Journal of Nursing Management, 2015

Surviving workplace adversity: a qualitative study of nurses and

midwives and their strategies to increase personal resilience

GLENDA MCDONALD P h D , B S o c S c 1, DEBRA JACKSON P h D , MN, BHSc, RN

2,3
, MARGARET H. VICKERS P h D 4
and LESLEY WILKES P h D , R N 5
1
Lecturer, School of Nursing and Midwifery, University of Western Sydney, Penrith, NSW, 2Professor of Nursing,
Oxford Brookes University, Oxford, UK, 3Professor of Nursing, University of New England, NSW, Australia,
4
Professor of Management, School of Business, University of Western Sydney, Sydney, NSW and 5Professor, Clinical
Nursing Research Unit, University of Western Sydney & Sydney West Area Health Service, Penrith, NSW, Australia

Correspondence MCDONALD G., JACKSON D., VICKERS M.H. & WILKES L. (2015) Journal of Nursing
Glenda McDonald Management
University of Western Sydney, Surviving workplace adversity: a qualitative study of nurses and midwives
School of Nursing & Midwifery, and their strategies to increase personal resilience
Locked Bag 1797 Penrith DC
NSW Aim To explore the experiences of Australian nurses and midwives who perceived
Australia themselves as resilient. The focus of this paper is to report the strategies used by
E-mail: [email protected] a group of nurses and midwives to develop and maintain their resilience, despite
encountering serious workplace adversity.
Background Despite the potentially adverse effects of nursing work, many nurses
and midwives thrive through exercising self-efficacy and coping skills. The
relationship between thriving and resilience is clear, as resilience refers to the
ability to cope well with adversity and change.
Methods The participants were part of an instrumental, collective case study
investigation of personal resilience amongst nurses and midwives. Prior to an
innovative, work-based intervention including workshops and mentoring,
participants were interviewed to collect baseline perceptions and experiences of
personal resilience and workplace adversity. Interview transcripts were analysed
thematically.
Results Participants attributed their ability to thrive in the workplace to three
major influences: support networks, personal characteristics and ability to
organise work for personal resilience.
Conclusions Participant insights contributed to a deeper understanding of
personal resilience and highlight future initiatives to enhance the ability of nurses
and midwives to thrive within health organisations and systems.
Implications for nursing management It is vital that resilience-enhancing
initiatives, such as peer mentoring and tailored work options to increase
autonomy, are implemented at earlier career phases.
Keywords: health workforce, interviews, midwives, nurses, resilience, workplace
adversity

Accepted for publication: 1 February 2015

around the world (Appel et al. 2013, Foureur et al.

Introduction
2013). Research literature highlights the challenges
Sustainability of nurses and midwives is a key interest of that nurses face in the workplace; both personal
health organisations, nursing researchers and clinicians and organisational demands that can impact on work

DOI: 10.1111/jonm.12293
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G. Mcdonald et al.

