Evidence-Based Education Program to Reduce Nurse Manager Burnout
The practice of nursing management is stressful, and stress can manifest in two
ways: eustress, which serves to facilitate drive and project focus, or distress, which can
lead to nurse burnout (O’Donovan, Doody, & Lyons, 2013). Acknowledgment that
work-related stress is inevitable facilitates a thought process leading nurses toward
eustress or distress (Sherrod & Campbell, 2015). Individuals must decide in which
direction the stress will progress. Previous experience or coping mechanisms affect how
individuals respond, often in the absence of alternative support systems (Mackoff,
Glassman, & Budin, 2013). Nurse managers experience stress responses and often
shoulder the burden of their stressors along with those of their staff members. The
creation of facility-specific resources for managers focused on stress reduction, such as
formalized support systems (Advisory Board, 2014) to better handle stressors, will result
in improved unit functioning, enhanced outcomes, and an overall increase in position
satisfaction (Miyata, Arai, & Suga, 2015).
The purpose of this DNP project was to develop an evidence-based educational
program focused on stress reduction and prevention to reduce nurse manager burnout.
This program included evidence-based techniques synthesized from best practices in
nursing and nursing management literature demonstrating effectiveness in helping nurses
cope with their daily stress. These evidence-based practices were synthesized to focus on
the nurse manager, resulting in an evidence-based program specifically intended to
support nurse managers in handling their stress. The practice environment for this project
was a magnet designated acute care hospital located in the Northeastern United States.
Potential benefits to the practicum site include a reduction in manager stress
levels, increased manager productivity, and greater position satisfaction.
Implementing evidence-based interventions to minimize distress or prevent nurse
manager burnout through the development of integrated manager support systems
may result in positive social change. Facilitating methods of stress management with
the intent of preventing manager burnout may enhance manager retention and unit
stability.
The role of a nurse manager in the acute care hospital has become
increasingly complex and stressful because of changing health care dynamics (Miyata
et.al, 2015). Stressors may increase based on the level of demand a manager faces
(Miyata et al., 2015). Research on how nurse managers handle stressors is limited.
At the project site, current practices involve managers developing unfocused
coping mechanisms to handle their stressors in the absence of clear resources for
individual stress management (HRC, 2016). Situations contributing to an environment
prime for burnout include high levels of distress, low manager-peer engagement, and
lack of support systems (HRC, 2016). Significance in the field of nursing management
was demonstrated at the project site by providing nurse managers with stress reduction
education specific to their unique practice needs.
At the project site, nurse managers experience elevated stress levels without a
system in place for stress management. According to the emergency department manager
(personal communication, February 2017), the facility does not currently have a
formalized process to assist managers in handling work-related stress. A lack of formal
stress management training or streamlined manager peer support for stressful situations
was reported in open forum by management staff members (HRC, 2016).
The emergency department manager reported that the topic of stress management
has been presented at management meetings and that other facilities in the hospital
corporation offer this type of support to their management teams (HRC, 2016; personal
communication, January 2017). The patient relation manager reported that factors had been
identified in the area of staff-physician relations regarding stress levels, which resulted in
shortened physician shifts with the intent of increased productivity as a result of decreased
stress. At a management neurology seminar in September 2016 (HRC,
2016), presenters identified the levels of unhealthy stress experienced by managers and
outlined code lavender education for situations following an episode that could result in
manager burnout (neurology manager, personal communication, April 2017). The
patient relations manager noted that this program has not been implemented at any level
in the facility (personal communication, April 2017). The program was mentioned as a
plan for future development during the annual managers retreat (HRC, 2017a).
Changes in role identity resulting from combining responsibilities of direct care
staff with those of senior administration result in a hybrid functioning leader struggling to
identify support systems (Kristensien, Christensen, Jaquet, Beck, Sabroe, Bartels, &
Mainz, 2016). A cochair of the manager’s council indicated that manager education is
conducted quarterly but focuses primarily on role changes and new responsibilities
resulting from a large corporate merger in 2016 (personal communication, February
2017). This training focus is reflected in the most recent publication of the facilities
management development and resource guide (HRC, 2017b). Workplace stress for
nursing managers has reached epidemic proportions with the concept of distress and
burnout identified as a major destructive problem facing the profession (Riahi, 2011).
The purpose of this DNP project was to synthesize evidence-based practices focused on
stress reduction and burnout prevention in nursing management to develop an education
program that could be implemented at the practicum site.
