Managing complex workplace stress in health care organizations: leaders' perceived legitimacy conflicts

Aim  To conceptualize how health care leaders’ strategies to increase their influence in their psychosocial work environment are experienced and handled, and may be supported.

Background  The complex nature of the psychosocial work environment with increased stress creates significant challenges for leaders in today’s health care organizations.

Method  Interviews with health care leaders (n = 39) were analysed in accordance with constructivist grounded theory.

Results  Compound identities, loyalty commitments and professional interests shape conditions for leaders’ influence. Strategies to achieve legitimacy were either to retain clinical skills and a strong occupational identity or to take a full leadership role. Ethical stress was experienced when organizational procedural or consequential legitimacy norms were in conflict with the leaders’ own values. Leadership support through socializing processes and strategic support structures may be complementary or counteractive.

Conclusions  Support programmes need to have a clear message related to decision-making processes and should facilitate communication between top management, human resource departments and subordinate leaders. Ethical stress from conflicting legitimacy principles may be moderated by clear policies for decision-making processes, strengthened sound networks and improved communication.

Implications for nursing management  Supportive programmes should include: (1) sequential and strategic systems for introducing new leaders and mentoring; (2) reflective dialogue and feedback; (3) team development; and (4) decision-making policies and processes.