Chapter 26: Managing Stress

An assistant nurse manager has relieved a staff nurse for lunch. After the nurse leaves, the assistant manager realizes there is a nursing administration meeting at noon. Which stress-producing event does this exemplify? 1. Poor leadership 2. Mismanagement of the unit 3. Role conflict 4. Miscommunication

Answer: 3 Explanation: 1. The unit was managed effectively so staff could get to lunch, which reflects good management and leadership skills. 2. The unit was managed effectively so staff could get to lunch, which reflects good management and leadership skills. 3. Role conflict occurs when an individual has two competing roles. The assistant manager was caught between the role of being a helper to staff and attending the meeting. 4. There was no miscommunication.

A busy ICU unit has a high noise level. This frustrates the charge nurse in part because it is difficult to focus when entering physician's orders into the electronic medical record. Which would be the most appropriate action by the ICU nurse manager? 1. Decrease the noise level on the unit. 2. Tell the staff members that they need to be quiet when sitting at the nurse's station. 3. Close the doors to the client's rooms. 4. Rearrange the space so that a quieter area is available for order entry.

Answer: 4 Explanation: 1. The long-term plan would be to work on lowering the noise level on the unit, but busy ICU units tend to be noisy. 2. Telling the staff to be quiet may create the additional stress of a disgruntled staff. 3. Closing the doors to client rooms is not always possible, and those rooms are generally not the areas where the excessive noise is produced. 4. The most logical of these options is to rearrange the area so that order entry can be done in a quieter environment.

________ is the result of incompatibility between the individual's perception of the role and its actual ________.

Answer: Role-conflict, requirements Explanation: Role-conflict is the result of incompatibility between the individual's perception of the role and its actual requirements.

A nurse manager is considering referring a nurse who is very stressed to the employee assistance program (EAP) offered by the institution. What does this consideration indicate? 1. The manager believes this service would promote the nurse's health and well-being. 2. The manager thinks the nurse is abusing alcohol to cope with the stress. 3. The manager thinks that this referral will help the nurse avoid sanction by the state board of nursing. 4. The manager believes the nurse is abusing controlled medications to cope with stress.

Answer: 1 Explanation: 1. EAPs are designed to help the nurse cope with a variety of issues and to support health and well-being. 2. EAPs are used for many issues other than alcohol abuse. 3. There is nothing in this question that indicates sanctions are pending. 4. EAPs are used for many issues other than substance abuse.

The chief nursing officer (CNO) recognizes a large increase in turnover on a given unit. The nurse manager of the unit says that this is just a coincidence and that the unit is "fine." What action by the CNO is appropriate? 1. Talk to current nursing staff and review the exit interviews of those who have left. 2. Call the unit supervisor and inquire as to why the turnover rate is high. 3. Discuss the matter with other nurse managers. 4. Discuss the matter with the hospital chief administrator.

Answer: 1 Explanation: 1. The CNO should investigate the matter to determine what has caused a high turnover in staff. Reviewing exit interview notes of employees who have left and insightful discussion of the matter with current staff will provide the CNO with information regarding the director's management style. Assessment is the first step of the nursing process. 2. If the nurse manager thinks all is well, it is unlikely that issues leading to turnover have been reported to the supervisor. 3. Other nurse managers will not be likely to have information about this unit that will be helpful. 4. The CNO may need to discuss the matter with another administrator at some time, but not until further investigation is conducted.

A medical-surgical nurse manager has received a complaint by a client regarding the noise level on the unit. The manager reviews the schedule and harshly reprimands the nursing staff who cared for the client. What is the evaluation of this manager's action? 1. It is appropriate and timely. 2. The action is inappropriate and increases the nursing staff's level of stress. 3. The action is inappropriate and should be reported. 4. It is appropriate and should be a model for future disciplinary actions.

Answer: 2 Explanation: 1. A harsh reprimand is seldom a professional approach to discipline. 2. Authoritative or punitive supervisory behavior is closely related to stress levels. 3. More information is required to decide whether the manager should be reported. 4. This action should not serve as a model.