performance, health and well-being (Keller et al. sense of coherence have been used to explain how a
2009, Vessey et al. 2009, Schluter et al. 2011). The person may absorb and recover from psycho-social
concept of resilience is considered a primary factor in harm caused by adverse events or stressful work (Ab-
the resolution of such workplace adversity (Jackson lett & Jones 2007, Jackson et al. 2007, Zander et al.
et al. 2007). This suggestion was confirmed in a case 2010).
study involving a work-based, educational interven- The construct of resilience is also conceptualised
tion to assist participants to develop and maintain from an ecological perspective. This view sees resil-
their personal resilience in the face of workplace ience as existing within social and physical environ-
adversity (McDonald et al, 2011; 2013). Despite ments, influenced by interactions with self and
workplace adversity, many nurses and midwives are significant others, but just as importantly at organisa-
able to sustain themselves physically, mentally and tional, community and sociocultural levels. The
emotionally (Koen et al. 2011). The insights of these quality of the environment or how successfully indi-
nurses and midwives contribute to a more complete viduals adapt to their environment is a predictor of
understanding of the development and maintenance of resilience, in spite of the number and scale of adversi-
personal resilience, and help to direct future initiatives ties they face (Ungar 2011). Identified environmental
that will enhance the ability of others to thrive within factors associated with resilience in nurses include the
health organisations and health-care systems. presence of teamwork, interpersonal communication
practices, mentoring and support, clinical supervi-
sion, organisational recognition and reward for effort
Aim
(Jarman & Newcombe 2010, Breen & Sweeney
The focus of this paper is on strategies used by study 2013).
participants to develop and maintain their resilience
before the onset of the study intervention, while work-
Methods
ing in a context of ongoing workplace adversity. The
findings discussed are drawn from their pre-interven- The study used a case study approach and qualitative
tion interviews. data collection methods to focus on the phenomenon
in question (Jirojwong et al. 2011). The study design
was an instrumental collective case study, investigating
Background
a particular case of nurses and midwives over time.
The terms ‘thriving’ or ‘flourishing’ have been used The study aimed to investigate personal resilience by
to describe health-care professionals who self-rate means of an instrument; examining the ‘wholeness’ of
highly on parameters of job satisfaction, optimism, the specific case facilitated understandings (de Vaus
sense of belonging and coping, group cohesiveness as 2014). Potential participants were recruited via flyers
well as clinical competence (Duggleby & Wright and posters in the unit that promoted the study inter-
2007, Stordeur & D’Hoore 2007). An important vention of six resilience workshops and a mentoring
aspect of thriving is coping self-efficacy, which programme where participants were matched with
defines people who maintain a strong belief that they retired nurse and midwife mentors. The nurses and
not only cope with whatever work stresses they meet, midwives who responded were provided with full
but positively change the outcome of circumstances details of the study and, upon consenting to partici-
(Koen et al. 2011). Thriving in nursing and mid- pate, were invited to discuss their experiences of
wifery is also understood as the capacity to lead in workplace adversity and perceptions of personal resil-
dynamic nursing roles and direct changes to practice ience in a qualitative, face-to-face interview. Inter-
within challenging nursing environments (Stavrianop- views were conducted at least 1 month prior to the
oulos 2012). study intervention.
The relationship between thriving and resilience is
clear; early researchers referred to resilience as the
Study setting
ability to cope well with significant change, adversity,
risk or stress (Wagnild & Young 1993, Jacelon 1997). The case study was set in a women’s and children’s
It is a broad term given to the cluster of personal health unit within a tertiary, public hospital in metro-
capacities that maintain equilibrium, despite negative politan Australia. The study’s unit of analysis com-
conditions. Individual attributes of resilience such as prised an ante-natal clinic, delivery suite, ante-natal
hardiness, positive outlook, emotional intelligence and and post-natal wards.

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2 Journal of Nursing Management
 Strategies to increase personal resilience

