Resilience as Accusation: A Critical Examination of Individual Resilience Training for Burnout Mitigation

Jacqueline Christianson; Bonnie Sommers-Olson; Jessica Leiberg; Dana Kaminstein

doi:10.25071/2291-5796.170

Authors

Jacqueline Christianson Marquette University
Bonnie Sommers-Olson United States Department of Veterans Affairs
Jessica Leiberg University of Wisconsin - Madison https://orcid.org/0000-0002-7481-0562
Dana Kaminstein https://orcid.org/0000-0002-1569-3052

DOI:

https://doi.org/10.25071/2291-5796.170

Keywords:

Burnout, professional, resilience, psychological, systems theory, workforce, patient advocacy

Abstract

Abstract

Burnout, a syndrome of work-related exhaustion and cynicism, is prevalent among nurses and is associated with workplace stressors. Resilience training programs are a prevalent method of burnout mitigation employed by healthcare institutions that aim to improve or alter how individuals respond to chronic stressors. Through the lens of General Systems Theory, we describe resilience training as a method of individualizing a systemic problem by problematizing a response to chronic stress exposure. Resilience training may furthermore serve as a mechanism which allows subversion of institutional responsibility for nurses’ well-being in the workplace. We describe several suggestions for nurses to resist being scapegoated for their responses to systemic problems. Sustainable change must include other disciplines and is likely to require multiple different avenues including individual (e.g., honoring meal breaks), institutional (e.g., increased leadership participation), legislative (e.g., mandatory staffing laws), collective (e.g., collective bargaining), and educational (e.g., emancipatory pedagogy) methods.

Downloads

Download data is not yet available.

Author Biographies

Bonnie Sommers-Olson, United States Department of Veterans Affairs

Bonnie Sommers-Olson, DNP, NP-C, RN, is a board certified Nurse Practitioner and a Chief for the Ancillary Diagnostic Services of Radiology and Laboratory. Her research interests include clinical topics of hospital flow and virtual medicine and nursing practice centered issues regarding intention to leave and professional equity issues.

Jessica Leiberg, University of Wisconsin - Madison

Jessica Leiberg, PhD, DNP, ACNP, RN, is a board-certified nurse practitioner in acute care adult medicine, DNP program director, population lead for the Adult/Geriatric Acute Care DNP track, and clinical associate professor at the University of Wisconsin Madison’s School of Nursing. Jessica’s clinical practice has focused on abdominal transplant and neurosurgery. Her scholarship focuses on topics surrounding nurse education including caring pedagogy in various class settings, investigating student grit, and disparity in nurse educator pay.

Dana Kaminstein

Dana S. Kaminstein, Ph.D. is an Adjunct Assistant Professor at the Graduate School of Education, University of Pennsylvania and a Qualitative Health Specialist at the Center for Health Equity Research and Promotion (CHERP) at the Crescenz VA Medical Center, Philadelphia. He has taught graduate students at the University of Pennsylvania for forty years. His research interests include rhetorical aspects of public meetings in traumatized communities, the dynamics of consulting in South Africa, designing honest and effective organizational diagnoses, group dynamics of Veteran community advisory boards, Veterans perceptions of potential harm due to lung cancer screening, and the menace of current theories and practices of leadership.

References

Ackoff, R. (1999). Recreating the Corporation: A Design of Organizations for the 21st Century. Oxford University. DOI: https://doi.org/10.1093/oso/9780195123876.003.0002

Ackoff, R. L. (1994). Systems thinking and thinking systems. System Dynamics Review, 10(2-3), 175-188. https://doi.org/10.1002/sdr.4260100206 DOI: https://doi.org/10.1002/sdr.4260100206

Akoo, C., McMillan, K., Price, S., Ingraham, K., Ayoub, A., Rolle Sands, S., Shankland, M., & Bourgeault, I. (2023, Nov 5). "I feel broken": Chronicling burnout, mental health, and the limits of individual resilience in nursing. Nurs Inq, e12609. https://doi.org/10.1111/nin.12609 DOI: https://doi.org/10.1111/nin.12609

American Association of Colleges of Nursing. (2024). Doman 7: Systems-Based Practice. Retrieved Mar 18 from

American Nurses Association. (2015). Code of ethics for nurses with interpretitve statements. American Nurses Association.

