I Gave Resiliency Training to 90 Critical Care Nursing Staff; Here's What Happened

As a doctoral student, I wanted my project to benefit nurses and help improve their quality of life. Burnout is something I've been passionate about since first entering the healthcare system over a decade ago. As soon as I began my career as a nurse, I recognized that my colleagues and I were at risk for not only leaving our organization, but the nursing profession altogether.

Recent statistics show this as well; studies show that 40% of nurses plan to leave the profession in the next decade, and 43% of new graduate nurses leave the bedside within the first three years of practice (Cleary et al., 2018).

After reviewing the literature, I hoped to make the biggest impact by creating a class for nursing staff that would help improve their resiliency and reduce their burnout symptoms. Nurses who are highly resilient report a lower level of burnout (Mealer, Jones et al., 2012, as cited in Wei et al., 2018).

Strategies for building nurse resilience include formal education programs, social support, meaningful recognition, meaningful patient interactions, and physical and spiritual well-being (Blackburn et al., 2020; Cleary et al., 2018; Kelly, 2017; Kester & Wei, 2018; Mealer, Conrad, et al., 2014; Rushton et al., 2015).

Highlights of the Project via Poster Presentation

Purpose

The purpose of my project was to determine if a resilience class would decreases burnout symptoms in critical care nursing staff.

The Intervention

I created a four hour class based on evidence-based strategies found in the literature as well as content from a successful previous course done by the Trauma unit at my hospital. The class included a presentation on emotional intelligence and resiliency, a mindfulness activity (meditation), and art therapy.

The hope was to enroll 100 participants into the resiliency course (titled RESTORE: Improve Resiliency, Manage Stress) from three different critical care units - Cardiac ICU, Cardiac Stepdown, and the Burn ICU. These units were chosen based on size as well as convenience - two of the units were units that I supported as a Clinical Nurse Specialist. 90 staff from these three areas participated.

Additionally, the study included a control group - the Medical Stepdown Unit. Staff from this unit were also given the burnout survey at the same time as the intervention group. This helped us confirm that any changes in the intervention group were indeed due to the RESTORE class.

The Measurement Tool

Participants were given a survey (called the Maslach Burnout Inventory [MBI] - tested for validity and reliability) before training and again six weeks later that measured burnout symptoms. This categorized burnout symptoms into three groups - emotional exhaustion (ideally low), depersonalization (ideally low), and personal accomplishment (ideally high).

Participants also completed a demographics questionnaire that asked about job position, age, gender, years in current position, years in critical care, plans to leave the organization or healthcare in the next five years, and highest education level. These demographics were used later to identify if they had any impact on burnout symptoms. A paired t test was used to evaluate if participants’ burnout symptoms decreased after resilience training.

Findings

Critical care nursing staff at this organization had worse burnout symptoms than those of the general population of workers in human services professions. Additionally, nursing staff who plan to leave the organization in the next five years were significantly more emotionally exhausted than those who do not plan to leave.

An unexpected outcome was the increase in depersonalization symptoms from the pre intervention to post intervention group. This may be explained by the study taking place during COVID and staffing challenges.

Age made a statistically significant difference in burnout scores; participants who were ages 25-34 showed a significantly higher mean score of depersonalization when compared to those 45-54 and 55 and older. Additionally, participants who were ages 35-44 showed a significantly lower mean personal accomplishment score when compared to those 55 and older.

Nursing staff highly valued the course and would recommend it to their peers.

Staff were also asked to circle their top three stressors. They were most stressed by the lack of staffing, lack of supplies/resources, and fatigue. Of those who circled "other", many of them cited lack of support from upper management.

Impact on Practice - What Does This Mean?

1. Resilience training is cost effective. The cost of implementing resilience training and burnout reduction strategies is justified, as this can help prevent the cost of turnover.

2. It may be beneficial to give targeted burnout strategies to nursing staff of specific age groups.

3. Nursing staff value resiliency training. They also believe that nurse leaders, such as managers, supervisors, and directors would benefit from resilience training.

4. The literature shows that resiliency training and its impact on turnover can improve patient outcomes, improve nurse job satisfaction and patient satisfaction, and protect nurses from burnout.

5. Annual resiliency training may positively impact the nursing culture and help create a progressive reputation for an organization. This may make it easier to attract and retain employees.

How to Make Resiliency Training Sustainable

Organizations (such as universities or hospital systems) can implement system-wide policies to help reduce burnout. The executive team can consider enlisting advocates for workplace issues, empower front-line staff to identify barriers and find solutions, and engage a burnout expert if needed.

Communication to nursing staff about the content, purpose, and research behind RESTORE is a strategy that could be very useful for staff buy-in. An expectation that this training is mandatory for all staff annually may also help instill a culture change and improve long-term buy-in with staff.

Critical long-term strategies needed to ensure sustainability include a financial commitment to paying for staff to get time away from the bedside. Funding for this training may be provided by the organization or from grants and scholarship. In this case, a person would need to be identified to create and submit applications to funding opportunities related to this topic.

Additionally, a long-term leader of the project should be assigned. This person or team would organize logistics related to training, and distribute, collect, and analyze any further surveys or studies related to the implementation of resiliency training.

Continued evaluation of the training can help obtain buy-in from stakeholders and assist with continued project support. This could include annual or more frequent measurements of staff turnover and retention, the comparison of NDNQI nurse satisfaction scores (annually), and/or the continued implementation of the MBI questionnaires.

The full project document can be read here if you’re interested!