The emotional well-being of the nurse within the multi-skill setting.

This article explores nurses' emotional well-being amidst the
growing phenomenon that they are compelled to apply a multi-skills
approach in emotionally demanding work environments. Health services in
South Africa present a challenging work environment for nurses. These
challenges include staff shortages, lack of training, overcrowded
hospitals, insufficient health service management, lack of support by
supervisors, long work hours and task overload (Aucamp 2003:1,5; De Haan
2006:4; Hall 2004:30). Limited growth in the number of nurses and the
simultaneous increased number of patients due to high levels of poverty
and the HIV and/or AIDS pandemic add to these challenges and
consequently put more demands on nurses (Mostert Oosthuizen
2006:429; Subedar 2005:89).
One of the consequences of these challenges is that nurses working
in health care services have to perform multi-skill tasks on a daily
basis (Triolo, Kazzaz Wood 2005:45). In other words, they have to
perform tasks for which they did not receive formal training and which
are outside their scope of practice (Adamovich et al. 1996:206).
Although this approach is widely implemented, concerns exist that its
application is motivated by economical considerations rather than
patient care, which could lead to lower quality care (Canadian
Association of Social Workers 1998). These factors may not only
introduce medico-legal risks (Pera Van Tonder 2004:172; Searle
2007:111; Verschoor et al. 1996:53), but also lead to nurses
experiencing stress and burnout. This, in turn, can have a negative
impact on their emotional wellbeing (Aucamp 2003:3; Csikszentmihalyi
Csikszentmihalyi 2006:96; Kozier et al. 2000:167; Smeltzer
Bare 2004:101; Van Vuren 2006:127).
Research in this area seems to focus on nurses' well-being and
satisfaction with their work environment (Begat, Ellefsen
Severinsson 2005:221; Begat Severinsson 2006:610). Boswell
(2004:57) also focused on nurses' well-being, concluding that one
of the most important considerations for nurses to leave the profession
is difficult work circumstances, coupled with a feeling of worthlessness
resulting from a lack of support by management. Another example of
research in this area is a study conducted by Ablett and Jones (2007) on
the resilience and well-being of hospice nurses rendering palliative
care. In the South African context, Jooste (2003), for example, explored
nursing staff's lack of involvement in and motivation for the
delivery of quality health care, as well as the role of nurse managers
in addressing nurses' motivational needs in the work situation.
Yet very limited evidence exist regarding the emotional well-being
of the nurse in the multi-skill setting. The researcher's own
experience as a professional nurse working in a multi-skill setting
confirmed the emotionally demanding nature of this work environment.
Owing to a high workload and shortage of medical and nursing staff,
nurses at this specific setting are expected to attend simultaneously to
trauma patients, patients in labour and pre-operative and postoperative
medical patients, and to implement skills that are not necessarily
within their scope of practice.
Problem statement
In view of the aforementioned discussion and the researcher's
experience, the study sought to investigate (1) what the nurse's
experience of working in a multi-skill setting is, (2) what the
perception about coping mechanisms within a multi-skill setting is, and
(3) what can be done to promote the emotional well-being of nurses
working in a multi-skill setting.
The study thus aimed to (1) explore and describe the experience of
the nurse working in a multi-skill setting, (2) explore and describe the
nurse's perception about coping mechanisms within a multi-skill
setting, and (3) formulate recommendations to promote the emotional
well-being of the nurse working in a multi-skill setting.
Definitions of key concepts
Level-2 hospital
The facility is defined as a district or regional hospital with
maternity and specialist services (De Kock Van der Walt 2004:2;
Uys Middleton 2004:63). The Level-2 hospital where this research
took place consists of a trauma unit, a theatre for uncomplicated
surgical procedures, a maternity section, and a 40-bed unit for patients
in need of medical as well as pre-operative and post-operative care. The
hospital is served by visiting medical specialists and a psychologist,
mostly on an outpatient basis and catering for private patients
(patients with a medical aid). Doctors visit the hospital only for
rounds and are available afterwards only via a callout system. Nurses,
including professional and enrolled nurses and nurse assistants, are
available 24 hours a day and are responsible for the care of private and
public health care patients in all the mentioned sections. Only two
professional nurses are allocated per shift and are responsible for
taking the lead in patient care. Together with a small team of enrolled
nurses and nurse assistants, they are responsible for the nursing care
in the trauma unit and maternity ward, as well as for the routine care
of the medical and pre-operative and post-operative patients. These
nurses are consequently compelled to apply multiple skills in emergency
situations, for example intubating patients and attending to widely
varying and complex health needs of patients.