American Nurses Credentialing Center. (2023). ANCC Magnet Recognition Program. Retrieved Jan 20 from https://www.nursingworld.org/organizational-programs/magnet/

Bailey, A. (2020). On Gaslighting and Epistemic Injustice: Editor's Introduction. Hypatia, 35(4), 667-673. https://doi.org/10.1017/hyp.2020.42 DOI: https://doi.org/10.1017/hyp.2020.42

Bakhamis, L., Paul, D. P., 3rd, Smith, H., & Coustasse, A. (2019, Jan/Mar). Still an Epidemic: The Burnout Syndrome in Hospital Registered Nurses. Health Care Manag (Frederick), 38(1), 3-10. https://doi.org/10.1097/HCM.0000000000000243 DOI: https://doi.org/10.1097/HCM.0000000000000243

Brborovic, O., Brborovic, H., Nola, I. A., & Milosevic, M. (2019, Dec 1). Culture of Blame-An Ongoing Burden for Doctors and Patient Safety. Int J Environ Res Public Health, 16(23). https://doi.org/10.3390/ijerph16234826 DOI: https://doi.org/10.3390/ijerph16234826

Byun, S., & Ha, O. (2019). Factors influencing nurses' intention to stay in general hospitals. Korean Journal of Occupational Health Nursing, 28(2), 104-113. https://doi.org/10.5807/kjohn.2019.28.2.104

AB-394 Health facilities: Nursing staff, Assembly bill no. 394 (1999). DOI: https://doi.org/10.1093/pch/4.6.394a

Chen, C., & Meier, S. T. (2021, Dec). Burnout and depression in nurses: A systematic review and meta-analysis. Int J Nurs Stud, 124, 104099. https://doi.org/10.1016/j.ijnurstu.2021.104099 DOI: https://doi.org/10.1016/j.ijnurstu.2021.104099

Cheng, C. K. T., Chua, J. H., Cheng, L. J., Ang, W. H. D., & Lau, Y. (2022, Apr). Global prevalence of resilience in health care professionals: A systematic review, meta-analysis and meta-regression. J Nurs Manag, 30(3), 795-816. https://doi.org/10.1111/jonm.13558 DOI: https://doi.org/10.1111/jonm.13558

Christianson, J. (2023). Why we work: Exploring the relationships between work rewards, work-related burnout, and intention to leave for professional nurses [Dissertation, Marquette University].

Christianson, J., Bekhet, A., Guttormson, J., Singh, M., & Johnson, N. (2024). Why We Quit: Relationships Between Work-Related Burnout, Work Rewards, and Intention to Leave in Nursing. Nursing Economic$, 42(1), 7-16. https://doi.org/10.62116/NEC.2024.42.1.7 DOI: https://doi.org/10.62116/NEC.2024.42.1.7

Christianson, J., Guttormson, J., McAndrew, N., & Calkins, K. (2022). Impact of COVID-19 on Intensive Care Unit Nurse Duty of Care and Professional Roles: A Qualitative Content Analysis. SAGE Open Nursing, 8. https://doi.org/10.1177/23779608221113539 DOI: https://doi.org/10.1177/23779608221113539

Clarkson, J., Dean, J., Ward, J., Komashie, A., & Bashford, T. (2018, Oct). A systems approach to healthcare: from thinking to -practice. Future Healthc J, 5(3), 151-155. https://doi.org/10.7861/futurehosp.5-3-151 DOI: https://doi.org/10.7861/futurehosp.5-3-151

Cleary, M., Kornhaber, R., Thapa, D. K., West, S., & Visentin, D. (2018). The effectiveness of interventions to improve resilience among health professionals: A systematic review. Nurse Education Today, 71, 247-263. https://doi.org/10.1016/j.nedt.2018.10.002 DOI: https://doi.org/10.1016/j.nedt.2018.10.002

