Nurse managers' perceptions of their work environments and their perceived impact on staff nurses and patient outcomes

The purpose of this study was to develop understanding of nurse managers’ perceptions of their practice environments, their roles and responsibilities within that environment, and how that environment is perceived to affect staff nurses and patient outcomes in their units. Nurse managers play a pivotal role in patient care delivery, yet few studies have assessed their work environment. In the last two decades, there has been an expansion in the scope of nurse managers’ roles and responsibilities, as well as increased complexity and workload. Recent studies showed that nurse managers intend to leave their positions within five years due to increasing responsibilities, stress, and burnout. With patient safety as top priority for healthcare institutions across the nation, nurse managers as frontline leaders are charged with creating an environment that ensures optimal patient safety. Unhealthy work environments for nurse managers have negative consequences because a stressed and ineffective nurse manager can adversely affect staff nurse functioning and organizational performance. Therefore, ensuring a patient care environment that supports staff nurses and improves patient outcomes requires a practice environment where nurse managers are equally supported in their role. This study utilized a qualitative hermeneutic phenomenological research design. Using the snowball sampling method, 17 nurse managers with 24-hour responsibilities for their units, and at least 6 months of managerial experience in an acute care hospital setting were enrolled as participants. With a guide consisting of 10 questions, data were collected using a one-time, in-depth, semi-structured audio-recorded interview. Data were analyzed using the hermeneutic circle. Three major themes and four additional sub-themes emerged from this study. The three major themes were overwhelming workload, inadequate training and resources, and team support and collaboration. The four additional sub-themes were stress, burnout and turnover, ineffective unit management, advocacy and listening, and nurse leader rounding. The findings revealed that although nurse managers love their job and nursing teams, they perceived being overworked with less than adequate resources, they are unable to effectively manage employees 24 hours around the clock, and they are not adequately trained prior to assuming the managerial role. Consequently, when managers are stressed and frustrated as a result of an overwhelming workload, lack of training, or lack of resources, it negatively impacts their staff nurses’ outcomes. Eventually, staff nurses decide to leave in search for better working conditions which in turn also negatively impacts patients with less than desirable patient outcomes.