Burnout, stress, and compassion fatigue are indisputable issues for nurses ― especially for those in high-intensity, high-volume areas of hospitals such as emergency departments and intensive care units.
When nurses are overburdened, “the fatigue starts to impact the quality of care that nurses can provide,” Kelly Kester writes in the June 2018 issue of Nurse Management. Increased fatigue and burnout can lead to decreased patient safety. To protect patients and nurses, many nurse managers are focusing on developing resilience techniques personally and for their staffs.
Nurse managers often have to ask nurses to do more in less time, which results in everyone being stretched thin. “Pulled between a commitment to excellent patient care and the perception that they can never keep up with increasing demand, 70% of nurses have experienced burnout, and nearly half have considered leaving the profession entirely,” Terry Zysk writes in “How to build resilience and reduce nurse burnout through better care team communication” for the website Healthcare Innovation.
Increased nurse practitioner stress, frequently felt by nurse managers, has made building resilience vitally important. Nurses face four key areas that make them less able to recover from stress, according to “Rebuild the Foundation for a Resilient Workforce,” a 2018 report:
- Frequent exposure to violence or threatening behavior
- Perceptions of unsafe staffing levels
- Lack of time to recover from traumatic patient experience
- Feeling isolated in a crowd due to care protocols and new technologies
The report found that hospital workplace violence had increased from 2008 to 2018. From 2005 to 2014, reported incidents of violence against healthcare workers increased by 110%. Some hospitals have added metal detectors at entrances, but nurses report that violence most often happens when they are working directly with patients and their families, Zysk writes.
Nurse practitioners who have the benefit of an advanced education can develop skills to help nurses work together and cultivate resilience, often through better communication and problem-solving abilities.
Educational options such as Ohio University’s online MSN program can help lay the groundwork for this new approach. Ohio University’s MSN program prepares registered nurses (RNs) and Bachelor of Science in Nursing (BSN) graduates for advanced careers as family nurse practitioners (FNPs), many of whom will find success and satisfaction in creating better resilience among nurses.
Strategies for Resilience
Nurse managers can initiate solutions that help nurses cope with increasing stress. The solutions can be surprisingly simple — nurse managers can structure schedules so nurses have time to communicate with each other regularly, for example. When nurses work as part of a larger care team, they can seek support from their colleagues to help address problems as they emerge.
Nurses who practice increasing their resilience “usually feel naturally energized, motivated, and capable of taking on more responsibilities,” notes an article on the Health Times website. “Those who are resilient in nature will generally have a higher sense of self-awareness, persistence, and the energy to sustain their mind and body.”
The article offers a number of tactics that nurses can use to build resilience, including these suggestions from the American Psychological Association (APA):
- Maintaining positive relationships
- Accepting that some circumstances are outside one’s control
- Having an optimistic, hopeful outlook
- Keeping a long-term perspective
Other strategies include:
- Practicing mindfulness, or paying attention to the present moment
- Being kind and compassionate
- Practicing gratitude
- Staying authentic and committed and trusting oneself
Who Is Resilient ― and Why
In developing their strategies, nurse managers also should understand the range of dynamics behind burnout and resilience.
“Performance Insights: Resilience for a Multigenerational Nursing Workforce,” a 2018 white paper from Press Ganey, analyzed how nurses of different ages and work situations responded to the stress inherent in their jobs. Press Ganey, an Indiana-based health care company, is best known for developing and distributing patient satisfaction surveys.
The findings were based on nationwide surveys that measured two critical components of resilience: A nurse’s level of engagement with work (called activation) and the ability to disconnect from work (called decompression). The biggest takeaway: Activation and decompression vary by generation, shift, and manager status.
“To effectively address nurse resilience and prevent burnout, health system leaders must recognize the unique components of resilience that vary among nurses by generation, role, shift, and tenure. Measuring engagement and resilience across different segments of the nurse workforce is necessary for identifying targeted strategies to reduce the devastating effects of burnout,” a press release on the report states.
In an article for Health Leaders, Jennifer Thew, RN, looks at some of the report’s particulars. Highlights include:
- Millennial nurses are the least engaged with work
- Millennial night-shift nurses have even more of an activation disadvantage
- Nurse managers experience higher levels of engagement than non-managers
- Non-managers are better able to decompress than managers
One thing is clear: Nurse managers, who are often nurse practitioners, are in a prime position to help nurses decrease stress and increase resilience, and they can often demonstrate this ability in their own work life. The nurse manager’s responsibility, Thew writes, is “to help nurses to feel joy in their jobs, feel valued, and to provide the tools and support needed for healthy work-life balance.”
Supporting Resilience After Crisis Situations
One way to determine ways to increase support for nurses’ resilience is to find the cracks in the foundation, according to the Nursing Executive Center. Nurses feel unsafe when violence occurs during patient or family interactions and they don’t feel equipped to handle these situations. Improving emergency response time ― so nurses don’t have to handle such situations alone ― can improve feelings of safety.
After experiencing an unsafe situation, nurses often feel that they don’t have time to use support services for debriefing and processing the experience. One solution is to make emotional support service “opt-out” only, the Nursing Executive Center advises.
Simple practices such as storytelling can help nurses recuperate from work-related traumatic encounters. Nurses often forgo sharing the story of a crisis because they are occupied with filling out electronic documentation. Leaders should prioritize ways for nurses to connect and rebound. Being part of a community that values their stories is an important step.
Ohio University’s Online Master of Science in Nursing (MSN) Program
The online MSN program at Ohio University is designed for practicing RNs who want to advance their expertise in the nursing field. Students in the Family Nurse Practitioner concentration take courses such as Primary Care of Adults and Primary Care Practice.
For more information about the online MSN degree program, MSN degree benefits, and additional concentrations for MSN nursing careers, visit Ohio University’s website.
Building Nurse Resilience: Nursing Management
How to Build Resilience and Reduce Nurse Burnout through Better Care Team Communication: Healthcare Innovation
Resilience in Nursing: Health Times
Press Ganey White Paper Analyzes Resilience Across Nursing Workforce Segments: Press Ganey
Nurse Resilience and Burnout Vary by Generation: Health Leaders Media
Cracks in the Foundation Undermine Nurse Resilience: Advisory Board Nursing Executive Center