The nursing unit has experienced high stress and a higher than normal turnover rate. The manager asks a longtime member of the nursing staff to analyze the manager's job performance. What is most likely the reason for this request? 1. The manager is questioning his or her leadership style and its effectiveness. 2. The manager is required to ask for input on his or her personal job evaluation. 3. The manager is attempting to show concern about unit conditions. 4. The manager is inquiring about other leadership styles the nurse has encountered.

Answer: 1 Explanation: 1. This nurse manager is in a stressful situation. Assessing whether his or her management or leadership style is helpful or appropriate allows the manager to enhance his or her performance. It is likely that this nurse is questioning his or her effectiveness in the role and is asking for the opinion of an experienced nursing colleague. 2. The evaluation process may require this input, but the rest of this scenario points to another answer. 3. The manager is not likely to be just trying to show concern. 4. The manager has asked the nurse to critique the manager's style, not about other styles.

The supervisor of critical care services tells the unit manager, "We must cut costs, so I am asking you to arrange your day so that you provide care to two or three clients and cover for lunch and rest breaks. Also don't forget that your budget estimates are due next week, as are your preliminary schedules for the winter holidays." Two days later, the nurse manager is stressed and exhausted. What should the manager do? Select all that apply. 1. Think through the roles being required. 2. Confront the supervisor and ask for clarification of status. 3. Try to improve work organization. 4. Tell the supervisor, "I can't work this hard. Get someone else to be manager." 5. Call in sick for a day to rest.

Answer: 1, 2 Explanation: 1. A role conflict is present. Is this nurse to provide care or complete managerial tasks? 2. The supervisor must be confronted and must understand that the two roles being asked of this nurse are in conflict. 3. Often nurses who are overloaded believe they can continue to carry the current load "if only I could get more organized." 4. The real problem here is conflicting role expectations, not the nurse's inability to work hard. 5. Calling in sick is not going to change the expectations when the manager returns to work.

A nurse who has just returned from two weeks of time off following minor surgery says, "I'm so glad to be back to work. I'm sick of watching television. I can't believe I missed the stress here." What are possible explanations for this statement? Select all that apply. 1. Lack of stress can cause boredom. 2. Stress can be motivational. 3. Apathy can occur if stress is absent. 4. Eustress occurs when stress is decreased too much. 5. A balance between stress and coping is essential.

Answer: 1, 2, 3, 5 Explanation: 1. A certain amount of stress is stimulating. Without stress, boredom can occur. 2. A moderate amount of stress can motivate a person to perform. 3. A person who is accustomed to stress may become apathetic if stress is removed. 4. Eustress is positive stress. 5. If there is not enough stress, the person feels "out of balance."

A staff nurse is late for work for the second time this week. When the manager mentions the tardiness, the nurse says, "I'm so sorry. I've just got so much going on with my impending wedding. I am so stressed." Which responses by the manager would help this nurse cope? Select all that apply. 1. "Good stress can be just as bad as negative stress." 2. "We need to get you back in balance." 3. "Your personal issues should not interfere with work." 4. "Weddings are fun, but they can be stressful as well." 5. "If you are late again, I am going to write you up."

Answer: 1, 2, 4 Explanation: 1. Good stress can be just as hard on the body as negative stress. 2. A balance should exist between stress and the ability to handle it. 3. The nurse realizes this fact, apologized, and offered an explanation for the tardiness. 4. Acknowledging the nurse's situation may help with coping. 5. A threatening response will not decrease the nurse's stress.

What are the warning signs of too much stress? 1. Physical illness 2. Prolonged anxiety 3. Clarification of roles 4. Abrupt changes in mood 5. Feeling of helplessness

Answer: 1, 2, 4, 5 Explanation: 1. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 2. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 3. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 4. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism. 5. The warning signs of too much stress includes physical illnesses, prolonged anxiety, feelings of helplessness, abrupt changes in mood, and perfectionism.