Cole, C., Wellard, S., & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing Ethics, 21(5), 576-582. https://doi.org/10.1177/0969733013511362 DOI: https://doi.org/10.1177/0969733013511362

Conolly, A., Abrams, R., Rowland, E., Harris, R., Couper, K., Kelly, D., Kent, B., & Maben, J. (2022, Jan-Dec). "What Is the Matter With Me?" or a "Badge of Honor": Nurses' Constructions of Resilience During Covid-19. Glob Qual Nurs Res, 9, 23333936221094862. https://doi.org/10.1177/23333936221094862 DOI: https://doi.org/10.1177/23333936221094862

Cooper, A. L., Brown, J. A., & Leslie, G. D. (2021, Jun). Nurse resilience for clinical practice: An integrative review. J Adv Nurs, 77(6), 2623-2640. https://doi.org/10.1111/jan.14763 DOI: https://doi.org/10.1111/jan.14763

Dall'Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2022, Winter2022). Burnout in nursing: a theoretical review. Journal of the Association of Occupational Health Professionals in Healthcare, 42(1), 13-26. http://0-search.ebscohost.com.libus.csd.mu.edu/login.aspx?direct=true&db=c8h&AN=156771570&site=ehost-live

Delgado, C., Upton, D., Ranse, K., Furness, T., & Foster, K. (2017). Nurses’ resilience and the emotional labour of nursing work: An integrative review of empirical literature. International Journal of Nursing Studies, 70, 71-88. https://doi.org/10.1016/j.ijnurstu.2017.02.008 DOI: https://doi.org/10.1016/j.ijnurstu.2017.02.008

Democracy at Work Institute. (n.d.). Democracy at Work Institutie: US Federation of Worker Cooperatives. Retrieved Feb 11 from https://institute.coop/

Dillard-Wright, J., & Shields-Haas, V. (2021, Jul-Sep 01). Nursing With the People: Reimagining Futures for Nursing. ANS Adv Nurs Sci, 44(3), 195-209. https://doi.org/10.1097/ANS.0000000000000361 DOI: https://doi.org/10.1097/ANS.0000000000000361

Duru, D. C., & Hammoud, M. S. (2022, 2022-2). Identifying effective retention strategies for front-line nurses. Nursing Management - UK, 29(1), 17-24. https://doi.org/doi:10.7748/nm.2021.e1971 DOI: https://doi.org/10.7748/nm.2021.e1971

Eder, L. L., & Meyer, B. (2022). The Mediating Role of Self-Endangering Cognitions between Nurses’ Altruistic Job Motives and Self-Esteem and Exhaustion: A Longitudinal Study. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4247691 DOI: https://doi.org/10.2139/ssrn.4247691

Esposito, C. L., Contreras Sollazzo, L., & DeGaray, C. (2020). Nurses Unions Can Help Reduce Stress, Burnout, Depression, and Compassion Fatigue, Part 2: NYSNA 2020 Staffing and Job Stress Survey Results. Journal of the New York State Nurses Association, 47(2), 32-44. http://0-search.ebscohost.com.libus.csd.mu.edu/login.aspx?direct=true&db=c8h&AN=148477252&site=eds-live&scope=site

Essex, R., Kennedy, J., Miller, D., & Jameson, J. (2023, Oct). A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations. Nurs Inq, 30(4), e12571. https://doi.org/10.1111/nin.12571 DOI: https://doi.org/10.1111/nin.12571

Etchin, A. G., Fonda, J. R., McGlinchey, R. E., & Howard, E. P. (2020). Toward a System Theory of Stress, Resilience, and Reintegration. Advances in Nursing Science, 43(1), 75-85. https://doi.org/10.1097/ans.0000000000000277 DOI: https://doi.org/10.1097/ANS.0000000000000277

Foster, K., Cuzzillo, C., & Furness, T. (2018, Jun). Strengthening mental health nurses' resilience through a workplace resilience programme: A qualitative inquiry. J Psychiatr Ment Health Nurs, 25(5-6), 338-348. https://doi.org/10.1111/jpm.12467 DOI: https://doi.org/10.1111/jpm.12467

Foster, K., Roche, M., Delgado, C., Cuzzillo, C., Giandinoto, J. A., & Furness, T. (2019). Resilience and mental health nursing: An integrative review of international literature. International Journal of Mental Health Nursing, 28(1), 71-85. https://doi.org/10.1111/inm.12548 DOI: https://doi.org/10.1111/inm.12548

Freire, P. (1970). Pedagogy of the oppressed. The Contiuum International Publishing Group Ltd.

