An institutional ethnography of nurses' stress.

There are three main conceptualizations of nurses' stress: occupational stress, moral distress, and traumatization (compassion fatigue, secondary traumatic stress, vicarious trauma). Although we have learned a great deal from these fields, some of them lack important contextual aspects of nurses' practice, such as the gendered nature of the workforce and the nature of the work, including bodily caring. The purpose of this study was to reformulate the nature of stress in nursing, with attention to important contextual aspects of nurses' practice. Smith's sociological frame of institutional ethnography was used to explicate the social organization of nurses' stress. Data collection methods included in-depth interviews, participant observation, and focus groups with pediatric intensive care nurses. Data analysis focused on the social organization of nurses' stress, including negotiating power-based hierarchies and articulating the patient to the system. The article concludes with recommendations for addressing nurses' stress through a more critical and contextual analysis.