Rural health care has been affected by health care changes. Twenty-seven percent of the U.S. population live in rural areas (Adams, 1993; Weinert & Long, 1991). The purpose of this study was to examine the tenure of rural Directors of Nursing (DONs) in the DON position, to examine the tenure of rural DONs in the organization, and to profile the personal system of the DON in a rural hospital. The significance of the study was that little is known about rural DONs.The Neuman Systems Model (Neuman, 1989) provided the theoretical. framework for the study using the personal system level. The sample included all rural acute care DONs in one midwestern state. The Assessment of DON Tenure Questionnaire (Rowles, 1992) was the instrument used to collect data. Thirty-three questionnaires were mailed to rural acute careDONs with a return rate of 100%.Rural DONs were found to have a longer tenure in the DON position than the tenure data in the nursing literature. Tenure in the organization was also found to be longer. The typical DON was found to be female, married, with children,45 years old, with a BSN in nursing. The rural DONS were found to be slightly dissatisfied with the job.The return rate of questionnaires demonstrated the rural DONs interest in nursing education, practice and research. The research implication called for further investigation into the tenure measure of rural DONs in other geographic location along with urban DONs tenure measure for comparative analysis. Rural DONs have limited education opportunities based on geographic location. Continuing education programs in nursing administration and practice that are accessible in the rural setting via TVs or computers would be beneficial. / School of Nursing

In balancing the divergent needs of staff, patients, families, support services and upper management, the nurse middle manager (NMM) in the acute care hospital faces daily stresses in dealing with the demands of the management role. The purpose of the study was to identify the relationship between hardiness, a stress resistance buffer, and coping effectiveness among NMMs. The conceptual framework used in the study was Lazarus' theory of stress and coping. The study was based on a descriptive correlational comparative design. The instruments used were: (a) the Health Related Hardiness Scale (HRHS), measuring hardiness; (b) the .Jalowiec Coping Scale (-JCS), measuring coping mechanisms and coping effectiveness; and (c) a demographic data form, describing the sample. A convenience sample of 201 (37.2X) NMMs representing 31 Indiana acute care hospitals participated in the study. Confidentiality of the subjects was maintained throughout the study. A Pearson r correlation, used to analyze the data of the HRHS and .JCS, indicated a weak: positive relationship at a significant level (r=.2S; p=':.OO1) between hardiness and coping effectiveness. Descriptive statistics wereused to determine that the most frequently used coping mechanisms were confrontive, optimistic, and self-reliant. No relationship was identified between hardiness and age (r=-.07; p=.33). No differences were identified between: (a) hardiness and present level of NMM educational preparation, and (b) hardiness and NMMs that reported 'adequate' and 'inadequate' social support (work and family). It was concluded that NMMs in the study had a high level of hardiness. A lower level of coping effectiveness (mean ;: effectiveness score, 3.30) indicated the use of a limited number of coping mechanisms, which may be the result of limitations in the work setting. The low correlation between hardiness with coping effectiveness may be the result of: (a) a low level of coping effectiveness, or (b) the use of a limited number of coping mechanisms resulting from limitations in the work setting. Confrontive, optimistic, and self-reliant coping mechanisms may be the most appropriate styles in the work setting for NMMs. The use of healthy coping mechanisms by the NMMs may be the result of the programs supporting the transition from clinician to manager provided by the participating hospitals. Organizations should plan strategies to help NMMs (both established and those new to the position) develop a sense of commitment to the organization, a feeling of challenge from the job demands, and a plan to provide control of the responsibilities of the position in order to sustain the present high levels of hardiness for the NMMs. / School of Nursing

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: This study provided a qualitative description of stress and coping as perceived by today's nurse manager incumbents. Background: The healthcare work environment as a source of overwork and stress has been implicated in today's nursing shortage. Nurse managers play a pivotal role in creating work environments for staff nurses, but little is known about the nature of nurse manager work. Methods: This qualitative descriptive study determined what situations contribute to nurse manager stress, what coping strategies they utilize, what health outcomes they report, and what decision-making processes they follow to address stressful situations in their roles. A purposive sample of 21 nurse managers employed at three U.S. acute care hospitals participated in the study. Participants completed a demographic questionnaire and a 14-question interview incorporating components of the Critical Decision Method. Content analysis was completed and themes identified. Results: Difficult situations reported included feeling pressure to perform, interpersonal conflicts associated with organizational communication deficits, and issues of human resources and staffing. Nurse managers utilized a combination of emotion-focused and problem-focused coping strategies. When comparing novice nurse managers (3 years or less in role) with experienced nurse managers (greater than 3 years in role), the novices used predominantly emotion-focused coping strategies, a narrow repertoire of self-care strategies, and experienced negative psychological, physiological, and functional outcomes related to their coping efforts. Experienced nurse managers working as co-managers demonstrated mostly problem-focused coping strategies, a broad repertoire of self-care strategies, and reported no negative health outcomes. The study produced a cognitive model in the form of 10 questions that guide nurse manager decision-making related to stressful situations. The study generated four themes amenable to intervention. Conclusions: Performance expectations for nurse managers in acute care hospitals have increased since the 1990's making the role requirements unrealistic. Rising expectations increase nurse manager stress perceptions, making coping more difficult, and potentially harming nurse manager and work environment well-being. Findings from this study suggest that to address stress, coping, and complexity in the nurse manager role requires a combination of strategies that address individual factors as well as organizational culture, supportive structures, and systems that facilitate the role.