A newly hired registered nurse is having difficulty focusing and performing nursing tasks. The nurse manager has noted a decrease in the nurse's performance. When meeting with the nurse, the manager learns the nurse has recently gotten married and moved into a new home. The client load in the unit has returned to normal levels from very high levels and the employment of another newly hired nurse was terminated for disruptive behavior. The nurse reports that "everyone has been so nice and they try to help me." Which situations are most likely causing this nurse's stress? Select all that apply. 1. Marriage 2. Purchasing a new home 3. Decreased workload 4. Assistance from other nursing staff 5. The coworker whose employment was terminated

Answer: 1, 2, 5 Explanation: 1. Even though getting married is a happy time, the wedding can be very stressful to plan. Adapting to married life can also be stressful. 2. Purchasing a new home is very stressful. 3. Typically, a reduced workload is not stressful. 4. Assistance from other nursing staff should not be stress inducing. 5. Working alongside a noncompliant coworker whose employment is terminated can be very stressful.

A nurse supervisor is aware that nurses in the facility have been under a great deal of stress while working through a major change in the ownership of the hospital. Which nurses would the supervisor be most concerned might develop compassion fatigue? Select all that apply. 1. Emergency department nurses 2. Outpatient diagnostic procedure nurses 3. Nurses working in the trauma surgery unit 4. Nurses working in geriatrics 5. Nurses working in obstetrics

Answer: 1, 3 Explanation: 1. Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Emergency department nurses fall in this category. 2. Outpatient nurses may be somewhat sheltered from caring for trauma patients, which is a major cause of compassion fatigue. 3. Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Trauma surgery nurses fall into this category. 4. Nurses working in geriatrics are not at as great a risk for compassion fatigue as other nurses. 5. Generally, the risk for compassion fatigue is not as high in nurses working in obstetrics.

An ICU nurse manager noticed a competent nurse has become forgetful and has made medication errors in the past few months. This type of behavior is unusual for this nurse. What action should the manager take? 1. Issue a written warning to the nurse. 2. Meet individually with the nurse to discuss the behavior. 3. Ask other staff members if they have noticed the behavior. 4. Report the nurse to the human resources department.

Answer: 2 Explanation: 1. It is premature to issue a written warning. 2. Meeting with the nurse will provide information. The nurse may be experiencing unusual stress at home, may be unaware of his or her behavior, or may have a medical condition. The first step should be to address and assess the situation. 3. It is not appropriate for the manager to involve other staff members. 4. It is premature to report the nurse to the human resources department.

The nurse manager asks a nurse to become a charge nurse, but then frequently questions the nurse's daily decisions. This situation reflects which problem that will increase the nurse's stress? 1. Reality shock 2. Role ambiguity 3. Role conflict 4. Burnout

Answer: 2 Explanation: 1. Reality shock occurs at the transition between nursing student and practicing nurse. 2. This manager has asked the nurse to perform a role but does not trust the nurse to fulfill it. This results in role ambiguity. 3. Role conflict is the result of incompatibility between the individual's perception of the role and its actual requirements. 4. Burnout refers to the perception that an individual has used up all of his or her available energy to perform the job. Burnout may occur if this situation continues.

The nurse manager holds a staff meeting and announces, "I want to aggressively manage the stress on this unit." Why would the manager have this goal? 1. Stress has a negative impact on the functioning of the unit. 2. If the stress level is too low, people become apathetic and bored. 3. Low stress levels will reduce turnover on the unit. 4. Coping mechanisms only work when stress is high.

Answer: 2 Explanation: 1. Stress is not always negative. 2. When stress levels are too low, the environment is not stimulating and people become apathetic, bored, and poorly motivated. 3. If the unit's stress level is so low that it is boring, the turnover rate may actually increase. 4. Coping mechanisms work at lower levels of stress. When stress exceeds coping, negative effects occur.

