Occupational Stressors, Stress Perception Levels, and Coping Styles of Medical Surgical RNs A Generational Perspective

Nada Wakim, PhD, RN, NE-BC

OBJECTIVE: The purpose of this study was to compare the occupational stressors, the perceived stress levels, and coping styles of 3 generations of medicalsurgical (MS) nurses.

BACKGROUND: The literature supports that the nurse’s role is stressful based on a variety of factors including physical labor, human suffering, work hours, staffing, and interpersonal relationships. Data indicate that there are generational differences in the response to stress. The 3 predominant nursing generations coexisting in the nursing workforce add to the complexity of the recognition and coping skills to address stress.

METHODS: A correlational design was used. A convenience sample of MS nurses participated in this study by completing 4 questionnaires.

RESULTS: Occupational stressors were found to be significant predictors for perceived stress among all generations of nurses in this sample. Also, the higher the level of stress perception among nurses, the higher the use of coping behaviors. Generation Y reported a higher level of perceived stress and higher use of escape avoidance coping behaviors, while baby boomers reported higher use of self-controlling coping behaviors. CONCLUSIONS:

By identifying the needs of each of the generational cohorts, nurse leaders, nurse educators, and policy makers can better assist the nursing workforce to remain at the bedside, improve patient outcomes, and maintain a positive work environment.

The nature and scope of stress and the effects on the generations of nurses in the workforce are unclear. Each generation possesses unique characteristics, values, and traits based on multiple variables.1 Currently, at least 3 nursing generations interact at the workplace. The generational values and ethics of these 3 cohorts of nurses result in differences in terms of work satisfaction and stress perception.1 Lack of understanding of the differences in the perception and handling of stress increases turnover, attrition, and nursing shortage.2 Data demonstrate clear relationships between increases in these areas related to nursing satisfaction1 and patient outcomes.1 Findings from this study will inform nurse leaders who are working with these generations.

Background:

Occupational stress negatively affects the nature of the caring relationship and healing environment, interfering with the nurse’s ability to observe, listen to, understand, and know the patient.2 The distraction and impact of occupational stress result in fewer opportunities for nurses to focus on patient’s safety, patient care, and optimal outcomes.2 Good stress management including the use of evidence-based coping skills has important implications for nurse retention, nursing satisfaction, and career longevity.2 Each of these areas is an important key indicator of optimal work environments and thus important for nurse leaders.

Occupational Stress:

Occupational stress affects individuals differently based on perceptions and personal characteristics.3 The way a stressful event is perceived is dependent on the individual’s characteristics and resiliency.3 Occupational stress creates a challenge in the nursing profession, given that our work is stressful. The handling and support of coping skills are an additional challenge for nurses because several generations work in concert to care for patients. The coexistence of at least 3 predominant generations in nursing has been reported to lead to intergenerational conflict in the workplace.3

To characterize the differences, baby boomers (born 1943-1960) are reportedly committed to their employer and enjoy meaningful work.1 Currently, baby boomers constitute 28% of the nursing workforce.4 Generation (Gen) Xers (born 1960-1981) view work as a job and believe that it is optimal to balance work and leisure.1 Gen Xers constitute 10% to 15% of the current nursing workforce.4 The literature reports that Gen Y or Millennials (born 1981-2003), which represent 12% of the US workforce,5 want flexible working arrangements and to achieve a work-life balance.1 These descriptors suggest differing views on values, work ethics, authority, and stress.1

Many studies have addressed occupational stress among nursing specialties (critical care and labor and delivery) and healthcare settings (acute care hospitals, long-term-care facilities, and nursing homes). Studies have frequently explored the relationship between stress and external variables such as shift length, gender differences, personal characteristics, family obligations, and work relationships. No studies have compared occupational stress among the 3 generations and in particular in the medical-surgical (MS) nurses. About the Study The purpose of this descriptive correlational study was to measure and compare the occupational stressors, the perceived stress levels, and coping styles among baby boomer, Gen X, and Gen Y MS nurses at 1 hospital.

Research Questions:

Research question 1: Will the variables of event (stressors) and personal characteristics (age, years of experience, educational level) be predictive of the appraisal of the event (stress perception)?

Hypothesis 1: Stressors, age, years of experience, and educational level, uniquely and as a linear composite, will be predictive of stress perception among MS nurses.

Research question 2: Will the appraisal of the event (stress perception) be positively correlated with the event outcome (coping)?

Hypothesis 2: Stress perception will be positively related to coping among MS nurses.

Research question 3: Will age cohort significantly affect perceived stress levels?

Hypothesis 3: The mean scores for perceived stress will positively differ significantly between age cohort groups of MS nurses.

Research question 4: Will age cohort significantly affect coping?

Hypothesis 4: The mean scores for coping will positively differ significantly between age cohort groups of MS nurses.

Theoretical Framework:

The stress and coping theory of Folkman and Lazarus6 was used as the framework for this study. The theory of stress and coping provides a testable model for understanding occupational stress among the 3 targeted nursing generations by 1st determining which antecedent variables explain stress appraisal as a loss/harm, challenge, or threat; then examining whether the primary appraisal and secondary appraisal are different from 1 generation to the next; and finally, determining the types of coping or the coping strategies characteristic of each generational cohort.