authors independently reviewed the transcriptions and constructed tables of code categories based on actual words or phrases (meaning units). We independently identified themes that represented one or more code categories and specific quotations that represented each code category; this qualitative content analysis approach was adapted from Graneheim and Lundman [
Participant Characteristics (
Age Mean (SD): 46.8 (6.0) | Experience as a nurse manager (years): 5.1 (2.3) | Academic background | Work unit Subhead |
---|---|---|---|
44 | 2 | Diploma in nursing | Education |
47 | 5 | Diploma in nursing | Outpatient |
50 | 1 | Diploma in nursing | Internal medicine ward |
50 | 9 | Graduate university | Surgery ward |
44 | 8 | Diploma in nursing | Intensive care unit |
47 | 7 | Junior college graduate | Internal medicine ward |
45 | 6 | Junior college graduate | Orthopedics ward |
51 | 7 | Diploma in nursing | Surgery ward |
50 | 4 | Diploma in nursing | Internal medicine ward |
45 | 5 | Junior college graduate | Stroke care unit |
49 | 7 | Junior college graduate | Dental oral surgery ward |
46 | 3 | Junior college graduate | Gastrointestinal and breast surgery ward |
46 | 3 | Junior college graduate | Cardiovascular ward |
47 | 4 | Junior college graduate | Respiratory, blood and oncology ward |
42 | 5 | Junior college graduate | High care unit |
The nurse managers were all women. The mean age was 46.8 years (range: 42 - 50 years). Mean years of work experience as a nurse manager was 5.1 years (range: one to nine years).
Three descriptive themes related to nurse managers’ stressors were identified: role overload, loneliness, and role conflict (
Role overload consisted of four subcategories: juggling many business roles; scheduling and coordinating human relationships; working with patients and families; and receiving numerous off-duty phone calls. Numerous and complex demands from staff members, colleagues, and families and multiple administrative duties caused overload, and high expectations also challenged nurse managers, who were asked to do too much for too many people in too little time. The nurse manager role has expanded over the years, mostly reflected in their greater responsibility for their staffs. The interviewees reported feeling overwhelmed, as reflected in the following comments:
“There is not enough time during the day. There are high expectations from staff, other health care professionals, and patients. There is not enough time during the day to manage multiple meetings, deal with patients’ and families’ complaints, and respond to staff needs.”
“I’ve often said, if there were no staff allocation problem, this job would be good to do. Yet indeed, staff allocation is a pain in the neck and gets me down day after day.”
The second major stressor identified by the participants was the sense of loneliness or isolation. This theme encompassed two subcategories: being solely responsible for managing ward-related problems and being unable to express fatigue because of the influence on staff members. Nurse managers expressed that because they could not share management problems with their chiefs and staff members, they worried about and experienced their problems on their own; they could not express their worries because of the influence on others, and they felt lonely. “We are stressed… a nurse manager is really lonely. I can consult the chief or staff members in my ward, but there are many things I cannot talk to them about―so I am carrying around the worries on my own”.
Role conflict consisted of two subcategories. Participants described feeling squeezed between conflicting demands: organizational performance targets from above and staff expectations from below and additional expectations from physicians and other department leaders, as reflected in the following comments:
“I do many things to improve the quality of nursing care. But sometimes it does not match the hospital policy. I can understand the feeling of the staff, but…”
“I consult the other department leaders and the physician about patient care. Sometimes, I feel anger, but it is not possible to show the anger.”
We also identified three descriptive themes related to their coping strategies: sufficient support and advice, taking
Theme | Sub-Category |
---|---|
Role overload | multiple business roles scheduling, coordinating human relationships working with patients and families numerous off-duty phone calls |
Loneliness | managing ward-related problems alone inability to show fatigue because of the influence on staff members. |
Role conflict | being caught between conflicting demands managing anger |
mental breaks when off duty, and general coping (
Regarding coping strategies, nearly half of the participants cited this theme as a significant stress mitigator. The theme consisted of three subcategories: advice from other administrators and nursing directors; sharing information with other nurse managers; and a hospital consulting system. Interviewee comments included:
“Fortunately, the senior nurse manager and vice nursing director listen to me. I receive advocating advice and criticism, too, but I feel happy that I can talk about my concerns to somebody else.”
“I would be very happy if there were an opportunity to share all my concerns with other nurse managers after work and receive appropriate advice from senior nurses.”