ing in the workplace, understandings of resilience and

Participants their views on resilience enhancement through profes-
Table 1 below outlines the demographic details of the sional development.
16 case study participants and potential factors influ-
encing their experience of nursing work. Most of the
Data analysis
participants were Australian-born residents; three had
migrated from Europe or Asia. Although the partici- Thematic analysis was based on a non-linear process
pants told of negative effects of workplace adversity of comprehending, synthesising, theorising and re-con-
such as exhaustion, emotional labour and stress dur- textualising the words of the participants into an
ing the pre-intervention phase, there were six who authentic explanation of experiences (Polit & Beck
perceived themselves as ‘thriving’ within this environ- 2006). The process began with several readings of the
ment. transcripts, taking note of essential ideas, experiences
and opinions of participants (Borbasi & Jackson,
2012). Thick description was used to form clear,
Ethical considerations
articulate interpretations of the phenomena being
Ethics approval for the study was granted by the rele- explored. Then key aspects of both individual and col-
vant university and health service human research eth- lective perspectives were integrated to form themes.
ics committees. Specific ethical issues of anonymity
and confidentiality were encountered due to a small,
Rigour
closely knit target population. It was critical that great
care was taken during analysis so that nuances of In keeping with a qualitative, exploratory approach,
excerpts relating to participant experiences did not trustworthiness, rather than generalisability, was the
identify them or their colleagues. aim in this study (Polit & Beck 2006). Although find-
ings were based on a small sample, conclusions were
drawn from replication in a number of cases and rival
Data collection
explanations were maintained during analysis. Inter-
After giving their informed consent, the participants pretations of the participants’ insights and resilience
were interviewed at a convenient time and place on- strategies were considered in terms of their alignment
site at the hospital. The interviews were designed to with current resilience discourse and refined by the
be semi-structured and conversational, covering topics entire research team.
from the participants’ personal support networks,
work environment, experiences of surviving and thriv-
Results
The study participants were aware of the negative
Table 1
effects that nursing work caused to the health and
Demographical information of study participants
well-being of their colleagues, and reported that they
Years Employment
experienced similar burdens themselves at various
Pseudonym Age nursing Position mode
stages of their careers. Six of the 16 participants were
Vicky 59 15 Registered Nurse/Midwife PT, nights positive and confident about using protective mecha-
Rose 53 >19 Clinical Nurse Specialist FT, days
Patrice 53 23 Enrolled Nurse FT, rotation
nisms to limit the harmful effects of their everyday
Lynette 51 31 Registered Nurse/Midwife PT, days work. They drew on collegial support networks and
Marika 51 31 Clinical Nurse Specialist FT, days described other strategies that they believed enhanced
Lisa 48 3 Registered Nurse PT, rotation
Talia 46 20 Registered Nurse/Midwife PT, days their resilience in the workplace. Three major themes
Jodie 45 18 Clinical Nurse Specialist PT, rotation revealed how these nurses and midwives resolved the
Karin 41 18 Clinical Nurse Specialist PT, days
negative impact of workplace adversity: support net-
Alice 40 3 Registered Nurse/Midwife FT, rotation
(left at Phase 1) works for resilience, personal characteristics for resil-
Lauren 39 10 Enrolled Nurse FT, rotation ience and organising work for resilience (Table 2).
Neralie 37 20 Enrolled Nurse FT, rotation
Monica 34 0.6 Registered Midwife PT, rotation
(left after Phase 1)
Lucinda 33 12 Registered Nurse/Midwife PT, days
Support networks for resilience
Gillian 30 8 Registered Nurse/Midwife PT, rotation
Tina 26 3 Registered Nurse FT, rotation Interpersonal factors were identified as being useful for
the embodiment of personal resilience and thriving

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Journal of Nursing Management 3
G. Mcdonald et al.

