Understanding the Causes and Consequences and the Role of Supervisor Support

The nursing profession has long been recognized as a stressful occupation, with many nurses reporting high anxiety levels resulting from job-related stress. During their everyday work life, nurses are likely to struggle with excessive work constraints, work-family conflict, verbal abuse, negative teamwork experiences, inadequate support, and overtime. The stress from these regular experiences is associated with lower job satisfaction, increased turnover intentions, and actual turnover. Given that individuals have limited psychological, emotional, and physical resources with which to effectively deal with these challenges, it is important to gain an in-depth understanding of the nature of a nurse’s work environment so solutions can be identified to ultimately reduce anxiety experienced by nurses.
 
Using data collected from 1,080 mid-career licensed registered nurses, our interdisciplinary team set out to examine the relationships between four predictors of nurse anxiety (work constraints, work/family conflict, verbal abuse, negative team orientation among nurses) and their subsequent effects on job satisfaction and turnover intentions. We further explored how supervisor support can play a role in mitigating the negative consequences of nurse anxiety for key satisfaction and retention outcomes. 
 
What causes anxiety?
 
Using this data collected from mid-career nurses, those having worked in the profession for 10-15 years, our team identified four consistent causes of nurse anxiety, including work constraints, work/family conflict, verbal abuse, and negative team orientation. Work constraints consist of lack of equipment or supplies, lack of necessary information about what or how to complete tasks, conflicting job demands, and inadequate help from others. Work-family conflict refers to work demands that interfere with time spent with family and responsibilities at home (e.g., child care, paying bills, cooking, cleaning, repairs, etc.). Verbal abuse can come from other nurses, physicians, patients, and patients' families. Negative attitudes towards working in teams relate to perceptions among nurses and their colleagues that working in teams unnecessarily wastes time.
 
Interestingly, of these four commonly identified predictors of anxiety, negative job satisfaction, and retention-related outcomes, our findings indicate work constraints are the strongest predictor of nurse anxiety while perceived verbal abuse is the weakest predictor. Although much research has surfaced regarding workplace bullying and other forms of verbal abuse, in comparison to perceived work constraints, work/family conflict, and negative team orientation, verbal abuse appears to be of lesser importance. We speculate this finding is partly a function of the nature of our sample, which was comprised solely of mid-career stage nurses who may have been more likely to experience verbal abuse/bullying in their earlier years. Future research is needed to investigate the notion that verbal abuse/bullying is more impactful among newer nurses than among their more experienced constituents. Indeed, research has suggested that senior nurses are often the perpetrators of the very forms of verbal abuse/bullying that is reported by more junior nurses. Further, more research is needed to explore the factors (e.g., organizational support and communication practices, perceived procedural and distributive justice in the allocation of work resources, etc.) that determine perceptions of workplace constraints among employees.
 
What role do supervisors play?
 
Supportive supervisors listen to their employees and what they have to say about job-related difficulties. They also encourage their employees to express their opinions. Our results indicate nurses who perceive their supervisors provide high levels of support have reduced turnover intentions as a result of job dissatisfaction. This highlights the importance of supportive supervisors in retaining nurses.
 
What are the practical implications?
Business leaders/managers must be aware of the anxiety-provoking potential of workplace constraints on nurses. Widespread nursing shortages make nurse retention particularly important, and our findings illuminate the clear role played by leaders/managers. Nurses may be especially sensitive to the restrictions of organizational rules and procedures and perceived lack of equipment and supplies. Further, perceptions they have insufficient information, time, help, and/or resources or conflicting job demands can be particularly stressful for nurses. Identifying frequent roadblocks and resources nurses can use to navigate these situations may be especially beneficial. Similarly, ensuring sufficient co-worker backup may alleviate perceptions of work constraints and help develop more supportive workplace cultures. Other potentially useful initiatives may involve (a) advance purchasing of supplies and/or their strategic placement throughout the facility to minimize perceptions of unavailable resources, and (b) more frequent communication of roles and expectations, which may directly decrease perceptions of role conflict and lack of information. Organizational culture shifts that emphasize the value of employee voice are also likely to minimize the predictive role of these workplace conditions on anxiety and work-related outcomes.
 
Another interesting finding is that negative team orientation was a strong predictor of anxiety and associated negative outcomes among nurses. This is particularly telling given that today's health care context emphasizes the norm of team-based and coordinated patient care. This is an important observation from both personnel selection and training perspectives. When nurses enter the workplace with a negative perception of interdependent work or develop frustrations with teamwork over time, their willingness to contribute and engage in co-worker backup behaviors diminishes. From a selection perspective, if patient care is coordinated within teams, then recruiters might consider the extent to which dispositional tendencies towards teamwork may be useful insights into nurse applicants.
 
Finally, employers must identify tangible ways to help their employees meet the demands of both their work and non-work roles, as WFC will ultimately affect job satisfaction and turnover intentions via its effect on anxiety. Tangible assistance may include access to quality child care around the clock, sick time to tend to ill family members, job sharing options and/or shorter work shifts.
 
In conclusion, given the shortage of qualified nursing professionals, it is of particular importance to identify those who will be a good fit for the context (e.g., team orientation) and tangible behaviors managers can engage in to help nurses navigate the work environment.