Journal of Nursing Management, 2016, 24, 211–218

Conflict management style, supportive work environments and

the experience of work stress in emergency nurses
1 2
MARY L. JOHANSEN PhD, NE-BC, RN and EDNA CADMUS PhD, RN, NEA-BC, FAAN

1
Assistant Clinical Professor, Associate Director, New Jersey Collaborating Center for Nursing, School of Nursing,
Rutgers, The State University of New Jersey, 180 University Avenue, Newark, NJ 07102, USA and 2Clinical
Professor, Specialty Director, Leadership Tracks, School of Nursing, Rutgers, The State University of New Jersey,
180 University Avenue, Newark, NJ 07102, USA

Correspondence
Mary L. Johansen Clinical
Assistant Professor.
Associate Director NJ
Collaborating Center School of
Nursing Rutgers,
The State University of New
Jersey 180 University Avenue,
Newark,
New Jersey 07102
USA
E-mail: mjohanse@rutgers.edu
JOHANSEN M.L. & CADMUS E. (2016) Journal of Nursing Management 24, 211–218.
Conflict management style, supportive work environments and the
experience of work stress in emergency nurses
Aims To examine the conflict management style that emergency department (ED)
nurses use to resolve conflict and to determine whether their style of managing
conflict and a supportive work environment affects their experience of work
stress.
Background Conflict is a common stressor that is encountered as nurses strive to
achieve patient satisfaction goals while delivering quality care. How a nurse
perceives support may impact work stress levels and how they deal with conflict.
Methods A correlational design examined the relationship between supportive
work environment, and conflict management style and work stress in a sample of
222 ED nurses using the expanded nurse work stress scale; the survey of
perceived organisational support; and the Rahim organisational conflict
inventory-II.
Results Twenty seven percent of nurses reported elevated levels of work stress. A
supportive work environment and avoidant conflict management style were
significant predictors of work stress.
Conclusions Findings suggest that ED nurses’ perception of a supportive work
environment and their approach to resolving conflict may be related to their
experience of work stress.
Implications for nursing management Providing opportunities for ED nurses in
skills training in constructive conflict resolution may help to reduce work stress
and to improve the quality of patient care.
Keywords: conflict management style, perceived organisational support, supportive
work environment, work stress

Accepted for publication: 1 March 2015

environments, work stress and conflict management

Introduction
styles in ED nurses.
Emergency department (ED) nurses work in high
stress, high conflict environments (Emergency Nurses
Overview of the literature
Association (ENA) 2007). How the nurse perceives
support may impact his or her work stress level and Nurses who work in emergency departments are
how they deal with conflict. The purpose of this study especially susceptible to work stress as they encoun-
was to assess the relationships among supportive work ter particular work stressors that may not be typical

