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Stress Among Charge Nurses

Stress Among Charge Nurses

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Published by Rey Allan Bonus

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Categories:Types, Research
Published by: Rey Allan Bonus on Nov 09, 2010
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05/14/2013

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Stress among Charge Nurses: Tool Development andStress Measurement
Hanna Admi, PhD, RN; Yael Moshe-Eilon, PhD, RNPosted: 09/17/2010; Nurs Econ. 2010;28(3):151-158. © 2010 Jannetti Publications, Inc.
Abstract and Introduction
Introduction
Changes in health care systems, including the international shortage of nursing staff, have implications on rolestress felt by nurses, especially by nursing managers. In a review of 68 articles on nurses' role stress, the mostfrequently identified stressors were workload, role conflict, ambiguity, and lack of support (Chang, Hancock,Johnson, Daly, & Jackson, 2005). Stress leads to job dissatisfaction, burnout, and absenteeism; also, negativelyimpacts patients (Aiken et al., 2001; Lee & Henderson, 1996).Most research has focused on traditional and general role stressors, measured by standardized tools. Studies of the specific stressors unique to nursing roles are few. One such role is the managerial role of charge nurses inhospitals. Charge nurses serve on the front line of the profession. They are expected to be responsiblesimultaneously for three separate groups of clients: patients, nursing staff, and multi-disciplinary staff. Thecharge nurse has a central role in patient outcomes and safety, the well-being of the nursing staff, liability prevention, and managing a multi-disciplinary team (Doherty, 2003; Sherman, 2005).Though a complex and challenging position, the role of the charge nurse has received little attention in nursingliterature compared with other nursing leadership positions (Connelly, Yoder, & Miner-Williams, 2000; Miner-Williams, Connelly, & Yoder, 2000; Sherman, 2005).The objectives of this study were:1.
 
Develop a specific tool for measuring the stress of charge nurses in hospitals.2.
 
Assess the level of stress of charge nurses.3.
 
Explore the relationship between stressors and demographic characteristics (age, seniority, andeducation).
L
iterature Review
In their review of 100 studies, Lambert and Lambert (2001) found the following to be associated with nurses'role stress: high job demands; low supportive relationships; dealing with death and dying; work overload;uncooperative family members and clients; inability to reach physicians; unfamiliarity with situations; concernfor the quality of nursing staff, medical staff, and patient care; inability to deliver quality nurse care; timedemands; state laws restricting the ability to carry out the advanced practice role; poor relationships withsupervisors, co-workers, and physicians; and low organizational commitment.According to Lazarus and Folkman (1984), stress is a complex multi-dimensional phenomenon focusing on a particular dynamic relationship between a person and his/her environment. They proposed that stress isdetermined by a person's subjective perceptions and interpretations of a given transaction as taxing or exceedinghis/her resources and endangering his/her well-being. In applying this theory to the charge nurse, we focus on
 
the demands of the role and on nurses' resources such as competencies, knowledge, clinical experience, andsocial support.The charge nurse is responsible for a hospital patient care unit during the evening and night shifts in the absenceof the nurse manager. This role is critical, particularly considering workforce shortage and the high demands for nurse proficiency. The charge nurse is responsible for the proper function of the unit during the shift, and for maintaining appropriate standards of care and professional staff/patient interactions. This position often provides the first opportunity for formally exercising the leadership skills that nurses use throughout their careers (Connelly et al., 2000; 2003).
Stress among Charge Nurses
The charge nurse is required to use managerial as well as clinical expertise (Connelly et al., 2003; Sherman,2005). Charge nurses are expected to always be available, to be in control of all activity taking place in the patient care unit, and to serve as role models to the staff (Castledine, 2001).Recently, additional demands have been added to the charge nurse position in many organizations: proficiencyin computerized nursing records, coordination of the activity of the unit as a whole, and clinical expertise in aspecialized field of nursing. The charge nurse is expected to be clinically competent, to assess patientsthoroughly, to plan patient care, and to evaluate nursing interventions based on evidence, protocols, and procedures (Castledine, 2001). The charge nurse is not expected to supervise the bedside work of the staff nurses in the patient care unit, but to provide advice and support when his/her expertise is required (Endacott,1999). Critical thinking skills enable charge nurses to troubleshoot and think ahead (Connelly et al., 2000).Other important role demands and expectations are the ability to prioritize the workload; to become an activemember of an emergency team; to assist staff members with heavy or difficult assignments; to dealempathetically with family members; to communicate effectively with medical staff members, peers, and other health care professionals; to solve dilemmas of conflict management; and to foster team building (Ambrose,1995; Sherman, 2005). The role requires making difficult and potentially unpopular decisions, such as assigninga new admission to an overburdened staff nurse (Connelly et al., 2000).The high stress inherent in the charge nurse position is apparent. Frequent decision making, regular interruptions, and high expectations for constant availability and assistance make it one of the most stressfulroles in nursing (Connelly et al., 2000). Though the stress factors mentioned here are felt by all nurses, theymay be most strongly experienced by the charge nurse, due to his/her accountability for leadership activity inthe absence of the nurse manager during shifts. Therefore, we hypothesized that the main stress factors oncharge nurses are role specific.
Methods
Design
This quantitative descriptive study identified stress factors related to the role of the charge nurse. Data werecollected via an anonymous self-completed questionnaire among charge nurses and nurse managers at thelargest tertiary hospital (900 beds) in the northern region of Israel.
Sample
Table 1 presents the demographic characteristics of a convenient nursing sample obtained from all the patientcare units at the hospital (N=45). Of 215 charge nurses, potential charge nurses, and nurse managers whoconsented to reply voluntarily and anonymously, 129 nurses completed the study's questionnaire (60% response
 
rate). The inclusion criterion was the completion of a preparedness program for charge nurses. The samplecharacteristics are representative of the intended hospital staff population.
Table 1. Demographic Characteristics (N = 129)Gender
 Male 22 (17%)Female 105 (81.5%)Missing 2 (1.5%)AgeUp to 30 years 53 (41.1%)31±40 years 42 (32.6%)41±50 years 20 (15.5%)51±60 years 13 (10.1%)Missing 1 (0.8%)Hospital Patient Care UnitsOncology 13 (10.1%)Internal medicine 34 (26.4%)Psychiatry 3 (2.3%)Surgery 25 (19.4%)Operating room 6 (4.7%)Intensive care 18 (14%)Maternity & Gynecology 15 (11.6%)Pediatrics 11 (8.5%)Missing 4 (3.1%)Professional SeniorityUp to 5 years 48 (37.2%)6±10 years 21 (16.3%)11±15 years 11 (8.5%)16±20 years 14 (10.9%)20+ years 21 (16.6%)Missing 14 (10.9%)Seniority in the Current Clinical FieldUp to 5 years 71 (55%)6±10 years 18 (14%)11±15 years 12 (9.3%)16±20 years 9 (7%)20+ years 18 (14%)Missing 1 (0.8%)Seniority as Charge Nurse None 32 (24.8%)Up to 1 year 19 (14.7%)2±5 years 31 (24%)6±10 years 7 (5.4%)11±15 years 10 (7.8%)15+ years 24 (18.6%)Missing 6 (4.7%)Job PartialityFull-time job 76 (59.4%)Part-time job 52 (40.6%)Missing 1 (0.8%)Post-Graduate Clinical CourseWith 58 (47.5%)Without 64 (52.5%)Missing 7 (5.7%)Professional EducationRN 25 (19.4%)RN + BA 81 (62.8%)RN + MA 22 (17.1%)Missing 1 (0.8%)

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