Evaluation of a Stress, Coping, and Resourcefulness Program for VA Nurses During the COVID-19 Pandemic
Background: The COVID-19 pandemic, combined with the shortage of nursing staff, contributed to higher levels of stress. Sustained stress has been associated with burnout. However, nurses have traditionally demonstrated resourcefulness skills that resulted in building resilience.
Observations: This pilot project recruited US Department of Veterans (VA) registered and advanced practice nurses to participate in a resourcefulness skills training initiative. VA nurses were found to have a moderate level of burnout at baseline. Nurses participated in Resourcefulness Training to handle stress and possible burnout. Resourcefulness Training themes included accessing family and peer support, developing organizational and problem-solving skills, and using distraction.
Conclusions: Nurses must be vigilant in appraising and managing their ability to cope and adapt to individual stress, while also being aware of their colleagues' stress levels. Educational institutions, professional organizations, and health care facilities must strive to educate and support nurses in identifying stress and healthy coping mechanisms. In this project, relying on family and peers emerged as an important resourcefulness skill.
RESILIENCY AND RESOURCEFULNESS
Rushton and colleagues describe resiliency as the “ability to face adverse situations, remain focused, and continue to be optimistic for the future.”4 For nurses in complex health care systems, resiliency is associated with reduced turnover and symptoms of burnout and improved mental health. Humans are thought to have an innate resiliency potential that evolves over time and fluctuates depending on the context (eg, societal conditions, moral/ethical values, commitments).4 It is believed that resiliency can contribute to the development of new neuropathways that can be used to manage and cope with stress, prevent burnout, and improve quality of life. However, it appears these adaptations are individualized and contingent on situations, available resources, and changing priorities.16 Consequently, resiliency may be an essential tool for nurses to combat burnout in today’s complex health care systems.17
Although resilience and resourcefulness are conceptually related, each has distinctive features.18 Celinski frames resilience as transcendence and resourcefulness as transformation.19 Thus, while resilience suggests transcendence in terms of rising above, going beyond, exceeding, or excelling; resourcefulness reflects transformation, such as making changes in thoughts, feelings, behaviors, actions, or reactions. Resourcefulness has been conceptualized as an indicator of resilience.18
Resourcefulness comprises 2 dimensions, including the use of self-help strategies (personal resourcefulness) and seeking help from others (social resourcefulness), to self-regulate one’s thoughts, feelings, and behaviors to cope with high levels of stress, anxiety, or depression.18,20,21 Personal resourcefulness skills include the use of cognitive reframing, positive thinking, problem-solving, priority-setting, and planning ahead. Social resourcefulness involves actively seeking help from others. Formal sources of help include, but are not limited to, nursing and medical care practitioners and community organizations such as hospitals and clinics. Informal sources of help include family members, friends, peers, and coworkers.
During the COVID-19 pandemic, nurses were especially challenged to provide support for each other because of limited nursing staff and treatment options, increased complex patient assignments, shortages of supplies, and reduced support services. Many nurses, however, were able to find innovative, peer-supported strategies for coping.13 Nurses’ use of resourcefulness skills is believed to be indicative of their resilience. This pilot project aimed to identify and evaluate some of these strategies and resourcefulness skills.
INTERVENTION
This pilot study among VA Northeast Ohio Health Care System (VANEOHS) nurses was designed to assess nursing burnout and resourcefulness during the pandemic. Those who agreed to participate completed a baseline survey on burnout and resourcefulness. Participants agreed to review a training video on resourcefulness skills (eg, relying on and exchanging ideas with others, and reframing and using ‘positive self-talk’). They were encouraged to document their experience with familiar and new resourcefulness skills. Weekly reminders (eg, emails and phone messages) reminded and coached participants in their journey.
The study identified and implemented an existing Resourcefulness Training (RT) intervention, which was developed for informal family caregivers and found to be effective.22 We measured burnout and resourcefulness preintervention and postintervention.23 This survey and educational intervention were reviewed by the VANEOHS institutional review board and ruled exempt. The survey also gathered information on nurses' contact with individuals infected with COVID-19.
Despite the many staffing and resource challenges during the COVID-19 pandemic, a convenience sample of 12 nurses was recruited from nursing committees that continued to have scheduled meetings. These meetings allowed time to answer questions and provide information about the study. The majority of nurses queried declined to participate, citing no time, interest, or burnout. Participants completed a baseline survey, reviewed a 30-minute RT video, and tracked their experience for 28 days. Participants completed postintervention surveys 6 weeks after the video. Details of the survey and measures can be found in previous studies.20,21