Table 2 of finding resolution from feelings of guilt and shame,

Strategies to increase personal resilience
and regaining confidence in her nursing abilities after
Theme Sub-theme mis-interpreting a client’s adverse test result:
Support networks for resilience Collegial networks in the workplace You’d wake up and think ‘Oh no. This hap-
External support
Personal characteristics for Self-care
pened and I feel really badly about it,’ and then
resilience Self-motivation you’d think about it all day. Eventually, talking
Organising work for resilience Autonomy to [colleagues], getting their positive feedback,
Optimistic approaches to work
reflecting on what happened, different ways of
responding and how I can improve in the future,
it just sort of gradually faded away. [Lynette]
within a potentially damaging workplace. Support
between colleagues in the workplace was an effective
form of protection against the effects of workplace Notably the majority of thriving participants
adversity for a majority of participants, and particularly enjoyed work processes and conditions which sup-
for those who considered themselves to be thriving. ported sustainable relationships at work; they were
Sub-themes of collegial networks in the workplace and generally able to take meal breaks together, and they
external support were identified. worked regular hours so it was easier to arrange
opportunities for interaction and reciprocity, such as
car-pools. Thriving participants nominated support
Collegial networks in the workplace
they received from managers as also important for
The thriving participants were very aware of the role of their sense of coping and resilience. For Rose, having
collegial support, believing it provided the most signifi- an approachable person in the NUM (nursing unit
cant benefit when facing challenges or negative out- manager) position was an integral part of feeling
comes at work, even more effective than that of secure and satisfied in the job, and influenced her
support from partners or close friends. These partici- sense of belonging and desire to stay in nursing:
pants had built an atmosphere conducive for positive
[Her] door is always open if you’re stressed, you
communication within their work environments. Rose
can always knock on her door, sit down in her
described her workplace as one where colleagues would
office and go through it. [Rose]
‘talk with each other a lot at work, we help each other’
and ‘download throughout the day’ when necessary.
Lynette, an experienced midwife, stated that her first External support
action when dealing with work concerns was informal
Another important factor associated with participants’
discussion with a colleague, signifying a depth of trust
sense of resilience was supportive external relation-
and confidence in the support of her colleagues:
ships – with partners, family and friends. The partici-
If we have any problems we can follow one of the pants strongly believed these networks of support
other girls up and say look, this is happening and increased their ability to feel emotionally secure and
what do you suggest?. . . Just talking to someone to sustain a positive self-concept when dealing with
about it is fairly important and it would be hard to the negative events and conditions of their working
cope if you didn’t have someone else to talk with. lives. Lucinda expressed the value she placed upon her
[Lynette] husband and her peer group who provided emotional
and practical support:
An important element of these support networks
was that colleagues shared ‘insider’ knowledge of the I have a very supportive husband, he’s good to
organisational hierarchies and issues and understood talk to and he does more than me on the home
the subtleties of the relationship dynamics within the front. . . I go to a Mothers Group. . . they’re a
department. These participants had built reciprocal, really great support network. . . [Lucinda]
supportive relationships with each other over years of
working together, sharing similar experiences of car-
ing for clients and dealing with workplace challenges.
Personal characteristics for resilience
They believed, because of these shared experiences,
their colleagues could best understand their feelings Personal factors associated with resilience were seen
and circumstances. Lynette recounted her experience as crucial to withstanding the effects of workplace

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4 Journal of Nursing Management
 Strategies to increase personal resilience

adversity. These nurses and midwives perceived that self to be thriving, she revealed insights into self-pres-
their personal skills and resilient attributes which had ervation when she stated her need to conserve energy
developed over time contributed to their sense of com- outside working hours and linked this practice to pro-
petency and wellness. In addition, personal practices tecting herself from the effects of workplace adversity:
supporting holistic health and well-being, and self-
I have a tendency to do more than I should, but
affirming beliefs about themselves and their ability to
I know I have to rest, so I’m careful about what
change situations to their advantage had helped them
I do [off shift], that’s a priority. I have to be
to persevere, sometimes over long careers, despite per-
aware of the limits because I don’t want to do
sistent and potentially damaging problems with their
anything that’s going to prevent me from contin-
workplace. Two sub-themes of self-care and self-moti-
uing work. [Lisa]
vation emerged as significant personal characteristics
for resilience.

Self-motivation
Self-care
The use of intentional, self-motivating thought pat-
Participants who felt they flourished in the work envi- terns and behaviours was also beneficial in sustaining
ronment described how they purposefully engaged in the participants’ sense of hardiness and well-being.
a range of therapeutic activities when not working Cognitive strategies, such as self-affirmations and posi-
which allowed rest, relaxation and distraction from tive self-talk, were helpful for some in mitigating some
worrying aspects of work. The concept of self-care of the harsher effects of the workplace. Other partici-
outside work was more widely understood and preva- pants motivated themselves through reading self-help
lent amongst the participants than work-based strate- or inspirational books. One participant, Rose, who
gies. Participants believed that reflective activities, described herself as thriving, recounted how she man-
such as music, yoga, reading, journaling and massage aged stressful work experiences, such as caring for
were relaxing and helpful for dealing with workplace women having terminations or those whose babies
stress. Higher energy or interactive activities such as had died. By drawing on her philosophical approach
dancing, gardening, socialising with friends and spe- to her work in such circumstances, she motivated her-
cial interest groups were also helpful for some partici- self to maintain effective nursing practice while man-
pants. Alice described gardening among her self-care aging the stress:
strategies:
If I can make that woman’s stay as pleasant as
I just go home, put some music on and I’ll go possible, I know I’ve done a good job. . . and it
and do some gardening. . . start digging away, do doesn’t hurt [me] as much. I’ve learnt these strat-
some pruning, cut all my trees down! And I do egies over the years and it’s only experience that
reflect. [Alice] gives it to you. [Rose]

