Resuscitating our Nursing Team by Increasing Resilience in Labor and Delivery Nurses

Friday, 28 July 2017

Susan Faron, MN
Labor and Delivery, and Triage units, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA
Julie Albers, BSN
Labor & Delivery and Triage, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA

Nurses confront many types of stressors on the job, including the demands from various healthcare environments, providers, patients, families, as well as the physiological demands to which they are frequently exposed. Research indicates that good personal resilience facilitates nurses’ ability to endure the numerous difficulties they face in their daily work and contribute to providing effective, safe patient care (Wei et al., 2014, Hart, Brannan, & DeChesnay, 2014). Rushton, Batcheller, Schroeder and Donohue (2015) indicated that a greater resilience protected nurses from emotional exhaustion and contributed to optimal patient care outcomes. When nurses cultivated strategies and practices for resilience, patients were less likely to experience harm. Gaining a better understanding of nurses’ resilience and its causes and effects can be very beneficial for nurses in helping them develop greater personal resilience that can contribute to overall quality patient care (Aiken et al., 2012).

There have been some theories that examine the concept of resilience as having several domains that can be empirically studied (Wei, 2014). It has been suggested that resilience should be studied as a multi-dimensional construct focusing on improving stress relief, mindfulness, and work/life balance. Based on the construct from the literature, interventions addressing the three domains of resilience were implemented for bedside nurses working on a busy, high acuity labor and delivery inpatient hospital unit.


Resilience has been defined as the ability of individuals to cope successfully despite adverse circumstances and stressful environments (Wei & Taormina, 2014). Nurses’ ability to manage day-to-day operations may be influenced by stress which ultimately can affect patient outcomes (Aiken,Clark & Sloane, 2012). There are many strategies that have been shown to be successful at decreasing stress, increasing mindfulness, and increasing work/life balance. Providing nurses with the tools and coping strategies they need to improve their coping skills and increase resilience can impact nurses’ professional performance and improve quality and safe patient outcomes.


The evidence based conceptual framework guiding this project includes an assessment of nurse by conducting a pre-intervention assessment of nurse resilience using the Refined Connor-Davidson Resilience Scale (CD-RISC). Interventions addressing the construct of resilience will be presented to the staff nurses working on a busy, high acuity labor and delivery inpatient hospital unit. Post-intervention assessment of nurse resilience one month following completion of all interventions will be conducted using the same scale. The data from the CD-RISC was analyzed and practice changes that improve stress, mindfulness, and work/life balance will be advanced and adopted in a way that can simply be done on the unit in the future.

Interventions were focused into three dimensions: stress relief, mindfulness and work/life balance. Stress relief was addressed by providing healthy snacks for the staff for both day and night shifts for an entire week. Short hand massages were provided during work hours and nursing staff were encouraged to attend complimentary yoga classes away from the hospital. Mindfulness was addressed with weekly email “Mindful Monday” inspirational messages, providing relaxation tea and starting each shift with a short guided meditation. Essential oil relaxation sprays were available for voluntary use. Work/life balance interventions such as nature hikes and a beachside bonfire were not well attended, but the staff anecdotally reported appreciating the availability of these interventions.

Voluntary pre- and post- intervention assessments were performed using the 10-item CD-RISC. Validity and reliability measures have been established for the Refined CD-RISC in the literature (Campbell-Sills et al. 2007). A prior power analysis was completed and it was determined that a sample size of 100 registered nurses was estimated for a two-tailed test alpha=0.05 to achieve a power of at least 80% at a medium effect size (Polit & Beck, 2012). A paired t-test was used to evaluate the mean difference for each question included in the pre- and post- data from 106 respondents. Post-intervention data was collected at 1 month post intervention completion to ascertain impact. Long-term impact will be assessed at the 12 month interval.


Among the 10 questions included in the Revised Connor-Davidson Resilience Scale, the post- intervention analysis indicated statistical significance was achieved on question 10: “I can handle unpleasant feelings.”

p Value

Able to adapt to change


Can deal with whatever comes


Tries to see humorous side of problems


Coping with stress can strengthen me


Tend to bounce back after illness or hardship


Can achieve goals despite obstacles


Can stay focused under pressure


Not easily discouraged by a failure


Thinks of self as a strong person


Can handle unpleasant feelings



Stress relief, mindfulness and work/life balance strategies can be used to assist inpatient nursing staff to increase their personal resilience and contribute to providing effective, safe patient care.