Professional nurseA person who is trained, competent and accountable for practicing
nursing in an independent and comprehensive manner (South Africa 2005).
In this study, such professional nurses implemented multitasking in a
Level-2 hospital where both private and public health services are
Enrolled nurse
A person who is trained, competent and accountable for rendering
basic nursing care (South Africa 2005). In this study, such nurses were
defined as enrolled nurses who implemented multitasking in a Level-2
hospital where both private and public health services are rendered.
Nurse assistant
A person who is trained, competent and accountable for rendering
elementary nursing care (South Africa 2005). In this study, nurse
assistants implemented multitasking in a Level-2 hospital where both
private and public health services are rendered.
An approach to care according to which nurses are expected to
perform tasks outside of their scope of practice and for which they were
not originally trained (Adamovich et al. 1996:206). This concept also
refers to the combination of two or more roles or skills within a
multi-skill role (Cameron 1997:1). In this study, multiple skills were
expected from nurses in a Level-2 hospital where both private and public
health services are rendered.
Emotional well-being
The ability to acknowledge, accept and express one's own
emotions appropriately and accept personal limitations (Kozier et al.
2000:167), coupled with the ability to function comfortably and
productively (Smeltzer Bare 2004:101). This study focused on the
emotional well-being of the nurse working in a multi-skill setting.
Research method and design
Research approach
This study was performed according to an explorative, descriptive
and contextual design with a qualitative approach. This design was
deemed appropriate, as it is applied when exploring and describing
qualitative, subjective material in an attempt to understand human
experiences (Burns Grove 2005:27; Polit Beck 2006:16), in
this case those of nurses working in a multi-skill setting and their
perceptions of coping mechanisms within this setting. This information
was used to formulate recommendations to promote the emotional
well-being of these nurses.
Research methodPopulation
The population consisted of all the nurses (professional nurses,
enrolled nurses and nurse assistants) working in a multi-skill setting
at a specific Level-2 hospital.
Because the entire study population worked in a multi-skill
setting, the sample was all inclusive.
Data collection
Individual semi-structured interviews, as discussed by Brink, Van
der Walt and Van Rensburg (2006:52), were used to collect data. This
data collection method allows the researcher to explore the experiences
and perceptions of participants by asking questions relating to the
research problem and objectives, whilst being allowed to ask prompting
and follow-up questions. Based on the research objectives, the following
interview questions were used:
* What is your experience of the multi-skill setting?
* What is your opinion on effective coping mechanisms within a
multi-skill setting?
* In your opinion, what can be done to enhance the emotional
well-being of the nurse within a multi-skill setting?
The researcher approached potential participants personally to
explain the purpose of the research and expectations regarding
participation. This explanation was also provided in writing and
adequate time was allowed for answering the potential participants'
questions about the research. After informed consent was obtained,
interviews were scheduled for a convenient time and place for each
participant. Some interviews were conducted in an office at the
hospital, whilst others took place at the participants' homes.
Interviews were audio-recorded and transcribed. Field notes were
compiled after each interview. A rich set of saturated data was obtained
during interviews with:
* three professional nurses
* six enrolled nurses
* one nurse assistant.
All participants were female and the sample included Black and
White participants. The participants are collectively referred to as
'nurses' in the discussion of the results.
Data analysis
Results, in the form of transcribed interviews, were analysed using
the method described by Creswell (2003:192). All the transcribed
interviews were reviewed to form a general impression of the responses.
Themes were identified according to the research objectives and grouped
into columns. During a subsequent round of revision, notes were made
pertaining to the identified themes. Each theme was given a descriptive
heading and divided into categories, with similar categories being
grouped together. An independent co-coder was appointed to co-analyse
the data. After discussion with the co-coder the results were divided
into appropriate main and subcategories.