DOI: 10.1111/jonm.12302
ª 2015 John Wiley & Sons Ltd 211
M. L. Johansen and E. Cadmus
of most other professions. Emergency department
nurses work in an environment that includes the
direct involvement in critical incidents such as caring
for patients who are critically ill, participating in
end-of-life decisions with families, resuscitative efforts
and unexpected patient deaths (Institute of Medicine
(IOM) 2006, ENA 2007, Pemberton & Turpin 2008,
Verhaeghe et al. 2008). Over the past two decades,
the role of the emergency staff nurse has expanded
to include other care responsibilities that can increase
work stress such as serving as the primary provider
of health care for many individuals in the commu-
nity, attending to the urgent and primary care needs
of the uninsured; and providing emergent care to
acutely ill patients and victims of major trauma.
Moreover, the inherently challenging work environ-
ment that emergency nurses experience can lead to
increased levels of exhaustion and work stress (IOM
2004, 2006, ENA 2007, Li & Lambert 2008) con-
tributing to the 12% registered nurse vacancy rate
(IOM 2006).
The perception of one’s work environment, that is,
the perceived organisational support may likely
impact work stress levels in emergency department
nurses (Rhoades & Eisenberger 2002). Perceived or-
ganisational support also known as a supportive
work environment is characterised by perceptions of
supervisor support, fairness and open communication
(Rhoades & Eisenberger 2002). A supportive work
environment contributes to win–win solutions for the
employee and the organisation and thereby reduces
levels of work stress. Research suggests that nurses in
acute care settings such as the ED with greater levels
of perceived support from their supervisors experi-
ence less work stress (Hall 2007, Verhaeghe et al.
2008).
Due to the nature of the emergency department,
conflict is an inevitable characteristic of the work
environment and a common work stressor that
emergency nurses encounter in the unpredictable
workplace where nursing responsibilities are driven by
patient needs that are often complex and dynamic
(Laschinger et al. 2008). The style that the individual
utilises to manage conflict may be directly shaped by
the task at hand or by the interpersonal relationships
between peers, physicians and supervisors and may
directly affect the level of work stress (Laschinger
et al. 2006).
Conflict management style (CMS) is a multidimen-
sional concept consisting of five styles of managing
conflict (integrating, obliging, dominating, avoiding
and compromising) (Rahim 1983). These styles are
212
complex and while an individual may use one style
more than others, the style that is used is dependent
upon the situation and the players (Rahim 1983,
Friedman et al. 2000). According to the seminal work
by Rahim (1983) integrating involves exchanging
information, examining differences to solve the prob-
lem, and looking for alternatives to solve the issue in
a manner that is acceptable to all parties involved.
Obliging involves an attempt to minimise differences
and to emphasise commonalities to satisfy the con-
cerns of the other parties. The dominating style
involves one party satisfying their needs or concerns
at the expense and the needs and concerns of the
other party. In contrast, when avoiding conflict, there
is often no attempt to satisfy needs and concerns of
any of the parties. Lastly, compromising involves both
parties giving up something to make a mutually
acceptable decision (Rahim 1983).
Individuals who have a high concern for themselves
have personal internal resources and are more skilled
in ensuring that their interests are represented when
urgent needs arise and as a result, these individu-
als experience lower levels of work stress. These
individuals tend to use a dominating or integrating
(problem-solving) conflict management style. Con-
versely, individuals who have a low concern for them-
selves lack personal internal resources and fall short
of representing their own interests, making them
passive receivers of others’ actions that lead to higher
levels of work stress. These individuals usually are
avoiders or obligers (Friedman et al. 2000).
Thus, the conflict management style rendered in
response to conflict may directly affect the level of
work stress and may be an important determinant of
work stress in emergency department nurses (Fried-
man et al. 2000, Montoro-Rodriguez & Small 2006,
Vivar 2006, Sportsman & Hamilton 2007).
Although findings in the literature indicate that sup-
portive work environments and conflict management
styles are directly related to work stress, it is thought
that the individual’s perception of their work environ-
ment may lessen the negative effects of conflict man-
agement style on overall work stress (Friedman et al.
2000, Rhodes Rhoades & Eisenberger 2002). The aim
of this study was not only to examine the relation-
ships among conflict management style, supportive
work environment and work stress in staff nurses who
work in hospital-based emergency departments but
also to determine whether a supportive work environ-
ment support minimises the negative effects of oblig-
ing and avoidant conflict management style on work
stress in emergency department nurses.
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 211–218

