By Martha Jurchak, PhD, RN, Barbara Lakatos, DNP, PMHCNS-BC, APN, Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, Aimee Milliken, PhD, RN, HEC-C, Monique Mitchell, MS, PMHCNS-BC, APN, and Christine Murphy, MSN, RN, PMHCNS-BC, CARN-AP

The Department of Nursing is focused on supporting nurses’ physical and emotional well-being and fostering resilience after challenges of the COVID-19 surge this spring. Over the last three months, many nurses were able to participate in resilience support groups facilitated by the BWH Psychiatric Nurse Resource Service, Ethics Service and C.A.R.E Clinic.

Our experts shared the following information and resources to help nurses recognize warning signs of toxic stress and build resilience following a period of rapid change and challenges. This is especially important as we face uncertainty about the future course of the pandemic and strive to adapt to a new normal.

Understanding Resilience

Resilience is the ability to cope and move through challenges without lasting negative effects. In other words, it is the ability to bend, not break. Resilience develops from the lessons and skills learned throughout life and the availability of resources. Survival, healing and thriving are concepts associated with resilience. Some characteristics associated with resilience and thriving include:

  • positive self-esteem
  • sense of coherence
  • social resources
  • low fear of failure
  • tolerance for uncertainty
  • hardiness
  • self-efficacy
  • adaptability
  • determination
  • strong coping skills
  • optimism
  • confidence
  • perseverance

Resilience is best achieved when physical, mental, behavioral and emotional well-being are optimized, as shown in the Resilience Model.

An important aspect of building resilience is the ability to reflect and recognize stress within oneself. Stress responses may vary, however, when stress is experienced as frequent and prolonged. This is referred to as toxic stress.

Types of stress response chart

Monitor Your Stress Level

The Stress Continuum Model is a visual way to self-reflect on your level of stress. It is normal to vacillate along a continuum, and it is important to be aware when you might be entering the orange or red zone in the table below. The goal is to prevent entering these zones to mitigate physical and behavioral health consequences.

One form of stress often not as easily identified is moral distress. This is the discomfort or unease felt when you are doing something contrary to what you believe is the right or good thing to do. Moral distress can add to other forms of stress, compounding their impact, and over time may even lead to moral injury.

Moral injury, an injury to one’s core values, can occur due to repeated or particularly severe experiences of moral distress. This can include witnessing or learning about these circumstances. Developing the skills of resilience and accessing available resources are ways to mitigate the experience of moral distress and help prevent or process moral injury. The following table from our Employee Assistance Program may help you reflect on your current state of emotions.

Stress Continuum Model

Stress Continuum Chart

Seek Support

In addition to the support groups held for nurses over the past few months, a variety of resources are available to help staff bolster resilience, support self-care and prevent burnout:

Additional information on accessing these resources is available here. Please note that this link is available only to employees of the Mass General Brigham system.