Another factor that decreased participants’ stress was taking mental breaks while they were off duty. This theme consisted of two subcategories: awareness of the importance of taking time off and recognizing physical symptoms such as fatigue. Participants were aware of the need to take time off in order to reduce their stress and expand their chief nurses’ training. Participants’ comments included:
“I think we need to take some rest. Some nurse managers work all the time without taking rest, so I believe we need rest.”
“In the past, even if I took rest, I received many phone calls, so I couldn’t take sufficient rest. Today, I transferred my responsibility to the chief nurse so I can take rest. I think it improves the chief’s motivation as well.”
This theme encompassed four subcategories: thinking positively; enhancing one’s private life; separating private life from work; and identifying individual effective strategies. Stress-related emotions differed between the novice and experienced nurse managers, and coping strategies differed depending on the nurse manager’s experience.
One novice nurse manager (with less than four years of experience) consulted other nurse managers as her coping strategy. Another eleven participants (who had more than four years of experience) spoke of coping strategies such as maintaining enriched relationships with their families, taking private time, and completely shifting from work to private life. Participants’ comments included the following:
“I would say that the first thing to do for stress coping is to talk with other nurse managers.” (a novice nurse manager)
“I have been in this position for seven years, and I have had a lot to learn. I am always trying not to think about my work when I am off duty and to give my attention to other areas such as my family.” (an experienced nurse manager)
Role overload and role conflict, which were extracted as stressors for nurse managers in this study, were consistent with the results obtained in other developed countries [
Theme | Sub-Category |
---|---|
Sufficient support and advice | advice from administrators and nursing directors sharing information with other nurse managers hospital consultation systems |
Taking mental breaks when off duty | awareness of the importance of taking time off recognizing physical symptoms such as fatigue |
Individual coping strategies | thinking positively enhancing private life keeping work and private life separate devising personal coping strategies |
guity and diversity are considered to contribute to the excessive number of roles nurse managers must serve [
Next, the theme of coping strategies, such as seeking advice from superiors and coworkers and developing individual coping strategies, supported the results from previous studies. The increasing span of control is reported to cause effects such as lack of mentoring, increased stress, and decreased job satisfaction [
By contrast, however, the sense of isolation that was extracted as a stressor in this study was not reported in other studies. Limited recognition of nurse managers’ roles as administrators and their inability to manage stress are considered the background for the above. In particular, it was difficult for novice nurse managers to establish personal coping methods. Therefore, it is necessary to provide novice nurse managers with opportunities to seek advice from experienced managers so that they are not isolated on their wards and their stress does not increase. Further, nurses’ need for continuing stress management education has been reported from clinical sites. Nurse managers are expected to achieve organizational objectives while establishing a healthy workplace for the staff in their units [
This study extracted general stress-related factors; “role conflict” and “sense of isolation” as stressors and “recognizing the need to rest” as a coping strategy were the primary factors extracted in this study, but the contents of specific stressors were not extracted. Therefore, in the future, it is necessary to collect quantitative data to supplement this study’s results with specific individual stressors, using questionnaires. The study results suggest the need to establish a system in which nurse managers’ duties are clearly defined and they can receive consultation and advice to reduce their stress.
In this study, we aimed to identify nurse managers’ occupational stressors and coping strategies through interviews. The results can be utilized for future nurse manager stress management, including offering suggestions for reducing stress. In addition, for nurse managers who feel overloaded, hospitals should support them in learning how to work efficiently and how to manage their responses to their job demands. Nurse managers are known to juggle multiple demands from hospital nursing directors and staff nurses. Although it is difficult to eliminate role conflict, nurse managers should be given a safe place to discuss their concerns and receive advice on how to manage their conflicting demands.
We found that nurse managers’ occupational stressors were role overload, loneliness, and role conflict, and their coping strategies included receiving sufficient support and advice from other administrators and nursing directors and taking mental breaks when they were off duty. However, individual coping strategies were very different. The nurse managers in this study appeared to recognize the impact of their stress on other staff members and also appeared to be aware of stress management strategies.
We thank all the nurses who took time from their busy schedules to participate in this study.
AChiharuMiyata,HidenoriArai,SawakoSuga, (2015) Nurse Managers Stress and Coping. Open Journal of Nursing,05,957-964. doi: 10.4236/ojn.2015.511101