Literature control
A literature control was conducted after data analysis, with the
aim of confirming the results, pointing out unique results and
reflecting current knowledge about the research topic (Burns Grove
2005:95). Databases used to search for relevant literature included
Nexus (National Research Foundation), SAePublications, ScienceDirect and
EBSCOhost (Academic Search Premier, CINAHL, PsychInfo).
Ethical considerations
Ethical permission for the research was obtained from the Ethics
committee of the North-West University (reference number 07K08).
Permission to conduct the research at the identified Level-2 hospital
was subsequently obtained from the hospital manager. The potential
participants were then approached and the purpose and nature of the
research, and potential benefits and risks (e.g. the potential for
emotional upset) were explained to them.
Ethical principles as discussed by Brink et al. (2006:31-34) were
implemented. The principle of respect for participants was implemented
by obtaining informed consent, providing information on the study and
offering participants the choice to withdraw. The principle of
beneficence was upheld by explaining the risk-benefit ratio to the
participants, namely that they may not experience immediate benefits
from participating and that a counsellor would be available after the
interview for the purpose of debriefing, if needed. The principle of
justice was adhered to through ensuring fair selection and treatment and
the right to privacy, anonymity and confidentiality.
The framework for trustworthiness as described by Babbie and Mouton
(2004:276) and also Hek and Moule (2006:78) was applied in this
research. The framework entails four main criteria for trustworthiness,
namely truthfulness, applicability, consistency and neutrality.
Truthfulness was ensured through:
* the researcher's experience of working in a Level-2 hospital
* audio-recording interviews to ensure that the researcher did not
forget or misinterpret the participants' words
* writing field notes directly after each interview to ensure that
no significant observations would be forgotten
* reporting the participants' own words to indicate the range
and variety of responses representing each topic
* continuing with data collection until data saturation was
* analysing and discussing responses with a co-coder to ensure that
the participants' true opinions were identified (triangulation)
* consulting the two study supervisors to review the process and
the findings
* comparing the findings with published studies and other
literature (triangulation).
Applicability was achieved through rich description, whereby the
research process, the characteristics of the participants and the
context are supplied to allow readers to determine to which extent the
circumstances are similar to their own context.
Consistency was ensured by initial independent analysis by the
researcher and co-coder, after which findings were compared during a
consensus meeting.
Neutrality was ensured by the researcher's keeping the
original interview schedule and the audio recordings, the transcripts,
notes and memos to provide an audit trail.
Results and discussion
Four main response categories emerged, which were subsequently
divided into subcategories. Participants' experiences were similar,
irrespective of their position (professional nurse, enrolled nurse or
nurse assistant) and are therefore presented as a whole. As shown in
Table 1, the following main categories were identified:
* positive experience of the multi-skill setting
* negative experience of the multi-skill setting
* personal coping mechanisms within the multi-skill setting
* promotion of emotional well-being within the multi-skill setting.
In the subsequent discussion of these response categories,
statements by the participants are included in support of the results
and findings are discussed in relation to existing literature to
facilitate critical reflection.
Positive experience of the multi-skill setting
Several reasons emerged for nurses' positive experience of the
multi-skill setting.
An opportunity to gain experience
Nurses experience the multi-skill setting as a learning environment
as they work in different units and new patients are attended to in the
trauma unit daily. Nurses learn to function independently and to rely on
their own decision-making skills. A participant stated: 'With
different people and different patients ... from casualty and the whole
ward, you learn a lot.'
The finding is in line with that of Adamovich et al. (1996:206),
who state that the multi-skill setting provides an opportunity for
learning additional clinical skills, professional development,
broadening one's scope of practice and improving efficiency through
coordinating clinical services.
An opportunity to prepare for possible further studies
Nurses find opportunities to sharpen clinical skills in the
multi-skill setting, which can be helpful when doing a bridging course
to improve their position. Participants stated:
'Even if I can go to be a staff nurse, I won't have a
problem. I don't think I will struggle ... it's nice for me to
learn rather just to do the vital observations.'
