The second a nursing student receives their license, they are awarded the heavy responsibility of a nurse. It is a challenging accomplishment, but one that does not prepare them for the full weight of that responsibility.  They have a basic knowledge of a complicated world with life and death circumstances. This is why orientation is critical. 

If we don’t do our part to set nurses up for success,
we all but guarantee their failure.

Much like graduating nursing school, completing orientation is not the end of learning, but a new beginning. It takes them from basic knowledge to a novice level of experience. They still need mentoring, advice, and training to continue growing in competence as a nurse. An effective transition between student and new grad nurse is crucial to patient safety and the nurse’s long term success. 

Over the last few years there has been a noticeable trend in new nurses’ ability to cope with the emotional stress of the job. Burnout is skyrocketing and nurses are leaving the profession at younger ages. It has reached the point that the nursing program that I am an Alumni of has created a Resilience Department to add curriculum on resilience techniques. It takes a great deal of time and money to add a new department to a program and restructure the curriculum, but the growing need for a stronger emotional foundation amongst graduates over the years is undeniable (and this was before the pandemic). 

Every student comes from different backgrounds with different coping mechanisms, emotional thresholds, and expectations. Nursing school builds an educational foundation of basic biology, chemistry, medications, and nursing interventions. Every nurse knows that nursing school is just that, the basics. On the job experience takes that foundation and begins adding a wood frame. As the years pass, that frame gets filled with wiring, piping, insulation, and drywall. Once you hit the expert level of experience in your specialty, you have a move-in ready house. Even a completed house needs maintenance to keep it in working order. That is where more education, certifications, or new interventions are added to the nurse’s knowledge in order to stay current with the ever-evolving medical profession.

Nurses need a solid emotional foundation
to successfully build resilience on.

Just as nurses need strong educational foundations, they need a strong emotional foundation to handle the inevitable stress that comes with caring for the sick and dying. Some students may have more characteristics of resilience than others when they enter the program, but most students do not come with a fully prepped foundation. It may have some cracks or pristine but too small to support the weight of a nursing career or be missing entirely. If time and effort is not taken to repair, enlarge, and strengthen the emotional foundation at the infant stages of the career, everything the nurse builds (their confidence in skills, assertiveness in advocating for patients, joy in the career, longevity of career…) will not be structurally sound. 

Ignoring the importance of creating a firm foundation in resilience has led to an emotional crisis amongst nurses. It has perpetuated poor coping techniques from trainer to trainee for generations of nurses and reinforced by a healthcare system which does not prioritize staff mental health. The current culture of nursing is proving to do more harm than good. 

The unhealthy culture of the nursing profession looks at the cracks and missing areas of a new nurse’s foundation and says, “start building”,  “it’s the job,” and “you’ll be fine.” Since that is the norm, nurses do not know how to ask for or do anything differently. Even if they want to take the steps to remain emotionally healthy as a nurse, they do not have the support and resources to be able to put the necessary time and effort into fixing a poor foundation. 

It is crucial to develop a strong emotional foundation in nurses early to produce healthy nurses with long-lasting, satisfying careers.

What nurses do not realize is that redoing their emotional foundation at the beginning of their career is going to be less costly than fixing it later. Patient deaths, close calls, violent patients, and moral and ethical dilemmas pile up and cause their emotional house crack, shift, sink, or crumble. At that point, they have to painfully tear the whole house down and start from scratch— but only if they have the time, resources, and desire to start over.

Nurses will have only two options:

1. Accept the new challenge to repair the foundation and build again from the ground up.
2. Continue to ignore the damage and house your emotions in a condemned building. This will make you more vulnerable to the stressful elements of the job.

It is surprising how many nurses choose to ignore the damage. Nurses become more and more desperate to bury their emotional scars instead of processing them.  This leads to increasingly toxic coping skills. They lose themselves in drugs, alcohol, and unhealthy relationships. More nurses are abandoning the profession entirely only to take their poor emotional foundation with them when they try a new job. 

We need to put more emphasis on the emotional foundation of nurses— in school and on the job. Professors and Clinical Nurse Educators need to assess the foundations of their nurses. They need to teach and encourage healthy coping techniques. Resilience is a core value of the nursing industry, but few nurses have a strong foundation. 

To Create Resilient Nurses:

1. Awareness— Problems will get worse if you ignore them. Poor emotional coping skills passed down over generations of nurses have proven to amplify the negative impact on nurses instead of self-correcting. There is a significant problem with the emotional foundation of nurses and we need to address it if we want to reverse and prevent avoidable emotional damage.
2. Resources— Schools and hospitals run on budgets. In order to build resilience amongst nurses, schools and hospitals need to allocate time and money to the cause. Sometimes it takes facilities to be hurt financially before they make a change, but facilities are ignoring the fact that poor emotional foundations lead to burnout and dissatisfaction which are the leading causes of staff turnover. Continually replacing unhappy staff costs exponentially more than retaining happy staff.
3. Training— Nurses need Resilience Training by a qualified facilitator. It needs to be during nursing programs and throughout their professional careers. Resilience takes practice and patience. Just like everything in life, you start out as a novice and slowly work your way toward being expert. Many times nurses become complacent with protocols and strategies. They cut corners because of time constraints or pure exhaustion. Negative coping strategies re-emerge because it is easier and what nurses are used to. By incorporating resilience training as a core component to continuing education of nurses, we continually encourage positive coping techniques and correct the negative strategies that have crept back into play.
4. To shift nursing culture— If we acknowledge the current unhealthy nursing culture and provide the training needed to process the unavoidable stress of the job; we will be able to build resilient nurses and transform the nursing culture into one that cares for both patients AND nurses with excellence.