So far, 2020 has been a very trying year, to say the least. COVID-19 caught long-term care teams unaware and has not only affected staff physically, but emotionally as well. Illness and loss of life among both residents and employees, combined with lack of supplies, testing, staffing, and the fear of bringing the virus home to family has been very stressful and is affecting everyone. As part of the management team, the director of nursing services (DNS) needs to be able to measure their facility staff’s emotional health and aid them to adapt or “bounce back” from adversity. In other words, the DNS needs to cultivate resilience. This article will assist the DNS and other nurse leaders to have a better understanding of what resilience looks like and will provide tips on how to encourage staff to build resilience and find strength in this difficult time.
What happens when the leadership team doesn’t build resilience?
When staff lack resilience and that lack goes undetected, not only is it detrimental to the individual, but it also affects the facility in general. Staff who feel unappreciated or unsupported are more apt to experience burnout and become unable to function effectively, which compromises resident safety and care. These symptoms may also evolve into post-traumatic stress disorder or other chronic illness for the person later (Wu et al., 2020). If staff feel out of control or insufficiently trained, they are more likely to call off work, further straining a facility’s staffing issues. Individuals unable to bounce back may have an increase in mental health issues, such as anxiety, depression, and insomnia (Miller, 2020), which may affect their ability to work.
What is resilience?
To promote and assist staff in building resiliency, the DNS must first understand what it is. Resilience is defined as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress” (American Psychological Association, 2012). Being resilient doesn’t mean a person does not experience difficulty or stress, but rather that they find a way to deal with that stress and become stronger, move on, and prosper. Resilience is a set of positive behaviors, thoughts, and actions that can be learned and developed. There are many factors that contribute to resilience (Cherry, 2019). Among them are:
- Supportive relationships
- Ability to make realistic plans and carry them out
- Positive view of self
- Confidence in strengths and abilities
- Communication skills
- Ability to manage feelings
Why is resilience important?
During stressful situations, like a pandemic, if staff do not have resilience, it can impact their professional abilities and personal lives. They may experience burnout, compassion fatigue, and moral distress. Eventually, the individual may become overwhelmed and turn to unhealthy habits to cope (Cherry, 2019). This lack of resilience can negatively affect the facility in the form of absenteeism, turnover, staffing issues due to call-offs, and, ultimately, poor quality of care either due to the turnover or mistakes staff with fatigue or burnout make.
What traits does a resilient person have?
Those who are more resilient tend to be better at managing emergencies and are more accepting of change. They are the ones you never see sweat, who are flexible under stressful situations. Some of the traits that can be learned include:
- Knowing boundaries – Resilient people understand that who they are and what is causing their stress are two different things, and that the stress is temporary and does not define them.
- Developing positive relationships – Resilient people tend to surround themselves with other resilient people who support, listen, and encourage them without trying to fix the problem themselves.
- Cultivating self-awareness – Resilient people know what they need, when they need it, and when to reach out for help.
- Not having answers – Resilient people do not have all the answers, and they know this is okay.
- Practicing self-care – Resilient people apply good habits, such as healthy eating, exercise, meditation, etc., to help them through the tough times.
- Considering all possibilities – Resilient people can reflect on a situation and say “Can this be looked at a different way? Have we exhausted all possibilities?”
Most individuals who are resilient do not view themselves as victims, and they know they can change things they have control over. They have solid goals and the desire to achieve those goals. Lastly, they have a positive image of the future (Waters, 2013).
Barriers to resilience
Like anything else, promoting resilience has its barriers as well. Impediments to resilience can be internal factors, external, or both. Internal barriers are those that the individual may perceive, such as concerns they will be seen as weak or not doing their job. External barriers are those outside of the individuals, such as facility culture. Does facility management have an open-door policy and good communication with the staff? When communication is lacking or staff does not have confidence in the accuracy of what is being communicated, they will feel more anxiety. Another barrier is long hours—staffing may be short due to COVID-19. This, paired with either a lack of breaks or shortened breaks, heightens anxiety and stress. Staff need a respite from the stimuli. Lastly, lack of work-life balance can make it difficult to adopt resilient behaviors. As staffing constraints may prompt employees to work more hours, disrupting this balance can increase stress at home—which impairs the home environment’s ability to serve as a respite from work. The DNS needs to be aware of such barriers their staff may be dealing with to break through to them and improve resilience.
