Research Article Critique, Part One

Occupational Stressors, Stress Perception Levels, and Coping Styles of Medical-Surgical RNs
(Wakim, 2014)

Instructions: A major skill that is learned in this course is how to critically read and critique nursing research articles. The purpose for critiquing an article is to critically evaluate the research process followed by the author(s) of the assigned article. This is an information and time intensive process that is not learned overnight. To demonstrate your skill at critiquing an article, you will complete this open-book multiple choice assignment.

Here’s how you should approach completing this week’s assignment to finish critiquing an article:

1. First, do your assigned reading in Grove, Gray, and Burns (2015) and complete the reading worksheets early in the week. This will introduce you to the critique skills you will need for the week.

2. Skim the entire instructor assigned research article that has been posted on Blackboard for you so that you will have an idea of what it is about. Then, for this week, re-read carefully the first half of the article, starting with the abstract and stopping after the first paragraph of the results or “findings” section.

3. Print this document and find the best answer to each question below based on your Grove, Gray, and Burns (2015) assigned reading for the week and what you have read in the instructor assigned research article.

4. Some of the questions in the critique assignment below will seem unfamiliar to you. Look up key terms from the question in your textbook. Some examples of these terms might be: problem statement, variables, and cross-sectional. You can also look in Chapter 12 for an example of a critical appraisal (or critique) of a quantitative research article.

5. Once you have completed this assignment “on paper”, go into blackboard and enter your answers by the assignment due date and time listed in the syllabus. Ignore any wording from Blackboard that indicates that “this is a test” and carefully enter your answers from this document.

6. You will have two access attempts to record your answers. This is given to you so that if you encounter technical difficulties on your first attempt, or you would like a second attempt to try to improve your grade, you may do so. You will not be able to see the questions that you missed when you submit your attempt. Blackboard will record the highest grade from the two submissions.

If you have questions about this assignment, you can post them to your group discussion board for help. Please do not post the exact question from the assignment below and ask the group for the answer as this would constitute academic dishonesty.

Questions 1 – 4: Research Problem and Purpose. (For help with these questions, refer to chapters 2, 5, and 12)
1. Which choices below best reflect the problem statement for the instructor-assigned article?
a. The purpose of this study was to compare the occupational stressors, the perceived stress levels, and coping styles of three generations of medical surgical nurses.
b. The nature and scope of stress and the effects on the generations of nurses in the workplace are unclear.
c. Based on the findings of this review of literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention.
d. No studies have compared the occupational stress among the three generations and in particular in medical surgical nurses.

2. Which of the choices below best reflects the purpose statement for the instructor assigned article?
a. Occupational stress negatively affects the nature of the caring relationship and healing environment, interfering with the nurses ability to observe, listen to, understand, and know the patient.
b. 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 MedSurg nurses.
c. The stress and coping theory of Folkman and Lazarus was used as the theoretical framework for the study. It provides a testable model for understanding occupational stress among the three targeted nursing generations.
d. Based on the findings of this review of literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention.

3. According to Grove, Gray, and Burns (2015), which of the following statements are important when considering the significance and relevance of a study’s problem and purpose? (Select all that apply.)
a. Does it consider ethical principles in its design?
b. Does it predict the non-significant findings anticipated in the study?
c. Does it specifically influence nursing education in university settings?
d. Does it identify the future research to be generated by the study?
e. Does it promote theory testing or development?
f. Does it identify extraneous variables?

4. When considering the feasibility of a study’s problem and purpose, Grove, Gray, and Burns (2015) suggest that several areas should be evaluated, including: researcher expertise, money commitment, ethical considerations, and availability of subjects, facilities, and equipment. Which of the following statements accurately assesses the feasibility of this article?
a. Funding sources for the study were clearly identified in the article.
b. The author’s credentials to design and conduct research are described.
c. 100% of the eligible subjects contacted participated in the study.
d. Evidence of protection of the subjects’ rights was mentioned in this article.

