Pandemic conditions have placed emphasis on the quality of resiliency in nursing. In reality, this quality has always been valuable. Let’s examine what resiliency is, how nurses develop it, and how it can be assessed.

What is resiliency?

Every healthcare provider faces stressful situations on a daily basis. The cumulative effect of difficult situations leads to a much higher risk of anxiety, depression, stress-related illnesses, and career burnout. Resilience is defined in an article from Health Insights as:

“The ability to recover and recuperate quickly from difficult or challenging situations. This quality is different from stress management in that the focus of resilience is to understand that stress is bound to happen and should be treated as a normal part of the day. Stress management, on the other hand, will typically require a breakdown of the situation in order to resolve the stress.”

This type of thinking requires a paradigm shift for most of us. Avoiding stress is taught as a coping mechanism, with phrases such as “work-life balance” and “stress relief techniques”. Resilience requires a different viewpoint. Nurses (and other health clinicians) must run toward stress to do their jobs effectively. Accepting stress as a daily part of the job is a quality that is a bit hard to define but can make a difference in long-term career success and mental health.

The ability to “bounce back” with resilience after a difficult patient, day or situation has been found to equate to better patient outcomes, higher nursing retention rates, and increased job satisfaction. Resiliency is a set of definable skills that be cultivated by nurses themselves and promoted by the work environment.

Resilient Qualities

Diane Sieg, in an article published by Sigma Global Nursing Excellence, identified the “7 Habits of Highly Resilient Nurses.” This oft-cited article was very timely, in November of 2020, as nurse managers were struggling to stem the nursing burnout and find additional staff. Sieg draws from an American Psychological Association study that identifies several factors that develop and sustain resilience, but she attributes them all to one critical skill – mindfulness.

Within the scope of mindfulness, dwell the seven named habits of highly resilient nurses:

1. A beginner’s mind: The quality of approaching new situations in life with a sense of curiosity and learning, refraining from cynicism and assumptions.
2. Letting go: Releasing the need to control the outcome of a situation. Being aware of thoughts and feelings, putting a name to them, and then letting go. Sieg states that this is the habit most useful for healthcare providers, due to the exposure to pain and suffering and associated helplessness.
3. Compassion: This is a given, right? Yes, compassion is most often the reason people go into nursing, however, it is important to remember this - even when faced with non-compliant patients, an irate physician, or an unrealistic family member. Compassion begins with kindness to ourselves and becomes contagious. This means eating healthy foods, sleeping, taking a walk, etc. to be kind to the body and mind.
4. Gratitude: Seeing and appreciating the blessings of life. This is an active process of thinking and choosing what to focus on. Choosing gratitude means that disappointment and negativity are not the focus anymore, and the mind has room to see the everyday things – like a stable job, a decent income, important skills that help people.
5. Authenticity: Being true to oneself. The personality, spirit, character, and “grit” despite external pressure. Relentlessly being yourself sometimes takes courage but reduces the stress of pretending to be something or someone you are not.
6. Commitment: Being dedicated to do things patiently and consistently, even when times are tough. Remember the phrase “when the going gets tough, the tough get going?” Commitment is sticking around, helping to make things better, and working through situations.
7. Trust: Embracing faith over fear - faith in yourself, your abilities, and your gut instincts. Trust that you are resourceful and capable of getting through a situation and coming out ok on the other side.

Sieg believes that if these qualities are not innate, that nurses can cultivate them one at a time, using mindfulness - consciously choosing to perform each skill until it becomes a habit.

Cultivating Resilience in the Workplace

While nurses can work on personal qualities that develop resilience, there is also another side to the issue. Dr. Michael Traynor, professor of Nursing at Middlesex University, argues that the literature surrounding resilience in nursing should focus less on coping and more on workplace support and policy. His model is called “critical resilience” and promotes a mutually supportive discussion between nursing staff and hospital policymakers.

Factors like workload, support staff, scheduling, and overall culture can nurture resilience and satisfaction. When nurses cope with additional, preventable stressors, those then compound the burden of the work itself – which is naturally stressful.

Hiring Resilient Nurses

Obviously, resilience is a very desirable quality in the nursing field. The question becomes – “can we recruit for resilience?” In a roundabout way, yes you can. The only true way to observe a nurse’s resilience would be to place them right in the middle of a situation that would evoke a resilience response – or not. This approach is not exactly practical.

The key when interviewing for resilience is to identify the exact traits needed, and carefully craft ways to assess those. It is important to go beyond the tried-and-true questions such as “tell me about a time you dealt with a challenging situation/patient/family” (you get the idea). Generally, candidates will pick a very positive example and come prepared for this question, so it is not as authentic or useful anymore.

According to the Resilience Edge, the focus should be shifted to how the candidate dealt with the situation on a personal level but asking questions such as:

• What coping techniques did you use in this situation?
• How did you move on after the situation occurred?

And

• What did you learn from the situation?

The Resilience Edge also lists 6 core pillars of resilience to guide interview questions:

Under each pillar are the specific skills or mindsets to assess.

Combining Strategies for a Winning Team

Refining recruitment efforts, training, fostering mindfulness, and leading workplace culture in a resilient direction all combine to create a recipe for success. Each phase requires the other to be successful. For instance, hiring a highly-skilled, resilient nurse into a workplace of negativity and burnout will not foster longevity. That nurse will feel unfulfilled and discouraged and begin to seek work elsewhere.

There is no doubt that healthcare is difficult, stressful, and overwhelming at times. This is not a new phenomenon and will likely never completely go away. Controlling the response to those difficult times, supporting staff, and hiring for these important qualities can develop nursing staff towards the critical competency – resilience.

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