‘Focused coping’ relieves job stress

Employers can improve HCW coping skills

Each nurse has a way of coping with the stresses of the job, whether there is conflict with coworkers or patients or difficulty balancing the demands of work and family life. But those who cope most effectively use just one or two strategies, recent research shows.1

Nurses who used focused coping reported fewer physical symptoms, less burnout and greater overall sense of being able to deal with stressors, even after controlling for workload, sense of control and support in the workplace, the study found.

By encouraging this “focused coping,” employers can help health care workers manage the stress and ultimately improve their ability to function at work, says Robert Wright, PhD, a postdoctoral researcher at the Center for Research on Occupational & Environmental Toxicology at the Oregon Health & Science University in Portland.

“There was not one coping strategy that was universally most effective,” says Wright. “Finding a good match between the stressor characteristics and coping efforts seems to be what’s [important]. For each individual, there may be a unique match between those characteristics and the coping method.”

Wright’s study involved 144 RNs from around Oregon and was part of the multi-year Oregon Nurse Retention Project. The nurses completed a web-based questionnaire every week for 12 weeks, which asked them about the most positive and negative things that happened in that week. The questionnaire also asked about coping strategies.

Wright and his colleagues identified nine possible strategies, including actively trying to change the problem, trying to reinterpret it to create a more positive outcome, getting relief from humor or prayer, seeking social support, or trying to avoid or ignore the problem.

Finding the right strategies may be important in nurse retention, especially for new nurses, says Bob Sinclair, PhD, associate professor of psychology at Clemson University in South Carolina and a project leader in the retention research.

“Some people are better at finding the right strategy than others,” he says. “[That’s important] particularly in the first few years of a nurses career, when they learn to cope with the demands of the job. Some people do and some people don’t.”

The research pointed to steps employers could take to encourage coping skills, Wright says. Here are some of the significant issues:

A high workload means less coping. “We did find as hours worked per week increased, the effectiveness of coping efforts decreased,” he says. By managing work hours and schedules, employers can help avoid burn-out among nurses, he says.

Experienced nurses are better at coping. Longer tenure was associated with better coping. Employers could encourage mentoring of younger nurses by older nurses and create teams that have a mix of organizational experience, Wright says.

Policies can address major stressors. It may be possible to reduce or even eliminate some of the triggers of work stress. Many hospitals have anti-bullying policies or policies that govern physician behavior. The Joint Commission’s leadership standard has elements of performance that require hospitals to develop a code of conduct and a process for managing “disruptive and inappropriate behaviors.” Inappropriate behavior can include verbal outbursts, refusal to answer questions or return phone calls, or condescending language. Magnet hospitals, which have higher rates of nurse retention, also rely on teamwork rather than a strictly hierarchical structure.

Nurses can be empowered to help fix problems. If you want to know why nurses are stressed out, you should ask them, says Sinclair. He advises using an employee survey and following up with focus groups. “It’s not just listening, it’s actually responding,” he says. “You might find out that the most important issue is that you’ve got computer technology that’s outdated and not effective.”

Coping skills can be taught. Employers can conduct education sessions to help nurses develop coping strategies, Wright says. This could be incorporated with wellness, since sleep and exercise may help employees cope, as well.

Nurses often need to resolve conflicts with each other. In Wright’s study, the greatest interpersonal conflict was among nurses. Often, it involved a perceived injustice or unfairness, he says. For example, younger nurses would complain that older nurses would relegate them to doing more menial or unpleasant tasks. The results echoed the widely quoted claim that “nurses eat their young.” Employers can work to counterbalance that by providing formal mentoring and a way for nurses to communicate their concerns, Wright says.


1. Wright, R.R. (2012). Coping with interpersonal conflicts at work: An examination of the Goodness of Fit Hypothesis among nurses. Dissertation.Portland State University, Portland, OR.