OPERATIONAL PERFORMANCE

How to strengthen resilience to overcome nurse burnout during COVID-19 and beyond

Teresa M. Stephens, PhD, MSN, RN, CNE

The World Health Organization has called burnout an “occupational phenomenon,”1 with research showing it affects up to 43 percent of nurses.2 Now, with so many of you caring for patients with COVID-19, that number has likely gone up.

Nurse burnout by the numbers

43%
Affected by burnout2
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50%
Say they spend an inefficient amount of time with their patients3
96%
Report fatigue at the
beginning of their shift3
54%
Report excessive workloads3
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I recognized the negative effects of burnout as a newly graduated nurse almost 33 years ago, and I promised myself I would one day do something to make the workplace healthier for other new nurses. For the past 10 years, I have focused on combatting burnout among nursing professionals by helping to increase their personal resilience and by building resilient teams to address the bigger systems issues that lead to burnout cultures.

Whether the current health crisis has you feeling overworked, facing a shortage of personal protection equipment, juggling added family responsibilities, worried about finances or any number of other stressors during this unprecedented time in history, you’re not alone. I’ve heard caregiver stories of fear, uncertainty, dread, grief, despair, sadness and anger—and you may be experiencing a rollercoaster of all these emotions.

Typical symptoms of burnout

Emotional exhaustion
Greater cynicism
Less productivity

What you can do?
By using your personal protective factors (PPFs) and boosting your personal resilience,
you can learn to understand your emotions and then take steps to help you cope more effectively.

Personal protective factors

During times like these, it can help to tune into your personal protective factors, which have been described as “individual or environmental characteristics, conditions, or behaviors that reduce the effects of stressful life events.”4 They may vary from person to person, and it’s important to remember that a positive response may not come naturally to you, especially considering the enormity of the situation.

The key to using your personal protective factors? Making the positive choice.
  • You may not feel like going for a walk, but you can choose to anyway.
  • You may not feel like talking to a trusted friend, but you choose to reach out.
  • You may not feel like laughing, but you choose to find humor in the moment.

Those who are highly resilient make these kinds of positive choices, typically using some of their personal protective factors.

7 personal protective factors to focus on now:
  • Purpose
  • Support
  • Positive health behaviors
  • Humor
  • Hope
  • Flexibility
  • Faith
Tap into these personal protective factors now

Determine your purpose
The evidence is clear that people who find meaning during times of stress or adversity experience positive health benefits. One way to find purpose is to see difficult situations as a way to learn and grown.

Questions to ask yourself to help find your purpose:
  1. What am I learning today that will be useful to me in the future?
  2. How will my work be improved?
  3. How will my relationships be improved?
  4. How will my current policies and processes be improved?
  5. How will the essence of nursing be changed for the better?
Tip: Another way to find purpose is to help other nurses get through this tough time. Identify one staff member each day, even if it’s simply an encouraging text message or phone call. Altruism can strengthen your own sense of wellbeing.
Reach out for support

A sense of belonging can also help boost your resilience, particularly when you’re hurting. Sometimes that requires actually scheduling time to connect with your support network. Think about the people who you trust and can go to when you’re scared, emotionally exhausted or angry, and find a way to connect with them, especially if you live alone.

Tip: Instead of a text or phone call, get more personal by talking face-to-face via a program like FaceTime, Skype or Zoom.
Draw on your faith

Belief in a higher power can help build resilience in even the grimmest situations. It also offers a direct path to many other protective factors, including hope, optimism, perseverance and support. If you want to use your faith as a protective factor, sneak in moments for regular prayer, meditation or worship.

Tip: Take advantage of religious services that are now being streamed online to enhance a sense of community and bond with others who share your faith.
Elevate your education

Furthering your education is both a short-term and ongoing way to help decrease burnout and rekindle your passion for your career.3 In fact, a LinkedIn study shows that 94 percent of employees would stay at a job longer if the employer invested in their career.5 Look into educational opportunities at your facility or check out the many options Medline offers to help empower nurses, such as the Skin Champion program, skin health Best Practice Guides and Tools, and a full selection of continuing education courses through Medline University.

Tip: Medline has pulled together COVID-19-specific resources to empower nurses to feel more confident about doing the right thing.
Practice positive health behaviors

Be intentional in your focus on personal health. Maintain a healthy diet, prioritize sleep and exercise. If possible, get outside, even if only for a 5- or 10-minute walk. Avoid the constant barrage of distressing news by limiting your time online.

Tip: Seek out and enjoy moments of quiet. This promotes a sense of control and may help you avoid feelings of being overwhelmed.
Find some humor

Give yourself permission to take a humor break from the constant media flood of discouraging news. Watch a funny movie or video, read a lighthearted book, gather friends or family for a virtual game night.

Tip: When you find something that makes you laugh, share it with others who may benefit as well.
Increase your flexibility

You may be experiencing a lot of disruption in your normal routines, but you can maintain a healthy and informed perspective by being openminded and flexible. This is especially relevant to work-related practices and policies that may be shifting to accommodate more and sicker patients. Recognize the gift in the opportunities for change.

Tip: When possible, take advantage of opportunities to learn something new or develop an even better way of doing things. Remember, many great advancements have come from times that force people out of their comfort zones.
Have hope

Hope is the belief in a better future, that something positive lies ahead. Acknowledge your fears and sadness, but also recall past challenges that you overcame. Remembering how you successfully survived and thrived can help move you forward during the current crisis.

Tip: Remind yourself that “feelings aren’t facts” and that your emotions may be exaggerated due to your current high stress levels.
Leaders, support your frontline staff

Crisis often reveals the true character of a leader. The nursing staff will remember how you respond
during this time. Here are some ways you can help them cope during this crisis:

  • Focus on compassion, connection and courage in all interactions with nurses
  • Be a voice of hope for nurses who may be finding it difficult to maintain perspective, especially if they are struggling to meet their family’s basic needs
  • Seek input when making decisions and avoid knee-jerk reactions that may lead to even more stress for your team and organization
  • Provide regular, honest updates and offer virtual office hours to provide a reassuring presence for staff who may be overwhelmed by uncertainty for their future.
  • Recognize each nurse as an individual who is juggling many responsibilities
  • Plan for a process of continued support when this crisis begins to wane. Right now, most nurses are focused on the here and now, without a lot of time for reflection, but frontline staff may also experience symptoms of post-traumatic stress, moral distress, grief and depression afterward.
When to seek professional help

There is nothing to be ashamed of in admitting you’re overwhelmed and might need professional help to get you through this time. Beyond reaching out to your support network, lean on the professional resources available to you through your employer and community. Right now, there are a variety of telehealth options for mental health screening through your state health department, local hospital and professional psychological organizations.

Here are two great resources for seeking immediate, credible support:
Key takeaway

You have unique personal protective factors that you can tap into at any time. By consciously and intentionally integrating these resilience strategies and concepts into your daily life, they can help you face immense challenges, adversity and stressors.

Dr. Teresa M. Stephens PhD, MSN, RN, CNE is associate professor, RNBSN Lead Faculty, College of Nursing, Medical University of South Carolina. She is a clinical consultant to Medline Industries, Inc.