Healthcare systems are facing tumultuous, challenging times that are likely to become the new normal. As a crucial part of the healthcare team, the nurse leaders of today are faced with ever-increasing responsibilities; higher levels of accountability; and multiple, ongoing stressors that can have a daily, detrimental impact on a leader's ability to succeed, let alone survive. In response to these challenges, the nurse leader needs to develop and sustain a significant capacity of resilience to thrive and succeed as a transformational leader within the profession of nursing.
The purpose of this article is to provide current and future nurse leaders with new insights into developing and maintaining personal and professional resilience in the face of perpetual challenges and continual change. Although various concepts and characteristics have been described within the construct of resilience, this article proposes and describes the importance of the relationship between the concepts of equanimity, optimism, and perseverance, and how the three assemble to create a paradigm that may be foundational to resiliency in today's nurse leaders.
Nurse as leader
Nurse leaders have a tremendous responsibility; those they lead are often holding human life and dignity in their hands. Without inspiration and support, the opportunity to make a difference in a person's life may pass. The characteristics of a successful transformational nurse leader are described throughout the literature. The importance of integrity, authenticity, and honesty within a transformational leader can't be underscored enough. However, these characteristics can also be considered the basic foundation for a leader's ability to be personally and professionally resilient.
Today's nurse leaders often find themselves torn between priorities and are challenged by competing needs of their staff and organization. It's in this moment that a nurse leader needs to have the belief and hope that he or she can continue to make a difference. Experience as a successful nurse leader tends to foster this belief, which helps build resilience.1 Leaders who are resilient know who they are and what they stand for, which enables them to be directed by their inner compass—their foundational values. This level of introspection allows them to focus on what's meaningful.2 The question then is: How does a nurse leader build and maintain his or her resiliency in the face of turbulence and increasing levels of accountability?
Resiliency in leadership
Successful leaders hold themselves accountable to following their values and keeping their commitments.1 As healthcare requirements are increasingly placed on the shoulders of nurse leaders, the ability to follow through with commitments and feel like a job was well done is becoming progressively more difficult. All levels of nursing leadership are impacted in every healthcare organization. Evidence of burnout and fatigue is reflected in various nurse leadership satisfaction and turnover rates.2 Nurse leaders must deal with crises having minimal preparation and, frequently, with less than adequate resources.3 Feelings of personal inadequacy may lead to self-doubt, which is also a factor when the nurse leader is viewed as the reason for a department's problems or the service line's lack of performance.
The staff may see the nurse leader as the figurehead of the relentless change that's occurring. A state of vulnerability for the nurse leader occurs when feelings of inadequacy and self-doubt are amplified by lack of support and increasing demands. A nurse leader who's vulnerable faces ongoing challenges that can be potentially harmful, both professionally and personally.3 As healthcare and technology spiral into a state of constant change, the need for strong, committed, effective leadership is augmented. The requirement for resilient nurse leaders is a crucial one.
To be resilient, one must be able to not only rebound and recover from hard times, but also function in his or her role during those times.3 In order to be resilient, nurse leaders need to feel that their work has true meaning and purpose; without meaning, resilience is futile. The resilient leader is determined and competent. Self-reliance is a strong suit of the resilient leader, who's able to adapt to challenges with a sense of balance and fortitude.4
The level of professional resilience can depend on an individual's personal resilience. In order to be in a place to lead, nurse leaders need to first and foremost take care of themselves and focus on maintaining a healthy balance between the requirements of their career and the important aspects of home, family, and friends. Resiliency broadens with being able to live and think in the present moment, increasing the awareness and openness to situations and opportunities.5
Being resilient enables the nurse leader to transcend beyond simple survival. Resiliency promotes growth, where the leader thrives as a visionary role model for others. Various stressors, such as financial responsibilities, human resource challenges, and dwindling resources, combined with expanding requirements, compete against each other, causing nurse leaders frustration, emotional distress, anxiety, and apprehension.6 In order to develop the needed clarity and energy to flourish, the nurse leader needs to be self-reflective and learn to know the inner self. Identification of emotional triggers and subsequent reactions can help create self-awareness—one must realize that no one person is perfect. By developing a strong sense of self-esteem and a positive self-concept, a leader can further his or her emotional stability, become solution-oriented, and create a sense of mindfulness.3
Mindfulness enables authenticity, creativity, and a positivity that's contagious. A resilient leader is consistent in his or her beliefs and behaviors.3 Decision-making processes become increasingly objective in nature because the nurse leader is able to see the issue for what it is and not assign unnecessary emotions, which create increased stress and frustration. There are questions that nurse leaders can ask themselves, which might offer insight into their level of personal and professional resilience. (See Table 1.)
A gold standard measurement of resilience hasn't yet been identified. However, there are several resiliency tools within the literature, including the Brief Resilience Scale, that offer valid measurement of resilience.7 Although resilience-focused nursing research didn't begin until the 1980s, the profession of nursing encompasses the most expansive views on and approaches to the concept.8 Literature analysis and qualitative research studies have helped clarify concepts, as well as identify conceptual relationships. In 1996, a concept analysis of adult resiliency was developed, which described how self-determination and a positive attitude toward society produced encouraging outcomes such as improved coping and increased self-confidence.8
A conceptual triad for resilience
A famous quote by the American author, Charles R. Swindoll, “Life is 10 percent what happens to you, and 90 percent how you react to it,” is a foundational statement for the existence of resilience. When detrimental situations occur, it's how you deal with them, then how you move on that determines your ability to bounce back the next time a difficult situation arises. Resiliency feeds upon itself; it's self-propagative. How does an overwhelmed, self-defeated nurse leader begin the repetitive and enduring cycle of resiliency? The relationship between the concepts within the proposed and untested triad model of nurse leader resiliency, as seen in Figure 1, may create some initial awareness and strategy for the struggling nurse leader.