As with Alice, solitary activities contributed to self-

care for several participants. They found it useful to Organising work for personal resilience
disengage completely from other people through activ-
Participants described the ability to fashion their roles
ities such as solitary swimming or running, seeing a
within the health organisation as a means of enhanc-
movie or having a regular day alone:
ing their sense of fulfillment. They found ways to
Going for a run is very therapeutic. I love the en- increase their personal autonomy within their roles
dorphins. They’ve got music video screens in the and organised their work to emphasise the satisfying
gym and I’ll just zone out of what’s happening, aspects, which helped them cope with the work-based
I’ll not be aware that anyone else is actually difficulties they faced. These measures facilitated self-
beside me, just. . . in this completely other place. recognition of their contribution in an atmosphere of
[Neralie] little formal acknowledgement, instilling some intrin-
sic rewards. Work became more personally rewarding
Some participants found that knowing their limits with greater scope for leadership, decision-making and
and protecting personal energy levels was a necessary enjoyable challenges. Further, sub-themes of auton-
part of self-care. Although Lisa did not consider her- omy and optimistic approaches to work emerged from

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Journal of Nursing Management 5
G. Mcdonald et al.

the analysis of the process of organising work for per- stances’. They valued the scope for change and variety
sonal resilience. within their roles and enjoyed the diverse range of
women and families they engaged with in their every-
day practice. One participant, Marika, who had
Autonomy
enjoyed a long career, summed up this positive atti-
One area of work that provided job satisfaction and tude to the nature of her work.
influenced feelings of competence and control was the
We do something different each day. . . this
degree of autonomy. Participants recalled how, when
morning I was team leader. . . tomorrow morning
they were able to focus on those elements of their prac-
I’ll have a clinic. It is a good job. [Marika]
tice they found personally fulfilling, or were performing
roles of greater responsibility but also greater control,
there was a positive effect on their feelings of psycho-
social health and well-being. They found working in Discussion
interesting specialised roles, even if for only part of the
For the participants in this study the most significant
time, was a good strategy for resilience. These specialist
form of protection from workplace adversity was col-
roles also provided respite from the overloaded pace of
legial networks of support. This is in keeping with
the wards and the harsh gaze of colleagues:
earlier literature identifying collegial networks as a
When I have my own clinic I have autonomy crucial element of workplace resilience (Jackson et al.
and it’s great. . . I’m thriving. . . I get lots of posi- 2007). In this study, the participants who believed
tive feedback from the people I see, and I know they were thriving had established reciprocal relation-
I do a good job. [Lucinda] ships which resulted in helpful information being con-
veyed when needed, reduced stress in individuals and
enabled smoother, effective processes of patient care.
The participants who had greater control over their
Their supportive networks enabled successful naviga-
work were able to concentrate on providing person-
tion through the organisational hierarchy, which less-
centred care and meaningful engagement with their
ened the personal burden experienced and positioned
clients, which reinforced feelings of efficacy, confi-
participants for greater job satisfaction and potential
dence and job satisfaction. In fact, understanding the
career advantage. Their collegial networks reinforced
links between autonomy and resilience to negative
a sense of belonging which influenced the positive atti-
workplace effects had led some participants to take
tudes towards the workplace and kept their commit-
actions at work that enhanced feelings of autonomy.
ment to work alive. The link between a sense of hope
Talia recounted how she followed up the women she
and purpose in nurses and the quality of their work-
had cared for in the ante-natal clinic after they moved
place relationships was found to be significant in ear-
out of her work sphere:
lier research (Duggleby & Wright 2007). The role of
It’s very hard to find the time to see [women] on collegial support in helping to resolve negative self-
the ward. I look up their birth on the com- judgements and loss of confidence as a result of clini-
puter. . . make follow-up calls and speak to them cal errors or adverse effects on patients was revealed.
at home in between [appointments]. . . it could The participants perceived that the most effective
be just 5 minutes touching base. . . but one little source of support for this kind of setback was colle-
thing can make a difference. [Talia] gial support. The importance of experiencing authen-
tic peer support and mentoring to overcome
challenges in nursing work has been discussed in other
Optimistic approaches to work research findings (Cortese et al. 2010).
Fortunately, the participants’ enjoyment of their work Personal practices of self-care and motivation also
counteracted, to an extent, the more negative factors emerged as primary ways that nurses and midwives
of their jobs. The thriving participants unanimously help themselves maintain a sense of equilibrium in
stated that they loved the work they were doing, it challenging, sometimes chaotic, workplaces. Previous
was interesting, stimulating and rewarding. They felt research proposed the advantages of workers in large-
their work gave them purpose and fulfilled a need for scale organisations possessing optimism and flexibility
their clients, as Lisa expressed, ‘my special interest is (Avey et al. 2010). Generally, the study participants
talking to those mums who have difficult circum- were pro-active and committed to ensuring they did