'Normally they teach us, they say that we must know. I think
also maybe if you want to study further, like if you want to be a staff
nurse or maybe [a] sister ...'
This result appears to be specific to this study, as the researcher
could not find any related existing literature confirming or contrasting
the finding.
An opportunity for task sharing
The multi-skill setting creates the opportunity for nurses to learn
skills and gain confidence when assisting senior nursing staff to share
the workload, when required. A participant stated: 'And, sometimes,
if it's very busy you can help the sister; you can put up the new
admission's drip or maybe put up the catheter ...'
Although Mathijs (2008:35) confirms that this phenomenon, known as
task shifting, is widely practiced and respondents in this study
experienced it as a positive aspect of working in a multi-skill setting,
they also shared that such situations are a source of stress (see Table
Negative experience of the multi-skill setting
In spite of the positive experience, nurses also experience the
multi-skill setting as stressful. The high workload, high level of
responsibility and staff shortages lead to the experience of the
multi-skill setting as unpleasant and, sometimes, even intolerable.
Misrepresentation of the term 'multi-skills setting'
Nurses were of the opinion that the term 'multi-skill
setting' is justified in its use only when all the nurses working
in this setting possess the necessary clinical skills, as reflected by
the following statements:
'You can't place someone who is supposed to work in
casualty if you do not have the skills to work there. Most of the time
you do not have an idea of what is going on. So, it does not help that
you have people who are so-called "multi-skilled".'
'They say it's a multi-skill hospital; it is because we
are working everywhere ... Casualty, ward, everywhere we work. Theatre,
even though we are not supposed to work there, we must work in theatre
as well.'
Literature supports the notion that 'multi-skill' and
'multi-skilling' are ambiguous terms, which are applied and
interpreted in various ways (Adamovich et al. 1996:206; Cameron 1997:1).
There is little consensus about the responsibilities of multi-skill
staff, the skills and competencies that these staff should have or how
to apply a multi-skills approach appropriately. This is also true in the
South African context, which confirms the need for research such as this
Stress brought on by staff shortages
Nurses experience staff shortages as stressful. It appears that the
imbalanced representation of the different categories of nurses, namely
the shortage of professional nurses relative to the number of enrolled
and assistant nurses, is a very specific area of concern, as evident
from the following statements:
'[There is] a shortage of staff.'
'There's a shortage of sisters.'
'I think there is a shortage of staff and not everyone has the
same skills.'
Begat et al. (2005:222) confirm that the nursing staff shortage
impedes the nurse's ability to render quality patient care, which
Aucamp (2003:20) confirms is perceived as a source of stress. Richards
(2003:1) also mentions that the nature
of work circumstances is one of the main causes of work
dissatisfaction amongst nurses.
Subjective consequences of task overload
Nurses experience several subjective consequences of task overload,
namely increased levels of stress, physical and emotional exhaustion,
loss of concentration, work dissatisfaction and interpersonal conflict,
all of which may have a negative influence on emotional well-being. The
following statements support this finding:
'It's strenuous and difficult.'
'You become tired; sometimes you get overloaded
'You loose concentration [in] your work.'
'Sometimes you forget what you were doing.'
'Sometimes you don't finish your work.'
'You feel stressed and you feel guilty.'
'It's difficult, because you are one nurse and there are
many things to do at one time.'
'You feel stressed and tired and sometimes you get
Aucamp (2003:21) confirms that workload is a determining factor in
emotional exhaustion. Begat et al. (2005:228) further mention that the
less time a nurse has to complete tasks, the more physical symptoms of
stress are evident or experienced. Demir, Ulusoy and Ulusoy (2003:823)
also found that work overload leads to burnout and work dissatisfaction.
Unreasonable staff allocation
Nurses find the allocation of staff in the multi-skill setting as
unreasonable and confusing. They are rotated between wards in an
unorganised manner and have to be prepared to work in different
specialties owing to the unpredictable nature of patient presentation at
a hospital. Participants shared the following:
'Weare working stressfully ... [in] the wards and casualty at
the same time.'
'I know they say this is a multi-skill hospital. Actually, I
think it's because you work all over, casualty and the ward. And we
have to work in [the] children's ward. We have a paediatrics ward
as well. I just see everything [as] disorganised here.'
