**4. Discussion**

Thus far, this paper has provided a phenomenon of concern to nurse managers. Specifically, we discuss the negative impact of time pressure on psychosocial care, which is a key performance outcome for healthcare, and offer two evidence-based approaches to positively moderate that negative relationship. We have also provided metaconjectures to better demonstrate how practitioners can deliberately manage their time pressure situations. Yet, research tradition alone may not fully demonstrate the impact the application of theory to practice can have in a nurse manager's work environment. In this section, we go a step further to demonstrate how the quality of interactions between nurse manager and staff can be improved, and thus lead to a better climate for patient care. Therefore, we now provide a scenario to better understand how the Time Pressure Mitigation Model for Nurse Managers might apply to decision making in a healthcare environment:

Tina was a young nurse who found herself in a challenging situation on a medical/surgical unit. Currently, she was responsible for an elderly patient who was upset because his pain medication was not su fficiently relieving his discomfort. Visiting family members were also giving Tina a challenging time with regular interruptions, unhappy that their father had pushed the call light repeatedly and felt he was not receiving the attention he deserved from his nurse. It seemed the whole day had gone like this for Tina. Tina started her day with documentation being behind from the previous shift, and she had two new admissions waiting for her in the Emergency Department. Additionally, the phone was ringing intermittently due to the nursing secretary calling in sick with no replacement at hand at that time. This was a stressor that she felt needed attention by someone other than herself. Her patient load was filled with several patients with high acuity who needed a variety of treatments this day. She felt that she was trying her best with the time that she had with this patient who was in pain, but she felt overwhelmed. Unfortunately, the next time Tina went by the room of the patient that was in pain, she blew up and shouted into the room, "Look. I don't have time for this! Your dad will ge<sup>t</sup> his needs met, but I've go<sup>t</sup> two other rooms I have to deal with right now that have patients in a lot worse condition who need my attention!"

Suzanne, the nurse manager on the unit, hearing the commotion, entered the room to find the patient crying, an upset family pacing, and Tina dashing down the hallway. Suzanne reassured the family that she would help address the issue immediately, which she does with the rounding doctor at hand. Suzanne was not happy with Tina's interaction with the family, but unfortunately scenarios of this nature were far from uncommon on her unit. Time-pressure seemed to be a constant adversary for both her and her nursing team. She felt the whole team needed self-leadership training and at this point she needed to step up and practice some of her own self-leadership skills. Suzanne decides to use constructive self-talk to improve her interaction with the distraught patient and the family members, as well as Tina, who seemed to be in crisis mode. She says to herself, "I've dealt with similar problems in the past, and the stress on my unit has been lessened." "I picture myself in a calm manner listening to the patient and family and providing individualized care." She also addressed Tina's concerns over her challenges and o ffers her timely help, encouragement, and useful, deliberate direction. She also visualizes a later meeting with Tina going well and leaving with a feeling like she can tackle her next shift in a positive manner. She tells herself she is in this role because of how she's handled similar situations. Suzanne reminds herself that, though her unit is on the verge of being understa ffed, she has just hired a new nurse. That hire will surely help spread some of the duties among the sta ff. Then Suzanne returns to the patient that was in pain to check on his status.

In the above situation, we observe a nurse manager addressing a poor decision made by a frontline nurse under time pressure. In the hypothetical scenario, self-leadership practices help her envision a way to provide better psychosocial care in her unit. Time pressure situations like this could also be moderated with better time managemen<sup>t</sup> practices as well. For Suzanne to provide improved psychosocial care to her patients in her unit, the Time Pressure Mitigation Model for Nurse Managers suggests that she become an expert implementer and coach of time managemen<sup>t</sup> and self-leadership practices.
