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Why analyze resilience
Resilience programs are now common in hospitals, but the word is used loosely, sometimes as a personal trait, sometimes as an outcome, and sometimes as a reason to ask nurses to tolerate unsafe conditions. A DNP project on nurse well-being needs a clear definition before it can measure anything. This analysis follows Walker and Avant's (2019) method.
Uses of the concept
In everyday language, resilience means bouncing back. In ecology and engineering, it describes a system's ability to absorb disturbance and keep functioning. In psychology and health, it has been studied in children facing adversity, in older adults and in workers in high-stress jobs. Windle's (2011) review and concept analysis drew on the research literature and expert input across disciplines and described resilience as the process of effectively negotiating, adapting to or managing significant sources of stress or trauma, supported by assets and resources within the individual, their life and their environment.
Defining attributes
Drawing on Windle (2011), resilience in nurses has three defining attributes:
- Significant adversity: exposure to stress or trauma beyond everyday hassles, such as a patient death, violence at work or sustained short staffing.
- Assets and resources: individual (coping skills, self-efficacy), relational (supportive colleagues and leaders) and environmental (adequate staffing, access to support).
- Positive adaptation: continuing to function well, or returning to functioning, despite the adversity.
The second attribute matters most for nursing: resilience depends on resources around the nurse, not only on personal qualities.
Cases
Model case. After a violent assault by a patient's relative on her unit, an experienced nurse is offered time off, a debriefing with her team and counseling through the employee assistance program. Her manager changes security procedures. She returns to work after a week, talks about the event with colleagues and continues to practice confidently. All three attributes are present.
Borderline case. A new graduate copes with a high-acuity assignment by working through her breaks and staying late every shift. She is functioning, but without support, and is close to burnout. Adaptation is fragile and resources are missing.
Contrary case. A nurse experiences repeated unsafe staffing without support, becomes exhausted and cynical, and leaves the profession. There is adversity, but no positive adaptation.
Antecedents and consequences
- Antecedents: exposure to significant adversity; the presence of resources at individual, team and organizational levels.
- Consequences: continued safe practice, retention, professional growth and well-being. When resources are missing, the likely consequences are burnout and turnover instead.
Empirical referents
Several validated self-report resilience scales exist. Because they mainly measure individual characteristics, a DNP project should pair them with measures of the work environment, such as staffing and leadership support, to capture the resources attribute.
Implications for doctoral practice
Defining resilience as a process that depends on resources changes what an organization should do. Resilience training for individual nurses may help, but it can't substitute for safe staffing, leadership support and debriefing after traumatic events. DNP-prepared leaders should be cautious about programs that place the whole responsibility for coping on individual nurses.
References
Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Pearson.
Windle, G. (2011). What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21(2), 152–169. https://doi.org/10.1017/S0959259810000420
