What are some potential reasons that nurses experience higher levels of stress?

Chapter 05: Managing Time and Stress

Huber: Leadership & Nursing Care Management, 6th Edition

MULTIPLE CHOICE

1. _____ is defined as the accomplishment of specified activities during the time available.

a. Stress

b. Mismanagement of resources

c. Time management

d. Self-management

ANS: C

Time management is defined as the accomplishment of specified activities during the time

available. It is the process of managing the things an individual does with his or her available

time. At its core, time management is self-management.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

2. Nurses who are successful at time management:

a. display an ability to set measurable goals and objectives.

b. frequently volunteer for new and creative projects.

c. hesitate to delegate because of perfectionist characteristics.

d. tend to accomplish specific activities within a time frame.

ANS: D

Time management is accomplishing specific activities during the time available. It is a

process of managing the things an individual does with his or her available time.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

3. Jay, a nurse in the intensive care unit, has been caring for a patient with end-stage renal

disease, congestive heart failure, and a stroke. The client has had four cardiac arrests in 4

days. Despite the grave prognosis, the client’s family continues to want resuscitation at all

cost. Jay knows that further medical care is futile. Jay is at risk for:

a. confrontational conflict.

b. resilience.

c. burnout.

d. moral distress.

ANS: D

Moral distress is linked to issues related to patient care, including ethical dilemmas that can

put professionals in difficulty and give rise to feelings of unease. It occurs when an individual

knows what ethical action should occur but is prevented from doing so by either internal or

external barriers (Rushton, 2006).

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Physiological Adaptation

4. Nurses who must manage unplanned and regular responsibilities simultaneously may

experience:

a. complexity compression.

b. resilience.

c. moral distress.

d. empowerment.

ANS: A

When unexpected conditions are added to regular responsibilities, nurses may experience

what experts call complexity compression , which has been linked to burnout, turnover, and

other types of work-related stress (Krichbaum et al., 2007). Nurses experience this when they

must manage unplanned (complexity) and regular responsibilities simultaneously

(compression).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

5. Creating a safe, empowering, and satisfying work environment can be accomplished through

implementation of:

a. Institute of Medicine Coalitions.

b. health care reform.

c. the Troubled Asset Relief Program.

d. Healthy Work Environment (HWE) standards.

ANS: D

A Healthy Work Environment (HWE) is one that is safe, empowering, and satisfying. The

American Association of Critical-Care Nurses (AACN) has established six standards that

support Healthy Work Environments (AACN, 2005). Although developed for nurses, they are

applicable for all types of employees.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

6. A staff nurse has a concern about a co-worker who may be diverting medications. The staff

nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her

colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake

of patient safety. This nurse is experiencing:

a. stress.

b. procrastination.

c. moral distress.

d. burnout.

ANS: C

Moral distress occurs when clinicians know what is the ethical action to take, yet are

prevented by either external or internal obstacles. Moral distress will contribute to stress and

eventual burnout if the staff nurse does not take action.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

10. Nurse managers are in a position of impacting the stress levels of employees through

improving work environments and creating a culture of enhanced staff satisfaction. Having

structures and processes in place to prevent work-related stress from happening in the first

place requires:

a. genuine intention and corresponding action.

b. additional evidence about the human and financial costs of work-related stress.

c. more stability in the health care industry.

d. decreased demands from payers, consumers, and regulators.

ANS: A

It has always been challenging to secure the necessary resources for prevention, even for

patient care. However, failure to do so puts employees at risk, which in turn can jeopardize the

lives of patients. It is no longer possible to wait for more evidence about the human and

financial costs of work-related stress. Waiting for more stability in the industry, which may

never come, wastes precious time. Once that is embraced and there is genuine intention, then

design and creation can begin in earnest.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

11. There is evidence of a link between _____ employees with higher productivity and more

satisfied customers.

a. stressed

b. empowered

c. financially focused

d. creative

ANS: B

Employees who are empowered in their jobs are also more engaged and satisfied. Research

indicates that structural empowerment leads to higher productivity and satisfaction for the

employee, which translates to more satisfied customers.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

12. Nurses on the midnight shift are experiencing difficulty with receiving materials from the

central supply department. Last night a patient was admitted to the unit from the emergency

department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be

placed in the unit as a standby in case the patient required its use. The central supply unit did

not comply until the patient required its emergent use. The nurse was stressed. This is an

example of which type of stress?

a. Job stress

b. Overload of role

c. Moral distress

d. Role conflict

ANS: A

Job stress is a tension that arises related to the person-in-environment demands of a person’s

role or job. Job stress, or “disquieting influences,” can accumulate into levels that are too

high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and

lowered job productivity.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

13. When a nurse leader is able to fully embrace the American Association of Critical-Care

Nurses’ (AACN’s) Healthy Work Environment and engage others in its achievement, what is

the leader demonstrating?

a. Authentic leadership

b. Meaningful recognition

c. True collaboration

d. Skilled communication

ANS: A

The nurse leader is demonstrating authentic leadership when he or she is able to embrace and

model the AACN’s Healthy Work Environment.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

14. A new nursing manager is falling behind on the staffing schedule, the monthly budget, and

employee evaluations. She says to her director, “I’m working 60 hours per week and I still

don’t have enough time to do it all.” The nursing director suggests which of the following to

her?

a. Setting priorities

b. Obtaining additional preceptoring.

c. Scheduling blocks of time for each activity to be accomplished.

d. Giving up management and returning as a regular staff nurse.

