Unintended consequences: the impact of protocol change on critical care nurses' perceptions of stress

CONTEXT: The Family Communication Coordinator protocol was implemented to facilitate effective communications during potential organ donation cases. Previous research records its effectiveness relative to donor outcome measures. By redefining and clarifying role responsibilities, the protocol may be associated with reduced job stress for those caring for potential donors. OBJECTIVES: To determine the relationship of the Family Communication Coordinator protocol on the role stress of critical care nurses. To examine role stress in terms of role ambiguity, role conflict, and role overload within the context of potential organ donation cases. DESIGN: Retrospective nonexperimental descriptive design. SETTING: Critical care units of an academic teaching hospital. PARTICIPANTS: Nineteen critical care nurses with experience before and after implementation of the Family Communication Coordinator protocol. MAIN OUTCOME MEASURES: Job dimensions, role stress, job satisfaction, and commitment, measured using surveys. These data were supplemented with interviews and hospital records. RESULTS: The findings demonstrate that the Family Communication Coordinator protocol is associated with reduced role stress. More specifically, the nurses perceived significant reductions in role ambiguity and role conflict, and some reduction in role overload. The findings highlight high satisfaction with the protocol, as well as improved job satisfaction, and professional and organizational commitment. CONCLUSIONS: The results suggest that reduced role stress among critical care nurses is associated with implementation of a protocol already associated with improved organ donation outcomes. The findings suggest positive outcomes also may impact other staff, multidisciplinary functions, and the organization. Similar protocols may be appropriate in other end-of-life situations to reduce uncertainty and stress among critical care professionals.