The healthcare environment can be increasingly stressful, especially given the heterogeneous human environment. Healthcare practitioners and administrators should constantly look for stress indicators that can adversely impact nurse practitioners, given their level of involvement that requires them to be versatile and complementary in different situations. Nurses are especially at risk given their intermediary roles, where interdisciplinary approaches are essential in patient-centered care models adopted in different healthcare settings. Scott (2017) noted that nurses’ high level of involvement toward a patient had the potential of over-stretching their responsibilities, thereby causing them to be over-extended while losing sight and balance between personal and professional boundaries due to impaired judgment. The author noted that such scenarios led to poor patient care and burnout due to the high levels of work-related stress. This writing aims to outline recommendations for a stress management program (SMP) following an evidentiary process that will provide insights about the specific areas that should be considered in developing effective programs in the nursing environment.
Research Question
The primary methodology of this study would be a mixed approach where both qualitative and quantitative methods would be applied. This study would address the following questions: How can nurses be transitioned to practice to cope with different stressors emanating from the nursing environment? Would an extended or standard residency program be effective in addressing issues related to work-related stress? How much time is required to evaluate the level of preparedness of the NGNs?
Background and Rationale
Job satisfaction, along with the quality of the work environment, have been noted to factor significantly into the nursing outcomes (Al-Maaitah et al., 2018). Additionally, current literature has found that nurses working in favorable environments tend to report lower burnout. Kramer et al. (2012) found that adequately designed transition-to-practice programs led to an overall improvement in quality and safety practices, increased job satisfaction, and low stress. The healthcare environment is especially sensitive, given the modalities that require frequent interactions regularly.
Existing Gaps in Current Literature
Through an integrated systematic review of the current literature, it has emerged that there needs to be more knowledge about the existing relationships between the quality of the work environment and the job satisfaction factors that have consequently inhibited the productivity of nurses. According to Al Sabei et al. (2020), no published evidence demonstrates a relationship between the quality of the work environment and nurses’ turnover intention, burnout, and perceived quality of care. The limited knowledge of how work environment conditions result in the prevalence of stress and burnout in healthcare settings would be the primary focus of this study. According to Lake (2007), a positive nursing work environment has the highest level of clinical practice that supports nurses to work effectively with an interprofessional team of healthcare workers in mobilizing resources efficiently. Such an environment is characterized by an extensive and elaborate residency program that considers the need for a transition to practice program that provides graduate nurses the opportunity to learn, through different methods, the ways of coping with stress.
The Nursing Work Environment
In order to understand the relationship between the work environment and the prevalence of work-related stress and burnout, it is important to conceptualize the nursing ecosystem. According to Al Sabei et al.(2020), the nursing work environment is multidimensional and features several components of the organizational structure that influence professional nursing practice. These components include the participation of nurses in hospital affairs, the nursing foundation for quality care, the ability and leadership of nurse managers in offering support, staffing and resource adequacy, and collegial nurse-physician work relationships (Al Sabei et al., 2020). These factors are critical in addressing the issues associated with the quality of the work environment vis-à-vis the concerns over work-related stress and burnout in the nursing work environment. Therefore, in the development and implementation of effective SMPs, these components would feature as core elements of a robust framework of policies and guidelines that would be applied at various levels of the clinical setting in mitigating work-related stress.
Project Objectives
This study would aim to develop an effective SMP applied across various clinical settings, particularly in the nursing work environment. The SMP would be a structured model reflecting the minimum requirements outlined earlier, featuring the components of the nursing work environment. For instance, the program would be designed to restructure the organizational structure of healthcare institutions to encourage nursing managers, chief nursing officers (CNOs), and registered nurses (RNs) to participate in some of the critical decision-making functions.
Workforce Stability
The nursing residency program (NRP) is essential in the operations of a hospital. Cadmus and Roberts (2022) explained how workforce stability was a critical issue for nurse leaders. It was particularly exacerbated by the supply and demand factors emanating from the immediate health environment. In order to mitigate the challenges occasioned by the pandemic due to acute restrictions and remote learning models, chief nursing officers (CNOs), including registered nurses (RNs), had to devise newer employment models that would reduce the stress levels caused by such shifts. In such a scenario, nurses were overwhelmed and were predisposed to stress and burnout. During the pandemic, Cadmus and Roberts (2022) noted many gaps left by experienced nurses who opted for retirement, with others moving into an agency and traveling positions to reduce their working hours. It is prudent for healthcare organizations’ management to give nursing leaders the mandate to develop structures that would be adaptive in light of the disruptions caused by a heterogeneous, unpredictable health environment.
Specific, Measurable, Attainable, Relevant, and Time-bound Objectives
Arguably, workforce stability is a critical factor that determines how the work environment can be optimized in order to be adaptive to the stress factors that contribute toward nurse burnout. Implementing a successful SMP should be centered on addressing the workforce stability issues that directly or indirectly affect the work environment. Therefore, to design a specific, measurable, attainable, relevant, time-bound (SMART) SMP objective, the project objectives would be centered on NRPs and how they can be designed to address issues regarding workforce stability within the nursing environment.