Gavin, J. (2011). Galileo's Philosophy of Science [Thesis, University of Southern Mississippi].

Ge, M. W., Hu, F. H., Jia, Y. J., Tang, W., Zhang, W. Q., & Chen, H. L. (2023, Sep). Global prevalence of nursing burnout syndrome and temporal trends for the last 10 years: A meta-analysis of 94 studies covering over 30 countries. J Clin Nurs, 32(17-18), 5836-5854. https://doi.org/10.1111/jocn.16708 DOI: https://doi.org/10.1111/jocn.16708

Grace, P. J., Peter, E., Lachman, V. D., Johnson, N. L., Kenny, D. J., & Wocial, L. D. (2023, Jul 7). Professional responsibility, nurses, and conscientious objection: A framework for ethical evaluation. Nurs Ethics, 9697330231180749. https://doi.org/10.1177/09697330231180749 DOI: https://doi.org/10.1177/09697330231180749

Hagedorn, J., Paras, C. A., Greenwich, H., & Hagopian, A. (2016, Jun). The Role of Labor Unions in Creating Working Conditions That Promote Public Health. Am J Public Health, 106(6), 989-995. https://doi.org/10.2105/AJPH.2016.303138 DOI: https://doi.org/10.2105/AJPH.2016.303138

Jaber, A., Ta'an, W. F., Aldalaykeh, M. K., Al-Shannaq, Y. M., Oweidat, I. A., & Mukattash, T. L. (2022, Nov). The perception of shared governance and engagement in decision-making among nurses. Nurs Forum, 57(6), 1169-1175. https://doi.org/10.1111/nuf.12817 DOI: https://doi.org/10.1111/nuf.12817

Janzarik, G., Wollschlager, D., Wessa, M., & Lieb, K. (2022, Jan 6). A Group Intervention to Promote Resilience in Nursing Professionals: A Randomised Controlled Trial. Int J Environ Res Public Health, 19(2). https://doi.org/10.3390/ijerph19020649 DOI: https://doi.org/10.3390/ijerph19020649

Johnson, V. E., Nadal, K. L., Sissoko, D. R. G., & King, R. (2021, Sep). "It's Not in Your Head": Gaslighting, 'Splaining, Victim Blaming, and Other Harmful Reactions to Microaggressions. Perspect Psychol Sci, 16(5), 1024-1036. https://doi.org/10.1177/17456916211011963 DOI: https://doi.org/10.1177/17456916211011963

Kelly, L. (2020, Jan/Mar). Burnout, Compassion Fatigue, and Secondary Trauma in Nurses: Recognizing the Occupational Phenomenon and Personal Consequences of Caregiving. Crit Care Nurs Q, 43(1), 73-80. https://doi.org/10.1097/CNQ.0000000000000293 DOI: https://doi.org/10.1097/CNQ.0000000000000293

Kurtzman, E. T., O'Leary, D., Sheingold, B. H., Devers, K. J., Dawson, E. M., & Johnson, J. E. (2011, Feb). Performance-based payment incentives increase burden and blame for hospital nurses. Health Aff (Millwood), 30(2), 211-218. https://doi.org/10.1377/hlthaff.2010.0573 DOI: https://doi.org/10.1377/hlthaff.2010.0573

Lee, S. E., Dahinten, V. S., Ji, H., Kim, E., & Lee, H. (2022, 2022-10). Motivators and inhibitors of nurses' speaking up behaviours: A descriptive qualitative study. Journal of Advanced Nursing (John Wiley & Sons, Inc.), 78(10), 3398-3408. https://doi.org/doi:10.1111/jan.15343 DOI: https://doi.org/10.1111/jan.15343

