Nurse Manager Stress and Nursing Performance Outcomes

The article “Understanding nurse manager stress and work complexity” by Shirey et al. (2010) was a study about the various causes of stress for nurse managers, one of which was associated with performance outcomes. Shirey et al. (2010) argued that strong nurse leadership was essential to effective nursing, and a healthy and efficient work environment for nurses, but that overwork and stress are significantly debilitating the ability of nurse leaders to do their jobs well (pg. 82). Because nurse managers are so critical to the effectiveness of the nursing staff in general, the wellbeing of nursing leadership should be a priority. Shirey et al.’s (2010) article focused on what exactly a nurse manager’s job entailed and what factors acted as stressors.

While there were a number of stressors associated with nurse leadership, 67% of the study’s subject identified performance outcomes as a “major source of stress” (Shirey et al., 2010, pg. 84). Key among the outcomes mentioned was retention. The nurse managers who participated in the study indicated that inadequate staffing in general and retention concerns, in particular, made it difficult to provide a stable and efficient management experience to the staff (Shirey et al., 2010, pg. 84). Since retention was suggested to be so important to other performance outcomes, it would be reasonable for nurse managers to prioritize nurse retention for the good of the staff, the hospital and the patients.

One of the key components of nurse retention was identified by Kramer et al. (2012) as being a healthy work environment (pg. 149). One of the primary concerns of Kramer et al. (2012), both in their own study and in their recommendation for future research, was the definition of a healthy work environment. While no precise parameters were identified, the general consensus of existing literature was that a healthy work environment promoted the health and well-being of nurses and the efficient, high-quality care of patients (Kramer et al., 2012). This result combined with the findings of Shirey et al. (2010) suggested that professional nursing development and leadership, positive performance outcomes like high retention, and the generally desirable qualities of a healthy work environment are all cyclical with each other.

This conclusion has also been supported by other studies. Tourangeau et al. (2010) found that the intention of nurses to stay employed was heavily contingent on their overall job experience, particularly their confidence in the organizational structure of their hospital. One of the organizational issues most of the nurses in this study considered highly important was the degree of orientation and ongoing, on-the-job training for recently hired nurses (Tourangeau et al., 2010). Nurse managers are in an ideal position to identify and act upon situations in which better orientation or greater attention to training would benefit their staff. It is difficult for nurse managers to invest that degree of attention and energy in one aspect of their staff, however, when they are already intensely overworked.

Because the evidence indicates that strong leadership creates an environment in which nurses are happier and more efficient and that in turn eases the stress of leadership, it is evident that competent nurse leaders with reasonable workloads are key to a positive healthcare environment. Nurses will perform better and retention will be higher and patients will, in turn, receive faster and higher quality care. The governing body of a hospital would be wise to consider these findings and divert resources to ensuring that their nurse units are properly staffed to prevent the cascade of failures that can result from overworked nurse leaders. This is a message that could also be communicated to the nursing staff and to other nurse leaders for a healthier, more understanding work environment. All the administrative duties of a nurse manager might not be evident to a staff nurse, but if it was communicated that nurse managers have a lot of responsibilities that are not always evident, the staff might be more understanding of the load carried by nursing leadership. Other nurse leaders would also benefit from this discussion by the virtue of transparency. If they understand that expectations are higher and that their responsibility is sometimes a mystery, they may be more understanding and more motivated to provide the education to their staff that so many nurses identified as being critical to a positive work environment.

References

Kramer, M., Halfer, D., Maguire, P., & Schmalenberg, C. (2012). Impact of healthy work environments and multistage nurse residency programs on retention of newly licensed RNs. The Journal of Nursing Administration, 42(3), 148-159. 

Shirey, M. R., McDaniel, A. M., Ebright, P. R., Fisher, M. L., & Doebbeling, B. N. (2010). Understanding nurse manager stress and work complexity: Factors that make a difference. The Journal of Nursing Administration, 40(2), 82-91. 

Tourangeau, A. E., Cummings, G., Cranley, L. A., Ferron, E. M., & Harvey, S. (2010). Determinants of hospital nurse intention to remain employed: Broadening our understanding. Journal of Advanced Nursing, 66(1), 22-32. Retrieved April 28, 2013, from http://europepmc.org/articles/PMC3412219/reload=0;jsessionid=qEfVyoHKrMzrfVDJeyhq.0