First, the goals of the program would have to be defined. They would have to feature in the SMART objectives. For instance, the primary goals would feature identifying the significant stressors and burnout factors and their manifestations. A clear and SMART objective would reduce nurse burnout by 50% in the six months. Secondly, an SMP would be developed to involve a multidisciplinary team of practitioners in the nursing practice, such as educators, experienced nurses, and mental health professionals. The purpose of this phase of the program would be to equip the new graduate nurses (NGNs) with tools in self-care, coping mechanisms, and resilience. The NGNs enrolled in NRPs are usually predisposed to these stress factors that lead to burnout due to the transition to the practice phase, which was a particularly stressful period that led to anxiety (McNulty et al., 2022). Moreover, NRPS must be designed to address these issues of work-related stress since the importance of NRPs in ensuring workforce stability can not be emphasized enough. For instance, the issues related to workforce stability and the nursing environment are tied to factors highlighted earlier, including staffing and resource adequacy, nurse manager ability, and leadership in supporting nurses.
Therefore, depending on the design of the NRPs of a given healthcare environment, these issues related to workforce stability and the nursing environment should be addressed. By and large, extended and standard residency programs have been at the center of several debates regarding their significance in ensuring workforce stability and job satisfaction. Perron et al.(2019) found that extended NRPs had multiple advantages toward workforce stability and organization as they led to higher retention rates and job satisfaction levels—factors that reduced the prevalence of stress and burnout.
Methodology
The study design would involve a mixed approach employing qualitative and quantitative research methods. First, there would be an integrated systematic review of the relevant literature that addresses issues regarding the nursing work environment and the stressors in those environments. An inclusion and exclusion criteria of relevant articles would feature peer-reviewed journal articles that specifically address the subject as it relates to the nursing work environment issues. The Cochrane method and Covidence extraction method would be used to seek the relevance of the articles that had specific mentions of critical terms, “stressors,” “burnout,” and “nursing environment.” This approach would be ideal given the need for identifying the specific variables that can be switched when instituting practice change approaches to ensure that the nursing environment is resilient and adaptive to extreme situations that can be stressful for nurse practitioners. Cadmus and Roberts (2022) noted that CNOs should address gaps in their NRPs to provide support and resources needed to retain NGNs in the organization, as a smooth transition to practice needed to be achieved.
Intervention or Practice Change
A potential intervention that can be adopted is an extended residency program. An additional transition-to-practice program is included in the approaches to ensuring workforce stability in the nursing environment. This approach would take an apprenticeship model where NGNs are taken through an extended residency, given their predisposition to stress and burnout. The transition-to-practice program would involve educators, experienced nurses, and mental health professionals who would take the NGNs through a comprehensive stress management program where they would be trained and provided tools for coping and building resilience in the nursing environment.
Implementation Plan
The transition to practice SMP objectives would coincide with the NRPs’ learning modules and outcomes. It would feature within the timelines of the extended residency program that would run for over one year. The professionals involved include experienced nurses, educators, and mental health experts. CNOs would feature in a management capacity to ensure that there are adequate resources for the implementation of the program.
Evaluation Methods
Some areas have been identified to generate work-related stress. They would be used to determine how well the NGNs can cope with the different stressors emanating from challenges such as delegation, prioritization, management of care delivery, conflict resolution, and utilization of feedback (Goode et al., 2018). Different NGNs would be subjected to different tasks that would be used to determine their performance and, more importantly, their ability to manage stress.
Expected Outcomes and Implications
It is anticipated that the transition-to-practice SMP will be standardized as part of addressing stress management in the nursing practice. Additionally, the transition-to-practice SMP would be designed to address the specific job-related tasks that contribute towards clinical decision-making by NGNs and an overall increase in job satisfaction, thereby reducing stressors.
Conclusion
Effective SMPs are a core feature of a competent healthcare system that ensures there are sufficient mechanisms that foster resilience among nursing practitioners. These mechanisms include structures that are developed to address the underlying issues that are often assumed about the need for adaptive healthcare systems. It is, therefore, imperative that SMPs are designed to address workforce stability issues related to the nursing environment under programs such as the NRPs that provide NGNs the clinical opportunity to learn and adapt.
References
Al-Maaitah, R., AbuAlRub, R. F., & Al Blooshi, S. (2018). Practice environment as perceived by nurses in acute care hospitals in Sharjah and North Emirates. Nursing Forum, 53, 213–222. https ://doi.org/10.1111/nuf.12245
Goode, C. J., Glassman, K. S., Ponte, P. R., Krugman, M., & Peterman, T. (2018). Requiring a nurse residency for newly licensed registered nurses. Nursing Outlook, 66(3), 329–332.
Kramer, M., Maquire, P., Halfer, D., Budin, W., Hall, D., Goodloe, L., & Lemke, J. (2012). The organizational transformative power of nurse residency programs. Nursing Administrative Quarterly, 36(2), 155–168
Lake, E. T. (2002). Development of the practice environment scale of the nursing work index. Research in Nursing and Health, pp. 25, 176–188. https:// doi.org/10.1002/nur.10032
Lake, E. T. (2007). The nursing practice environment. Medical Care Research and Review, 64(2, Suppl.), 104S–122S.
McNulty, D. S., LaMonica-Way, C., & Senneff, J. A. (2022). The impact of mindfulness on stress and burnout of new graduate nurses as a component of a nurse residency program. JONA: The Journal of Nursing Administration, 52(4), E12-E18.
Perron, T., Gascoyne, M., Kallakavumkal, T., Kelly, M., & Demagistris, N. (2019). Effectiveness of nurse residency programs. Journal of Nursing Practice Applications & Reviews of Research, 9(2), 48-52.
Scott, P. A. (Ed.). (2017). Key concepts and issues in nursing ethics. Springer.
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