Hospitals and health systems have never been more committed to engagement, retention, and wellness. Yet, nurses around the world are stressed, overworked, and burned out. According to Maslow’s hierarchy of needs, individuals can’t reach their full potential if they are struggling with basic needs. In today’s health care environment, there are unaddressed needs—or “cracks in the foundation”—undermining nurse resilience and leading to burnout.

Use the strategies and best practices in this report to repair the four cracks in the foundation of the care environment and build a more resilient nursing workforce.

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Frontline Nurses Are Stressed and Burned Out

Three out of four nurses report concerns about stress and overwork, and 70% report feeling burned out. These numbers are alarming because, in addition to negatively impacting nurses' well-being, stress and burnout are linked to an increase in adverse patient outcomes, lower workforce productivity, and higher rates of nurse turnover.

Health Care Leaders Are Committed to Building Individual Resilience

To reduce frontline stress and burnout, nurse leaders are striving to build individual nurse resilience through engagement and wellness initiatives. In fact, hospitals and health systems have never been more committed to nurse engagement, retention, and wellness.

Despite this commitment, these initiatives alone are not sufficient, because stress and burnout are still increasing. As a result, health care leaders are now asking: What are we overlooking that is undermining nurse resilience?

"Cracks in the Foundation" Undermine Nurse Resilience

According to Maslow's hierarchy of needs, individuals can't reach their full potential if they are struggling with basic needs. But in today's health care environment, there are unaddressed needs—or "cracks in the foundation"—undermining nurse resilience and leading to burnout.

The four foundational cracks are:

1. Violence and point-of-care safety threats are now commonplace in health care settings
2. Nurses feel they have to make compromises in care delivery
3. Staff bounce from traumatic experiences to other care activities with no time to recover
4. New technology, responsibilities, and care protocols cause nurses to feel "isolated in a crowd"

Use this report to learn how to address these cracks in the foundation.

Introduction: Spotlighting cracks in the care environment

Section 1: Reduce response time to routine point-of-care threats

Use this section to address that violence and point-of-care safety threats are now commonplace in health care settings.

• Practice 1: Disruptive Behaviour Algorithm
  Supporting Tools: Additional Resources from Sharp Grossmont Hospital
• • Practice 2: Security-Driven Unit Rounding
    Support Tool: Security Rounding Tool
  • • Practice 3: Frontline De-escalation Team (p.35)
      Supporting Tool: Valley Health’s Code Atlas Protocol
      Supporting Tool: Valley Health’s Code Atlas Summary Report
    • Practice 4: Behavioural Health Emergency Response Team
      Supporting Tool : Mission Health’s BERT Flow Diagram

Section 2: Surface and address frontline perceptions of unsafe staffing

Use this section to address that nurses feel they have to make compromises in care delivery

• Practice 5: Staffing Assumptions Leadership Exercise (p. 56)
  Supporting Tool: Valley Children’s Health Care Action Planning Selection Guide
• • Practice 6: Frontline Moral Distress Consult (p. 63)

Section 3: Make emotional support opt-out only

Use this section to address that staff bounce from traumatic experiences to other care activities with no time to recover.

• Practice 7: Manager-Triggered Psychological First Aid (p. 73)
  Supporting Tool : Main Line Health’s Critical Incident Response Team (CIRT) Report Form
  Supporting Tool Main Line Health’s CIRT Brochure
  Supporting Tool : Main Line Health’s CIRT Flyer
• Practice 8: Embedded Emotional Support Bundle
• Expert Insight: How Advocate Children's 'Bounce Back Kits' Improve Nurse Resilience

Section 4: Reconnect nurses through storytelling

Use this section to address that new technology, responsibilities, and care protocols cause nurses to feel “isolated in a crowd”

• Practice 9: Ninety-Second Storytelling
• Practice 10: Routine Clinical Reflections

Special Report: Addressing incivility

• Practice 11: Float Nurse Unit Civility Survey
• Practice 12: Staff-Driven Code of Conduct
• Supporting Tool : Northumbria Healthcare NHS Foundation Trust's Ward Charter