A mixed methods research study: Exploring resilience in contemporary nursing roles in Wales

Background: Nursing is categorised as a highly stressful occupation, stress and burnout are known consequences of healthcare workplace adversity which can negatively affect care. Critical care nurses are known to be at high risk of burnout (Mealer et al., 2007). Resilience is known to buffer stress. Nurses’ ability to perform is inextricably linked to challenges and support available (Maben et al., 2012). However, limited research exists that examines nurses’ understanding of resilience and its relevance to workplace environments. Purpose of the study: To explore a more holistic socio-ecological (Ungar 2011) examination of nurses’ resilience. To provide novel insights into the intrinsic and extrinsic influences, that shape resilience of nurses in Wales. Methodology: A mixed methods design consisting of a purposely-designed questionnaire and analysis of free text responses exploring perceptions of resilience and work environments was employed (December 2016). Participants included Registered Nurses (N = 1459) from across Wales, including over 100 critical care nurses. Quantitative and qualitative responses including 8,000 free-text comments (over 89,000 words), were descriptively analysed utilising “Smart Survey”, SPSS, Excel and Microsoft Word. Early findings were shared, to inform the study, at a pan Wales stakeholders’ event (March 2018). Findings: Three main areas were presented: - what nurses understand resilience to be, adversities experienced and nurses’ routes to resilience. Nurses’ resilience was presented as a normative professional attribute, outcome and process that contributes to the functioning of nurses and others to deliver- composed, compassionate excellent care whilst managing their own and others emotions. The process of resilience is learnt from exposure to adversity, contributes to the outcome of career longevity shaped by the availability of both intrinsic and extrinsic resources. Resilience ripples: levels high or low are contagious. Nurses’ resilience acts as a resource for others, stabilising emotional flow, within everyday emotionally charged environments to enable patient flow. Secondly, adversities facing nurses were presented, unlike other research nurses’ traditional intrinsic work, although demanding, seemed not necessarily the challenge, more nurses’ inability to deliver care required and overcome environmental challenges, particularly resources and workload. Acute and or accumulative adversities that tested nurses’ resilience that transpired into critical tipping/turning points as well as personal thresholds for some, were presented. Leaving no doubt concerning the demanding nature of nurses’ work. Finally, despite such adversities there was an overriding sense of nurses’ commitment to deliver quality care, their own resilience and others. Which made these findings striking indicating that even in the most severe circumstances nurses can navigate routes to resilience drawing upon extrinsic and intrinsic resources; support seemed critical to this. Conclusion: These unique insights can inform practice, education, policy and research and open the door for resilience to be re-defined within a professional and employment frame that is less individually psychologically orientated. These insights into the environment that nurses experience the adversity and respond to it, could help nurses’ resilience and lead to better support for critical care nurses striving to deliver excellent patient care