Burnout and Resilience Among Nurses Practicing in High-Intensity Settings.
BACKGROUND
The high level of stress experienced by nurses leads to moral distress, burnout, and a host of detrimental effects.


OBJECTIVE
To support creation of healthy work environments and to design a 2-phase project to enhance nurses' resilience while improving retention and reducing turnover.


METHODS
In phase 1, a cross-sectional survey was used to characterize the experiences of a high-stress nursing cohort. A total of 114 nurses in 6 high-intensity units completed 6 survey tools to assess the nurses' characteristics as the context for burnout and to explore factors involved in burnout, moral distress, and resilience. Statistical analysis was used to determine associations between scale measures and to identify independent variables related to burnout.


RESULTS
Moral distress was a significant predictor of all 3 aspects of burnout, and the association between burnout and resilience was strong. Greater resilience protected nurses from emotional exhaustion and contributed to personal accomplishment. Spiritual well-being reduced emotional exhaustion and depersonalization; physical well-being was associated with personal accomplishment. Meaning in patient care and hope were independent predictors of burnout. Higher levels of resilience were associated with increased hope and reduced stress. Resilience scores were relatively flat over years of experience.


CONCLUSIONS
These findings provide the basis for an experimental intervention in phase 2, which is designed to help participants cultivate strategies and practices for renewal, including mindfulness practices and personal resilience plans.
Cynda Hylton Rushton is the Anne and George Bunting Professor of Clinical Ethics, a professor of nursing and pediatrics, Johns Hopkins University, Berman Institute of Bioethics and School of Nursing, Baltimore, Maryland. Joyce Batcheller is president, CNO Solutions, Austin, Texas, and former senior vice president/systems chief nursing officer, Seton Healthcare Network, Austin, Texas. Kaia Schroeder is a former staff educator in critical care, Seton Healthcare Network. Pamela Donohue is an associate professor in pediatrics and director of clinical research, Division of Neonatology, Johns Hopkins University, School of Medicine, and Charlotte R. Bloomberg Children's Center, Baltimore, Maryland. crushto1@jhu.edu.
Cynda Hylton
CH
Rushton
Cynda Hylton Rushton is the Anne and George Bunting Professor of Clinical Ethics, a professor of nursing and pediatrics, Johns Hopkins University, Berman Institute of Bioethics and School of Nursing, Baltimore, Maryland. Joyce Batcheller is president, CNO Solutions, Austin, Texas, and former senior vice president/systems chief nursing officer, Seton Healthcare Network, Austin, Texas. Kaia Schroeder is a former staff educator in critical care, Seton Healthcare Network. Pamela Donohue is an associate professor in pediatrics and director of clinical research, Division of Neonatology, Johns Hopkins University, School of Medicine, and Charlotte R. Bloomberg Children's Center, Baltimore, Maryland.
Joyce
J
Batcheller
Cynda Hylton Rushton is the Anne and George Bunting Professor of Clinical Ethics, a professor of nursing and pediatrics, Johns Hopkins University, Berman Institute of Bioethics and School of Nursing, Baltimore, Maryland. Joyce Batcheller is president, CNO Solutions, Austin, Texas, and former senior vice president/systems chief nursing officer, Seton Healthcare Network, Austin, Texas. Kaia Schroeder is a former staff educator in critical care, Seton Healthcare Network. Pamela Donohue is an associate professor in pediatrics and director of clinical research, Division of Neonatology, Johns Hopkins University, School of Medicine, and Charlotte R. Bloomberg Children's Center, Baltimore, Maryland.
Kaia
K
Schroeder
Cynda Hylton Rushton is the Anne and George Bunting Professor of Clinical Ethics, a professor of nursing and pediatrics, Johns Hopkins University, Berman Institute of Bioethics and School of Nursing, Baltimore, Maryland. Joyce Batcheller is president, CNO Solutions, Austin, Texas, and former senior vice president/systems chief nursing officer, Seton Healthcare Network, Austin, Texas. Kaia Schroeder is a former staff educator in critical care, Seton Healthcare Network. Pamela Donohue is an associate professor in pediatrics and director of clinical research, Division of Neonatology, Johns Hopkins University, School of Medicine, and Charlotte R. Bloomberg Children's Center, Baltimore, Maryland.
Pamela
P
Donohue
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002055:Burnout, Professional / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009014:Morals; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data*; D055500:Resilience, Psychological; D029181:Spirituality; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult