The Effects of Environmental Turbulence on Nurse Performance

Abstract

The purpose of this study was to determine the effects of environmental turbulence on nurse performance. The sample (N = 95) was randomly selected from among staff registered nurses working on 19 medical-surgical and pediatric units in a state-supported medical center hospital. Environmental turbulence, the potential stressor, was operationalized as: day-to-day change in acuity and occupancy, and number of admissions to/discharges from and number of transfers on and off a unit in a 24-hour period. Experience was operationalized as number of roles and clinical areas a nurse had worked in since graduation. Education reflected educational level attained. Five instruments were used: The Tolerance-Intolerance of Ambiguity Scale measured ambiguity tolerance, the Hardiness Scale measured personality hardiness, the Technical Support Services Questionnaire measured availability and responsiveness of technical support services, the Perceived Environmental Uncertainty Scale measured the nurse's perception of uncertainty in the work environment, and items from the Six-Dimension Scale of Nursing Performance measured ability to implement nursing process, perform technical skills and prioritize care, and communicate effectively and maintain interpersonal relationships with patients, families, and other health care personnel.

Contextual regression revealed that individual variables (alone) had a greater effect on each of the performance measures than did group level variables (alone). In each performance model the R$\sp2$ differences were significant when the models with group level variables (alone) were compared to models with group and individual variables (together). The R$\sp2$ difference when models with individual variables (alone) were compared to models with group and individual variables (together) were nonsignificant, indicating that individual level variables significantly contribute to explained variance in performance when added to the effects of group level variables.

Path analysis showed that one measure of environmental turbulence (the number of admissions and discharges in a 24-hour period), had a significant negative effect on each performance measure. The direct negative impact of admissions and discharges on interpersonal relations/communication skills was not buffered by the effects of mediating variables. Personality hardiness emerged as a predictor of performance, not as a mediator of stress and had a positive effect on both implementation of nursing process and skills performance by increasing the perception of uncertainty. Level of education had a negative effect on each performance measure as a result of its negative effect on ambiguity tolerance. Technical support services had a positive effect on both implementation of nursing process and skills performance.