Status and influencing factors of work stress among nurse managers in western China: a cross-sectional survey study

The results showed that the total stress load score of the nurse managers was 60.5 (50.00, 70.75), indicating that this group is more likely to be at risk of developing stress-related illnesses, which is similar to the survey results of Gu et al. [22]. The event load score in this study was higher than that reported in previous studies, the possible reason is that the participants in this study were nurse managers, who were clinical nursing practitioners and nursing decision-makers and were required to have more solid professional knowledge and the ability to handle matters. At the same time, the survey period was during the COVID-19 pandemic, when the demand for nursing human resources in the society rose sharply, the number of people working in hospitals decreased, and the workload increased sharply. Nurse managers should not only coordinate their work but also balance human resources and scheduling and be under significantly higher pressure than ordinary clinical nurses. Research has found that scientific stress management methods and psychological counseling can alleviate nurses’ job burnout and negative emotions, reduce the incidence of adverse events, and thus enhance their professional identity [23]. Therefore, hospitals should strengthen the ability to manage stress and psychological counseling training of nurse managers and allocate personnel reasonably through learning flexible shift adjustment and increasing the number of “mobile nurse libraries” [24]. Attention must be paid to the physical and mental state of the nurse managers, and early detection, early intervention, and early counseling must be performed for those with moderate to high-stress load levels, ultimately reducing their stress load.

The results showed that the total score of organizational support for nurse managers was 51.00 (10.00, 13.00), which was above the average level. Among them, the score for the emotional support dimension was relatively low, indicating that the hospital provided insufficient emotional support, which is consistent with previous research results [25]. The organizational support score in this study was higher than that of another study [26], which may be related to the research subjects and the period of the survey. The research participants in this study were nurse managers, and the organization provided them with more material and spiritual support than ordinary nurses. During the survey period, the country and society attached great importance to nursing work [27], which made them feel more valued, recognized, and cared for by the organization, indirectly increasing the professional identity and organizational support of nurse managers, resulting in higher scores of organizational support. According to the social exchange theory, both parties in the exchange relationship follow the “principle of reciprocity“ [28]. When employees feel the support and trust of the organization in their work, they feel that their work is full of value and achievements, which increases their sense of professional mission, and they work more actively. Therefore, hospitals should provide material and spiritual support to nurse managers, meet their self-actualization needs, and encourage groups to exert subjective initiative, thereby increasing their sense of organizational support [29].

The results showed a negative correlation between perceived organizational support and work stress (P < 0.01), which is consistent with another research results [16]. When nurse managers do not feel the support and affirmation of the organization, they can question and feel powerless about their work and doubt its value [30]. Ultimately, work pressure cannot be alleviated. Research has indicated that a high level of organizational support can help improve employees’ subjective initiative and enthusiasm for work, and this positive emotion can help them overcome difficult environments, alleviate the pressure generated in clinical nursing work, and reduce perceived pressure [23]. According to the theory of self-determination [31], employees feel empowered by the organization, which not only meets their power and achievement needs, but also motivates their autonomy, ultimately enhancing their perception of internal identity. It is recommended that hospitals actively understand the deep-seated needs of nurse managers, provide sufficient resources and support in the work process, and promote the role of nurse managers in the development of hospitals and the maintenance of patient health; pay attention to the mental health of nurse managers, strengthen effective communication, and promote their stress release. Hospitals should also delegate power and be adept at delegating power in order to provide a platform for nurse managers to fully exercise their autonomy and enhance their sense of organizational support [30].

This study showed that the older the age, the lower the stress load and the greater the sense of organizational support among nurse managers, which is consistent with a previous research result [32]. As managers age, their work experience, quality, and efficiency increase, and they can handle work tasks effortlessly. Consequently, their organizational benefits and sense of professional belonging increase, promoting their sense of organizational support. Therefore, hospitals should increase their leadership training for young nurse managers, improve their job competency and self-efficacy, establish and encourage them to participate in psychological activity groups, and exercise their excellent professional ability and psychological quality; communication should be promoted among nurse managers through hospital cultural construction, such as establishing a balanced group to strengthen communication between doctors, nurses and patients, and share work experience. The importance of education of professional values for young nurse managers should be emphasized, while providing timely recognition and rewards for their work and enhancing their sense of organizational support [29].

Differences in pressure among nurse managers with different professional qualifications. With an increase in professional titles, the pressure load shows a trend of initially increasing and then decreasing, which may be related to the previous professional title promotion system for health technicians in China [33]. As leaders of the nursing team, nurse managers perform multiple functions, such as administration and business management. Supervisor nurses and deputy chief nurses have been working on the front line for a long time and their problem-solving skills are still insufficient. In addition, competition for the promotion of professional qualificationsis fierce, putting heavy pressure on the group [34]. The chief nurse is the highest professional title and there is no pressure for promotion. Fatigue often occurs after work, and lack of attention to improving one’s abilities leads to decreased stress levels. Therefore, hospitals should conduct hierarchical management based on different professional titles, increase training for nurse managers with lower professional titles, and promote the improvement of their comprehensive quality; the management of nurse managers with senior professional titles should be strengthened after their appointment by refining assessments [35], avoiding the “one size fits all” approach to professional titles, and mobilizing their work enthusiasm; a team support system should be built, such as organizing employee assistance plans to promote the dissemination of higher vocational titles by managers with lower vocational titles and play a role in spreading, helping and guiding; a sound reward and punishment mechanism should be established to promote work enthusiasm and organizational support of nurse managers in the entire hospital, effectively improve the overall quality of nursing, and ultimately achieve a dynamic balance between pressure of nurse managers and organizational support.

This study suggested that the higher the hospital grade, the greater the stress load on nurse managers and the stronger their sense of organizational support, which is consistent with previous research results [36]. Perhaps because the higher the hospital grade, the richer the medical facilities and nursing resources and the more visits, nurse managers must have a more abundant clinical knowledge reserve and practical skills. Therefore, the higher the hospital level, the higher the stress load on nurse managers, and the higher the importance that hospital management attaches to nursing, the stronger the sense of organizational support it provides. Secondary hospitals have a low sense of organizational support, which may be due to the hospital placing more emphasis on the overall development of the hospital and insufficient emphasis on the nursing team, resulting in a low sense of organizational support [36]. Nurses have the largest workload and are closest to patients in hospitals. The quality of their work directly affects the quality and social image of hospitals. Hospital managers should emphasize the importance of the nursing team and provide appropriate organizational support for nurse managers to reduce work pressure and improve professional identity and work enthusiasm [27].

The working ward with the highest stress load in this study was the emergency department. The nature and working environment of different departments can affect the pressure and organizational support of nursing staff [37]. From the perspective of sudden public health emergencies, emergency medical staff on the front line of hospitals face higher occupational exposure risks, work overload, and serious psychological impact. Therefore, hospitals should fully assess the risks, pressures, and management difficulties faced by different departments and provide targeted organizational support, such as rational allocation of human resources, increased psychological support and counseling, organizational culture and emotional support, and increased team-building opportunities for departments with low organizational support. Promotion of participation of nurse managers in decision making through authorized leadership can help build a harmonious hierarchical relationship, allowing them to feel trust and support from the organization and ultimately strengthening their sense of organizational support [38].