Significance to Nursing Practice
Nurse manager turnover in acute care hospitals has been identified as increasing
and surpassing that of higher level nursing executives (Loveridge, 2017). The most
frequent response provided by nurse mangers regarding their desire to change practice
focus was burnout (Loveridge, 2017; Warshawsky & Havens, 2014). Analysis of role
responsibilities and performance initiatives revealed that nurse managers spend
approximately 25% of their time with meaningful position-related tasks, and the
additional 75% is spent on meaningless tasks that compound daily stress levels (Baker
et al., 2012). Consistent characterization of a nurse manager’s job by practicing mangers
includes a lack of autonomy, high levels of responsibility, and high levels of stress
(Bulmer, 2013). Improvement in the field of nursing management may be demonstrated
through the development of evidence-based techniques focusing on reducing manager
burnout.
A gap in practice existed in the current knowledge base used by nurse managers
to navigate daily stressors (Dyess, Sherman, Pratt, & Chiang-Hanisko, 2016).
Information from the nurse managers of critical care, emergency department, patient
satisfaction, and cardiac care units at the project site indicated that current methods for
coping with stress consist of relying on previous experiences of stress-reducing
behaviors. Resources were not in place to provide nurse managers with primary
intervention stress-reduction strategies. Current resources focused on direct patient care
roles because the topic has been studied more thoroughly (Kath, Stichler, Ehrhart, &
Sievers, 2013). These resources include person-focused interventions, organization-
focused interventions, and integrated stress-prevention initiatives such as employee-
assistance facilitators, meditation sessions, and peer support groups (Roberts, Grubb, &
Grosch, 2012). Nurse managers who become overwhelmed may elect to seek private
assistance from the employer in the form of a crisis help line, but this resource focuses
on the recovery following an event as opposed to primary intervention (HRC, 2014).
The nature of a manager’s roles combined with the increasing complexity of
health care marketplaces and 24/7 accountability requirements can overwhelm the
resources designed for staff nurse stress management. Expanding management roles,
increased facility expectations, complex staff needs, and enhanced patient expectations
can overburden the most experienced managers (Johansson, Sandahl, & Hasson, 2013;
Sherrod & Campbell, 2015). When stressors are encountered beyond the individual’s
coping thresholds, eustress is exhausted, and distress can ensue (Quick & Henderson,
2016). Continued exposure to distress without intervention may eventually lead to
manager burnout (Cieslak et al., 2014).
Practice-Focused Question
Can developing an evidence-based stress reduction education program empower
nurse managers to better handle work-related stressors and reduce burnout?
Addressing the Practice Gap
Nurse managers cope with occupational stressors on a daily basis. Methods used
for stress management are often not evidence based, leading to ineffective coping
strategies. This DNP project addressed the gap in practice by identifying an evidence
base for the synthesis, development, and formalized implementation of education that
may reduce stress and minimize burnout for nurse managers. Leadership at the facility
may use the evidence and recommendations to implement the interventions focused on
enhancing nurse managers’ ability to navigate workplace stressors.
Summarized Approach
Organization and analysis of this DNP project was achieved through the use of a
synthesis matrix. This matrix was arranged by theme to represent evidence source
relation. The synthesis matrix enabled me to sort and categorize different points or
informational aspects related to the chosen topic (see Parris & Peachy, 2013). Literature
was organized using the Walden University literature review matrix (Walden University,
2010) and rated by The Johns Hopkins Nursing Evidence-Based Practice Rating Scale
(Johns Hopkins University, n.d). I used the rating scale to evaluate and synthesize
literature based on evidence level and quality.
Purpose Statement
The purpose of this DNP project was to address the identified gap in the practice,
which was insufficient knowledge related to stress reduction in nurse managers. Addressing
this gap was achieved through the development of an evidence-based stress management
education program. Findings from the literature review and analysis indicated several factors
relating to stress and nurse managers. Primary findings indicated that stress is present in the
daily functioning of nurse managers, but effective coping techniques are not routinely
implemented. Secondary findings indicated that poorly managed stress negatively impacts
the nurse manager, the nursing staff, and the ability to direct patient care. Evidence-based
literature analysis revealed that stress reduction techniques are effective for managers when
implemented in stressful work environments.
This DNP project provided nurse managers with an education program to minimize role-
related distress and burnout.
