Stress in the Health Care Work Environment

Stress in the work environment is a concern from multiple perspectives (Taylor & Seeman, 1997). First, stress contributes to organizational inefficiency, high staff turnover, sickness absenteeism, decreased quality and quantity of care, increased costs of health care, and decreased job satisfaction (Wheeler & Riding, 1994). Second, Americans are spending increasingly greater time at work than in years past. This observation is particularly alarming given that 40% of American workers reported their jobs to be extremely stressful (U.S. Department of Health and Human Services, 1999). Nurse managers, in particular, usually work 12 to 14 hour days and have 24-hour accountability for their areas of responsibility (Rudan, 2002). Although the span of control in other industries such as the government sector may be 7 to 15 employees per supervisor (Office of the Vice-President of the U.S., 1993), the span of control for each nurse manager in acute care hospitals is 54, 44, 30, and 16 staff members in facilities of greater than 350, 100-349, 50-99, and less than 50 beds, respectively (AONE, 2002). In some health care facilities, however, span of control may exceed 100 employees per nurse manager and result in an inverse relationship between span of control and employee engagement (Cathcart et al., 2004). Third, the estimated cost of stress-related illnesses in the United States is $4.2 to $60 billion a year (Benton, 2000) with per employee annual costs reported at $13,000 regardless of profession (Bruhn et al., 1995). Because nurse managers practice in a human services profession, they are reportedly more at risk to experience the detrimental effects of stress and burnout (Maslach & Leiter, 1998a). Lastly, given that the literature supports a relationship between stress, coping, social support, and individual health outcomes, a program of study to explore these relationships is warranted in the setting of complex, constantly changing health care environments. In past years, the occupational stress and burnout literature seemed to cite personal characteristics of the individual as the primary contributors to negative health outcomes (Medland, Howard-Ruben, & Whitaker, 2004). Increasingly, the current literature seems to place more emphasis on work environment and organizational structure as the primary contributors to stress and burnout (Maslach & Leiter, 1998b; Maslach & Leiter, 1999). Because stress-related illness contributes to rising health care costs and disability, creating a healthy work environment is a priority for maintaining an adequate nurse workforce and safe environments for practice (AACN, 2005). Through their leadership behaviors, nurse managers play an integral role in creating the health care work environment and modeling the way for staff nurses. Research has identified the positive relationship between leadership behavior and staff nurse job satisfaction, productivity, and organizational commitment (McNeese-Smith, 1995; 1996; 1997). The cascading effect of leadership behaviors extends beyond modeling to include challenging the process, inspiring a shared vision, enabling others to act, and encouraging the heart (Kouzes & Posner, 2002). Managers can significantly reduce stress and increase communication (Blegen, 1993; Irvine & Evans, 1995) to enhance elements of the work environment conducive to job satisfaction and patient safety. Similarly, the complexity of the situations the nurse manager faces may overload managers beyond their own resources and this can have a detrimental impact on the work environment.