Evaluation of a Stress, Coping, and Resourcefulness Program for VA Nurses During the COVID-19 Pandemic

Nurses are recognized among the most trusted professions in the United States.¹ Since the time of Florence Nightingale, nurses have been challenged to provide care to patients and soldiers with complex needs, including acute and chronic physical illness, as well as mental health issues. Nurses have traditionally met those challenges with perseverance and creativity but have also experienced stress and burnout.

A shortage of nurses has been linked to many interrelated factors including the retirement of bedside caregivers and educators, diverse care settings, expanding roles for nurses, and nurse burnout.^2-4 Therefore, there is a critical need to better understand of how nurses can be supported while they care for patients, cope with stress, and maintain positive personal and professional outcomes. The objective of this pilot project was to assess US Department of Veterans Affairs (VA) nurses’ levels of burnout and test an intervention to enhance resourcefulness skills during the COVID-19 pandemic.

Background

Stress has many definitions. Hans Selye described it as a biological response of the body to any demand.^5,6 Occupational stress is a process that occurs in which work environment stressors result in the development of psychological, behavioral, or physiological effects that can contribute to health.⁶ Occupational stress has been observed as prevalent among nurses.⁶ In 1960, Menzies identified sources of stress among nurses that include complex decision-making within a dynamic environment.⁷ Since the mid-1980s, nurses’ stress at work has increased because of legal, accreditation, ethical issues, fiscal pressures, staffing shortages, and the increasing integration of technology associated with clinical care.⁸

Sustained stress can lead to emotional exhaustion or burnout, which has been associated with nursing turnover, lower patient satisfaction, and patient safety risk.^2,9 An American Nurses Foundation survey reported that 51% of US nurses feel exhausted, 43% overwhelmed, and 36% anxious; 28% express willingness to leave the profession.² Burnout has been described as a response to physical or emotional stress leading to exhaustion, self-doubt, cynicism, and ineffectiveness.¹⁰ Employees with burnout are more likely to leave their jobs, take sick leave, and suffer from depression and relationship problems, and it affects nearly half of all US nurses, especially among critical care, pediatric, and oncology specialities.^10,11 It has been well documented that unmitigated stress can lead to burnout and contribute to nurses leaving bedside care and the health care profession.^2,3 Several studies on nursing stress and burnout have focused on its prevalence and negative outcomes.^4,7,9 However, few studies have addressed building resiliency and resourcefulness for nurses.^10,12,13

A 2021 National Academy of Medicine report advocated a multilevel approach to managing burnout and building resiliency among nurses.¹⁴ Taylor further identified specific interventions, ranging from primary prevention to treatment.¹⁵ Primary prevention could include educating nurses on self-awareness, coping strategies, and communication skills. Screening for burnout and providing resources for support would be a secondary level of intervention. For nurses who experienced severe burnout symptoms and left the workplace, strategies are sorely needed to provide healing and a return-to-work plan.¹⁵ This may include adjusting nurse schedules and nursing roles (such as admitting/discharge nurse or resource nurse).