A staff nurse finds a newly licensed, newly hired staff nurse crying in the break room halfway through a shift. The new nurse says, "I am just not getting this. I had no idea nursing would be this hard." The experienced nurse says, "Reality shock is terrible, but you will get through it." What does the nurse mean by reality shock? 1. A period when it becomes clear the new nurse is not able to function as a registered nurse 2. A period of surprise and disequilibrium about the nursing role 3. A period when expectations of the role are unclear 4. A period when managers determine if the new nurse is a good fit for the profession of nursing

Answer: 2 Explanation: 1. There is no indication that the new nurse cannot eventually function as a registered nurse. 2. Reality shock is the period of transition from a protected student role to a professional role in which the nurse is responsible and accountable for the care of several clients. 3. Being unclear about the role is role ambiguity. 4. It would be unfair for the manager to determine the nurse's fitness for the profession during reality shock.

A staff nurse on a busy outpatient surgery unit comes to the manager and says, "I don't know what is going on. I just feel unsettled and anxious." How should the manager interpret this statement? Select all that apply. 1. The nurse is trying to establish a problem for which days off will be necessary. 2. The nurse may be suffering from free-floating anxiety. 3. The nurse may be overstressed. 4. The nurse has compassion fatigue. 5. The nurse is about to experience posttraumatic stress disorder.

Answer: 2, 3 Explanation: 1. There is no indication that the nurse is trying to make up an illness to get time away from work. 2. Free-floating anxiety is anxiety that seems to have many alternating causes. 3. Stress can cause these feelings of anxiety or fear. 4. Compassion fatigue has much more serious symptoms than anxiety. 5. There is no evidence of posttraumatic stress disorder.

A staff nurse tells the nurse manager, "I don't know how you do it. You manage the unit, work extra shifts, and have so many people depending on you and yet you seem so calm and in control." What explains this nurse's perception? 1. Nurse managers don't do much direct client care, so their work is predicable. 2. The staff nurse is trying to manipulate the manager. 3. The manager has excellent coping skills and high stress tolerance. 4. Some people do a very good job of hiding their stress.

Answer: 3 Explanation: 1. A nurse manager's work is no more predictable than that of a staff nurse. 2. There is no indication that this nurse is not being honest in this assessment. 3. Some people seem to thrive on stress, but close examination reveals that they have developed excellent coping skills to go along with their ability to tolerate high stress levels. 4. Although some people can hide their stress for a time, it usually will begin to show in poorer work performance, attitude, or health issues.

An experienced nurse manager is serving as mentor to a newly appointed manager. The experienced manager says, "Always try to keep your staff as well informed as possible about what is going on at the administrative level." What rationale should the manager offer for this advice? 1. Nursing involvement at the administrative level is required by accrediting agencies. 2. Involvement of all departments in the agency supports the organizations' management style. 3. Staff members who are kept informed are less likely to be suspicious and spread rumors. 4. Sharing both the positive and negative information from administration helps to reduce the manager's stress.

Answer: 3 Explanation: 1. Although nursing involvement is encouraged, this is not the good rationale for this manager's statement. 2. This may be the case, but it is not the primary rationale for this statement. 3. When staff members are informed and find that managerial information is reliable, the amount of suspicion and rumor decreases. 4. The purpose of sharing information is not to reduce the manager's stress.

A hospital has been acquired by a new management company. As part of this acquisition, several different types of equipment have been introduced into the client care area. How can the manager best plan to reduce the stress of using this equipment? 1. Have all the equipment put into service at one time so learning will be compressed. 2. Teach the nurses with the most seniority to use the equipment and let them teach the other nurses. 3. Be certain that all nurses attend training sessions on the use of all equipment. 4. Post written instructions in the break room on how to use the equipment.

Answer: 3 Explanation: 1. Having all the equipment at once would complicate learning and increase stress. 2. The nurses with the most seniority will already be stressed by all the new equipment. Asking them to be responsible for teaching the remainder of the nursing staff is not a good plan. 3. The best way to decrease stress of using this equipment is to be certain training is adequate. 4. There is no assurance that all of the nurses will read these instructions. Many nurses do better when shown how to use equipment and allowed to practice.

