Concepts, Models, and Theories on nurse mentorship and burnout
The job demands-resource (JD-R) theory operates on the assumption that job
demands lead to stress in the absence of certain resources (Bakker, 2017). Evaluation of
local site information indicated the absent resource as education focused on stress
reduction. A single theoretical framework was insufficient to guide this project. Aspects
of the nursing process were integrated with the JD-R theory to support the project
consistent with the steps of assessment, diagnosis, planning and outcomes, implementation,
and evaluation (American Nurses Association, 2016).
Job Demands-Resource Theory
The JD-R theory is an expansion of the job demands-resource model composed of
job design and stress theory proposed by Bakker in 2001 (Bakker & Demerouti, 2015).
This theory explains how job demands and resources have multiple effects on job stress,
ultimately impacting a worker’s level of engagement. A strength of the JD-R theory for
guiding this project was the flexibility of its application. According to Bakker (2011), all
work environments and all job characteristics can be grouped into two categories: job
demands and job resources. The category of job demands encompasses physical, social,
organizational, and psychosocial aspects associated with a psychological response
(Bakker & Demerouti, 2015). Although all job demands are not classified as negative,
examples of negative demands include high-pressure work environments and emotionally
demanding interactions (Bakker, 2011). A hindrance to performance is experienced when
an individual must consistently use extreme efforts to meet these demands and does not
adequately recover (Bakker, 2017). The category of job resources encompasses those
aspects that reduce job demands along with psychological costs, enhance function in
achieving work goals, and stimulate personal growth and development (Bakker &
Demerouti, 2015).
The application of the JD-R theory to nursing has been documented through
research studies focusing on nursing engagement, stress, and resource utilization.
Montgomery, Spânu, Băban, and Panagopoulou (2015) conducted a multilevel study
using the JD-R model as a framework to investigate nursing engagement and teamwork
across seven countries. Gao, Newcombe, Tilse, Wilson, and Tuckett (2014) published
models for predicting nursing turnover using JD-R as a theoretical basis for the initial
studies. Laschinger, Grau, and Finegan (2012) tested the JD-R to assess the transition of
graduate nurses into the nursing workforce and what aspects contributed to their stress.
These examples represent a sample of studies using the JD-R as a framework to
enhance nursing practice.
Relevance to Nursing Practice
The research on stress management and coping techniques for nurse managers has
been limited. Existing scholarship indicated that the position of a nurse manager is
stressful, supporting the premise that nurse managers experience high levels of stress
during a normal work day (Van Bogaert, Adriaenssens et al., 2014). Recent studies that
focused on nurse manager burnout, indicating that stress is associated with a management
position, did not include recommendations to enhance coping or prevention (Kunie,
Kawakami, Shimazu, Yonekura, & Miyamoto, 2017; Maxwell, 2016; Taylor, Roberts,
Smyth, & Tulloch, 2015; Warshawsky & Heavens, 2014). This project demonstrated
relevance to nursing practice by offering evidence-based solutions to a well-documented
challenge facing practicing nurse managers.
History
Researchers have addressed the topic of stress in relation to nurse management.
Literature searches revealed surveys and articles dating back to 1990 focused on the
effects of stress in the nurse manager role (Van Bogaert, Adriaenssens et al., 2014).
However, the practice of nursing has evolved since that time. McVicar (2003) focused
on identifying stress in nursing and nurse management through an in-depth literature
review spanning January 1985 to April 2003. McVicar discovered that the emotional
costs of distress had increased during that period along with lagging organizational
interventions focusing on stress. The role of nurse manager has shifted over the years
from a clinical focus to an administrative focus resulting in 10-12-hour work days, 24-
hour availability requirements, and complex facility issues (Zastocki, 2010). Shirey
(2008) indicated that as expectations of nurse managers increase, perceptions of stress,
reduced ability to cope, and potential for harm also increase. Zastocki (2010) indicated
that changing workplace demands, decreased clinical involvement, enhanced regulatory
requirements, and increased complexity of hospitalized patients have contributed to role
stress, challenges, and burnout.
Current State of Practice
Nursing is described as emotionally draining work with challenges that increase
levels of stress and possible burnout (American Nurses Association, 2014). Interventions
focusing on helping managers cope with stress vary by institution, but the availability to
access an employee assistance program is a constant (Richmond, Pampel, Wood, & Nunes,
2017). Current methods focused on enhancing individual renewal or relaxation, changing
certain factors within the work environment, and promoting mentorship for the
management team are yielding positive results (American Nurses Association, 2017).
Elevated levels of occupational stress faced by nurse managers were viewed as a
regular occurrence within the position (Kath et al., 2013). Modifying preventable
stressors was identified as a primary intervention to reduce nurse manager burnout
(Happell et al., 2013). This modification involves engaging nurse managers to facilitate
modifying their work environments based on local assessments (Happell et al., 2013).
Researchers examining occupational stress and coping for nurse managers
recommended preventing burnout by seeking advice from administrators or taking
mental breaks (Miyata & Suga, 2015). Udod & Care (2013) indicated that senior nurse
leaders play important roles in imparting knowledge and preparing less experienced
nurse managers to cope with role-related stressors. First-time nurse managers who are
empowered by senior leadership reportedly experience less stress than those who are not
(American Nurses Association, 2017).
When stressors become overwhelming for nurse managers, the nurse manager may
seek help from an employee assistance program. These programs were originally designed to
provide guidance to staff members who were experiencing acute phases of alcohol or
substance abuse but have grown to include issues with stress and coping at home or in the
workplace (U.S. Office of Personnel Management, 2017). Unfortunately, these programs are
underutilized in most settings with only 4-6% of employees accessing the benefits
(American Psychiatric Association, 2016; Zamosky, 2014). Managers may avoid these
programs because of perceived stigmas regarding substance use or mental health issues
(American Psychiatric Association, 2016; Richmond et al., 2017).
This doctoral project filled a gap in practice associated with stress education for
the nurse manager. Literature reviews revealed the prevalence of increasing stress in
nursing management. The practice of managers attempting to cope with stress in an
unsupportive environment facilitates a cycle of recruitment and retention issues (Moore,
Sublett, & Leachy, 2016). This project filled the gap in practice through the development
of a synthesized evidence-based education program for nurse managers. Health care
clinicians are now focusing on the patient to enhance the delivery of care. Viewing the
nurse manager as a whole and presenting education synthesized from best practices
would facilitate the development of enhanced coping skills for this group.
