| Description |
Background: Due to the stressful and emotional nature of the job, nurses experience high levels of burnout and adverse mental health outcomes. Burn-unit nurses are at particularly high risk for these adverse outcomes because of their frequent exposure to patients' trauma, pain, and suffering. In addition to adverse outcomes for individuals, burnout and poor resilience negatively affect healthcare systems. Burnout is associated with increased rates of nursing turnover, which carries a profound financial cost-an average of $4.82 million per hospital in 2023. Hospitals with higher rates of burnout experience longer patient lengths of stay, increased incidence of failure to rescue, and higher patient mortality rates. These associations indicate that poor mental health among nurses carries a cost for individuals, hospitals, and patients. Local Problem: The project site is a 15-bed burn unit, employing around 60 nurses, that provides critical and acute care to patients from initial injury to discharge. Turnover in the first 1-2 years of practice is high, and around 50% of nurses have less than 2 years of experience. High stress among new burn-unit nurses often leads to care-related errors and lower quality care. Despite this, there is no specific education or intervention to improve resilience and confidence in handling work-related stress in onboarding for new burn-unit nurses. Methods: A four-session group resilience intervention was administered to two cohorts of new burn-unit nurses. Participants were surveyed before and after the intervention using the Brief Resilience Scale (BRS) and a burn unit-specific self-efficacy scale (BSSES). Participant interviews and surveys were completed post-intervention to assess usability, feasibility, and satisfaction. Intervention: A resilience skills group including four 60-75-minute-long sessions was administered to two cohorts of new nurses over 6-8 weeks. Each session included psychoeducation, self-reflection, group discussion, strategies for handling burn unit-specific stressors, and cognitive skills teaching. Psychoeducation topics included resilience, mindfulness, trauma-informed care, self-compassion, radical acceptance, and self-care strategies. Unit-specific stressors addressed included wound care, critical situations, communicating with patients, communicating with providers, and creating work life-balance. Cognitive skills taught in each session included gratitude exercises, identifying situations, thoughts, and emotions, Socratic questioning, and identifying and strengthening alternative thoughts. Results: Paired pre- and post-intervention scores on the BRS and BSSES surveys were analyzed using the Wilcoxon sign-rank test. The small sample size (N=9) did not yield statistically significant changes in resilience and self-efficacy post-intervention on any of the survey measures. Post-intervention surveys showed the majority of participants felt the intervention was usable and feasible. Ninety-two percent of participants were satisfied or very satisfied with the intervention and recommended continuing the intervention with future cohorts. Conclusion: A unit-specific resilience skills group aimed at improving resilience and self-efficacy for new burn-unit nurses was feasible, usable, and resulted in high levels of satisfaction. While the intervention did not lead to statistically significant improvements in resilience and self-efficacy, the results of the project indicate that participants gained skills and resources to better handle work-related stress and improve their resilience. |
