1. Cunningham, Tim DrPH, RN, FAAN


Health care organizations should manage burnout from the top down.


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The 2019 consensus report by the National Academy of Medicine, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, highlights the shattering effects of burnout while emphasizing how resilience can mitigate this condition that is costing the careers-and even the lives-of some of our best nurses. The report tells us that resilience "generally reflects the ability of a person, community, or system to withstand, adapt, recover, rebound, or even grow from adversity, stress, or trauma." We know there is a clear connection between self-care and personal resilience. Though research on self-care in nursing is nascent, we have known for years about the benefits of practices like exercise, yoga, meditation, and engagement with the arts. The choice to practice self-care can be as dynamic and diverse as our nation's nursing workforce, and health systems and nursing schools are increasingly encouraging nurses to practice resilience-personal resilience, that is.

Figure. Tim Cunningh... - Click to enlarge in new windowFigure. Tim Cunningham

It is clear that personal resilience is only one small piece of the puzzle. If we, as leaders, push nurses to practice resilience but do nothing to address systemic problems such as staffing, the electronic health record, and incivility in the workplace, then we are missing the boat. In fact, if we tell our colleagues to take more time for self-care, but we do not enact meaningful systemic changes, then we are doing nothing more than putting the burden of resilience on the shoulders of our overworked, overtaxed, clinical frontline nurses.


I know many nurses who feel personally blamed for not being resilient enough, not being good enough, if they struggle with managing their work-related stress. I've been asked by many nurses working for various health systems, "What is the health system doing to support our resilience? We can only bounce back for so long if systems do not change."


Before we, as a profession, get burned out on personal resilience, we should make some changes now.


* Health systems leaders should take on the responsibility of resilience for their teams. We should take responsibility when we lose a nurse to burnout or worse, suicide. As leaders, we should own this blame and not our clinical nurses.


* We should implement systemwide resilience opportunities that empower unit leaders and nurse managers with time, funding, and ideas about how to better support staff.


* We should build in time during regular shifts so that staff can practice resilience activities, as well as time for "resilience retreats" (read: paid time) for staff to practice self-care together. The last thing we should do is require nurses to take on resilience practices when they're on their time off. All you have to do is look at the decompression scores on nationwide Press Ganey surveys to know that nurses already have a hard-enough time leaving work at work.



One way to invigorate resilience for health systems is from the top down by establishing a chief resilience officer (CRO) or chief wellness officer (CWO) role. The CRO/CWO should be a nurse (since we are the largest profession in the health care workforce). This officer should have a budget-this seems obvious, but there are far too many crucial positions in health care with fancy titles but no resources. The CRO/CWO should sit in the C-suite and report to the highest level of leadership. This role would prioritize advocating for bedside clinicians, changing staffing structures, addressing systems concerns that cause unnecessary stress on staff, and support evidence-based resiliency programs. The rollout of programs such as "Code Lavender," "The Pause," resilience practice retreats, and narrative medicine rounds should all be considered at the systems level and made available.


It's time for us as leaders to step up to authentically support the resiliency of our people and our systems.