June 30, 2017
When Coping Strategies Are Not Enough in a Highly Pressured and Complex Environment A Research for Health Follow-Up
“I remember talking with one nurse manager in an acute facility and asked her what it was like being a nurse manager on her unit. She began to cry,” describes Dr. Sonia Udod. “That’s a strong reason to undertake this research.”
Dr. Sonia Udod, Assistant Professor in the College of Nursing at the University of Saskatchewan began her research as a 2013-14 SHRF Establishment grant recipient, and Top Researcher in Socio-Health, during a time of high turnover for nurse managers in Saskatchewan’s acute care health system. Little research had been done in Canada in the areas of stress and the coping mechanisms of nurse managers in this setting. The nurse manager has assumed a more critical role in managing challenging healthcare workplaces and workforce issues. The nurse managers’ work day frequently consists of responding to multiple demands, often with incomplete information, time constraints, frequent interruptions, and workload pressures that have an impact on staff, patient, and organizational outcomes. With the help of SHRF funding, Udod and her team have shed light on the top role stressors and coping strategies of nurse managers, that can ultimately facilitate healthier work environments. Stress can impact nurse managers’ mental and physical health and thus affect their managerial performance and intent to stay in the role.
Top Role Stressors
Senior Management’s Disconnection from Practice – Participants in the study felt that senior management lacked the understanding of what nurse managers face in their everyday work practice. Often it seemed as if there was a disconnection between how middle and senior managers wanted initiatives implemented and how front line staff believed initiatives should be done. Even when there was a feeling of support from senior management, it can often be like “swimming upstream” to voice another viewpoint.
Working with Limited Resources – Referring to budget and human resources, but also to the idea of time scarcity, or not having enough time to accomplish what you want to accomplish. Nurse managers are more and more being pulled away from their units due to meetings or committee work, making them less visible or accessible to their staff.
Fragile Interpersonal Relationships – Focusing on the pressure that staff feel when they’re forced to deal with change without resources in place. Having less ability to control what and how they do what they do, staff can often turn on their managers. This results in push back and resistance, conflict and miscommunication, which causes nurse managers to spend a lot of time in crisis mode and affects their ability to do their work. Without support in place to handle the changes, this can be an “add on” to what nurse managers must deal with on a daily basis.
Top Coping Strategies
Planful Problem Solving – This includes being aware and being proactive. By ensuring that nurse managers are visible on the unit and are able to build and support relationships with staff, they know what is happening and can work to solve issues for staff and alleviate their own stress down the road.
Reframing Situations – This is a psychological process that involves reflecting, reorienting and reconciling situations as a way to downplay anxiety and fear.
Having Social Support – This comes from all directions, including directors, colleagues, family and friends. Particularly, when this support existed with upper management, found it particularly helpful as a sounding board to vent, share ideas and attain guidance to navigate the intricacies of the role.
A major finding of Dr. Udod’s research is that the nurse manager is the person that creates and sustains a healthy work environment for the unit. A nurse manager’s efforts are compromised due to overwhelming stressors that extend beyond the top three mentioned earlier to include adherence to changing policies and standards, meeting union agreements and the introduction of new initiatives, such as the Lean management system. Increasing patient health care needs, such as patients facing comorbidities, the fact that people are living longer, caregiver needs, or that they may have to travel a long way for care, add to the stress of nurse managers as they are accountable for safe, competent, and coordinated care by nursing staff enabling nurses to carry out their complex roles.
Nurse managers want to do meaningful work, which is important for senior leaders. However, nurse managers face huge, complex and changing organizational stressors, and coping strategies aren’t always enough given the intensity of their role in the delivery of effective health care.
This understanding of nurse manager stressors and coping strategies also becomes a key factor in not only retaining, but recruiting nurse managers. Dr. Udod and her team noted that nurse managers need to be able to talk positively about their work for the position to be a desirable next step for some staff, especially Generation Y, who don’t always see it as desirable to take on those leadership roles with the overwhelming stress they observe.
Dr. Udod’s team includes Dr. Greta Cummings, professor at the University of Alberta and 2015 inductee to the Sigma Theta Tau International Nursing Research Hall of Fame, and Dr. W. Dean Care, dean and professor at Brandon University. Her team continues to expand their research and find ways to share the results in meaningful ways with nurse managers and senior leadership in Saskatchewan’s acute care health system to improve not only the work environment, but positive patient outcomes as well.
With the original, SHRF-funded study taking place in Saskatchewan and Alberta, and mainly in an urban setting, team member Dr. Care and Sonia Udod have received funding to lead the replication of this study with a focus on rural nurse managers in Manitoba. This will not only expand the knowledge of the study but bring in a larger rural perspective that has a lot of relevance to our vast prairie province.
As Saskatchewan’s acute care health system faces another wave of nurse manager turnover, and with the impending amalgamation of health regions in the province, the onus will be on the organizations to decrease the number of stressors and reduce chronic stress can affect long term health when the ability to cope is not enough.
To read how Dr. Udod’s research began, check out her story in our first edition of Research for Health.