title: Stress and resilience in a post-Francis world - a qualitative study of executive nurse directors.
abstract: OBJECTIVE
  The aim of this study was to explore the role stressors experienced by executive nurse directors and strategies employed to maintain resilience.
  
  
  BACKGROUND
  Recent financial pressures on and care quality scandals in the UK NHS impact on the work of executive nurse directors. The short length of tenure and the high number of vacancies for these posts point to the exacting demands of the role and raise questions about the support mechanisms available for the most senior nurses in NHS organizations.
  
  
  METHODS
  A grounded constructivist study.
  
  
  METHODS
  Semi-structured telephone interviews conducted between February-July, 2014.
  
  
  RESULTS
  Stressors were both chronic (workload, lack of corporate responsibility for quality, reductions in quality team staffing, tensions between financial solvency and care quality and personal vulnerability) and acute (dealing with complaints and major incidents). Resilience required the support of fellow executives, peers, family and mentors and could be enhanced by self-discipline, good preparation for the post and ongoing coaching.
  
  
  CONCLUSIONS
  Recent fiscal austerity and scandals relating to quality of care have increased pressure on executive nurse directors. Increasing size of organizations, limited resources devoted to quality combined with poorly defined limits of responsibility are all major stressors and executive nurse directors, both in the United Kingdom and internationally, need clear strategies to maintain resilience. Repetitive demands for data by oversight organizations may detract from more important quality assurance strategies.
authors.affiliation: School of Healthcare Sciences, Cardiff University, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kelly
authors.affiliation: School of Healthcare Sciences, Cardiff University, UK.
authors.forename: Annette
authors.identifier: http://orcid.org/0000-0002-2418-3783
authors.initials: A
authors.lastname: Lankshear
authors.affiliation: School of Healthcare Sciences, Cardiff University, UK.
authors.forename: Aled
authors.initials: A
authors.lastname: Jones
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008611:Mentors; D009718:Nurse Administrators; D036301:Qualitative Research; D011787:Quality of Health Care; D006113:United Kingdom; D016526:Workload
keywords: Francis; Mid-Staffordshire; nurse executives; nursing; quality of care; resilience; stress; telephone interviews