A nurse manager notes that staff members are struggling with caring for an increased client load while a new management system is being implemented. What managerial action would help reduce this stress? 1. Asking a nursing faculty friend to use the unit for a student clinical 2. Hiring two newly licensed nurses for each shift 3. Asking for nurse input into decisions that directly affect care 4. Instituting a method of shift rotation that increases staff on each shift

Answer: 3 Explanation: 1. Helping to manage and supervise students is stressful for many nurses. 2. Helping to orient newly licensed nurses is stressful for many nurses. 3. Involving staff in decision making is one way to identify and reduce stress. 4. Working rotating shifts is very stressful to many nurses.

The hospital has elected to initiate a rotating 8-hour shift schedule. Which strategy, taken by the nurse manager, will help staff cope with the stress associated with this staffing pattern? 1. Rotate the shifts several times each month so no one is on one shift very long. 2. Rotate the nurses among all shifts so that they know the concerns of each shift. 3. Be certain that nurses are taking their meal and work breaks during each shift to increase rest. 4. Schedule a "double back" at the end of each rotation to allow new rotations to start uniformly.

Answer: 3 Explanation: 1. It takes several weeks to acclimate to a new shift, so rotating several times a month will increase stress. 2. Nurses should rotate only between two shifts. 3. Reducing physiological stress can occur by receiving adequate rest and work breaks. 4. Double-back shifts (in which the nurse works 8 hours, is off 8 hours, and comes back to work for 8 hours) should not be scheduled.

A charge nurse has been trying to please all the nurses, physicians, clients, and staff of the unit. This has caused considerable stress for this nurse. After a few days off, the nurse decides to manage the role differently. What has occurred to the nurse over these days off? 1. Role conflict 2. Role definition 3. Role redefinition 4. Interrelated conflict

Answer: 3 Explanation: 1. Role conflict may be what caused the nurse to experience the stress. 2. The role has already been defined upon promotion to charge nurse. 3. Role redefinition involves clarifying roles and attempting to integrate or tie together the various roles individuals play. This nurse had to redefine the role and role expectations. 4. Interrelated conflict does not apply to this situation.

A rural hospital has been at capacity for the past 3 months. The chief nursing officer (CNO) has heard numerous complaints from the nursing staff. Most of the complaints are issues related to other nursing departments and are minor. How should the CNO interpret these complaints? 1. The nursing staff members are inefficient in managing the client load. 2. This is a typical reaction among nursing departments. 3. The nursing staff are stressed due to a sustained increased workload. 4. The nurses are ready to unionize.

Answer: 3 Explanation: 1. The nursing staff's efficiency is not in question. 2. It is not appropriate to dismiss these issues as "typical" among nursing departments. 3. Stress can result from job-related factors, such as task overload, conflicting tasks, inability to do the tasks assigned because of a lack of preparation/experience and insufficient information regarding the assignment. 4. There is no evidence that this is the case, but improving workplace conditions is a primary reason that nurses seek collective bargaining.

A nurse manager praises a staff nurse by saying, "You are such a perfectionist, and it clearly shows in your work." The supervisor who hears this praise is concerned for which reason? 1. Giving such high praise to a staff nurse may result in the nurse asking for a raise. 2. The manager should not praise a staff nurse so highly in front of other nurses. 3. The manager may be promoting a trait that often leads to constant stress. 4. This type of praise often leads to the nurse behaving in a superior manner when around the other nurses.

Answer: 3 Explanation: 1. There is no indication that this staff nurse will ask for a higher salary. 2. It is fine to praise a nurse highly in front of other nurses. 3. Perfectionism is setting unreasonably high standards for oneself, which can result in a state of constant stress. 4. There is nothing to indicate that this is the case with this nurse.

The unit nurses take turns filling the charge nurse role. Which statement reveals risk for development of role conflict in these nurses? 1. "I think I do a better job as charge nurse than the other nurses." 2. "I like being charge nurse better than being a staff nurse." 3. "Sometimes it is just faster to do things myself." 4. "I have difficulty with understanding the report from the previous shift."

Answer: 3 Explanation: 1. Thinking that one does a good job in a role is not an example of role conflict. 2. Liking one role better than the other is not a symptom of role conflict. 3. Inter-role conflict occurs when the differences between being a staff nurse (doing it myself) and a charge nurse (direct someone else to do the task) become stressful. The nurse suffering from this conflict may well "switch over" to the other role in the interest of getting a task done quickly or well. 4. Having difficulty understanding a report is not a symptom of role conflict.

