Understanding the Stress and Coping of Specialist Nurses Before and During the COVID-19 Pandemic

Crynodeb

As a result of understaffing, large workload pressures and insufficient staff support, the specialist cancer nursing workforce in the UK is said to be in crisis. However, due to the rise of the COVID-19 pandemic, the pressures put on both the cancer workforce and the NHS as a whole further increased, with staff sickness rates being the highest ever recorded. Within a rural health board in West Wales, concerns have been raised for cancer Clinical Nurse Specialists (CNS), as they have been recognised to be experiencing high levels of stress and anxiety, and are deemed in need of psychological support. The current thesis employs a mixed methods design to explore the stress and coping of cancer CNSs within the Hywel Dda University Health Board (HDUHB) to inform a psychological support intervention. The theoretical literature on occupational stress and coping is considered, including the JD-R theory, the context of the research, the role of cancer CNSs, and the identity of the nurse. The thesis uses semi-structured interviews across two different timepoints, with the aims of identifying the factors contributing to the stress and coping of cancer CNSs within the HDUHB, and how these evolved during the COVID-19 pandemic. Fifteen interviews were conducted with cancer CNSs, and data was analysed using a thematic analysis. The findings identified that cancer CNSs are faced with various job demands which are associated with stress, and different job resources which facilitate coping. However, job resources were also found to be a source of stress, and many job stressors were exacerbated through the nurse’s individual perception of the stressor. This was particularly found to be the result of the CNSs professional identity (PI), which was suggested to be the result of their enhanced professional status. Additionally, many of the stressors which the CNSs experienced prior to the pandemic were consistent and remained the same throughout the two timepoints, however, other stressors manifested in different ways, and some were either intensified or reduced, as a result of the COVID-19 context. The influence of the CNSs PI on their experiences of stress was however consistent across the two timepoints. The qualitative results challenged the existing theoretical literature on occupational stress, coping and PI. To determine whether these findings were only relevant to nurses working within higher status roles (i.e., CNSs), and thus identify whether the support intervention should encompass these findings, a quantitative online survey was employed to test the theoretical interpretations, by testing whether objective status, subjective status, organisational identity (OI), PI, and overcommitment predicted stress in nurses from a variety of roles and levels. To maximise the sample size, nurses from the HDUHB and South West London and St George’s Mental Health NHS Trust (SWLSTG) were recruited. A total of 119 practicing nurses completed the survey, and the data was analysed using a Multiple Hierarchal Regression Analysis with two models– Model One and Model Two. When testing the assumptions, both objective and subjective status did not correlate with stress, and were thus removed from the analysis– creating Model Three and Four. Model three identified that PI negatively predicted stress in nurses (B= -.064, p≤ .01), and when overcommitment was accounted for in Model four, OI also negatively predicted stress (B= -.274, p≤ .05). Overcommitment was then found to positively predict stress (B= .908, p≤ .001), however, the
significant effect of PI on stress was lost, implying a potential moderating effect. A Moderation analysis was conducted to identify whether overcommitment moderated the relationship between PI and stress. The results revealed that overcommitment moderated the effect of PI on stress (B=.017, p≤ .001), and therefore the qualitative interpretations were partly supported. The thesis identifies various insights, which not only add to the literature for the HDUHB, but
also, with relevance to the global literature. Novel findings are contributed in relation to nurse PI and overcommitment, and the current occupational stress models and theories are challenged. Areas of theoretical debate are thus provided, though more research is required to disentangle these innovative findings. Nonetheless, the findings identified that psychological support interventions should focus on altering the way in which cancer CNSs perceive themselves in their role and attempt to reduce their levels of overcommitment. This should help reduce some of the internal pressure which the CNSs put on themselves when they haven’t delivered the desired standards and expectations of care, and ultimately reduce their level of stress. However, future policy and practice should also consider the PI of nurses when designing support interventions, and conversations regarding the perception of nursing ideals should be encouraged. With these considerations in mind, it is hoped that stress can be reduced within cancer CNSs, but also, within the entire nursing workforce.

Dyddiad Dyfarnu	2024
Iaith wreiddiol	Saesneg
Sefydliad Dyfarnu	Prifysgol Aberystwyth
Goruchwyliwr	Rachel Rahman (Goruchwylydd) & Simon Payne (Goruchwylydd)