title: The impact of protocol on nurses' role stress: a longitudinal perspective.
abstract: OBJECTIVE
  The study examined the impact of a protocol directed at increasing organ donation on the role stress and work attitudes of critical care nurses involved in potential organ donation cases. The research examined whether the protocol could positively affect nurses' perceptions of role stress, and if so, could the work environment improvements be sustained over time.
  
  
  BACKGROUND
  The Family Communication Coordinator (FCC) protocol promotes effective communication during potential organ donation cases using a multidisciplinary team approach. Previous research found it associated with improved donation outcomes and with improved perceptions of role stress by critical care nurses. However, the previous study lacked methodological rigor necessary to determine causality and sustainability over time.
  
  
  METHODS
  The study used a quasi-experimental prospective longitudinal design. The sample included critical care nurses who had experience with potential organ donation cases with the protocol. Survey data were collected at 4 points over 2 years. Surveys used previously validated and reliable measures of role stress (role ambiguity, role conflict, role overload) and work attitudes (commitment, satisfaction). Interviews supplemented these data.
  
  
  RESULTS
  The nurses' perceptions of role stress associated with potential organ donation cases dramatically dropped after the protocol was implemented. All measures of role stress, particularly role ambiguity and role conflict, showed statistically significant and sustained improvement. Nurses' professional, unit, and hospital commitment and satisfaction reflect an increasingly positive workplace.
  
  
  CONCLUSIONS
  The results demonstrate that the FCC protocol positively influenced the workplace through its impact on role stress over the first 2 years following its implementation. The findings suggest that similar protocols may be appropriate in improving the critical care environment by reducing the stress and uncertainty of professionals involved in other end-of-life situations. However, the most striking implication relates to the reality of the workplace: meeting the goals of improved patient care outcomes and those of improving the healthcare work environment are not mutually exclusive and may be mutually essential.
authors.affiliation: Program in Patient Counseling, Virginia Commonwealth University, Richmond, VA, USA. haddodd@hsc.vcu.edu
authors.forename: Diane
authors.initials: D
authors.lastname: Dodd-McCue
authors.forename: Alexander
authors.initials: A
authors.lastname: Tartaglia
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Veazey
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Streetman
mesh_terms: D001291:Attitude of Health Personnel; D003422:Critical Care; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007318:Inservice Training; D007588:Job Satisfaction; D008297:Male; D008873:Mid-Atlantic Region; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D010558:Personnel Loyalty; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016526:Workload