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

RT is an online cognitive-behavioral intervention that teaches and reinforces personal (self-help) and social (help-seeking) resourcefulness skills that have not yet been tested in nurses or other health care professionals.^22,24 The training included social resourcefulness (eg, from family, friends, others, and professionals) and personal resourcefulness (eg, problem-solving, positive thinking, self-control, organization skills). Participants were encouraged to review the videos as often as they preferred during these 4 weeks.

All 12 survey respondents were female and had received COVID-19 vaccinations according to the federal policy at the time of data collection. The number of patients cared for with COVID-19 infections varied widely (range, 1-1000). The baseline burnout score ranged from 1 (no burnout) to 3 (1 symptom of burnout, such as physical and emotional exhaustion), with a mean score of 2.2. In the follow-up survey, the mean score was 2.0. At baseline, participants reported a variety of activities to manage stress and burnout, including times with friends and family, engaging in hobbies, and prayer. Postintervention, some participants mentioned using skills learned from RT, including reframing the situation positively by refocusing and putting stressors in perspective (Table 1).

DISCUSSION

Recent American Nurses Association efforts to develop organizational and professional goals include the importance of nurses to recognize and manage stress to prevent burnout.²⁵ The American Nurses Association Code of Ethics notes that nurses have the same duties to care for themselves as they do for others.²⁵ Nurses have demonstrated the ability to adapt and remain resilient during stressful times. VA nurses are a resourceful group. Many used resourcefulness skills to manage stress and burnout even before the pandemic. For example, nurses identified using family/friends for support and validation, as well as prayer and meditation. Some of the new activities may have been influenced/inspired by RT, such as organizing schedules for problem-solving and distraction.

Relying on family and peers emerged as an essential resourcefulness skill. Support from peers—battle buddies—has been recognized as a key strategy among combat soldiers. A battle buddy is paired with a fellow soldier for support to keep each other informed about key instructions and information. This promotes cooperative problem-solving. Outcomes associated with battle buddies include increased morale and confidence, and decreased stress.²⁵ Over time, it is hoped that these coaching/mentoring relationships will result in enhanced leadership skills. Battle buddy strategies are currently being adapted into health care environments.^12,26 Such programs need to be further evaluated and information disseminated.

Findings from this pilot program support the use of interventions such as RT to decrease burnout among nurses. This study suggests that RT should be tested in a larger more representative sample to determine efficacy.

Limitations

This pilot study was limited by its small sample size, single facility, and female-only participants; the findings are not generalizable. Nurses were recruited from VA nursing committees and may not be representative of nurses in the general population. In addition, the RT intervention may require a longer time commitment to adequately determine efficacy. Another limitation was that personal or family exposure to COVID-19 was not measured, but may be a confounding variable. An additional limitation may have been the time interval. A baseline survey was completed prior to watching the teaching video. Daily logs were to be completed for 28 days. A post survey followed at 6 weeks. It is possible that there was insufficient time for the nurses to have the opportunity to use their resourcefulness skills within the short time frame of the study. While it supports the need for further studies, findings should be interpreted cautiously and not generalized. It may be premature based on these findings to conclude that the intervention will be effective for other populations. Further studies are needed to assess nurses’ preferences for healthy coping mechanisms, including RT.

Conclusions

As the nursing shortage continues, efforts to support diverse, innovative coping strategies remain a priority postpandemic. Nurses must be vigilant in appraising and managing their ability to cope and adapt to individual stress, while also being aware of the stress their colleagues are experiencing. Educational institutions, professional organizations, and health care facilities must strive to educate and support nurses to identify not only stress, but healthy coping mechanisms.

Acknowledgments

This work was supported by the US Department of Veterans Affairs Central Office rapid response COVID-19 funding initiative, the Veteran Affairs Northeast Ohio Health Care System, and Geriatric Research, Education, and Clinical Center (GRECC). The Resourcefulness Scale, Resourcefulness Skills Scale, and the Resourcefulness Training intervention are copyrighted and were used with permission of the copyright holder, Jaclene A. Zauszniewski, MD.