key: cord-0839564-o71a6615 authors: Grossman, Valerie Aarne title: Resiliency During the Pandemic: What Keeps a Team Together? date: 2021-08-26 journal: J Radiol Nurs DOI: 10.1016/j.jradnu.2021.07.002 sha: d5d351332fb1a9814dff7bbaa9beb4718acb4e16 doc_id: 839564 cord_uid: o71a6615 nan It may seem too good to be true that a team of radiology nurses experienced a 0% turnover rate for the first 15 months of the coronavirus disease 2019 (COVID-19) pandemic, with four parttime nurses waiting for full-time positions and a nurse manager who was working remotely. How could that even happen? Against all odds, a team of 25 professionals in a Magnet-designated community hospital stepped up, stuck together, and showed up to work every day to care for patients who trusted them. Many of these nurses would describe their tight bond with their "work family" as extraordinary, their exceptional dedication to caring for very sick patients who depended on them, and the trusted unabating support from their nurse manager. Wakeman often asks, "What would great look like?" and quickly follows with "How can YOU make that happen?" (Wakeman, 2017) . Great looks like the resilience exhibited by this team of radiology nurses. The next question of how, is harder to understand and achieve. We've never had enough Around the world, health care is suffering from a shortage of nurses. While it may be hard to believe, the nursing shortage began as long ago as the 1930s. As more hospitals were being built, the need for nurses rose. Nurses then began to leave to serve during wartime (reportedly 25% of hospital nurses left for the military), and soon, hospitals began training their own registered nurses. They added in licensed practical nurses and unlicensed assistive personneldand still, there were not enough nurses to care for their patientsdmuch like we are experiencing today (Roberts, 1954; Goostay, 1941) . The COVID-19 pandemic has affected the life of every person in our world. It has overwhelmed our healthcare arena, the professionals, and supply chains. This pandemic has been an experience like no other and will likely be the most challenging year of most people's healthcare careers. You will hear many healthcare organizations discuss how they are "hemorrhaging nurses" and scrambling to find solutions to their staffing problems. Figure 1 lists nursing turnover statistics in the United States. Around the world, nurses change positions for an array of reasons. This opportunity has been prevalent throughout history, whether owing to job dissatisfaction or interest in seeking new adventurous employment options. Retention of nursing teams has grown increasingly complex, especially as the challenges of the pandemic greatly influenced the decisions nurses made to stay in their positions or to leave. Refer to Figure 2 : reasons for nursing turnover before and during the pandemic. Retaining a consistent team of excellent nurses is a priority for every organization. The financial hardship of losing just one nurse is estimated to be more than $44,000. This can easily create a financial burden of $3.6 to $6.1 million per year for an organization (NSI, 2020; Lockhart, 2020) . A low nursing turnover rate results from (but is not limited to) many factors from the physical environment, wage/benefits, services offered, individual relationship with immediate supervisor, and organizational resiliency. Organizations must successfully navigate tremendously difficult times by having a resilient leadership team in order for employees to feel safe and secure enough to remain committed to their jobs. Resilient organizations must: Maintain the organization's mission and vision at the center of their focus and see how current events may impact the future. Be transparent with information that is updated in real-time openly communicate with hopeful messages that "we can do this together" Quickly correct weaknesses or failures, learn from them, and recover in a professional manner Be visible on the front line, listen to staff with empathy, provide follow-up as promised Update policies in real-time, make them easily accessible to all employees Disclaimer: The view expressed herein is that of the author and does not reflect the official policy or position of Highland Hospital or the University of Rochester. Senior leadership must remain calm and engaged while leading the command center during any disaster; this can be incredibly challenging for long-lasting events such as the COVID-19 pandemic. To serve their organizations, teams, and patients, organizational leaders MUST include personal plans of self-care. Staff notice when senior leaders look worn out or react without compassion Be nimble, able to adapt to events regardless of the organization's capacity being stretched, tested, or overwhelmed (Veenema, 2019; Rangachari, 2020; Aarne Grossman 2021b; Renjen, 2020; Bennis,2002; Lofti, 2018) . Nursing leaders must have compassion for all team members, with a deep appreciation for the uniqueness of all employees: diversity may include generations, cultures, religions, races, languages, and so on. Much more is required, though, to be a successful leader who can inspire a team naturally. The nurse leader must commit to learning from adversity calmly and professionally and steadfastly advocate for their team members toward achieving their own individual greatness through their confidence, intelligence, loyalty, kindness, and commitment (Aarne Grossman, 2020; Wakeman, 2021; Lofti, 2018) . During the COVID-19 pandemic, every nursing leader was tested in ways never experienced in their past. In the early days of the pandemic and subsequent surges, nurse leaders often worked 7 days a week, throughout the day and night. They shared the same fears and uncertainty as their staff, yet, as the role model continuously "on stage," they were pushed in one of two directions: sink or swim as a leader. The development of resiliency is a complicated and long personal journey of learning to overcome adversity and find solutions to challenging situations. Nurses develop resiliency throughout their careers from personal experiences and by learning from those around them. Refer to Figure 3 for characteristics of a resilient nurse. Resilient nurse leaders learn from life