Questions 5 – 7: Review of the Literature. (For help with these questions, refer to chapters 6 & 12.)
5. According to Grove, Gray, and Burns (2015), which one of the following is NOT a major purpose of the review of literature (ROL):
a. Describing the current knowledge of the practice problem
b. Identifying gaps in the knowledge base of the practice problem
c. Explaining how the current study contributes to the knowledge being built
d. To explain the reasons behind the selection of the statistics used in the study.

6. Select three MAJOR topics covered in the review of literature (ROL) from the list below:
a. The nursing profession should be concerned about academic stressors for masters and doctoral nursing students as well.
b. The nature and scope of stress and the effects on the generations of nurses in the workforce are unclear.
c. A descriptive correlational design was used to examine the relationship of occupational stress, age, years of experience, education level, and stress perception among a sample of MedSurg RNs.
d. Occupational stress affects individuals differently based on perceptions and personal characteristics.
e. Managers should increase their knowledge of generational diversity. It is suggested that understanding how to relate to multiple generations can lead to improved nursing work environments.
f. the researcher used for instruments that were administered in the following order: the Demographic tool, the Nursing Stress Scale (NSS), the Perceived Stress Scale (PSS), and the Ways of Coping Scale (WAYS).

7. Current knowledge in the review of literature (ROL) (all information included before the “Methods”) is considered to be articles that are within 5 years of the publication date of the article. This is often assessed by reviewing the citations that are used in the ROL and counting the number that meet this criteria. Which number below most closely reflects the number of current citations in the ROL? (HINT-look for references in the ROL that are between 2014-2010.)
a. 1
b. 4
c. 7
d. 10

Questions 8 – 10: Study Framework. (For help with these questions, refer to chapters 7 & 12)
8. Which of these statements best describes this study’s research framework?
a. This study has an implicit framework, which is not fully developed.
b. The theoretical framework supporting the research is stress and coping by Folkman and Lazarus (1985).
c. The authors developed the study’s theoretical framework based on Carver and Candela’s (2008) Theory of Generational Nursing with manager knowledge as an antecedent.

9. What are some of the key concepts in this study’s theoretical framework?
a. This study does not have any clearly defined concepts within a framework because it has an implicit framework.
b. Manager’s understanding of intergenerational relationships will result in an improved nursing work environment.
c. It is important to determine which antecedent variables explain stress appraisal as a loss/harm, challenge, or threat.

10. Which one of the statements below is an example of a relational statement from the theoretical framework?
a. Stress is a major component of nursing and can be detrimental to nurse retention.
b. This study does not have any clearly defined relational statements because it has an implicit framework.
c. Coping strategies used by each generational cohort may (or may not) be the same.

Questions 11 – 15: Research objectives, questions, or hypotheses and research variables. (For help with these questions, refer to chapters 5 & 12)

11. The author states that the first research objective, question, or hypothesis was “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)?” on page 633. This is best described as a
a. Research objective
b. Research question
c. Research hypothesis
d. None of the above

12. Which of these are considered to be MAJOR study variables in this study. (Select all that apply)?
a. emotional intelligence
b. psychological empowerment
c. occupational stressors
d. perceived stress levels
e. manager interactions with nursing staff
f. coping processes
13. What is the conceptual definition (as defined in the review of the literature) of the following study variable: occupational stress
a. The conceptual definition of occupational stress is not clearly provided in the review of the literature.
b. The factors that influence nursing academic success need to be better understood.
c. After students are admitted, they are to be afforded resources that will foster their persistence in the nursing program as well as promote their academic success.
d. Admissions staff are tasked with the ever more difficult charge of distinguishing applicants who can be successful.

