The best ways are for leadership to 'listen, to be present, and not assume that we know what the staff wants or needs,' CNO says.
Resilience is a blend of individual responsibility—coping adaptively, having knowledge of self, and accepting limitations—along with support provided by others, according to one nursing study.
Hospitals and health systems should foster nurses' resilience by integrating support and education—not only to help them successfully cope with their high-stress job, but to provide high-quality care, the study says.
Mary Jo Loughlin, who recently was named chief nursing officer and senior vice president of patient care services for Hunterdon Medical Center in Flemington, New Jersey, places high priority on cultivating resilience in her nursing staff.
HealthLeaders spoke to Loughlin about how Hunterdon continues to build resiliency for its nurses.
This transcript has been lightly edited for length and clarity.
HealthLeaders: Why is resiliency important in a nurse?
Mary Jo Loughlin: Because nurses give so much to other people and if they don't care for themselves, they're not able to then provide that care to others, whether it's patients or their co-workers. Nurses are stretched so often, like a rubber band, because of the role we're in, and you need to be able to bounce back, and the ability to do that will reflect on whether you're going to be successful in a nursing career.
It's emotionally and physically draining to be at the bedside, to be a nurse, and it's challenging to not let it get to you. And you need to be able to find different outlets so you can bounce back and be able to care for yourself, the patients and their families, and your co-workers. You're also caring for your family on the outside and you're giving, giving, giving and you're pulled in so many different directions, so it's imperative that you not be stretched so thin and have a moment for yourself.
HL: What are some examples of nurses who have been particularly resilient during this pandemic and why they managed to do so well?
Loughlin: The two that come to mind are on our COVID unit. There was a nurse who had an artistic background—photographs were her thing—and she had brought in a lot of her work. If you think about the height of COVID, the units look like war zones, with PPE (personal protection equipment) everywhere, there are all these carts in the hallways, the doors are shut, and there's nothing pretty. This nurse brought in her artwork and had all over the unit, along with fresh flowers that she worked with a local shop to have for the unit, so there was something pretty to look at.
The second is [during a COVID surge] when we turned a med/surg unit into a second ICU and there was a nurse there that utilized tiered nursing [where non-ICU nurses augment the trained and experienced ICU nurses]. She created this environment that was positive even though people were scared because they are not critical care nurses [but] they became a critical care unit. They were using baby monitors to monitor the patients because that unit was not equipped as a traditional ICU.
She really embraced and partnered nurses together [based on] skill sets that each one of them had to be able to support one another, so everyone felt like they were in it together. That unit, because of her, is more resilient than some of the other units because they really embraced that team and caring for each other by doing a tiered approach to patient care.
HL: How different is resiliency during the pandemic than from before the pandemic?
Loughlin: Over the history of being a nurse, burnout happens and people feel like days are tough and it's hard sometimes to bounce back. The difference with the pandemic is staffs are seeing no end because it's not going away. There's fear about the vaccine and people who aren't getting vaccinated in the community and some of it's becoming political and that's what's making it different for the staff.
You can't get away from it outside of work because it's in your home, it's in worrying about whether you're going to the store or church or whatever it is. So normally prior to a pandemic, you're just dealing with those challenges and fatigue while you're at work and now with the pandemic, you can't get away from it.
HL: What are some of the roadblocks to nurse resilience?
Loughlin: Staffing. During the pandemic when everything shut down, we had enough staff because we weren't doing elective surgeries, physical therapy was shut down, and there were more staff than patients. Primary care physician offices were closed, and everybody was deployed to the hospital.
Coming out of the initial surge of the pandemic, we lost a lot of nurses to retirement, so that's adding to the shortage, and then you have the younger nurses who think this is not exactly what they went in it for and didn't have the best experience. You've got both of those things, post-pandemic, playing into staffing shortages.
The staffing issues are beyond what any of us could have ever expected and it's not just the nurses, it's ancillary help, patient care assistants, and transport. Now that the pandemic is "over," which it's not, we're picking up the pieces and wondering how we're going to find staff [and] figuring how we're going to provide care in a different way. It's the new norm.
HL: What are some of the most successful resilience strategies that you've been a part of?
Loughlin: The biggest thing is having leadership listen, to be present, and not assume that we know what the staff wants or needs. If you know your staff and you know the culture, you can tell when people are getting [stressed out] and they may not even recognize it in themselves. Our strategies have been to help them recognize that they're getting to the point where they're getting stretched too thin and need some assistance.
We have connected our staff with Schwartz Rounds [conversations with nurses and other staff about the emotional impact of their work] and we offer EAP [employee assistance program] services. One of the things that has been the most effective is we trained for Stress First Aid [which teaches individuals how to identify stress in others or themselves].
Other things we've done are simple but make people feel appreciated and valued. All units have hydration stations for the self-care component of resiliency. These stations also have things like mints, lip balms, skin protectors, and mask extenders.
We have what we call "Zen Dens," which is a room with a chair that gives a full body massage and it's quiet in there with dim lighting, aromatherapy, and music therapy, and staff can take five minutes and go in and just chill. We've done videos on burnout, self-care, spiritual resilience, and seeking help through EAP.
HL: What are some of the differences in building resiliency in new nurses versus older, more-experienced nurses?
Loughlin: The generations all want and need different things. How you recognize them is different; some people want in-person, one-on-one [conversations], while some people like texts. Generations have different needs of what recharges their battery and what makes them more resilient and able to face the challenges.
The newer nurses value time off; they know how to unplug a little better. They're also better at asking for help. The more seasoned nurses feel like they shouldn't be asking for help and that they should be resilient. You have to identify and monitor those individuals differently because they're not going to present the same way.
The older nurses have been through it, like myself; we've been through AIDS and bounced back from Ebola and other challenges in healthcare. We've gotten more used to it and have figured out ways to recharge our batteries. The younger nurses know how to do it on the outside but are having difficulty thinking that it's going to get better because they haven't been through challenges and seen that it does get better. It ebbs and flows; the pendulum swings back and forth.
“Nurses are stretched so often, like a rubber band, because of the role we're in, and you need to be able to bounce back and the ability to do that will reflect on whether you're going to be successful in a nursing career.”
Mary Jo Loughlin, chief nursing officer and senior vice president of patient care services, Hunterdon Medical Center
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
Resiliency in nurses is important because if they don't care for themselves, they won't be able to provide care for others.
Staffing issues are a major roadblock to nurse resiliency.
Newer nurses are better at self-care, while seasoned nurses have the knowledge that difficult situations always get better.