Which factors increase the stress associated with interpersonal relationships in healthcare? Select all that apply. 1. Longer length of stay for clients 2. Few assistive personnel 3. Job redesign 4. New technology 5. Unrealistic expectations of other disciplines

Answer: 3, 4, 5 Explanation: 1. A shorter length of stay for clients is more likely to increase staff stress. 2. Surpervising assistive personnel is very stressful. 3. Trying to do more with less is very stressful. 4. New technology can be very stressful during the learning curve. 5. Unrealistic expectations from anyone can increase the nurse's stress.

The manager is watchful of compassion fatigue among the nursing staff of the emergency department. What is the best indicator to the manager that this disorder is occurring? 1. Nurses complain of being too tired to work. 2. Clients complain that nurses are not compassionate. 3. Physicians complain that the nurses are not taking good care of clients. 4. Symptoms much like severe burnout occur in the staff.

Answer: 4 Explanation: 1. A nurse could complain about being too tired to work for a variety of reasons. 2. Clients might complain about lack of compassion, but nurses who do not have compassion fatigue may exhibit it as well. 3. Physicians may complain about lack of good care for a number of reasons. 4. Compassion fatigue is secondary traumatic stress experienced by caregivers. It is similar to posttraumatic stress disorder, but the term originated in nursing. It affects individuals who care for others who are experiencing physical and/or emotional pain and has symptoms similar to those of severe burnout.

A nurse who had advanced to assistant nurse manager was demoted back to staff nurse last month. The manager gives the nurse low-acuity client assignments. The nurse is efficient, unhappy, and bored. The nurse's response is most likely related to which phenomena? 1. Low self-esteem 2. Low morale 3. Mismanagement 4. Underutilization

Answer: 4 Explanation: 1. If this situation is not changed, low self-esteem may result. 2. If this situation is not changed, low morale may result. 3. It is difficult to be certain if this is a situation of mismanagement from the information provided in the question. 4. Being underutilized or not having much responsibility may be seen as stressful by a person who is a high achiever or who has high self-esteem. Currently this nurse is likely experiencing being underutilized.

A nurse who transferred from the medical-surgical unit completed orientation to the ICU 6 weeks ago, but is stressed and unsure of personal skill competency. The nurse manager learns of this lack of confidence. Which action by the manager would best benefit this nurse and the unit? 1. Reduce the nurse's client assignment. 2. Transfer the nurse back to the medical-surgical unit. 3. Provide written instruction regarding the desired unit specific skills. 4. Provide additional weeks to orientation with a focus on skill development.

Answer: 4 Explanation: 1. Reducing the nurse's work load is not addressing the nurse's concerns or requests. 2. Transferring the nurse to the medical-surgical unit may add to the stress and is not a win-win situation for both parties. 3. Written instructions will not address the nurse's concerns or requests. 4. If staff members appear to be under a great deal of stress, the manager must help identify the source and decide how these can be reduced or eliminated. In some cases, additional training or education is necessary.

During an annual performance review, the staff nurse admits to being very stressed by the demands of the job, marriage, and four teenage children. Which comment by the nurse manager is indicated? 1. "We need to figure out what you can give up in your personal life to help decrease your stress." 2. "You need to be more flexible with the hours you work." 3. "You should not let your personal problems affect your work." 4. "Let's talk about how we can help you develop some resiliency."

Answer: 4 Explanation: 1. The nurse manager would look to the nurse's professional life for areas to decrease stress and should only make global statements regarding personal life. 2. Asking the nurse to be more flexible with work hours, when there are the family's demands on time, would only increase stress. 3. It is not reasonable to think that the nurse's personal life can be completely disregarded while the nurse is at work. Even if the nurse is not focusing or thinking about personal issues, the stress is still there. 4. To manage the demands of a job, family, and society effectively and keep stress at levels that enhance performance, the key is to develop resiliency.