14. What is the operational definition (as defined in the methods section) of the following study variable: occupational stress
a. The conceptual definition of occupational stress is not clearly provided in the review of the literature
b. The Perceived Stress Scale (PSS)
c. No studies have compared occupational stress among the three generations and in particular in the medical surgical nurses.
d. The Nursing Stress Scale (NSS)

15. Which demographic variables were assessed by the author for this study? (Select all that apply.)
a. Age
b. Highest education level
c. Years of nursing experience
d. Nursing specialty
e. Generational cohort self-identification
f. Race

Questions 16- 19: Research Design (For help with these questions, refer to chapters 1, 8, & 12)
16. Which phrases best describe the research design of this study? (Select all that apply.)
a. Descriptive
b. Correlational
c. Quasi-experimental
d. Experimental
e. Mixed methods

17. Which phrase best describes the time element of the research design of this study?
a. Cross-sectional design
b. Longitudinal design
c. None of the above

18. Does the study include a treatment or intervention described in the methods section?
a. The Ways of Coping Scale (WAYS) used in the study may be considered a treatment or intervention.
b. 5262 medical surgical nurses were invited to participate in the intervention.
c. A control group of nurse technicians were also asked to complete the survey.
d. This study was not designed with a treatment or intervention.

19. Does the author specifically mention that a pilot study was done prior to conducting this study? (Hint: look at the words “prior to this study”.)
a. Yes
b. No

20. The authors indicate on page 635 of the article that the institutional review board (IRB) authorization was acquired. This indicates than an IRB gave approval to conduct the research. In addition, anonymity and confidentiality was protected. Per Grove, Gray, and Burns (2015), which of the following would NOT be considered essential information for informed consent? (Select all that apply.)

a. a statement of the research purpose and any long-term goals of the study
b. a copy of the abstract of the article that will be used in the publishing journal.
c. an explanation of the procedures to be followed in the study
d. a complete list of references to be used in the study.