'Maybe the ward is full and we are maybe three assistant
nurses. We have to go up and down: casualty, private ward,
children's ward.'
This seems to be a unique finding of this research.
Duties beyond scope of practice
Nurses experience stress and fear when they are forced to practice
outside their scope of practice. Sustained exposure to this stressful
situation leads to burnout with a consequent negative effect on
emotional well-being. Participants made the following statements:
'We don't have enough staff and some of the things we
[just] cannot do. Our scope doesn't allow us to do that.'
'We always work outside of our scopes, every day.'
'I'm not even trained to do the SSD [central
sterilisation department], but I'm doing those things.'
'It seems as if it's not my scope of practice, it makes
me stressed ... because I'm putting myself in danger. What if they
[the Nursing Council] find me doing those things and I'm not
supposed to do those things?'
Stewart and Arklie (1994:183) also found that nurses whose roles
are not clearly defined and who perform tasks beyond their scope
experience increased levels of burnout.
Insufficient resting time
Some nurses were of the opinion that there are not enough
opportunities to rest during the work day, as reflected by the following
'You have to go on tea. Sometimes, because there's a
shortage [of staff], you can't even go on tea.'
'You can't even go to lunch sometimes. You [have] not
[gone] since the morning.'
This seems to be a unique finding of this research.
Negative perception towards management
Nurses indicated a negative perception towards the mangement of the
hospital owing to management not attending to the nurses' emotional
needs. The following statements illustrate this finding:
'... but the management is not right ... they don't care
about the employee's feelings.'
'They don't care about our opinions.'
'It breaks your self-esteem ... you don't feel
'You satisfy their needs. They don't care.'
Boswell (2004:56) and Mynhardt (2006:547) both found that health
care workers' perception about management has an important effect
on their level of motivation in the workplace. The more nurses perceive
that they are being treated fairly, the more they are engaged with their
work and motivated to perform additional tasks.
Personal coping mechanisms within the multi-skill setting
Task prioritisation
Nurses were of the opinion that prioritising is an important coping
mechanism in the multi-skill setting. Nurses felt in control when they
could complete more important tasks before performing less important
ones. This decreases stress and creates an effective work environment.
It also contributes to work satisfaction and emotional well-being. The
following statements support this finding:
'I try to divide my time
'I prioritise.'
'I complete one task at a time, and you do what you can. I
finish the most important things first and then I can start with the
next thing. You then feel in control of things.'
Literature confirms that the degree to which nurses have time to
plan ahead has a definite influence on their general well-being (Begat
et al. 2005:227).
Nurses rely on their faith in God as a coping mechanism in the
multi-skill setting. The following statements support this finding:
' I just pray: "God, help me".'
'Just maybe, that you can pray and just believe every day.
Because if you trust God, He will help you to cope.'
This seems to be a unique finding of this research, as literature
to support this finding could not be found.
Nurses often use self-motivation as a coping mechanism in a
multi-skill setting, as illustrated by the following statements:
'I tell myself that the work must be done, I have to keep
'I just tell myself that this thing doesn't have to
bother me. And I don't get stressed. It doesn't help to become
stressed. It only makes things worse.'
Coon (1998:407) describes self-motivation as continued positive
thinking and behaviour and the ability to persevere in spite of negative
circumstances. Begat et al. (2005:227) confirm that nurses use
self-motivation to cope with difficult work circumstances.
Mutual support amongst colleagues
Nurses experience mutual support amongst colleagues as very
important within the multi-skill setting. It serves as a coping
mechanism and is a motivational factor in this stressful work
environment. The following statements support this finding:
'Sometimes we help each other.'
'You learn how to co-operate with people. Colleagues ... are
not [all] the same.'
'You help each other.'
'You know what? Actually, we are working as a team, but
sometimes it's difficult to work with some other people because ...
instead of working like maybe I want [to work] - we have to work
together they just remain behind and then they push you to do the things
[to complete the tasks].'