Method
Research design
A descriptive, correlational design was used to investi-
gate the relationships among supportive work environ-
ment, conflict management style and work stress and
to answer the following research questions: (1) How
does conflict management style contribute to the level
of stress experienced by the ED nurse? (2) Does a sup-
portive work environment moderate or lessen the
effect of conflict management styles on stress?
Participants were recruited through the use of a
mailing list of registered nurses who were current
members of the Emergency Nurses Association
(ENA) and work in the USA. Systematic sampling
was used to select 1000 nurses from this list who
were mailed questionnaires and follow-up reminders
using a modified Dillman method (Dillman 2007).
The data were collected in 2009–2010 over a
4 month period. Sample inclusion criteria included
current membership in the ENA, current employment
as a staff nurse in a hospital based emergency depart-
ment in the USA and a direct patient care provider.
Sample exclusion criteria included nurses employed
in education, nurse practitioner and management
roles.
Human subjects protection
This study was approved by the Institutional Review
Board (IRB) at the Office of Research and Sponsored
Programs at Rutgers, The State University of New Jer-
sey. IRB number 09-600M.
Sample
The sample size for the study was estimated based on
power analyses for correlational and regression analy-
sis that was used to test the research questions. For
correlational analysis, using a moderate effect size
(r = 0.30) based on the literature (Rhoades & Eisen-
berger 2002, Tabak & Koprak 2007), a sample size of
84 was needed to obtain a power of 0.80 at a 0.05
significance level. Using a moderate effect size
(f2 = 0.30), based on a review of the literature (Hall
2007, Tabak & Koprak 2007, Verhaeghe et al. 2008)
and 14 predictor variables (the total number of sub-
scales in the instruments), a minimum sample size of
135 was needed to obtain a power of 0.80 at a signifi-
cance level of 0.05 (Cohen 1992) for regression analy-
sis. Based on Dillman’s (2007) estimate of mailed
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 211–218
Conflict management, work environment & stress
survey response rates with repeated mailings, a
minimum sample size of 290 nurses was anticipated
to yield more than sufficient power for statistical
analyses.
Three hundred surveys were returned for a 40%
response rate. Seventy-eight of these surveys were
excluded because responders identified their current
position as educators, nurse practitioners or nurse
managers. The final sample size for this study was
222 staff nurses who worked in hospital-based emer-
gency departments.
Instruments
All data were collected using a demographics ques-
tionnaire developed by the investigator; the expanded
nursing work stress scale (ENSS) (French et al. 2000);
the abbreviated survey of perceived organisational
support (SPOS) (Eisenberger et al. 1986); and the
Rahim organisational conflict inventory-II (ROCI-II)
(Rahim 1983). The expanded nurse work stress scale
(ENSS) is a 57 item self-report survey with nine sub-
scales and measures the nurses’ experience of work
stress as perceptions of sources and frequency of work
stress experienced in the workplace rather than gen-
eral work stress (French et al. 2000). The ENSS sub-
scales consist of items related to the following sources
of stress: (1) death and dying, (2) conflicts with doc-
tors, (3) inadequate emotional preparation, (4) prob-
lems with peer support, (5) problems with supervisors,
(6) workload, (7) uncertainty concerning treatment,
(8) patients and families and (9) discrimination. The
ENSS is a 5-point Likert response scale. Each item is
scored from 1 to 5. The responses are (1) ‘never
stressful’, (2) ‘occasionally stressful’, (3), ‘frequently
stressful’, (4), ‘extremely stressful’ and (5) ‘doesn’t
apply’. The ENSS yields a total score of 228 in
the nine subscales. The higher the score, the more the
respondent agrees that the situation is stressful. The
ENSS has demonstrated an acceptable reliability
(a = 0.96) (French et al. 2000). The reliability for the
ENSS subscales has ranged from 0.65 to 0.88 (French
et al. 2000).
The abbreviated survey of perceived organisational
support (SPOS) (Eisenberger et al. 1986) was used to
measure a supportive work environment in this study.
This widely accepted 16-item, self-report instrument
measures the extent to which nurses perceive that
their employer values them. Using a 7-point Likert
scale respondents are asked to rate the extent to which
they disagree or agree with statements concerning the
organisation’s value of the individual such as ‘The
213
M. L. Johansen and E. Cadmus