JONA
Volume 44, Number 12, pp 632-639
Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
THE JOUR N A L O F NUR S I N G A D M I N I S T R A T I O N
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 ofMSnurses 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, andmaintain a positivework 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 onmultiple 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
632 JONA
Vol. 44, No. 12
December 2014
Author Affiliation: Director ofNursing, SouthMiami Hospital,
Florida.
The author declares no conflicts of interest.
Correspondence: DrWakim, SouthMiami Hospital, 6200 SW
73 St,Miami, FL 33143 (nadaw@baptisthealth.net).
Supplemental digital content is available for this article. Direct
URL citations appear in the printed text and are provided in the
HTML and PDF versions of this article on the journal’s Web site
(www.jonajournal.com).
DOI: 10.1097/NNA.0000000000000140
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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 nursingworkforce.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 studywas
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.
Literature Review
A search was conducted using electronic databases in
the fields of nursing,medicine, education, psychology,
and sociology. Using ProQuest Direct and EBSCO
search engines, the following databaseswere accessed:
CINAHL (Cumulative Index to Nursing and Allied
Health Literature), MEDLINE in PubMed, Ovid, and
PsycINFO. The search terms were grouped in the following
key concepts: (a) occupational stress in nursing,
(b) stress perception in nursing, (c) occupational stressors
in nursing, (d) nursing generational diversity, and (e)
coping in nursing. In a commentary on patient safety
in nursing practice from the Agency for Healthcare
Research and Quality, Hughes and Clancy7 reported
that complexity and bullying represent 2 clear examples
of nurse stressors. Li and Lambert8 concluded
that nurses who are more satisfied with their job are
more likely to remain in the workforce and to be committed
to delivering high-quality patient care. Hall9
found that healthcare professions have some unique
characteristics leading to occupational stress including
physical responsibility for people, potential catastrophic
effects on the patient and the employee, frequent
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
exposure to pain and suffering, and exposure to infectious
diseases and potential hazardous substances.
Hamaideh et al10 identified that death and dyingwere
the strongest stressors perceived by Jordanian nurses.
In this study, workload and guidance were found to
be the most supportive behaviors provided to nurses
facing stress followed by emotional support.10
Carver and Candela11 concluded that considering
the global nursing shortage, managers should increase
their knowledge of the generational diversity. It
is suggested that understanding how to relate to multiple
generations can lead to improved nursing work
environments.11 Repar and Patton12 found that the
combined effects of compassion fatigue, chronic grief,
and emotional and physical exhaustion led to significant
burnout and prolonged job dissatisfaction in the
nursing profession. In this study, using guided sessions,
a massage therapist gave 10-minute chair massages,
and a visual, language, ormusical artist engaged participants
in imaginative and creative activities such as
poetry reading, free writing, guided imagery, and listening
to live music.12 The results suggest that the activities
reduce some of the unpleasant, stressful, and
tension-producing emotions that nurses typically experience
at work, leaving them more peaceful and energized.
12 Based on the findings of this review of the
literature, it is recognized that stress is a major component
of nursing and can be detrimental to nurse
retention. In addition, most studies identified some
differences that exist between the present generational
nursing cohorts in terms of values and beliefs.No studies
were identified reporting how work-related stress affects
different generations of nurses, how the generations
perceive stress, andwhat coping styles are used.
Study Design
A descriptive correlational designwas used to examine
the relationship of occupational stress, age, years of
experience, and education level and stress perception
among a sample of MS RNs. Measures of perceived
stress and coping were compared between the 3 age
cohorts to determine if there is a difference between
these groups. The researcher used 4 instruments that
were administered in the following order: a demographic
tool, the Nursing Stress Scale (NSS),13 the Perceived
Stress Scale (PSS),14 and the Ways of Coping
Scale (WAYS).15
A 4-item demographic questionnaire developed by
the researcherwas used to describe the participants and
to measure select study variables such as age, gender,
years of experience, and the highest level of education.
The NSS scale was designed to measure the frequency
inwhich hospital nurses had work-related sources
of stress. The NSS consists of 34 items that describe
situations that have been identified as causing stress
for nurses in the performance of their duties. The subscales
