Nurses across the continuum experience stress unknown to most professions. Long, high-paced shifts, life-or-death decisions and the constant push to provide high-quality nursing care in a flawed healthcare system puts pressure on nurses from day one. This constant stress leads to burnout, compassion fatigue, and high turnover. New graduate nurses (NGNs) spend a great deal of their first year learning their roles and responsibilities. It is heavily supported in the research that NGNs experience a phase of transition shock where they become disillusioned with their decision to become a nurse. Their comfort, confidence, and job satisfaction dive to an all-time low and they disengage from their role. 

The Iowa Online Nurse Residency Program curriculum has always included content related to self-care during the transition to practice period, but resiliency is more than just taking care of yourself. Program leaders wanted to go beyond simply encouraging new nurses to eat healthily, get adequate sleep, and exercise. Instead, it was important to give new graduates tangible skills they could use every day to begin to build resilience from day one. A transition journal was added to the curriculum in early 2019 to do just this. Leaders felt that by providing participants with structured activities that helped them to reflect on their practice and use evidence-based positive psychology exercises to focus on their strengths, they could help new nurses develop habits and routines to prevent burnout while sustaining ongoing satisfaction with their nursing career. The journal includes various methods pushing nurses to practice gratitude, set goals, prime their brain for positive thinking, and build a growth mindset. Not only has the journal been an effective way to create lasting change, but it creates a beautiful snapshot of their first year as a nurse.  

The COVID19 crisis brought a renewed focus to the issue of clinical wellbeing, especially for new graduate nurses entering practice during a global pandemic. Since the start of the COVID pandemic in early 2020, there has been a rise in trauma, anxiety, and burnout in the nursing profession (International Council of Nurses, 2020). Building skills needed for resilience in nurses helps to reduce emotional exhaustion, increase work engagement, and enhance abilities needed to face challenges of the workplace (Fiona et al., 2019). While clinician wellbeing has been identified as a system issue (Sinsky et al., 2020) it continues to be important for NGNs to learn how to find balance and apply strategies to manage stress responses in their new role. 

To further augment the program and provide a broader range of training the program has partnered with Dr. Patrick Jeffs at The Resiliency Solution to provide a comprehensive training program aimed at Building Resiliency in Healthcare. When asked about the importance of resiliency training for new graduate nurses Dr. Jeffs said, “The Iowa Online Nurse Residency Program is supporting their new nurses in a way that many other administrations only talk about. It is no longer sufficient to just educate and train nurses in the healthcare side of their job. Delivering continued focus is also required to ensure each nurse’s resiliency and capacity can meet the demands of their workload.” 

This comprehensive resiliency curriculum builds on what the participants were doing in the transition journal and helps them to find ways in which they can integrate practices throughout their shifts to regulate their stress levels, connect with their patients, and build optimism by reframing common negative thinking patterns. New nurses enrolled in the IONRP are guided through 5 microlearning sessions in which they learn the science behind resiliency and are given tactical strategies to practice.  

“IONRP understands that the changing demands of this moment in healthcare also requires a change in how nurses are trained and supported. Nurses that receive targeted resiliency training and support WILL be able to meet this moment better than most. Additionally, these resiliency skills, while designed for the workplace, translate with them to ensure they have a fulfilled private life as well,” Jeffs said.  The goal for providing this training as part of the IONRP is to establish the skills necessary for NGNs to bounce back from negative experiences, engage in meaningful work, and flourish both at home and the bedside for years to come. 

Nicole Weathers, Program Manager, IONRP nicole-weathers@uiowa.edu

References: 

Fiona, Y, Raphael, D., Mackay, L., Smith, M., & King, A. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International journal of nursing studies, 93, 129-140. https://doi.org/10.1016/j.ijnurstu.2019.02.014 

International Council of Nurses (2020) International Council of Nurses COVID 19 Update. https://www.icn.ch.  

Sinsky, C. A., L. Daugherty Biddison, A. Mallick, A. Legreid Dopp, J. Perlo, L, Lynn, & C. D. Smith. 2020. Organizational Evidence-Based and Promising Practices for Improving Clinician Well-Being. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/202011a