By Jennifer Thew, RN
Burnout is a common experience for bedside nurses. But burnout also affects nurse managers as well.
In a 2014 study published in Nursing Economics, researchers surveyed 291 nurse managers working in hospitals, and found 72% of the study participants were planning to leave their position in the next five years. Burnout was the most common reason cited for intent to leave by the entire group.
This is concerning. At 300,000 strong, nurse managers are the largest segment of the healthcare management workforce. They have immense potential to influence clinical outcomes and strategic goals, says Heinrich M. Huerto, MSN, RN, ONC, CMSRN, nurse manager at Providence Holy Cross Medical Center in Mission Hills, California.
"We are juggling so many things. [We are responsible for] operations, quality metrics, staff engagement, and patient satisfaction," says Huerto. "[We're] the ones who guide the staff. If you have a lot of turnover of nurse managers, that doesn't benefit the company or its ministry because they have such an essential role in the organization."
In light of this enormous and important job scope, Huerto, along with a group of nurse managers and researchers at the medical center, wanted to find a way to better equip nurse managers to deal with the challenges that come their way, which can, essentially, keep managers from burnout.
"In healthcare, it's never-ending changes and adapting to the new changes," she says. "And we were thinking, 'How do we support ourselves and how do we support the other nurse managers?'"
The group chose to focus on what is often cited as the antidote to burnout—resilience (the ability to recover from or adapt to stress)—and how to cultivate it among nurse managers. To help nurse managers identify specific areas in their personal and professional lives where they could cultivate resilience skills, the researchers explored the use of a tool to measure nurse manager resilience. They also promoted professional development activities to develop resilience skills.
The R@W Scale Tool
While not specific to nurse managers, the researchers identified the Resilience at Work (R@W) scale and its subscales as an accurate way to assess resilience behaviors among that group.
"The tool, although it has never been used previously with nurse managers and was really a corporate-type of tool, actually had high reliability for this population," says Sherri Mendelson, PhD, RNC, CNS, IBCLC, director of nursing research and Magnet program at Providence Holy Cross Medical Center, and who was involved in the study.
Designed in 2011 by organizational psychologist practitioner Kathryn McEwen and psychological well-being researcher Peter Winwood, the R@W scale is a measure of individual workplace resilience that measures seven components that interrelate and contribute to overall resilience outlined in the R@W Sustain 7 model.
Those taking the R@W Scale survey complete a personal assessment and rank the components on a scale of zero to six, with zero being the weakest and six being the strongest in each area.
These components, as outlined on Working with Resilience are:
1. Living Authentically
Knowing and holding onto personal values, deploying strengths, and having a good level of emotional awareness and regulation.
2. Finding Your Calling
Having work that offers purpose and a sense of belonging. Aligning work with personal core values and beliefs.
3. Maintaining Perspective
Staying optimistic and keeping a solution-focus when things go wrong. Reframing setbacks and minimizing the impact of any negativity around you.
4. Mastering Stress
Having work and life routines that help you manage your everyday stressors. Working to create work-life balance and ensuring time for relaxation and recovery.
5. Interacting Cooperatively
Seeking feedback, advice and support, and providing support readily to others.
6. Staying Healthy
Maintaining a good level of physical fitness, having a healthy diet, and getting adequate sleep.
7. Building Networks
Developing and maintaining the personal and professional support networks needed at home and at work to perform well in your job.
"It's asking about how you deal with resiliency, not only on the professional level, but also on a personal level," Huerto explains of the tool.
Strong Values, Strong Leadership
Huerto and her colleagues rolled out the R@W Scale survey to the Providence Holy Cross nurse managers. Forty-eight nurse managers responded to the survey. Huerto discovered that the nurse managers' three highest-ranked components about what they believed about themselves were Living Authentically (5.3), Interacting Cooperatively, (5.1), and Finding One's Calling (5.0).
"When I looked at those three: Living Authentically, which is living your personal values, that really is what nursing is all about," Mendelson says. "And, in order to be a leader and lead the nurses within your department, you have to be able to live by your own personal values."
Nurse managers in the Providence Holy Cross study ranked the subscale Maintaining Perspective (3.1) the lowest of all the subscales.
"If we look at the lowest [score], it suggested negative influences at work influenced nurse manager perspective. When problems arise at work, nurse managers tend to worry—and [they] worry about things while away from work. Maintaining perspective is hard when you are constantly on," Mendleson says.
Resiliency in Real Life
Naturally Huerto, like many other healthcare leaders, hoped to uncover the one secret ingredient to promote resiliency among all nurses through the study.
"I was hoping that it would have a standout result … [and be] the answer to the question: 'What do we need to be resilient?' and the "majority" of people would choose one. But it didn't go that way," she says.
Instead, the results reinforced that what is needed to develop resiliency varies from person to person.
"It's subjective and depends on what you were exposed to when you were young," she says. "Depending on hardships you've been through, you would answer it differently," Huerto says.
Yet that is the beauty of the R@W tool, Huerto explains. Through the self-reflection the R@W scale requires, nurses can identify areas where they need to build resiliency skills.
"[Nurse managers] can say, '[I] scored low in this [particular] subscale, so maybe I need to be more physically fit or I should do more deep breathing exercises or jogging or something to relieve that stress, which will help me be more resilient at work," she says.
Both Huerto and Mendelson say the R@W tool has value in helping organizations and nurse managers identify and cultivate the resilience skills needed to succeed as nurse leaders.
"One of the things within the workplace that will help with resilience for nurse managers, since most nurse managers come into their roles with a high sense of ethics, is if their organizations support their ethical values. Then they're going to be more resilient within their jobs," Mendelson says.
"[The R@W is] a good way to assess resiliency and open that topic to nurse managers—the challenges of the nurse managers, resiliency of nurse managers—as we are so focused with staff nurse resiliency," Huerto says.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.