organisation values my contributions and well-being’ Table 1

Sample characteristics (n = 222)
and ‘The organisation shows very little concern for
me’. Each item is scored from 0 to 6. The responses Variable n %
range from (0) strongly disagrees to (6) strongly agree.
Gender
The possible range of SPOS scores is 16 to 96, with a Male 31 14
higher score reflecting a higher level of organisational Female 191 86
Age
support perceived by the respondent. Cronbach’s 18–30 28 13
alpha coefficient of 0.90 has been reported for the 31–49 117 53
SPOS. The reliability for the SPOS subscales was 0.97 50 and above 77 34
Race
(Eisenberger et al. 1986). African-American/Black 3 1.4
The Rahim organisational conflict inventory-II Alaskan Native or American Indian 2 0.9
Asian 12 5.4
(ROCI-II) is a 28-item self-report instrument with five
Hispanic 9 4.1
subscales and was used to measure five styles of han- Caucasian/White 190 86
dling interpersonal conflict with the ‘people at work’ Mixed race 5 2
Highest nursing degree
(dominating, obliging, avoiding, integrating and com- Diploma 15 6
promising). The ROCI-II is a 5-point Likert scale. Associate degree 77 35
Individual items are scored from 1 to 5 with responses Baccalaureate degree 122 55
Masters degree 8 4
ranging from (1) strongly agrees to (5) strongly dis- Years of experience
agrees. Reliability for all ROCI-II subscales ranged 0–4 69 33
from 0.72 to 0.74 (Weider-Hatfield 1988). 5–11 75 33
12–34 78 33
Board Certification in Emergency Nursing
Yes 81 36
Data analysis No 141 64
Work status
A descriptive analysis of the demographic data was Full time 163 73
conducted to describe the sample characteristics. Cor- Part time 47 21
Per diem 12 5
relation and linear regression analysis were used to
test relationships among study variables. Hierarchical
multiple regression analysis was used to test the affect
of supportive work environment on the relationship board certified in emergency nursing (n = 81). A
between conflict management style and work stress. majority of nurses (74%) worked in facilities not des-
All data were analysed using Statistical Package for ignated as Magnet hospitals.
the Social Sciences (SPSS) version 16.0 for Windows
(SPSS Inc. Released 2007, SPSS for Windows, Version
Work stress
16.0; SPSS Inc, Chicago, IL, USA).
Regarding work stress, a large majority, 73% of
nurses experienced stress occasionally and reported
Results low levels of work stress (n = 161), while the remain-
ing 27% (n = 54) experienced stress frequently with
Demographics
moderate to high levels. Sixty-six percent (n = 147) of
The demographic characteristics of the sample are pre- the sample perceived low levels of organisational sup-
sented in Table 1. The mean age of the sample was port (Table 2). A little more than one in four nurses
43.75 years (SD = 10.41) with a range of 22 to (28%) reporting used an avoidant conflict manage-
69 years. Eighty six percent of the nurses were female, ment style; 7% reported using a dominating conflict
73% were employed full time. One-third of the nurses management style; and the remaining two thirds
had less than 4 years’ experience (n = 69); another reported using integrating and obliging conflict man-
one third of nurses had 5 to 11 years of emergency agement styles.
department experience (n = 75) and the remaining
third had 12 to 34 years of emergency department
Supportive work environment and work stress
experience (n = 78). The mean years of emergency
department experience was 10.68 (SD = 9.10). Fifty- When testing the relationship between supportive
nine percent of the respondents had at least a bacca- work environments and work stress, there was an
laureate degree in nursing (n = 130) and 36% were inverse, weak negative relationship. This suggests that
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214 Journal of Nursing Management, 2016, 24, 211–218