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6 Journal of Nursing Management
 Strategies to increase personal resilience

not become overwhelmed and devised their own strat- wives regarding self-care in the workplace could lead
egies to manage or disconnect from stressors. It is vital to better implementation of work-based programmes
that nurses and midwives are encouraged and sup- to improve health and well-being. The experiences
ported to set up and maintain their psycho-social and insights of the study participants reinforce the
health and well-being in a habitual and disciplined importance of sustained workforce initiatives that
way. Although self-care and self-motivation emerged encourage and support nurses and midwives as they
as the most important factors for these nurses and develop, enhance and maintain their personal resil-
midwives, they may be considered part of a range of ience. There are clear potential benefits of facilitating
resilient personal characteristics, including optimism, opportunities at work for nurses and midwives to
flexibility, hardiness, emotional insight and life bal- uncover and build on their personal strengths, and to
ance (Jackson et al. 2007). Recent research has promote strategies that they create themselves – for
expanded the notion of self-care to more than tempo- themselves. This could mean nursing managers
rary, pleasurable activities that distract from work- become more open to new and different activities in
place stressors and boost energy levels (Richards work spaces during work time that allow team mem-
2013). Rather, habitual maintenance of physical and bers to share and reaffirm their collective knowledge
emotional health and well-being should be seen as key about thriving amongst workplace adversity. Positive
to personal and professional resilience. steps could range from simple, having a ‘resilience rec-
Adapting one’s work for improved resilience is ipe swap’ in the tea-room, to more elaborate, regular
another way that nurses and midwives can thrive training and development about resilience. The signifi-
within environments affected by workplace adversity cant feature of initiatives is that of team members pre-
(Hodges et al. 2008). Most study participants who senting and sharing their abilities with colleagues,
perceived themselves as coping well despite the diffi- building a cohesive professional identity of resilience.
culties they faced at work were older, senior women Fostering informal peer mentoring, with particular
who had worked in the unit longer than their peers. attention to building supportive networks between
They had gained influential positions, sometimes new graduates or newcomers and more established cli-
informally, due to their clinical expertise and experi- nicians, could more rapidly develop a sense of belong-
ence coupled with tacit, insider knowledge about the ing amongst staff.
people and processes of the workplace. Finding ways The introduction of measures that assist nurses and
to incorporate satisfying elements into their daily midwives to increase their personal autonomy at ear-
work routines or re-framing a positive approach to lier career stages would be another step forward, tai-
negative situations brought them a sense of job satis- loring roles and work tasks wherever possible to align
faction. In most cases this had taken some time to with the aspects that staff members find personally
accomplish; as well, perseverance through times of dif- satisfying. This requires creating a work environment
ficulty and disillusionment had been required. where team members feel secure in putting forward
Although the dictates of working in large, complex their genuine likes and dislikes about their job.
health organisations can make this difficult (Schreuder Responding to team member attributes and prefer-
et al. 2010), the insights of the study participants sug- ences for work tasks and variety, within reason, may
gest that even small or incremental changes can pro- also support them to feel hopeful and recognised
vide significant benefits and protection from the within the workplace, even when their perceived goals
effects of workplace adversity. Of course, health or- are not immediately achievable.
ganisations should not be excused from taking action The findings of this study confirm previous argu-
broadly, definitively and systematically to improve the ments (McAllister & McKinnon 2009) that nursing
work experiences of their employees. management must ensure new graduates and early-
career nurses and midwives are aware of the potential
effects of workplace adversity on their health and
Implications for nursing management
well-being. Nursing graduates may be forewarned of
There are significant and timely implications from the potential dangers of professional burnout and may
these findings for nursing management. It was note- have practised self-reflection techniques; they should
worthy that routinely taking meal, water or toilet also understand how developing personal resilience
breaks were not a feature of these study participants’ could assist them to meet the demands of their
workplace behaviours promoting self-care. Further careers. Ample opportunities exist in the workplace
determinations about the beliefs of nurses and mid- for including reflection on the aspects of personal