measureworkload, uncertainty about treatment,
conflict with other nurses, conflict with physicians, inadequate
preparation, lack of support, and death and
dying. Responses are assessed on a 4-point Likert scale
ranging from (1) never stressful, (2) occasionally stressful,
(3) frequently stressful, and (4) extremely stressful.
The PSS scale is used to measure the individual’s
perception of stress. The scale also includes a number
of direct questions about current levels of experienced
stress. The PSS consists of 10 questions. Each item is
designed to identify how unpredictable, uncontrollable,
or overloaded the respondent has found his/her life to
be within the last month prior to completion of the
tool. Responses are assessed on a 5-point Likert scale,
with ‘‘0’’as ‘‘never,’’ ‘‘1’’ as ‘‘almost never,’’ ‘‘2’’ as
‘‘sometimes,’’ ‘‘3’’ as ‘‘fairly often,’’ and ‘‘4’’ as ‘‘very
often.’’ The PSS is scored by reversing responses (eg,
0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to the 4 positively
scored items (items 4, 5, 7, and 8) and then summing
across the scale. A higher score indicated a higher level
of perceived stress.
The WAYS scale measures coping processes. As
the definitive coping measure, the WAYS can assess
and identify thoughts and actions that individuals use
to cope with the stressful encounters of everyday living.
It measures coping processes. The Ways of Coping
Scale is a 66-item questionnaire where the subject responds
on a 4-point Likert scale (0 = not used; 1 = used
somewhat,2=usedquiteabit, and3=usedagreatdeal)
indicating the frequency with which each strategy is
used. Eight coping factors are measured by theWAYS
of coping scale: confrontive coping, distancing, selfcontrolling,
seeking social support, accepting responsibility,
escape-avoidance, planful problem solving, and
positive reappraisal.
Setting
Through the process of convenience sampling, participants
were accessed from a 680-bedMagnetA hospital
in a healthcare system inMiami, Florida. This hospital
has a total of 262 MS nurseswho work on 6MS units.
A total of 5 MS units were included, excluding the
author’s unit to avoid bias. The different units varied
in turnover rate, generational compositions, and length
of experience; however, all these units reflected high
nurse satisfaction scores asmeasured by the National
Data Base of Quality Indicators RN survey.
Sample
Based on the research hypotheses stated for this study,
a power analysis was conducted formultiple regression
634 JONA
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using 4 predictors (yielded a sample size of 84), a bivariate
correlation (yielded a sample of 84), and 1-way
analysis of variance (ANOVA) using 3 independent
groups (yielded a sample size of 159). It was anticipated
that some questionnaires may be returned incomplete
and therefore unusable.As a result, a total of
200 questionnaires were distributed to achieve the desired
sample size for this proposed study of 159. Therefore,
a convenience sample of 200MSnurseswhowork
at a 680-bed hospital in a Florida healthcare system
was used for this study. MS nurses were used as this
study sample because of inadequate amount of literature
available describing this population’s occupational
stressors, stress perception levels, and coping styles.
The sample consisted of MS RNs who worked mainly
full-time 12 hours’ shift. The majority was females
ranging in age between 21 and 61 years. Their years
of experience ranged between 1 and 40 years. Most of
them held a BSN. Gen X (31-51 years old) constituted
46.6% of the sample (see Table, Supplemental Digital
Content 1, http://links.lww.com/JONA/A356).
Ethical Considerations
Prior to data collection, approvalswere obtained from
the university and the hospital’s institutional review
board and fromthe chief nursing officer of the facility.
A cover letter from the author was used to explain to
participants the information related to the aims, benefits,
potential risks, data collection procedures and
data management strategies, data reporting, and dissemination
of the findings of the study. The researcher
attended theMS units’ staff meeting and posted flyers
soliciting nurses’ participation. The researcher also visited
theMS units for about 10 minutes biweekly to reach
out to RNs who were not present at the staff meetings.
The exclusion criteria were verbally explained to
nurses, using the cover letter and the flyer. Participants
were asked to drop the sealed survey envelope in a
locked box at the nursing station. The researcher collected
data biweekly for an 8-week period.
Each participant was assured privacy and anonymity.
Participantswere informed that participation
in this study is voluntary and that they could decline
to participate at any point in the study without penalty.
Potential participants were informed this was an exempted
study and that a returned, completed survey
indicated consent to voluntarily participate. After reading
the cover letter and agreeing to participate in the
study, the participants were given the cover letter and
the questionnaire in an envelope, along with a pen.
The length of time to complete the questionnaire was
estimated to be 35 to 45minutes. Unit nurse managers
agreed to grant time on the job for nurses to complete
