Oncology nurses know about resilience; we see it every day. We assess our patients’ psychosocial wellness, distress, and quality of life, recognizing the value in supporting resilience throughout the cancer continuum, but oncology nurses need to be resilient as well.
Resilience can be viewed like a tree in a storm that bends but doesn’t break under the stress, bouncing back to grow and thrive. It is “the ability to change disaster into a personal growth experience” (Polk, 1997) through “mechanism(s) of positive adaptation” (Molina, 2014). Positive adaptation draws on internal and external resources such as coping skills, optimism, mindfulness, social support, and spiritual practices (Molina, 2014).
Psychiatrists Southwick and Charney (2012) identified 10 resilience factors that can be fostered and grown in each of us.
- Being able to confront fears
- Maintaining an optimistic but realistic outlook
- Seeking and accepting social support
- Imitating sturdy role models
- Relying on an inner moral compass
- Turning to religious or spiritual practices
- Accepting the unchangeable
- Attending to our own health and well-being
- Actively solving problems and looking for meaning and opportunity for growth
- Accepting responsibility for our own emotional well-being
- Using adversity for personal growth
A Team Approach
ONS member Cindy J. Rishel, PhD, RN, OCN®, is a clinical associate professor of nursing at the University of Arizona in Tucson and director of nursing strategy, leadership development, and outcomes reporting at City of Hope in Duarte, CA. She knows that all too often oncology nurses put their own resiliency on the back burner when they’re busy supporting their patients.
“Sometimes, we fail to realize oncology nurses need to be resilient too, and we need to support each other in building personal resilience,” she advises.
Identify Your Risk for Health Consequences
The Healthy Nurse Health Risk Appraisal is a survey tool that can help nurses focus on strengthening their physical and emotional health. The survey takes about 20 minutes to complete; once done, nurses can compare their results with national standards that are available. A color-coded heat graph shows areas of high, medium, and low risk for health consequences.
Get Relief From Cumulative Grief
Oncology nurses are prone to cumulative grief (CG) due to repeated exposure to workplace stress combined with tending to the physical and emotional needs of oncology patients (Lindberg, 2012).
Symptoms include
- Fatigue
- Irritability
- Anger
- Withdrawal
- Detachment.
If compassion fatigue is affecting you,
- Seek support from colleagues and superiors.
- Attend to your spiritual life.
- Engage in reflection and meditation exercises.
- Participate in resiliency training, such as Three Good Things or the Healthy Nurse Risk Appraisal
Rishel says that she views resilience as the positive side of addressing burnout and compassion fatigue, which continue to be significant issues in oncology nursing, affecting up to 44% of us (Potter, Deshields, Berger, Clarke, Olsen, & Chen, 2013).
“Nursing is a team sport, and if we’re going to be successful, we need to be intentional about creating and supporting efforts to develop skills that promote resilience through mindful leadership,” she says. “If we take care of each other, the quality metrics take care of themselves. Resilient nurses are caring, compassionate, and create healthy work environments that improve patient care.”
To address resilience in oncology nursing, Rishel says that nurses have to first understand our motivation for doing what we do and then mindfully examine what keeps us there and why.
“Self-care and inner resources are important, but leaders must also understand that a healthy work environment plays a big role in giving nurses the tools and time to care for themselves and help them care for each other to care for the patient,” she explains. “We talk a lot about burnout and compassion fatigue, but it may be better to address them by supporting resilience and preventing them.”
A Dose of Self-Care
ONS member Mary Angelique Hill, DNP, is the oncology nurse navigator at North Florida Regional Medical Center in Gainesville. She says she hears of nurses leaving oncology nursing who cite burnout and compassion fatigue as contributing factors.
“We see colleagues become hardened and task-focused as a self-protective mechanism,” Hill says. “In burnout, I think about exhaustion at every level and extinction of passion because of the emotional requirements of the job.”
To help manage compassion fatigue, she explains that it’s essential to “recognize your own ebb and flow of energy, especially in shift work, and take care of yourself physically.”
“It’s important to recognize your own talents and what you personally bring to the bedside and, when compassion fatigue sets in, to recognize that you may need to step away to get perspective, examine your strengths and challenges, and ask for help,” Hill adds. “It’s also important that we recognize compassion fatigue in others and reach out to provide support.”
Incorporating Resilience in Your Practice
Rishel shares two examples of leading with resilience in mind. “On one unit, the staff created a Zen Room, a space set aside specifically for nurses to take time away and sit quietly. Another unit had a number of deaths in a short period of time, and the nurse leader arranged for social workers to lead small group sessions to debrief and provide a chance to discuss feelings and address grief.”
Finding mentors is another way to bring resilience factors into nursing practice, and Rishel says that these don’t have to be formal relationships. “You may not see an example of work-life balance in your nurse supervisor, but rather find a fellow staff nurse who is a good role model in that area.”
Think of Three Good Things to Strengthen Your Well-Being
J. Bryan Sexton, PhD, director of the patient safety center at Duke University, is a foremost expert on keeping the workplace safe and healthy. In his presentation, Bite Size Resiliency, he talks about a simple strategy that involves recalling three good things that happened during the day. Our brains are hardwired to remember the negative, so consciously remembering as few as three positive things on daily basis strengthens a person’s resiliency. Sexton and colleagues have data demonstrating that this simple exercise worked better than the antidepressant Prozac in 80% of the 350 study participants.
The data were so convincing that Duke University now sponsors an ongoing study for healthcare professionals. Participants can sign up for the study here and agree to submit three good things every evening for two weeks. An email reminder is sent out with a link to the data platform.
And while having the support of coworkers is helpful, Hill adds that “part of resilience is self-reflection. Recognize each day that oncology is ‘life work’ rather than a job and that this is an opportunity to see the beauty in life along with the emotionally messy and ugly parts. It’s a sacred covenant to walk the journey with people who may have life-limiting illnesses. We get to see the good qualities of patients that help us learn and grow."
Hill says that using a theoretical framework helps her learn from her work. “I like integrative nursing models that view the patient holistically rather than only medically. We come to each patient interaction asking what patients care about, allowing them to tell us what they need, and bringing our ability to care for and about what they care about in that moment.”
She continues, “The challenge for nursing today is to remain high-touch while embracing high-tech, and that can be accomplished by stopping and focusing on the patient rather than a computer screen and recognizing that kindness takes no more time or energy. We can only control so many things in our practices: our attitudes, getting enough rest, self-care, nutrition, and taking our breaks.”
Breaks are an area of passion for Hill. “We need to support each other in getting off the unit,” she says. “You need to be able to take your breaks and take vacations, maintain a sense of humor, and enjoy the people you work with. Aim to inspire patients and coworkers and voice appreciation and gratitude for others.”