Table 2
Work stress and perceived organisational support (supportive work
environment)
Variable n %
Level of work stress
Low 161
Moderate to high 54
Perceived organisational support
Low 147
Moderate to high 68
ED nurses experienced less work stress in a supportive
work environment (r = 0.292, P = 0.000).
Conflict management style and work stress
There was a moderate positive, relationship between
avoidant conflict management style and work stress
(r = 0.300, P = 0.000) indicating that ED nurses who
avoided conflict experienced less work stress
(Table 3). No significant relationships were found
between integrating, dominating and obliging dimen-
sions of conflict management styles and work stress.
Supportive work environment, conflict
management style and work stress
Regression analysis revealed that both supportive
work environment and avoidant conflict management
style were significant independent predictors of work
stress (b = 0.262, P = 0.003, b = 0. 209, P = 0.018,
respectively). That is, a supportive work environment
had an independent effect on work stress while con-
trolling for the effects of avoidant conflict manage-
ment style and avoidant conflict management style
had an independent effect on work stress while con-
trolling for the effects of a supportive work environ-
ment.
Hierarchical regression analyses revealed that there
were no significant relationships between conflict man-
agement style and a supportive work environment, on
Table 3
Relationships between perceived organisational support (support-
ive work environment), conflict management style (CMS) and work
stress
r b
Perceived organisational support 0.292**
Integrating CMS 0.024
Dominating CMS 0.012
Avoidant CMS 0.300**
Obliging CMS 0.129
*P < 0.05 **P = 0.002.
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Journal of Nursing Management, 2016, 24, 211–218
Conflict management, work environment & stress
the level of work stress in staff nurses who worked in
hospital-based emergency departments.
Discussion
73 A significant weak relationship was found between a
27
supportive work environment and work stress, indicat-
66 ing that nurses who work in emergency room settings
34 with greater levels of perceived support from their
organisation experience less work stress. In this study,
27% reported moderate to high levels of work stress
and 73% of nurses experienced low levels. These find-
ings from this study are similar to previous findings in
the literature that revealed 39% of staff nurses work-
ing in hospital-based inpatient units reported frequent
experiences of work stress (Rhoades & Eisenberger
2002, Parikh et al. 2004, Hall 2007). Moreover, while
this relationship has been previously tested in nurses
who work in hospital-based, inpatient settings (Hall
2007), findings from this study indicate that a sup-
portive work environment may be an important ante-
cedent to preventing work stress for nurses who work
in emergency department environments as well.
A significant moderate relationship was found
between an avoidant conflict management style and
work stress, suggesting that emergency department
nurses who use this conflict management approach are
likely to experience work stress. In this study more
than 25% of emergency nurses used an avoidant
approach to manage conflict, suggesting that more
emergency nurses may experience some level of work
stress. These findings are congruent with previous
studies, which demonstrated that nurses using an avoi-
dant approach to managing conflict have higher levels
of stress (Friedman et al. 2000, Tabak & Koprak
2007). The findings of the present study also under-
score the importance of the recommendations of The
Joint Commission (TJC) and the National Institute of
Occupational Safety and Health (NIOSH). Lack of
effective conflict management skills has been identified
as a root cause and contributing factor to behaviours
that can undermine the quality of patient care and a
culture of safety in the health care environment (Joint
Commission 2008). No direct relationship was found
between an integrating conflict management style and
dominating conflict management style and work
stress, indicating that emergency nurses who used
0.262**
these behavioural approaches to managing conflict
may have experienced less work stress. These findings
0.209*
differ from previous research that found significant
relationships between integrating and dominating con-
flict management styles and work stress in nurses in
215
M. L. Johansen and E. Cadmus
hospital settings (Tabak & Koprak 2007). An expla-
nation might lie in the complex relationship between
conflict management style and work stress. There is
an overall tendency of the individual to respond to a
conflict situation in a predictable way and hence the
approach to managing conflict is often chosen to
match the situation at hand (Sportsman & Hamilton
2007). Conflict management style may be related to
work stress through conflict experiences such as task
conflict or relationship conflict with a physician,
supervisor or a peer.
There was no significant relationship between an
obliging conflict management style and work stress,
suggesting that emergency nurses who used an oblig-
ing conflict management approach may not experience
high levels of work stress. Echoing previous studies
the results from this study appear to confirm that peo-
ple using the obliging conflict management style faced
a unique situation as they attempt to decrease work
stress by addressing the interests of others (Friedman
& Tidd 2002). This paradox may solve the immediate
conflict: however, for emergency nurses placating a
conflict can lead to increased work stress as they abate
their ability to assert their own interests.
The relationship between conflict management style
and work stress is complex. Empirical findings suggest
that conflict management style may be shaped by both
the task at hand as well as the interpersonal relation-
ship (Rahim 1983, Friedman et al. 2000). This study
demonstrated that there is a relationship between an
avoidant conflict management style and work stress.
These findings underscore the priority that the Joint
Commission (TJC) (2008) has placed on the use of
effective conflict management strategies in hospitals.
In fact, TJC recommendations suggest that nursing
administrators including those in emergency depart-
ments should provide an opportunity for staff nurses
to examine or become aware of conflict management
styles and should provide skills based training and
coaching in constructive conflict resolution to resolve
these differences between peers, physicians and super-
visors.
Limitations
There are several limitations in this study. For exam-
ple, nurses self-reported their style of managing con-
flict, experience of work stress and perceived support
by their organisation. Self-reporting measures run the
risk of potential common method variance which
could inflate or deflate the reported correlational rela-
tionships. There may also be unmeasured variables in
216
the analysis such as task and relationship conflict
which could affect the results. In addition, more
objective organisational variables such as hospital type
(urban, rural and suburban), trauma level and hospital
size, staffing levels and shift work could affect rela-
tionships. Selection bias may have occurred during the
data collection process as this study used only regis-
tered nurses who were current members of the ENA.
This also decreases the generalisability of these study
findings. Lastly, it should be noted that the data for
this study were collected approximately four years
ago.
Implications for nursing management
In this study 73% of emergency nurses reported occa-
sional experiences of work stress. These findings are
important since research has shown that there is a sig-
nificant relationship between work stressful nurses
and negative patient outcomes such as, medication
errors, IV errors, patient falls, reduced quality and
efficacy of care (Jones et al. 2003, Trinkoff et al.
2011). Findings from this study suggest that nursing
leadership in acute care hospitals should document the
prevalence of work stress among its ED nurses in
order to develop administrative strategies for reducing
work stress (NIOSH 2010, Shirey et al. 2010). Rec-
ommendations may include routine distributions of
work stress surveys, analysis of existing employees’
data such as injury and illness logs or worker compen-
sation data, or tracking staffing patterns.
Enhancing nursing leadership and staff skills in
managing conflict is important to develop and master.
Nurse managers and staff need to have strong emo-
tional intelligence (EI), which includes self-awareness,
self-management, social awareness and relationship
management skills in dealing with emotionally
charged situations (Goleman et al. 2002). These are
skills that can be taught to nurse leaders and staff.
Morrison (2008) conducted a study in three hospitals
in Mississippi to determine the relationship between
emotional intelligence and preferred conflict handling
styles with 94 nurses using three instruments. The
results showed that higher levels of emotional intelli-
gence positively correlated with collaborating and neg-
atively with accommodating styles. While this was a
small sample it demonstrates the importance of devel-
oping nurses’ emotional intelligence as a strategy to
employ to improve how conflict is managed. One of
the first exercises with staff is to understanding their
conflict management style to help determine how best
to enhance their emotional intelligence.
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Journal of Nursing Management, 2016, 24, 211–218