All nurses have experienced being led by various nurse leaders within their careers, and most have been able to note differences in the sense of upheaval or stability that the leaders projected. Most often, those who were able to consistently convey a sense of calm and control enabled the crisis or stressful situation to be dealt with in a more logical manner, with less of a negative impact on the department or unit. It's proposed that this sense of calmness and even-tempered ability, or equanimity, can be the first step in creating personal resiliency for the nurse leader.
When an individual feels a lack of control, this creates anxiety that can negatively impact sound decision-making skills and perpetuates inaccurate assessments or perceptions of the situation.9 Equanimity can be explained as the practice of self-control that's based on calmness, which creates composure and a sense of poise. Self-control is a vital component of being able to cope and develop coping strategies that enable future resilience.10 Uncertainty can create fear and increased stress.
When a nurse leader is presented with uncertainty, his or her perceived lack of control related to it increases the sense of urgency to return to a structural normalcy.11 Embodying the concept of equanimity allows the nurse leader to remain in control and assess situations clearly and accurately. It provides the nurse leader with the sense of self-confidence and the propensity to envision solutions with calmness and grace. It's with these thoughts that equanimity stands as first in the proposed sequential conceptual triad model of nurse leader resiliency.
As the nurse leader faces adversity with a sense of calmness, the next step in building resilience is to view the situation or crisis with positivity and optimism. The transformational nurse leader carries a high amount of positive psychological capital (PsyCap) within him- or herself.12 This construct symbolizes a person's proclivity to remain on task and be motivated toward reaching goals. In order to embody PsyCap as a leader, one must have hope and remain optimistic in life.12 PsyCap allows a person to move forward with optimism, which, therefore, can be thought of as central to the foundational element of nurse leader resiliency. The PsyCap model is similar in thought to the conceptual triad model proposed; however, it doesn't include the concept of equanimity and isn't necessarily thought of as a linear process.
The Theory of Attribution defines optimism as “a goal-based, cognitive process that operates whenever an outcome is perceived as having substantial value.”13 When a person is optimistic, he or she is able to view difficult times as a challenge and have hope that things will turn out for the best. Situations are viewed as external and caused for specific reasons.14 Alternatively, pessimism tends to create negativity because situations and potential outcomes are viewed as unfavorable with universal origins. The literature shows that individuals who are optimistic are more apt to be healthier and have a greater life expectancy than their pessimistic counterparts.15
Just as optimism builds upon itself, so does cynicism, which proliferates a cyclic evolution of negative interpretations followed by lack of progress toward goals.16 The nurse leader faces difficult situations and multiplying responsibilities everyday. In order for leaders to be successful, effective, and able to cope positively, they need to remain optimistic in the face of adversity. Although it can be detrimental to be overly optimistic, such as when situations aren't assessed to the full extent of clarity and reality is distorted, a positive outlook that's constructive and healthy can have a positive impact on self-efficacy and self-esteem.17 Not all individuals move toward optimism naturally. However, optimism can be learned, developed, and successfully role-modeled when one applies effort and fortitude.13
The third element that's foundational to the proposed resiliency model is perseverance—the ability to continue on and move forward. Courage is the essential component of perseverance. Having the drive and fortitude to continue to move forward in a world of constant change requires self-awareness and the capacity to sustain a passion for the future.18 Perseverance requires energy, and this needed energy comes from nurse leaders' confidence in themselves that they can and do make a difference. Nurse leaders become perseverant when they see that they can meet responsibilities and accomplish their own expectations of themselves. Positive self-efficacy combines with determination, leading the individual toward the ability to endure and progress. These beliefs and attributes that constitute the perseverance of the nurse leader are sown and nurtured from the conceptual relationships of optimism and equanimity within the triad model of resiliency.
Applications for nurse leaders
The suggested conceptual triad model of nurse leader resiliency is in its infant stages of development and requires further examination. However, the application to current and future nurse leaders could be significant. Nurse leader resilience is an absolute necessity for the future sustainability of healthcare. Nurse leaders are the individuals who inspire and uphold those who provide the most intimate and pivotal care for patients and families in every healthcare setting.
The nurse leader holds the ultimate responsibility: to engage, support, and develop those who hold life or death decisions within their grasp, thus enabling the most basic needs of humanity. The nurse leader can't afford to resort to volatility, pessimism, and feebleness. They must learn to be personally and professionally resilient, and must continually strive toward nurturing and strengthening these important attributes.
Resilient nurse leaders follow through with commitments, demonstrating wisdom and understanding. They're leaders who respond to harsh realities with courage and vision. Resilient nurse leaders take time to reflect on their perceptions, mind-set, and abilities so that difficult realities can be overcome and turned into opportunities for growth. Self-efficacy enables the nurse leader to build resilience through equanimity, optimism, and perseverance.
The conceptual triad model of nurse leader resiliency proposes that the three foundational elements of resiliency in nurse leaders may help to create the essence and substance behind resilience while providing a three-step core structure for responding to adversity within healthcare. Equanimity, optimism, and perseverance are the three primary elements to resilience. Additional elements, such as awareness, clarity, and compassion, are the sequential characteristics that evolve from the combination of the other three.
The cultivation of equanimity as the initial foundational element builds awareness of self and allows for an unblemished worldview of any situation. This clarity and calmness creates an intrapersonal sanctuary where positivity and effective optimism can be nurtured and utilized. However, it takes the third foundational element of perseverance, which encourages the strength and motivation to move forward, to enable the elements of equanimity and optimism to prevail. The suggested conceptual triad model of nurse leader resiliency offers new insights into the importance of resilient nurse leaders. It's recommended that further reviews and future nursing research should be allocated toward development of the proposed model.
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