Arielle Muffler and Dr. Katreena Merrill, College of Nursing

Background:

When I first heard about Dr. Merrill’s interest in leadership styles and impact of stress, I was intrigued with the idea of how stress can greatly influence a working and healing environment. Due to personal experiences working under various healthcare leaders, I could attest to how a stressed boss could make work and the healing environment very unpleasant and negative. While conducting a literature review, I discovered that there is an increasing burnout rate and nursing shortage and that many hospital employers are interested in reducing stressors—especially for the charge nurses (Ilhan, Durukan, Taner, Maral, and Bumin, 2007). These charge nurses—or leader nurses—significantly impact the healthcare work environment, and reducing their stress may promote a more beneficial environment in retaining nurses and in healing patients. Most importantly, there needs to be a baseline assessment so one could compare the results and analyze if certain methods were effective in reducing stress.

However, little quantitative research has been conducted to identify certain work-related stressors and evaluate numerically the levels of such stressors. The only major quantitative study was conducted in a tertiary care Israeli hospital, which produced a quantitative assessment tool called the “Charge Nurse Stress Questionnaire” (Admi & Moshe-Eilon, 2010). This was translated into English but had not yet been tested among United States Charge Nurses. My project plan was to determine the baseline stress level of charge nurses throughout Intermountain Health Care using this translated Charge Nurse Stress Questionnaire.

The ORCA Project:

The purpose of my ORCA project was to test the validity and reliability of the questionnaire in charge nurses in the United States and to identify stressors and level of stress related to the role of the charge nurse in an acute hospital setting.

The Charge Nurse Stress Questionnaire (CNSQ) is a 50 question instrument measuring the stress of the charge nurse role, was distributed via Survey MonkeyTM to select participants. Respondents were given specific scenarios and asked to indicate on a 6-point scale (very much to irrelevant) how much the scenario stressed them. The instrument had six subscales: authority-responsibility conflict, patient-nurse interaction, deficient resources (time, people, equipment), managerial decision making, role conflict, and overload (physical and emotional) and was accompanied by demographic information.

Due to some unforeseen obstacles, the CNSQ was distributed via convenience sample to six charge nurses and five nurse administrators. Instead of a large scale distribution, the project study became a semi-focused group study instead. Each participant tested the face validity and gave suggestions for improvement and rated the feasibility of a large distribution of the survey.

Results:

All eleven participants reviewed the CNSQ and commented on the strengths and weaknesses of the survey instrument. Although many felt that the areas of stress were very realistic to daily work, there were concerns about some of the questions translated oddly or that using the word “stress” or “challenges” would make charge nurses more aware of their stresses and be more displeased with work. In the end, the survey was not feasible on a larger scale. However, a future project opportunity is to help develop a new tool specific to the United States.

Formal Presentation:

I presented at the BYU College of Nursing Conference in October 2011.

Personal Reflections:

When I first began, I was more interested in receiving the money and being able to boost my job resume. However, my experiences of completing an ORCA project have significantly opened my eyes. First, I learned how to be flexible and gained a newfound respect for researchers as I suffered through the plethora of paperwork and reviews and faced several roadblocks. For instance, the hospital administrators did not like the term “stress” since this term could possibly raise awareness of negative aspects of the work environment and create disgruntled workers. So, the term “stress” was changed to “possible obstacles”. In another instance, my planned 215 distributed surveys became an 11 participant review group, so that my project could survive. The reviews all helped to point me to a new direction for a future project to create a new stress-test assessment tool.

Secondly, I experienced a paradigm shift of the student and professor relationship and the meaning of hard word work. As I developed a mentor-student relationship with Dr. Merrill, I discovered that I have a wonderful resource of guidance—in both school and life. This discovery has also aided my education and job opportunities with other professors. Dr. Merrill also helped to encourage me to endure. I learned that hard work is more than just laboring many hours, but it is about faithful dedication. As I faced one roadblock after another, I learned to view the roadblocks as not a final end, but an opportunity to try again or to reshape a project idea. In turn, my ORCA project became much more than a quantitative study but a character molding experience. As quoted by Mary Pickford: “Supposing you have tried and failed again and again. You may have a fresh start any moment you choose, for this thing we call “failure” is not the falling down, but the staying down.” Although the end was entirely different from what I expected, I now have a new opportunity for a future project with the nurturing relationships gained from this ORCA project to guide me.

References:

• Admi, H. & Moshe-Eilon, Y. (2010). Stress among charge nurses: Tool development and stress measurement. Nursing Economics, 2(3), 151-158.
• Ilhan, M., Durukan, E., Taner, E., Maral, I., & Bumin, M. (2007). Burnout and its correlates among nursing staff: questionnaire survey. Journal of Advanced Nursing, 61(1), 100-106. doi:10.1111/j.1365-2648.2007.04476.x