What is the role of resilience in being a nurse?
I believe I am a resilient person. I also believe that my resilience has been as a result of challenges that I have overcome over the years. Recently resiliency came up in conversation in the context of nursing practice.
The U.S. Department of State describes resilience as, “the ability to successfully adapt to stressors, maintain psychological well-being in the face of adversity. It is the ability to “bounce back” from difficult experiences.”
To be resilient means that you have had to adapt and adjust to adversity.
While I agree with this as a beneficial and often necessary competency in the context of innovation, intrapreneurship, and entrepreneurship, I am hesitant to see this as an entry level competency for a new nurse entering into clinical practice.
Let me explain through two commonly experienced unnecessary inefficiencies in nursing practice.
The first is the linen cart.
In direct care, one of the first responsibilities that you have is to assess each patient. This is often done at the start of each shift.
As part of that assessment, I, and many others, would take the opportunity to change the bed linens. This would take me to the linen cart that is on the unit.
Each unit has at least one linen cart. There, I would locate a top sheet, bottom sheet, pillow case, gown and some towels and washcloths for the patient to have in the room.
However, on many occasions, I would run into an issue where one or more of these items would be out of stock. So, I would need to come up with a solution, a workaround, if you will.
I could not enter the room without a pillow case or a gown when I have all of the other items. That would make no sense and look very strange to the patient. (How could the hospital not have enough?, one might think).
Instead, I would run to the adjacent unit and grab the missing linen items from the cart. I must have done this at least once a shift. Not once did I think about the fact that it would leave their cart short. Not once did I think that there was another solution to this challenge. Not once did I think of sharing this with my nurse manager as a challenge that could benefit from a larger solution.
Instead, I was focused on how much I had to do and how this challenge of missing linen was slowing me down from the more intensive care needs that needed to happen for that patient and all others. I also would get more and more frustrated as this seemingly small challenge would build over time with the other small challenges.
The Second involves Syringe Pumps
Another small challenge is the ability to easily access a syringe pump for medication administration.
The patients I cared for often required frequent IV medications for their treatment plans. Some of these meds required a syringe pump technology to infuse the IV medications.
The syringe pumps are hard to find in a care unit. Some are in use, while others are often scattered around the unit. The challenge is in finding one when you need it because there is rarely (if ever) a surplus. Instead, these items often feel scarce.
As a result, I, and others, would anticipate the need for these pumps and try to locate them in advance of needing them for our medication administration time. If lucky enough to find one, we would put them in a drawer in an empty room, if one was available, and pull the curtain a bit with hopes that no one would come looking for that pump before you need it.
What a workaround, huh?
I never thought anything of this practice other than I needed the syringe pump. I never thought to ask that we could use a better way to find and store syringe pumps. I thought this was what it was and I was having a hard time accepting the culmination of these small challenges that built up over time.
Did I develop resilience from these experiences? I am not sure. I do remember developing great frustration in being able to be a good nurse.
I talk about these workarounds as clues of innovative opportunities for system level solutions.
In the context of innovation and intrapreneurial mindsets, you can see how the workarounds can be used to inform the solutions.
Resilience
However, what if we work to solve these workarounds and relieve some of this pressure nurses face each day?
Should we be building resilience in nurses because of these inefficiencies that could be solved with some creative thinking, resources, time, and a commitment to better?
Does resilience truly need to be a skill we develop in the context of the work environment?
Would it not be better to leverage the challenges nurses face in providing complex care to patients at an individual level as the better source of building resilience?
I do see the need for developing resilience as an innovator, intrapreneur and/or entrepreneur.
I use these two examples in talks that I give as clues of innovative behaviors and opportunities to solve at a system level. However, to solve for these inefficient workarounds, leadership must be a part of the innovative development process and implementation effort.
If new nurses walked into these care areas and never knew of the linen cart or syringe pump workarounds, that would be a good thing. That would demonstrate progress in shifting away from a culture of workarounds. In those cases, the resilience is not needed and that energy can be placed to the care intended that required those items and tools, rather than on finding the items to deliver care.
So, I leave you with a thought provoking question, “what if we were able to reimagine and recreate work environments that focused on the needs of the nurse rather than teaching nurses how to be resilient in the work environment? Would that not be an amazing thing for the nurses, but also the patients?”
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