the questionnaire.
Instruments/Measures
The questionnaire used to collect data included a
researcher-developed demographic instrument with
items to measure participant variables as well as 3
standardized instruments. The NSS scale was used
to measure the frequency inwhich hospital nurses had
work-related sources of stress13; the test-retest coefficient
for the total scalewas 0.81.13 The PSS scale was
used to measure the individual’s perception of stress14;
reliability of the PSS was determined, and the coefficient
Cronbach’s ! scores for each test respectively
were .84, .85, and .86.16 Finally, theWAYS scale was
used to assess and identify thoughts and actions that
individuals use to cope with the stressful encounters
of everyday living15; reliability was determined, and
the 8 scales’ Cronbach’s ! scores were as follows: confrontive
coping (! = .70), distancing (! = .61, selfcontrolling
(! = .70), seeking social support (! = .76),
accepting responsibility (! = .66), escape-avoidance
(! = .72), planful problem solving (! = .68), and positive
reappraisal (! = .79).17
Findings of the Study
Four hypotheses were tested. Statistical analyses included
multiple regression, bivariate correlation, and
1-way ANOVA.
Hypothesis 1
Hypothesis 1 sought to determine if the measure of
stress perception among MS nurses was determined
by scores on 4 predictors: occupational stressors, age,
years of experience, and educational level. The research
hypothesis was accepted. Regression analysis found
that 28.3%(R2 = 0.283, adjusted R2 = 0.265) of the
variance in the dependent variable was explained by
the model and that the relationship was significant,
F4, 156 = 15.40, P = .00 (Tables 1 and 2). However,
examination of the ” weights revealed that occupational
stressors were the only predictor that contributed to
the model. Therefore, occupational stressors, such as
workload, death and dying, and lack of support, are
predictors of the perceived stress level among this sample
of RNs. The stress perception level is thus determined
by the type of occupational stressor that the
nurse is exposed to. However, age, years of experience,
and educational level ofMSRNswere not determinant
factors of the stress perception level.
Hypothesis 2
Hypothesis 2 considered the correlational relationship
between the scores for stress perception and those for
ways of coping. The research hypothesis was accepted.
As participants’ perception of stress increased, so did
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their use of ways to cope with the stress. Bivariate correlation
analysis found that ways of coping was significantly
correlated with perception of stress, r =
0.357, P G .00 (2-tailed). Therefore, there was a positive
correlation between the perceived level of stress
and the use of the different ways of coping. The higher
the stress perception level isamong the nurses, the higher
the likelihood of using the ways of coping behaviors.
Hypothesis 3
Hypothesis 3 considered differences in scores on the
measure of perceived stress between the 3 age cohorts,
baby boomers, Gen X, and Gen Y. The research hypothesis
was accepted.ANOVAdetermined that there
was a significant difference in the scores for perceived
stress between the age cohorts, F2,158 = 4.07, P = .02.
Post hoc Tukey identified that the scores for perceived
stress from theGenXcohort differed significantly from
those scores provided by the Gen Y cohort, P = .02,
with the Gen Y cohort reporting the higher level of
perceived stress (Table 3). Based on these results, Gen Y
reported a higher level of perceived stress than did
the Gen X and the baby boomers. The literature suggests
that Gen Yexpects immediate feedback and information.
18 Gen Y does not know a time without the
Internet and instant text messaging; therefore, they
crave stimulation and are easily bored, leading them
to expect instant gratification.18 Unlike Gen Y, Gen X
and baby boomers are more experienced and have
been in the nursing profession for a longer time. Baby
boomers are loyal and are willing to dedicate more
time to their work than to their own families1; they
have learned to adjust to difficult situations and new
technologies.18 In addition, the means of the relative
scores for the 7 subscales for types of stressors were
calculated and ranked in ascending order for the entire
sample. The 2most frequently reported occupational
stressors were workload and death and dying (Table 4).
Hypothesis 4
Hypothesis 4 considered differences on scores for the
measure of ways of coping between the 3 age cohorts.
The research hypothesis was rejected. ANOVA testing
found therewas no significant difference for the scores
for ways of coping between the age cohorts of baby
boomers (n = 22; mean, 1.48 [SD, 0.66]; SE, 0.45),
GenX(n = 75; mean, 1.33 [SD, 0.38]; SE, 0.04), and
Gen Y (n = 64; mean, 1.41 [SD, 0.381]; SE, 0.05),
F2,158 = 1.12, P = .33.
The means of the relative scores for the 8 subscales
for ways of coping were calculated and ranked
in ascending order for the entire sample (Table 5). The
mean scores for the 8 subscales for the 3 age cohorts
were then compared using 1-way ANOVA. There was
a significance between the groups for escape-avoidance,