Tips to build resiliency
Cultivating resilience in the facility is a multi-faceted approach. Some tips the facility may utilize to foster staff resilience are:
- Communicate change in a positive manner – Things change on a daily, sometimes hourly, basis in relation to COVID-19, and this can become stressful for staff. Be transparent with staff and communicate these changes in a concise and positive way.
- Accept change and be a model of resiliency – Change is inevitable. Accept the circumstances that cannot be changed and learn to adapt. Staff look to their leaders for guidance. If they see leadership with the ability to adapt, this may also assist them to adapt.
- Learn from the past – This is not the first hardship facilities have faced. Remind staff about situations they’ve already overcome and how they were able to find strength. Also, think about what was learned from previous experience and apply that knowledge.
- Goal setting – This is an ongoing effort. The facility should set achievable goals and move forward. Remember, even small steps are steps forward. Celebrate forward movement with staff. There will be times when the staff suffer setbacks. Try not to get discouraged, but if feelings of discouragement are voiced, work through them. Don’t ignore them, as this could lead to larger issues in the future.
- Be proactive – Do not procrastinate. If a problem is at hand, ask what can be done. Break the problem down into smaller pieces, if necessary, to see how to correct the issue.
- Foster wellness – Sleep, diet, and exercise are key to resilience, along with avoiding negative outlets. One idea is a “Wellness Wednesday” when leadership provides staff with tips to improve both mental and physical health. This can be promoted through weekly emails, meetings, or even flyers.
- Provide needed breaks – Stress is high, and staff need to get away at times. Ensure staff get their needed breaks. Leadership may also want to provide a small, quiet space where staff can go to in the facility to destress other than the employee breakroom. Quiet rooms with comfortable seating, low lighting, and maybe even soothing music could be a great help to staff.
- Provide support to staff – Check in with staff often to see how they are doing and if they need any assistance. If the organization has an employee assistance program available, promote it! The facility may want to organize peer groups for staff to discuss fears and other struggles, as people who have strong connections at work are more resistant to stress (Mind Tools, n.d.). Staff may also need other assistance due to lack of funds for necessities such as food or household items, or even extra PTO due to illness. Seek ways to provide this assistance, such as a food drive that staff can privately apply for to receive goods.
- Avoid negative outlets – Try to promote a positive culture. Negative talk “around the water cooler” can start out small but spread rapidly and cause issues.
- Staff training – Train staff on what resilience is and how they can build it. There are many resources available to assist with this, such as:
a. Johns Hopkins University https://www.johnshopkinssolutions.com/employers/
b. Centers for Disease Control (CDC) https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
c. Substance Abuse and Mental Health Services Administration https://store.samhsa.gov/product/Spotlight-Building-Resilient-and-Trauma-Informed-Communities-Walla-Walla-WA-Mobilizing-the-Community-for-Resilience/SMA17-5020
Although facility staff may be going through tough times now, circumstances will eventually get better. By utilizing these techniques, teams may “bounce back” faster and emerge even stronger in the long run.
American Psychological Association. (2012) Building your resilience. https://www.apa.org/topics/resilience
Cherry, K. (2019, November 27). What is resilience? https://www.verywellmind.com/what-is-resilience-2795059
Miller, K. (2020). Mental and emotional risks of frontline healthcare providers involved in responding to COVID-19 pandemic. Psychosociological Issues in Human Resource Management 8(1), 19-24. https://doi.org/10.22381/PIHRM8120203
Mind Tools. (n.d.). Developing resilience: Overcoming and growing from setbacks. https://www.mindtools.com/pages/article/resilience.htm
Waters, B. (2013, May 21). 10 Traits of emotionally resilient people. Psychology Today. https://www.psychologytoday.com/us/blog/design-your-path/201305/10-traits-emotionally-resilient-people
Wu, A., Connors, C., & Everly, G. (2020). COVID-19: Peer support and crisis communication strategies to promote institutional resilience. Annals of Internal Medicine. https://doi.org/10.7326/M20-1236
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