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Journal of Nursing Management 7
G. Mcdonald et al.

resilience described in this study. Individual team mem- Breen M. & Sweeney J. (2013) Burnout: the experiences of
bers could then develop personally meaningful resil- nurses who work in inner city areas. Mental Health Practice
17 (2), 12–20.
ience strategies. This element of workplace culture
Cortese C., Colombo L. & Ghislieri C. (2010) Determinants of
requires substantial attention by those endeavouring to nurses’ job satisfaction: the role of work–family conflict, job
improve the work environment of nurses and midwives. demand, emotional charge and social support. Journal of
Nursing Management 18, 35–43.
Duggleby W. & Wright K. (2007) The hope of professional
Limitations caregivers caring for persons at the end of life. Journal of
Hospice and Palliative Nursing 9 (1), 42–49.
The self-selected nature of the participants means
Foureur M., Besley K., Burton G., Yu N. & Crisp J. (2013)
there was potential for other nurses and midwives Enhancing the resilience of nurses and midwives: pilot of a
working at the selected hospital department, or mindfulness-based program for increased health, sense of
another site, to have different perceptions and experi- coherence and decreased depression, anxiety and stress. Con-
ences than those expressed in the findings. temporary Nurse 45 (1), 114–125.
Hodges H.F., Keeley A. & Troyan P.J. (2008) Professional resil-
ience in baccalaureate-prepared acute care nurses: first steps.
Conclusion Nursing Education Perspectives 29 (2), 80–89.
Jacelon C. (1997) The trait and process of resilience. Journal of
The insights of resilient nurses and midwives have Advanced Nursing 25 (1), 123–129.
important benefits for new graduates, mid-career health Jackson D.E., Firtko A. & Edenborough M. (2007) Personal
professionals and health organisation management resilience as a strategy or surviving and thriving in the face of
workplace adversity: a literature review. Journal of Advanced
regarding the personal and organisational initiatives
Nursing 60 (1), 1–9.
that may enable all nurses and midwives to enhance Jarman H. & Newcombe P. (2010) Support for nurses who are
their ability to withstand workplace adversity. new to emergency care. Emergency Nurse 17 (9), 16–19.
Jirojwong S., Johnson M. & Welch A. (2011) Research Meth-
ods in Nursing & Midwifery: Pathways to Evidence-based
Source of funding Practice. Oxford University Press, South Melbourne.
Keller S.M., Berryman P. & Lukes E. (2009) Effects of
The authors would like to acknowledge this research
extended work shifts and shift work on patient safety, pro-
study was supported by the Australian Research ductivity, and employee health. AAOHN Journal 57 (12),
Council LP0668875. The views expressed herein are 497–502.
those of the authors and are not necessarily those of Koen M., van Eeder C. & Wissing M. (2011) The prevalence of
the Australian Research Council. resilience in a group of professional nurses. Health SA Ges-
ondheid 16 (1), 1–11.
McAllister M. & McKinnon J. (2009) The importance of teach-
Ethical approval ing and learning resilience in the health disciplines: a critical
review of the literature. Nurse Education Today 29, 371–379.
This research study, HREC 07/106, was granted ethics McDonald G., Jackson D., Wilkes L. & Vickers M. (2011) A
approval by the UWS Human Research Ethics Com- work-based educational intervention to promote personal
mittee & Sydney West Area Health Service Human resilience in nurses and midwives. Nurse Education Today 32
(4), 378–84. doi:10.1016/j.nedt.2011.04.012
Research Ethics Committee.
McDonald G., Jackson D., Wilkes L. & Vickers M. (2013) Per-
sonal resilience in nurses and midwives: Effects of a work-
based educational intervention. Contemporary Nurse 45(1),
References
139–148.
Ablett J. & Jones R.S. (2007) Resilience and well-being in palli- Polit D. & Beck C. (2006) Essentials of Nursing Research:
ative care staff: a qualitative study of hospice nurses’ experi- Methods, Appraisal, and Utilization, 6th edn. Lippincott Wil-
ence of work. Psycho-Oncology 16, 733–740. liams & Wilkins, Philadelphia, PA.
Appel L., Labhart L., Balczo P., McCleary N., Raley M. & Richards K. (2013) Self-care is a lifelong journey. Nursing Eco-
Winsett R. (2013) A comparative study of a happiness inter- nomic 3 (4), 198–202.
vention in medical-surgical nurses. MEDSURG Nursing 22 Schluter P.J., Turner C., Huntington A., Bain C. & McClure R.
(5), 319–324. (2011) Work/life balance and health: the Nurses and Midwives
Avey J.B., Luthan F., Smith R.M. & Palmer N.F. (2010) Impact of e-cohort study. International Nursing Review 58, 28–36.
positive psychological capital on employee well-being over time. Schreuder J.A., Roelen C.A., Koopmans P.C., Moen B.E. &
Journal of Occupational Health Psychology 15 (1), 17–28. Grodhof J.W. (2010) Effort–reward imbalance is associated
Borbasi S. & Jackson D. (2012) Navigating the Maze of with the frequency of sickness absence among female hospital
Research: Enhancing Nursing and Midwifery Practice, 3rd nurses: a cross-sectional study. International Journal of Nurs-
edn. Elsevier Australia, Chatswood, NSW. ing Studies 47 (5), 569–576.