Trust and mutual support amongst colleagues are described by both
Boswell (2004:57) and Van Rhyn and Gontsana (2004:26) as important
contributory factors to work satisfaction. Aucamp (2003:4) also states
that nursing colleagues can be important resources amongst one another
to aid in the management of stress in the workplace. Similarly, Levert,
Lucas and Ortlepp (2000:37) report that limited support amongst
colleagues is an integral cause of burnout.
The promotion of the emotional well-being of nurses within the
multi-skill setting
The promotion of emotional well-being on a personal level, as well
as at management level emerged from the research.
Personal promotion of emotional well-being
Nurses mentioned several strategies that can be applied at a
personal level to promote emotional well-being. These further categories
include the following:
In-service training: Nurses suggested in-service training as a
strategy for the promotion of emotional well-being. The following
statements illustrate this finding:
'Maybe training ... can also help.'
'I think if maybe you gain more knowledge. [Through] training
people gain more knowledge and it will help them in a ward maybe to do
their work properly. And quality work ... You can improve them - and
then they will also feel more self-confident in their work.'
'It will decrease stress.'
Muller (2005:141) confirms that nurses should receive the necessary
training to ensure competent performance.
Support system: A support system, in the form of training about
topics related to emotional well-being, was suggested. This could
provide nurses with practical advice to cope with stress. Participants
also suggested that establishing a 'haven' could be valuable
in the promotion of their emotional well-being. They explained this
'haven' as a place where nurses can go to talk about stressful
experiences and obtain perspective in order to once again function
effectively in the workplace. The following statements reflect their
'... might sometimes need counselling as others, other things
in hospitals are [traumatic].'
'Maybe even to give nurses education on mood swings.
Sometimes, others ... can be rude if they like
'Sometimes when you feel, when you feel that work is too much,
[that] there's too much work and you get too busy, then you become
frustrated and you become rude.'
Hall (2004:34) also suggests that employers should support
employees by presenting programmes on the management of stress, as well
as creating opportunities for counselling. These services should be
avaialable free of charge for nurses of all categories (Hall 2004:34).
In addition, the former Minister of Health, Dr Manto Tshabalala-Msimang,
promoted the notion of 'wellness centres' for health care
workers to promote their well-being (Khumalo 2008:9)
Managerial involvement to promote emotional well-being
Nurses suggested several practical strategies whereby management
can improve the work environment, consequently contributing to the
emotional well-being of nurses.
Appointment of additional staff: Nurses felt that the appointment
of additional permanent staff is essential to ensure that there are
enough human resources available on a daily basis, as reflected by these
'Firstly, they can try to have more staff.'
'I think they can employ more nurses.'
'First thing they [the management] must do [is to] employ
people and stop using agencies.'
'They should at least appoint people permanently.'
'Sometimes there are too few staff
'There's a lot of people on the roster but they
don't want to call people to come on duty. And they don't want
to give people employment ... they only use agencies.'
Literature confirms that inadequate staff numbers not only hold
risks for patient safety, but can also have a negative impact on the
well-being of the nurse (American Nurses Association 2007).
Appropriate staff allocation: Nurses explained that they found it
stressful to have to work in various wards or sections and then be held
accountable for the care of all the patients.
Statements to support these views are as follows:
'I think there should be specific people that are always there
for casualties ... and a doctor also in casualties. I think there should
be a permanent [attending] doctor for casualties
'... maybe [if] there are nurses for theatre, nurses for
casualties and nurses for the ward.'
This seems to be a finding specific to this study.
Managerial involvement: Nurses perceived management not to be
adequately involved with staff on a personal level, as illustrated by
the following statements:
'Maybe from the hospital management, if they can maybe try to
understand the staff
'When they voice [complaints], they must help them. Not to
just leave them like that
'We need support from our hospital manager, the matron, the
ward manager, unit manager. I think if they can [set up] meetings with
nurses and ... communicate with the nurses more, it can be better.'
'They just sit in their office and they wait for people to
come and say who did what.'
'They must treat nurses equally.'
'... they must ask for opinions from nurses.'
Boswell (2004:59) confirms that, in general, there is a lack of
trust between nurses and management, because of nurses' perception
that their well-being does not receive enough attention.