Massachusetts Nurses Association. (2024). MNA and Collective Bargaining. Retrieved Jan 20 from https://www.massnurses.org/unionizing/mna-and-collective-bargaining-unit/

Mousavi, S., Ramezani, M., Salehi, I., Khanzadeh, A., & Sheikholeslami, F. (2017). The relationship between burnout dimensions and psychological symptoms (depression, anxiety and stress) among nurses. Journal of holistic Nursing and Midwifery, 27(2), 37-43. DOI: https://doi.org/10.18869/acadpub.hnmj.27.2.37

Nabizadeh-Gharghozar, Z., Adib-Hajbaghery, M., & Bolandianbafghi, S. (2020, Aug). Nurses' Job Burnout: A Hybrid Concept Analysis. J Caring Sci, 9(3), 154-161. https://doi.org/10.34172/jcs.2020.023 DOI: https://doi.org/10.34172/jcs.2020.023

New York State Nursing Association. (2023, Jan 20). Mount Sinai Hospital and Montefiore Bronx Win Groundbreaking Safe Staffing. https://www.nysna.org/blog/2023/02/28/mount-sinai-hospital-and-montefiore-bronx-win-groundbreaking-safe-staffing

Nsiah, C., Siakwa, M., & Ninnoni, J. P. K. (2020, Mar). Barriers to practicing patient advocacy in healthcare setting. Nurs Open, 7(2), 650-659. https://doi.org/10.1002/nop2.436 DOI: https://doi.org/10.1002/nop2.436

O'Shea, A., Boaz, A. L., & Chambers, M. (2019). A Hierarchy of Power: The Place of Patient and Public Involvement in Healthcare Service Development. Front Sociol, 4, 38. https://doi.org/10.3389/fsoc.2019.00038 DOI: https://doi.org/10.3389/fsoc.2019.00038

House Bill 2697, Pub. L. No. HB 2697, (2023). https://olis.oregonlegislature.gov/liz/2023R1/Downloads/MeasureDocument/HB2697/Enrolled

Penconek, T., Tate, K., Bernardes, A., Lee, S., Micaroni, S. P. M., Balsanelli, A. P., de Moura, A. A., & Cummings, G. G. (2021, Jun). Determinants of nurse manager job satisfaction: A systematic review. Int J Nurs Stud, 118, 103906. https://doi.org/10.1016/j.ijnurstu.2021.103906 DOI: https://doi.org/10.1016/j.ijnurstu.2021.103906

Prosser, S. J., Metzger, M., & Gulbransen, K. (2017, Apr). Don't Just Survive, Thrive: Understanding How Acute Psychiatric Nurses Develop Resilience. Arch Psychiatr Nurs, 31(2), 171-176. https://doi.org/10.1016/j.apnu.2016.09.010 DOI: https://doi.org/10.1016/j.apnu.2016.09.010

Raghupathi, V., & Raghupathi, W. (2020). Healthcare Expenditure and Economic Performance: Insights From the United States Data. Front Public Health, 8, 156. https://doi.org/10.3389/fpubh.2020.00156 DOI: https://doi.org/10.3389/fpubh.2020.00156

Richards, D. A., & Borglin, G. (2019, Mar). 'Shitty nursing' - The new normal? Int J Nurs Stud, 91, 148-152. https://doi.org/10.1016/j.ijnurstu.2018.12.018 DOI: https://doi.org/10.1016/j.ijnurstu.2018.12.018

Salvage, J., & White, J. (2019, Jun). Nursing leadership and health policy: everybody's business. Int Nurs Rev, 66(2), 147-150. https://doi.org/10.1111/inr.12523 DOI: https://doi.org/10.1111/inr.12523

Schlak, A. E., Aiken, L. H., Chittams, J., Poghosyan, L., & McHugh, M. (2021, Jan 12). Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes. Int J Environ Res Public Health, 18(2). https://doi.org/10.3390/ijerph18020610 DOI: https://doi.org/10.3390/ijerph18020610

