▶ Understanding stress and coping among nurse managers has been studied with the purpose of retaining them, but also as a vehicle for retaining staff nurses given the direct role that managers play in retaining staff. ▶ A literature review of research on this subject spanning 1980-2003 was divided into three broad categories, pre, intra, and post-re-engineering since these eras revealed different perspectives on the approach to understanding nurse manager stress and coping. ▶ From 1980-1991, research focused on stress associated with physician relationships, time and resource constraints, powerlessness, and role ambiguity with little reference to issues related to leadership and organizational support. ▶ From 1992-1999, research emphasized the challenges that emerged as nurses transitioned from the traditional head nurse to the nurse manager, specifically, the stresses of acquiring a new skill set to meet the demands of a changing role. ▶ From 2000 to today, stress is viewed in the context of a challenging work environment, shortages of nurse managers and an increased span of control, and the health effects of stress, impacting satisfaction and organizational commitment. ▶ Coping strategies appear to center on the possible acceptance of stressors rather than proactive management of stressors and tend to be increasingly emotion-focused rather than problem-focused. ▶ This integrative review of the literature revealed the opportunity to expand research done in the U.S., strengthen research, theory and methods, address the negative trends exhibited, more carefully study health effects, and seek longterm solutions.