F2,158 = 5.83, P = .00, and for self-controlling, F2,158 =
3.44, P = .03 (Table 6).
Post hoc Tukeywas performed to determinewhich
groups were different on the scores for escape-avoidance
and self-controlling subscales. Gen Y reported higher
use of escape-avoidance behaviors when dealingwith
stressful events comparedwithGenXand baby boomers.
Given this result, GenY tends to avoid the stressor than
to try to face it. Baby boomers reported higher use of
self-controlling behaviors when dealing with occupational
stressors compared with Gen X and Gen Y. The
higher age and years of experience of baby boomers
may explain why self-controlling is a highly used way
of coping among this age cohort.
Discussion
A total of 161 nurses working in an MS environment
in 1 hospital setting participated in this research. Four
Table 1. Means, SDs, and Intercorrelations for the Perception of Stress and Predictor
Variables (n = 161)
Variable Mean SD 1 2 3 4
Perception of stress 0.0 1.0 0.52a j0.15 j0.14 0.05
Predictor variable
1. Occupational stress V j0.04 j0.12 0.07
2. Age V 0.71 j0.09
3. Years of experience V 0.08
4. Educational level V
aP G .01.
Table 2. Regression Analysis Summary
for Participant Variables Predicting
Stress Perception
Variable B SE B ” t P
Occupational stressors 0.51 0.07 0.51 7.48 0.00a
Age j0.01 0.01 j0.15 j1.51 0.13
Years of experience 0.00 0.01 0.03 0.33 0.74
Educational level 0.01 0.12 0.00 0.04 0.96
aP G .01.
636 JONA
Vol. 44, No. 12
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hypotheses were tested. Occupational stressors were
found to be a significant predictor for perceived stress,
but the demographic variables of age, years of experience,
and educational level were not predictive of this
criterion. The results showed that the higher the stress
perception level, the higher the nurses’ use of coping
behaviors. The 2 most highly reported stressors among
all MS RNs were workload and death and dying regardless
of the generational differences.GenYreported
the highest scores on the stress perception scale compared
with the other 2 generations. There was no difference
between the 3 age cohorts’ scores on the ways
of coping scale. However, when comparing the mean
scores of the subscales, Gen Yused escape-avoidance
behaviors more frequently than did other generations,
while baby boomers used self-controlling behaviors more.
This study enables nurse leaders to identify the
needs of individual employees in order to promote individual
growth, retention, andwork satisfaction. An
essential element for nurse leaders is to create an environmentwith
open communication because assumptions
and criticism are often the cause of stress.18 In
order for nurses to perform their jobs safely and proficiently,
hospitals and nursing administrators should
create interventions to decrease nurses’stress. Guidance,
emotional support, and tangible assistance, as well as
various types of social support, are needed so that nurses
are able to balance their professional and personal lives.19
Nurse leaders can provide opportunities involving stress
management programs for nurses in each age group,
especially Gen Y nurses.
Administrators in schools of nursing will be able
to incorporate changes needed to foster learning in a
high-stress environment. Identifying stress perception
levels of each generation could benefit nursing students
to help improve their performance outcomes,whichmay
lead to better retention rates at the school of nursing.
Based on this study, Gen Y reported the highest perception
of stress levels. This information can be used to
add stressmanagement programs and courses to current
academic programs in schools of nursing and hospitals.
It is hoped that this research will lead to further
qualitative researches enabling nurse leaders to explore
how each nursing generation acts in presence of workrelated
stress. Supplying the nurse leaders with this information
can help them support and assist nurses in
each nursing generation when dealingwith stress, thus
increasing nurse retention.
This study will also assist public health policy
makers to identify work-related stress in the nursing
workforce as a high priority. Findingsmay assist public
health policy advocates to bring work-related stress
and unhealthy work environment back to the front.
Advocating for programs and initiatives that assist in
creating a healthy and less stressful work environment
should be a priority if leaders would like to retain the
nursing workforce (Table 7).
Significance of the Study
The results of this study provide data to inform nurse
leaders regarding the recognition and development
of coping skills among the generations in the nursing
workforce. Using this information should assist in the
retention of nurses as leaders deal with complex and
challenging care issues. Nurse researchers may build
on these findings and conduct future research further
exploring the presence of stress and the differentiating
issues among the generations of nurses in the workforce.
Nursing educators, hospital leaders, nursing researchers,
and public policy makers are expected to
Table 3. Summary Statistics for Perceived
Stress From the 3 Cohorts (n = 161)
Cohort Mean SD SE n
Gen X 1.46a 0.49 0.26 75
Gen Y 1.72a 0.56 0.07 64