Significance
This project has the potential to impact numerous stakeholders at the practicum
site. Stakeholders may experience a positive change congruent with their level of
interaction with nurse managers.
Stakeholders
Stakeholders for the project consisted of managers, nursing staff members, and
patients. Managers may benefit from enhanced coping abilities, increased job
satisfaction, and improved ability to focus on daily responsibilities previously deferred
because of high stress levels (see McVicar, 2015). The impact on staff members may be
achieved through having a leader who is better able to provide increased support and unit
guidance, real-time coaching, and modeling of desired behaviors for staff, as opposed to a
leader who is negatively affected by stress (Moss, Good, Gozal, Kleinpell, & Sessler,
2016). Patients are the stakeholders who may ultimately experience the greatest impact
from the project, as staff members take their cues from the manager. A manager sets the
tone for unit operation and models patient care behaviors that should be emulated by
staff. Enhancing a manager’s ability to focus on aspects outside of daily distresses may
promote enhanced patient engagement, leading to better overall patient experiences
(Byron et al., 2014). Managers who cope poorly with stress are not effective leaders
(Loveridge, 2017).
Contributions to Practice
Nurse manager stress education may contribute to nursing practice by minimizing
a factor identified by managers as a primary source of dissatisfaction in their practice.
This education may foster continued professional growth, enhanced work-life balance,
and longer tenure (Loveridge, 2017). The stressors experienced by nurse managers
remains problematic in many organizations (Riahi, 2011). Placing the focus on
management or leadership as the target audience for stress education will provide
additional insight into other nursing practice areas where similar issues exist (Miyata et
al., 2015). The notion that stress is unavoidable when working in health care may be
correct because of the immense responsibilities shouldered on a daily basis (United
States Department of Labor, 2017). Those in management roles should have an
appropriate level of support and resources available to aid them in fulfilling their roles
(Baran, Shanock, & Miller, 2012).
The impact of work-related stress for nurse managers is a widespread issue but
remains outside the scope of regular operations in many facilities (Van Bogaert,
Adriaenssens et al., 2014). This topic is beginning to gain attention from researchers
investigating best practices. The Advisory Board (2014) released a statement on
improving engagement drivers that included recommendations including asking whether
facilities offered stress reduction training or support to help prevent burnout. Developing
evidence-based nurse manager stress education aligns with the Advisory Board
recommendations.
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Potential Transferability
The development of evidence-based education focused on nurse manager stress
reduction provides the framework to inspire similar programs at other leadership levels
or facilities. Nurses identified as emerging leaders may benefit from receiving training or
information on manager stress reduction before assuming expanded leadership. Potential
transferability of this project exists in similar practice areas or regions seeking to
implement evidence-based stress education including emerging leadership programs,
executive leadership, and non acute care settings.
Implications for Positive Social Change
This DNP project has implications for positive social change within the selected
practice environments because of stress levels currently experienced by nurse managers.
Positive social change for the nurse managers through promoting evidence-based stress
management education has the potential to positively influence the leadership delivery at
the practicum site. Nurse managers proficient in coping with daily stress will benefit from
increased job satisfaction and the ability to focus on influencing care delivery on their
units (McVicar, 2015; Moss et al., 2016). Minimizing the negative effects of stress on
nurse managers may affect overall nursing practice through an unencumbered ability to
provide staff mentorship, real-time coaching, and coordination of care delivery (Moss et
al., 2016).
Summary
Profound levels of stress exist within the practice of nursing management. Two
types of stress are eustress and distress, which result in different physiological and
psychological symptoms. Eustress can lead to enhanced productivity or problem-
solving, while distress can result in career burnout. Managers must have access to
support systems to aid in managing their stress. Management-specific stress reduction
education programs were absent at the practice site at the time of the project study. A
lack of nurse manager knowledge in methods of stress management represented a gap
in practice. Evidence- based practices for stress management focused on nursing in
combination with peer support have the potential to reduce nurse manager stress-
related burnout. Aspects of this project are transferable to other areas of nursing
leadership, as the principles guiding stress management would be beneficial at all
leadership levels (Labrague, McEnroe, Leocadio, Van Bogaert, & Cummings, 2018).
This DNP project included formalized education on focused techniques to prevent
manager burnout resulting in anticipated positive social change. Section 2 outlines
evidence-based concepts, models, and theories applied to the education program;
relevance to nursing practice; local background and context; and my role in the
project.