Limitations of the study
The sample consisted only of female nurses, whilst the opinion of
male nurses may have contributed to the results of the study. In
addition, some nurses were reluctant to participate in interviews after
work hours, leading to fewer participants being available.
Recommendations for further research, nursing education and nursing
practice were formulated. Recommendations for nursing practice focus on
the promotion of the emotional well-being of the nurse within a
multi-skills setting.
Recommendations for further research
Further research on the following research topics related to the
emotional well-being of the nurse in the multi-skill setting is
* specialised training
* management style
* support networks
* task allocation and productivity
* patient experience of the quality of health care in the
multi-skill setting
* scope of practice
* economic implications of the multi-skill setting
* personal circumstances of nurses working in a multi-skill setting
* relationships between concepts portrayed in Figure 1 (also see
later for a discussion).
Recommendations for nurse education
Participants suggested in-service training on specific topics as a
strategy to promote their emotional well-being. In addition, it may be
valuable to include the recommendations for promoting the emotional
well-being of nurses in formal as well as informal training (see
'Recommendations for nursing practice').
Recommendations for nursing practice
These recommendations describe how emotional well-being of nurses
working in the multi-skill setting can be promoted. Firstly, adequate
in-service and formal training opportunities should be provided. This
should include appointment of training staff, encouragement of
'on-the-spot' training and provision of financial support for
further training. Furthermore, tasks should be allocated according to
nurses' individual training and capabilities. The scope of practice
of each nursing category should be available in writing and should be
monitored. Nurses should be allowed time to rest during shifts and a
suitable area for debriefing should be available. Improvement of
relationships between management and nurses should be a priority. Also,
the strengths nurses display, for example their coping mechanisms as
emerged from this research, should be acknowledged and promoted. Lastly,
a functional support system for nurses should be established.
Application of these recommendations may contribute to creating a
positive work environment that is less stressful and more conducive to
promoting the emotional well-being of the nurse. This, is turn, may lead
to nursing staff being more motivated towards and engaged in their work
and so contribute to quality nursing care.
The purpose of this study was to explore and describe the
experiences of nurses working in the multi-skill setting and their
perception about coping mechanisms within this setting. Findings
provided insight into the unique experiences and perceptions of these
nurses, which allowed recommendations for promoting their emotional
well-being to be formulated.
The results showed that nurses have contrasting experiences of the
multi-skill setting and conclusions from the study are presented
schematically in Figure 1.
On the one hand they experience it as a stimulating setting that
offers learning opportunities, but, on the other hand, they also
experience it as an unorganised setting associated with high demands
such as responsibility for all wards in the hospital in a high-paced
environment, where they are compelled to perform tasks beyond their
formal capabilities. This leads to fear and internal conflict, which
have a negative influence on nurses' emotional well-being. Nurses
furthermore experience a lack of support and engagement from management,
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Heleen French (1)
Emmerentia du Plessis (1)
Belinda Scrooby (1)
(1) School of Nursing Science, North-West University, Potchefstroom
campus, South Africa
Correspondence to:
Emmerentia du Plessis
Postal address:
Private Bag X6001, Potchefstroom 2520, South Africa
Received: 24 Mar. 2010
Accepted: 18 Nov. 2010
Published: 16 May 2011
TABLE 1: Experiences, coping mechanisms and strategies
to promote well-being of nurses working in the
multi-skill setting.
Positive Negative Personal coping The promotion
experience of experience of mechanisms of the
the multi- the multi- within the emotional well-
skill setting skill setting multi-skill being of nurses
setting in the multi-
skill setting
* An * Misrepresentation * Task * Personal
opportunity to of the term prioritisation promotion of
gain experience multi-skill emotional well-
setting' being:
* An * Stress * Faith ? in-service
opportunity for brought on by training
possible staff shortages * Self-
further studies * Subjective motivation ? support
consequences of system
task overload
* An * Unreasonable * Mutual * Managerial
opportunity for task allocation support amongst involvement to
task sharing colleagues promote
* Duties beyond emotional well-
scope of being:
* Insufficient ? appointment
resting time of additional
* Negative
perceptions ? appropriate
towards staff
management allocation
? managerial
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