events and professional experiences, which are positively impacted by age, tenure as a nurse, and intention to remain in each position (Kelly, 2021) . In addition to resiliency, nurse leaders must develop high-level expertise in leadership skills. No "one" algorithm leads a nurse to be a successful leader. Nurse leaders must be comfortable with their own selfreflection and work to improve gaps in their skills. Learning strategies from others will enhance the skills of the nurse leader, as well as continuing education through conferences, teaching days, journal articles, and so on. Kroning (2021) , Holge-Hazelton (2020), Aarne Grossman (2020), Fessel (2021) . Each team is different, and each team member is unique. The nurse leader must understand each member of their team and respect them without judgment or question. Listening carefully, maintaining positive, hopeful communication, and leading by example will promote the development of trust among members of the team. Staff nurses will appreciate working with a leader who consistently portrays inspiration, motivation, mentorship, professionalism, ability to solve problems (without scaring staff), and shows gratitude for the hard work of each nurse on the team. When nurse managers have developed their adaptive capacity and actively address every adverse situation, the team feels protected. Leaders should work diligently to make the environment a place where nurses can thrive, look forward to coming to work, want their friends to join their team, and they can grow into the nurses THEY wish to become (Spies, 2018; Bennis, 2002; Renjen, 2020; Aarne Grossman, 2020; Wakeman, 2021; Pishgooie, 2019) . When an organization, senior leadership, and nursing leadership maintain professionalism and portray resiliency, staff nurses on the team will have role models to emulate. Working where constant examples of resiliency occur at every turn, nurses will develop their own strengths, skills, and resiliency. Nurses remain in their positions when they are listened to, cared for, protected (physically, professionally, and emotionally), invested in, respected, empowered to speak up, and have their concerns taken seriously. During the COVID-19 pandemic, nurses with well-developed resiliency and a strong professional commitment immersed themselves into the care of patientsdin doing so, they experienced moral dilemmas in life like never before, yet found solutions that allowed them to maintain their drive to the bedside. Being part of a supportive team and having a robust personal support system Reasons for nursing turnover before and after the pandemic (Aarne Grossman, 2021a; Jones, 2018; Kelly, 2020; Berlin, 2021; Cabrera, 2020; Shah, 2021; NAM,2020; NASEM/NAM, 2019; Kelly, 2021; Hussan Madani, 2021; Rangachari, 2020; Fernandez, 2020; Tsernov,2021) . (family, friends) were better able to maintain their dedication to remaining in their position and caring for their patients. The answer to Wakeman's second question of "how" this team stayed together during a very challenging 15 months period is a synthesizing of resiliency, professionalism, dedication, and feeling safe in their current jobs. To better understand why these nurses and other nurses stayed in their positions during the pandemic, the author spoke to nurses worldwide. Many were eager to share their experience anonymously. Refer to Figure 4 ; I Stayed Because …. (Wakeman, 2021; Wakeman, 2017; Aarne Grossman, 2020; Yilmez, 2017; Holge-Hazelton, 2020; Spies, 2018; Pishgooie, 2019; Kelly, 2021) . V.A. Grossman / Journal of Radiology Nursing xxx (2021) 1e5 4 Personal conversations with nurses around the world. Respondents requested anonymity Leadership Essentials During a Disaster Advanced Practice and Leadership in Radiology Nursing Crucibles of Leadership Nursing in 2021: Retaining the healthcare workforce when we need it most insights/nursing%20in%202021%20retaining%20the%20healthcare%20workforce %20when%20we%20need%20it%20most/nursing-in-2021-retaining-the-healthcare-workforce-when-we-need-it-. most. .pdf?shouldIndex¼false 2020) 5 Dreadful Reasons Why Nurses Quit Their Jobs Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic Coronavirus Disease 2019 (COVID-19) and Beyond: Micropractices For Burnout Prevention and Emotional Wellness Supply, Demand, and Standards. The President's Address Leading unique cultures in departments with low turnover of nurses. A positive deviance approach study Letters from Pakistant-Brain Drain: The exodus of Nurses to Wealthier Countries is Killing Us. Daily Nurse: The Pulse of Nursing The Hemorrhage of Emergency Nurses Impact of nurse burnout on organizational and position turnover Reflecting on two distinct leadership roles during the pandemic Strategies to reduce nursing turnover Relationship between ethical leadership and organisational commitment of nurses with perception of patient safety culture Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being Taking action against clinician burnout: A systems approach to professional wellbeing (2020) 2019 NSI National Health Care Retention & RN Staffing Report. www.nsinursingsolutions.com/Documents/Library/NSI_Nation al_Health_Care_Retention_Report Correlation between nursing managers' leadership styles and nurses' job stress and anticipated turnover Preserving Organizational Resilience, Patient Safety, and Staff Retention during COVID-19 Requires a Holistic Consideration of the Psychological Safety of Healthcare Workers The Heart of Resilient Leadership Responding to COVID-19: A guide for senior executives American Nursing: History and Interpretation Prevalence of and Factors Associated With Nurse Burnout in the US Transformational leadership as a framework for nurse education about hypertension in Uganda Overworked Nurses are Killing your Healthcare Business Occupational outlook handbook: registered nurses Employment by detailed occupation Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and other Hazards The Top 5 Reasons Why Nurses Quit Their Jobs. Advisory Board Five ways to modernize your leadership and get rid of the drama No Ego: How leaders can cut the cost of workplace drama, end entitlement, and drive big results Resilience as a strategy for struggling against challenges related to the nursing profession