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resilience nurse trauma comeback

Health, safety, & wellness

Have you ever noticed that after a traumatic event, certain nurses break down completely while others emerge stronger than ever? This can occur after natural disasters, war, mass casualty events, or even an unexpected patient death. What is it that these strong, remarkable survivors possess that allows them to thrive? Resilience plays a large part in this phenomenon.

Many definitions of resilience exist, including the one word “hardiness.” In 2012, Sullivan et al defined resilience as “the capacity to keep functioning physically and psychologically in the face of stress, adversity, trauma, or tragedy.” McCann et al define it as “the ability to maintain personal and professional well-being in the face of ongoing work stress and adversity.” In their textbook Holistic Nursing: A Handbook for Practice, authors Dossey and Keegan describe resilience as “self-management and efficient utilization of energy resources across four domains: physical, emotional, mental, and spiritual.”

Resilience assists the nurse in resisting compassion fatigue and burn-out; it allows the nurse to effectively manage stress and maintain a positive attitude toward work and life in general. Resilience improves nurse perception of control and overall satisfaction.

Invaluable characteristics of a resilient nurse are a sense of humor, flexibility, optimism, hope, self-approval, hardiness, and a firm belief in self, mission, and profession. Resilient nurses engage in helpful behaviors and actions, such as laughing; leisure activities; reflective practices; maintaining supportive relationships; self-care; practicing faith, spirituality, or both; obtaining effective emotional support; and facing difficult issues. To cultivate resiliency, nurses avoid self-blame, abuse of substances or other destructive addictions, denial of issues, feeling hopeless, and helpless actions.

What does an effective resiliency program look like? J. Eric Gentry, PhD, LMHC, an expert on compassion fatigue, recommends the following activities to develop resiliency: exercise (after consulting a healthcare pro­vider), education of one’s support system for effective help, spirituality, a positive work-life balance, exploration of artistic or sports abilities, and kindness to oneself. Gentry also suggests short-term treatment in the event of compassion fatigue.

According to current literature reviews, employers can offer multiple types of resiliency-building activities and programs. Programs focusing on behavioral health, wellness promotion, compassion fatigue prevention, stress management, positive psychology, health coaching, and self-care can be invaluable. These may be available through employee assistance programs, support groups, mentors, tool­kits, continuing education modules, seminars, websites, bro­chures, and other types of education, training, and resources. Most important is providing a supportive, healthy, and safe work environment where staff feel valued. The work environment must offer reasonable work­loads, adequate staffing, breaks, and a healthy work-life balance. Managing work stress is the key to effective resilience. The Centers for Disease Control and Prevention, in its Total Worker HealthTM program, suggests that stress-management efforts focus first on decreasing workplace stressors and then on building worker resilience.

Today’s nurses need effective personal and professional resilience. Resilience development should begin during the student nurse’s basic education and continue through professional development during the nurse’s entire career. Amid the stress, drama, and trauma of nursing, RNs need to remember and embrace the joy, excitement, hope, camaraderie, knowledge, cutting-edge skills, respect, and opportunity to transform lives that the profession offers.

ANA’s Leadership Institute offers a webinar on developing resilient teams. For more information, visit http://www.nursingworld.org/HomepageCategory/NursingInsider/Archive-1/2013-NI/Nov-2013-NI/ANA-Institute-Seminar-Develop-a-Resilient-Team.html.

Selected references

McCann CM, Beddoe E, McCormick K, et al. Resilience in the health professions: a review of recent literature. Int J Wellbeing. 2013;3(1):60-1.

Sullivan P, Bissett K, Cooper M, et al. Grace under fire: surviving and thriving in nursing by cultivating resilience. Am Nurse Today. 2012;7(12).

Holly Carpenter is a senior staff specialist in Nursing Practice and Work Environment at ANA.

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