Another approach is to develop conflict coaching
skills in nurse managers using the comprehensive con-
flict coaching model (Brinkert 2011). This model can be
used to educate nurses on how to work through con-
flict. It includes four stages: (1) discovering the story,
(2) exploring the perspectives of identity, emotion and
power, (3) crafting the best story, and (4) enacting the
best story. This curricula includes education on commu-
nication skills, conflict management styles, negotiation
and dispute resolution; and a parallel process of identi-
fying learning needs and goal setting in the process
(Brinkert 2011). Role playing actual events in a safe
environment helps the nurse manager refine his/her skill
set around conflict management.
Brinkert (2011) conducted a study in two health-
care systems using this model. The results demon-
strated that this model was an effective means of
developing communication skills. While this model
holds promise the research is limited.
One example of interprofessional education that has
been recommended to reduce stress and conflict in the
literature is the use of TeamSTEPPs. TeamSTEPPS,
developed by the Department of Defense (DOD) in
collaboration with the Agency for Healthcare
Research and Quality (AHRQ) is an example of one
strategy that a nurse leader should consider incorpo-
rating into this environment. The DOD developed cur-
ricula and tools to improve communication and
teamwork skills among health-care professions
(AHRQ 2014). TeamSTEPPS modules focus on: team-
work, communications, how to lead teams, situational
monitoring and mutual support. These modules pro-
vide evidence-based strategies to create an environ-
ment that is supportive.
This framework has been employed primarily in
acute care facilities either at a unit or organisational
level. Outcomes demonstrated in the literature include
improved interprofessional communication in high
stress environments (Harvey et al. 2013), reduced
medication errors (O’Byrne et al. 2014) and an
improved culture of safety and engagement (Thomas
& Galla 2013). Broader evaluation of the impact
TeamSTEPPS has been measured using the AHRQ
Hospital Survey Patient Safety Culture. The results
have shown an improved perception of a safety cul-
ture in health-care organisations using TeamSTEPPS
(Thomas & Galla 2013).
Turner (2012) implemented TeamSTEPPs in an
emergency department in the western United States,
which treated 65000 patients per year. A Team-
STEPPS leadership team was identified to include
three MDs and three RNs who became master
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Journal of Nursing Management, 2016, 24, 211–218
Conflict management, work environment & stress
trainers. Specific ED vignettes were developed and
included staff as part of the videos to demonstrate the
TeamSTEPPs application in the ED setting. A wrap up
sheet was developed by the team to identify the things
that went well and those that could be improved dur-
ing highly stressful events. These sheets help to keep
leadership informed and on issues that needed to be
addressed. The outcomes of integrating TeamSTEPPS
improved communication between leaders and staff.
Many of the TeamSTEPPS studies have a small sample
size or are single institutions’ experiences and there-
fore cannot be generalised. This study also found that
66% of ED nurses perceived their work environment
was not supportive suggesting that they are experienc-
ing some degree of work stress.
Conclusions
A supportive work environment and avoidant conflict
management style were found to be significant pre-
dictors of work stress, suggesting that emergency
nurses’ perception of a supportive work environment
and their approach to resolving conflict may be
related to their experience of work stress. The find-
ings of the present study underscore the priority that
the Joint Commission and NIOSH have placed on
the use of effective conflict management strategies in
hospitals. Moreover, a majority of nurses in this
study indicated that they perceived a lack of organi-
sational support coupled with the finding that a
quarter of the sample rated their work stress level
as moderate to high; it appears that conflict
management skills training may benefit emergency
department nurses.
Ethical approval
IRB No. 09-600M, Rutgers, the State University of
New Jersey, Office of Research and Sponsored Pro-
grams.
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