Baby boomers 1.64 1.64 0.66 22
aP G .02.
Table 4. Rank Order of the Means and
SDs for the Subscales of Nurses Stress
Scale (n = 161)
Subscale Mean SD
Lack of support 1.71 0.67
Conflict with other nurses 1.76 0.58
Conflict with physicians 1.94 0.54
Uncertainty concerning treatment 1.96 0.55
Inadequate preparation 1.99 0.62
Death and dying 2.04 0.55
Workload 2.20 0.59
Table 5. Rank Order of the Means and
SDs for the Subscales of Ways of
Coping (n = 161)
Subscale Mean SD
Escape-avoidance 0.80 0.62
Distancing 1.04 0.57
Confrontive coping 1.06 0.61
Accepting responsibility 1.32 0.69
Self-controlling 1.48 0.56
Positive reappraisal 1.58 0.63
Seeking social support 1.68 0.62
Planful problem solving 1.89 0.54
JONA
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December 2014 637
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recognize the differences in occupational stressors, perceived
levels of stress, and coping styles based on values
and beliefs of baby boomer,Gen X, andGen Y nurses
in order to alleviate or reducework-related stress among
nurses. This, in turn,may result in improving quality of
care and patient safety and outcomes and reducing nursing
shortage and turnover.
Limitations
The sample was one of convenience, the participants
were selected from 1 hospital, and the selection process
was dependent on accessibility of the sample to
the researcher. Therefore, generalizability of the results
was limited. Also, there is a likelihood that the respondents
answered in a socially desirablemanner knowing
that the researcher is employed at the same organization.
In addition, the length of the questionnaires was
a limitation because of the time constraint placed on the
nurses. Nurses may not have completed the questionnaires
as directed because of time pressure. Another
possible limitation is lack of standardization of the conditions
under which the research study is carried out
such as the administration of the instruments. Another
limitation would be the selection of the subjects. Each
subject may differ from the other in age, ability, gender,
or racial/ethnic composition. In addition, there is the
possibility that some characteristics of the participants
selected for the study interact with some aspects of the
instruments. Examples of such characteristics could
include prior experiences, learning, personality factors,
or any traits that might interfere with their responses
to the questionnaires.
Implications for Nurse Leaders
Reducing stress in nursing is an important subject that
will improve patient safety, nursing turnover, staff satisfaction,
patient satisfaction, and patient outcomes.20
Nurse leaders should be educated about the aspects of
managing multiple generations in the workforce and
techniques and programs that support the development
of coping behaviors and skills among nurses. Identification
of occupational stressors and the implementation
of interventions to mitigate these are a key role for nurse
leaders20 (see Document, Supplemental Digital Content
2, http://links.lww.com/JONA/A357).
Conclusions
Findings from this study should lead to other quantitative
and qualitative studies exploring the variables
that can lead to a better understanding of the occupational
stressors encountered by nurses, their perceived
levels of stress, and the coping styles among the
different generations. By exploring these variables, it
is hoped that nurse leaders will have a better understanding
of each generation’s needs regarding occupational
stress and that nurses will be empowered to
make positive changes to their work environment and
support the delivery of quality and safe patient care.
Table 7. Tips for Nurse Leaders on How to
Reduce Occupational Stress per Generation
Baby boomers
1. Driven, dedicated17
2. Equate work with self-worth17
3. Loyal, committed3
4. Value promotions, titles, and recognition3
5. Prefer simplicity in life, autonomy over
professional status3
6. Least satisfied by organizational policies1
Gen X
1. Independence with desire for personal contact with
manager and corporate decision makers3
2. Comfortable with technology3
3. Least satisfied by pay1
4. View jobs as temporary1
5. Energetic and innovative1
6. Do not prefer direct supervision, prefer to be
coached and mentored1
Gen Y
1. Recognition is a key motivator17
2. Need stability, flexible work schedules and shifts,
opportunities for professional development, and
adequate supervision17
3. Crave stimulation, easily bored17
4. Expect instant gratification and immediate feedback17
5. Appreciate team-based collaborative approach17
6. Technology is part of their lives20
7. Accept advise from the more experienced
colleagues but wish to be treated at the same level20
8. Work is a small part of their lives, and private life is
so much more important20
Table 6. Summary Statistics for Escape-Avoidance and Self-controlling Scores From the
3 Cohorts (n = 161)
Escape-Avoidance Self-controlling
Cohort Mean SD SE n Mean SD SE n
Gen X 0.62 0.47 0.05 75 1.41 0.58 0.07 75
Gen Y 0.96 0.65 0.08 64 1.46 0.44 0.05 64
Baby Boomers 0.90 0.82 0.17 22 1.76 0.70 0.15 22
638 JONA
Vol. 44, No. 12
December 2014
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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