ANS: C

Time management involves a deliberative process of identifying, focusing, and completing

activities needed to accomplish specific tasks and achieve goals. Blocking time to get tasks

done is a strategy that can be used to for time management at work.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care

15. In setting boundaries it is important to do which of the following?

a. Set rigid boundaries.

b. Set boundaries based on individual needs.

c. Consider where one is in the lifespan when setting boundaries.

d. Set boundaries even if it produces more stress than not having boundaries at all.

ANS: B

Stress has a variety of induced changes, including increases in heart rate and blood glucose

levels, emotional changes, and burnout, and it can lead to acute and chronic health problems.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

3. Which of the following statements are true regarding job stress? ( Select all that apply .)

a. Job stress is related more to external demands that are brought into the workplace.

b. Job stress can lead to burnout.

c. Job stress is manifested as emotional and/or physical exhaustion.

d. Job stress increases productivity.

e. Levels of job stress that are too low or too high decrease individual productivity.

ANS: B, C, E

Job stress is a tension that arises related to the environmental demands of a person’s role or

job. Job stress can accumulate to levels that are too high, reach the point of burnout, and

manifest as emotional and/or physical exhaustion. Levels of job stress that are too low or too

high decrease individual productivity.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. What are some methods that nursing staff can use to manage personal stress levels? ( Select all

that apply .)

a. Take personal time each day.

b. Take on extra shifts to keep the mind occupied.

c. Get enough sleep.

d. Pay attention to diet and exercise.

e. Have a strong support network of friends and family.

ANS: A, C, D, E

While stress management is unique to each person, some of the tools that may be effective

include taking personal downtime each day, getting enough sleep, eating right, exercising, and

having a strong network of friends and family for support.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care

5. What are some potential reasons that nurses experience higher levels of stress? ( Select all that

apply .)

a. Nurses are skilled at setting boundaries.

b. Nurses often put others’ needs ahead of their own.

c. Staff nurses are under pressure to do more with less.

d. There are support staff cuts.

e. There are fluctuations in staffing levels.

ANS: B, C, D, E

Staff nurses are under constant pressure to do more with less, and this can cause professional

and personal stress for staff as well as managers. Support staff have been cut, jobs are fewer,

and staffing levels fluctuate. Nurses may have a difficult time dealing with stress, because

they often put others’ needs ahead of their own and need to be able to create healthy

boundaries.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care

6. Managers have a key role in mitigating stress in the workplace. Which strategies will assist

the manager in creating a more healthy work environment? ( Select all that apply .)

a. Recognize nurses for the value they bring to the organization.

b. Partner with the nursing staff to make policies and lead organizational operations.

c. Keep information confidential regarding safety concerns or initiatives.

d. Ensure staffing is an effective match between patient needs and nurse

competencies.

e. Ensure that the manager maintains responsibility for all aspects of unit functioning.

ANS: A, B, D

A healthy work environment (HWE) is one that is safe, empowering, and satisfying. Nurse

managers can foster an HWE by recognizing nurses for the value they bring to the

organization, partnering with the nursing staff to make policies and lead organizational

operations, and ensuring that staffing is an effective match between patient needs and nurse

competencies.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care

7. Conflict and stress in the workplace can be managed through building relationships.

Organizations can foster the building of relationships through: ( Select all that apply .)

a. social media.

b. informal social gatherings.

c. mentoring.

d. confidential meetings.

ANS: A, B, C

Building relationships can be fostered in organizations by formal and informal social

gatherings, mentoring, social media, and deliberate culture creation (Moreland & Apker,

2016). Perceived supportive work environments are characterized by perceptions that

supervisors are supportive, there is fairness, and there is open communication. Stress is

reduced when nurses feel that win-win solutions occur in the work environment.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

8. Job stress can accumulate into: ( Select all that apply.)

a. better time management skills.

b. feelings of elation.

c. burnout.

High stress is experienced by nurse leaders and stems from the challenges of a multifaceted

job with myriad sources of stress. Having support from others (e., supervisors, comanagers,

and coworkers) is a factor that decreases stress (Kath et al., 2012; Shirey et al., 2010). The

amount of autonomy and predictability in the job mitigates the negative effects of stress as

well (Kath et al., 2012).

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

What are the main causes of stress for nurses?

Which of the following can lead to high stress levels in nurses?

What is the most stressful part of nursing?

What factors lead to stress and burnout in nurses?