Burnout is characterized by fatigue, personal detachment, and cynicism from prolonged levels of high stress and is associated with increased turnover, decreased job and patient/family satisfaction, and decreased well-being in nurses.1,2 Nearly half of the neonatal intensive care unit (NICU) healthcare professionals experience burnout, and up to one-half of the nurses and physicians meet the criteria for severe burnout.3 Burnout among healthcare professionals directly influences quality of care, patient safety, turnover, and patient satisfaction.3 While frontline care providers are at risk for significant burnout, so too are clinical leaders. Clinical leaders need to be well-equipped to anticipate and manage their own individual stress as well as the stress experienced by members of their team.
LEADERS AND RESILIENCY
In today's evolving healthcare climate, NICU nurse leaders (eg, charge nurses and assistant nurse managers) must continuously work toward mastering complexity. They are at risk for burnout because of the constant ask to do more with less, maintain quality standards, and sustain both employee and patient/family satisfaction. Increased pressure at all levels, from frontline managers to nurse executives, requires resilience as a key strategy in the leadership toolkit. Nurse leaders need both individual and organizational resilience in order to be successful over a long period.4 Resiliency is the capacity to adapt to negative change, trauma, tragedy, threats, or significant sources of stress and to overcome it as soon as possible.4,5 Resiliency is more than simply surviving a situation; it involves thriving despite adversity and has been identified as a significant attribute of authentic leadership and employee engagement.4,6 In fact, nurse leaders who intentionally develop and apply resiliency to their work life will find that their collegial relationships and leadership capabilities are elevated and strengthened during challenging times.4 Resiliency practices including realistic goal setting, planning/anticipating responses to stressful situations, a positive work environment, and self-acceptance can support the well-being and longevity of nurse leaders.4 This means that resiliency is not something one is born with, but rather something that can be proactively cultivated, mentored, and coached. Nurse managers can learn to proactively and intentionally cultivate resilience responses as part of their own professional development, which will in turn place them in an ideal position to coach, mentor, and develop frontline staff. While it is important to learn from adversity and have a willingness to fail (which bolsters resistance), it is also important to train our minds to learn from situations that go well, helping to increase one's adaptive capacity for future challenges. Resilience is an essential leadership competency and an effective tool for improving nurse retention, patient safety, patient/family engagement, and quality outcomes.4
Resilient leaders view difficulties as challenges, not as paralyzing events, and mistakes or failures as opportunities to learn and grow. Acknowledging and recognizing stress before it results in burnout is key for NICU providers and leaders. Cultivating wellness and health is not a one-size-fits-all approach. While conventional mindfulness strategies have been successful for some, others have used abbreviated strategies to start their day. These intentional interventions are being deployed in NICUs and focus on positive beliefs, gratitude, and random acts of kindness to create an environment that reduces stress and burnout and promote patient safety.3
Exercising one's resiliency muscle is imperative in today's tumultuous healthcare environment. NICU leaders and providers need to be intentional and proactive to cultivate and develop resiliency. The following are 10 resilience-building strategies to help NICU leaders and providers to become more resilient4,7:
- Build positive beliefs in your abilities and focus on your signature strength (eg, strengths that define who you—appreciation, kindness, and curiosity)
- Find a sense of purpose and meaning in your work and personal life (eg, feeling passionate, committed, and innovative—an outward focus)
- Develop a strong supportive network of professional relationships and networks (eg, intentionally spend time at work socializing—do not always focus on work)
- Embrace change as inevitable, recognize those things in and outside your control
- Stay optimistic in the face of difficult situations—believe that things will get better and brighter days are ahead (eg, dwell on positive events and write down 3 good things)
- Self-care (essential component of resilience): Achieve life balance and spirituality. Nurture yourself with the right foods, exercise, recreation, and sleep (essential for creating a positive work culture)
- Develop problem-solving skills to overcome and learn from challenges (be proactive and anticipate challenges)
- Establish small and achievable goals (intentionally ask yourself at the beginning of the shift what your goals are and set out to achieve them)
- Practice thought awareness (avoid crippling cycles of negative thoughts) and emotional insight (develop awareness of triggers for stress, anger, impatience, as well as joy)
- Express gratitude and random acts of kindness (promote empathy, compassion, and a strong sense of community and belonging)
Burnout among neonatal leaders and frontline providers is prevalent and use of resilience-building practices to improve engagement, retention, patient safety, and quality outcomes is critical.
—Joan R. Smith, PhD, RN, NNP-BC
—Maggie Wolf, DNP(C), RN, NNP-BC
St Louis Children's Hospital St Louis, Missouri
1. Profit J, Sharek PJ, Amspoker AB, et al. Burnout in the NICU setting and its relation to safety culture. BMJ Qual Saf. 2014;23(10):806–813.
2. Rushton C, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity setting. Am J Crit Care. 2015;24(5):412–420. https://doi.org/10.4037/ajcc2015291
3. Tawfik DS, Phibbs CS, Sexton JB, Kan P, Sharek PJ, et al. Factors associated with provider burnout in the NICU. Pediatrics. 2017;139(5):e20164134.
4. Cline S. Nurse leader resilience: career defining moments. Nurs Admin Q. 2015:39(2):117–122.
5. American Psychological Association (APA). The road to resilience. http://www.apa.org/helpcenter/road-resilience.aspx
. Accessed August 4, 2018.
6. Hatler C, Sturgeon P. Resilience building: a necessary leadership competency. Nurs Leader. 2013;11(4):32–34, 39.
7. Sherman RO. Emerging RN Leader. Leadership resiliency. https://www.emergingrnleader.com/
. Published 2017. Accessed August 8, 2018.