Objective: This study provided insight into nurse manager stress and coping experiences. Background: Overwork and stress have been implicated in today's nursing shortage. Although nurse managers play a pivotal role in creating work environments that retain staff nurses, little is known about nurse manager work. Methods: This qualitative descriptive study used a sample of 21 nurse managers to determine what situations contribute to their stress, individual coping strategies, and health-related outcomes. Content analysis identified 3 study themes. Results: People and resources, tasks and work volume, and performance expectations affect nurse managers' perceptions of stress. When comparing novice nurse managers with experienced nurse managers, experienced nurse managers (especially comanagers) used more effective (problem focused) coping strategies and had fewer negative health-related outcomes. Conclusion: Findings from this study suggest that to impact stress, coping, and complexity in the nurse manager role requires a combination of strategies that address individual and organizational factors. © 2010 Lippincott Williams & Wilkins.