ª 2015 John Wiley & Sons Ltd

8 Journal of Nursing Management
 Strategies to increase personal resilience

Stavrianopoulos T. (2012) The clinical nurse leader. Health Sci- Vessey J.A., DeMarco R.F., Gaffney D.A. & Budin W. (2009)
ence Journal 6 (3), 392–401. Bullying of staff registered nurses in the workplace: a prelimin-
Stordeur S., D’Hoore W. (2007) Organizational configuration ary study for developing personal and organizational strategies
of hospitals succeeding in attracting and retaining nurses. for the transformation of hostile to healthy workplace environ-
Journal of Advanced Nursing 57 (1), 45–58. ments. Journal of Professional Nursing 25 (5), 299–306.
Ungar M. (2011) The social ecology of resilience: addressing Wagnild G. & Young H. (1993) Development and psychometric
contextual and cultural ambiguity of a nascent construct. evaluation of the Resilience Scale. Journal of Nursing Mea-
American Journal of Orthopsychiatry 81 (1), 1–17. surement 1 (2), 165–178.
de Vaus D. (2014) Surveys in Social Research, 6th edn. Allen & Zander M., Hutton A. & King L. (2010) Coping and resilience
Unwin, Crows Nest. Available at: http://www.eblib.com, in pediatric oncology nurses. Journal of Pediatric Oncology
accessed 4th December 2014). Nursing 27 (2), 94–108.

ª 2015 John Wiley & Sons Ltd

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