Shin, S., Park, J.-H., & Bae, S.-H. (2018). Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nursing Outlook, 66(3), 273-282. https://doi.org/10.1016/j.outlook.2017.12.002 DOI: https://doi.org/10.1016/j.outlook.2017.12.002

Sillitto, H., Dori, D., Griego, R. M., Jackson, S., Krob, D., Godfrey, P., Arnold, E., Martin, J., & McKinney, D. (2017). Defining “System”: a Comprehensive Approach. INCOSE International Symposium, 27(1), 170-186. https://doi.org/10.1002/j.2334-5837.2017.00352.x DOI: https://doi.org/10.1002/j.2334-5837.2017.00352.x

Soosova, M. (2021). Association between nurses' burnout, hospital patient safety climate and quality of nursing care. Central European Journal of Nursing and Midwifery, 12(1), 245. DOI: https://doi.org/10.15452/cejnm.2020.11.0039

Tan, M. L., Pek, J. H., & Wong, S. H. (2024). Burnout in emergency department personnel—A continuing concern post pandemic. Hong Kong Journal of Emergency Medicine, 31(1), 13-21. https://doi.org/10.1002/hkj2.12008 DOI: https://doi.org/10.1002/hkj2.12008

Taylor, R. A. (2019, Jul). Contemporary issues: Resilience training alone is an incomplete intervention. Nurse Educ Today, 78, 10-13. https://doi.org/10.1016/j.nedt.2019.03.014 DOI: https://doi.org/10.1016/j.nedt.2019.03.014

House Bill No. 106, (2021). https://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2021&sessInd=0&billBody=H&billTyp=B&billNbr=0106&pn=0547

The Joint Commission. (2019). Developing Resilience to Combat Nurse Burnout. Quick Safety(50). https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_nurse_resilience_final_7_19_19pdf.pdf

Thompson, J., Buchbinder, S., & Shanks, N. (2012). An Overview of Healthcare Management. In Introduction to Health Care Management. Jones & Bartlett.

U.S. Department of Veterans Affairs. (2021). Burnout and Resilience: Frequently Asked Questions. Retrieved Jan 11 from https://www.va.gov/WHOLEHEALTHLIBRARY/tools/burnout-resilience.asp

von Bertalanffy, L. (1972). The History and Status of General Systems Theory. Academy of Management Journal, 15(4), 407-426. https://doi.org/10.5465/255139 DOI: https://doi.org/10.2307/255139

Weick, K. E., Sutcliffe, K. M., & Obstfeld, D. (2005). Organizing and the Process of Sensemaking. Organization Science, 16(4), 409-421. https://doi.org/10.1287/orsc.1050.0133 DOI: https://doi.org/10.1287/orsc.1050.0133

Wied, M., Oehmen, J., & Welo, T. (2019). Conceptualizing resilience in engineering systems: An analysis of the literature. Systems Engineering, 23(1), 3-13. https://doi.org/10.1002/sys.21491 DOI: https://doi.org/10.1002/sys.21491

Witter, S., Thomas, S., Topp, S. M., Barasa, E., Chopra, M., Cobos, D., Blanchet, K., Teddy, G., Atun, R., & Ager, A. (2023, Sep). Health system resilience: a critical review and reconceptualisation. Lancet Glob Health, 11(9), e1454-e1458. https://doi.org/10.1016/S2214-109X(23)00279-6 DOI: https://doi.org/10.1016/S2214-109X(23)00279-6

Yadava, O. P. (2023, Sep). 'Medical gaslighting'-an eye-opener. Indian J Thorac Cardiovasc Surg, 39(5), 441-442. https://doi.org/10.1007/s12055-023-01588-3 DOI: https://doi.org/10.1007/s12055-023-01588-3

Zhai, X., Ren, L.-n., Liu, Y., Liu, C.-j., Su, X.-g., & Feng, B.-e. (2021). Resilience Training for Nurses: A Meta-analysis. Journal of Hospice & Palliative Nursing, 23(6), 544-550. https://doi.org/10.1097/NJH.0000000000000791 DOI: https://doi.org/10.1097/NJH.0000000000000791