HEALTH SYSTEM

Giving young nurses staying power

How do we foster resiliency in the next generation of nursing graduates in the fallout from COVID-19?

Recently, I have begun to question how the next generation of graduate nurses, so full of potential, excellence, and leadership acumen, will find their way in a health-care system that is broken, been assaulted by a pandemic, and facing one of the most significant shortages in decades.

Despite nursing’s ethical mandate grounded in compassion, health, and healing, nurses are stretched beyond capacity. Many have left the profession due to exhaustion, burnout and workplace stress related to COVID19.

Findings from a 2018 rapid review of the literature by Michael Sandler on why new graduates leave the profession within one year of hire indicate low self-esteem and a lack of confidence in their clinical abilities as contributing factors.

Yet it is the “interpersonal violence” within the profession itself or in the relationships with other health-care providers that have been shown to be the primary reason. Not surprisingly, the evidence is fraught with first-hand accounts by new graduates regarding unhealthy and unsafe work environments, heavy workloads and decreased staffing ratios, lack of good mentorship, emotional and physical exhaustion, and moral distress.

The unforgiving nature of the health-care system is designed to diminish and reduce, rather than inspire and promote. Each year, accredited and highly competitive BSCN nursing programs across the province educate students for success despite the knowledge that these graduates will be entering a system that is damaged.

Independent of the public’s trust in the profession — and a career choice by many often motivated by a commitment to care for others — the question remains how these nursing graduates, so full of promise, intelligence, and a passion to advance the nursing profession, will form a healthy nursing identity, and thrive in a time where retention is more the exception than the norm.

The recent promise by Premier Tim Houston to address the nursing shortage across the province by committing to employ nursing graduates over the next five years offers a bold initiative. Without sufficient supports and resources, however, retention and sustainability will prove challenging.

Nurse researchers Kathryn Chachula, Florence Myrick, and Olive Younge suggest implementing supports that include well-designed orientation programs, nurse mentors to build confidence and skill acquisition, interprofessional teams to foster respect and team-building, and a welcoming environment will positively impact new graduate nurse retention.

But to negotiate the harsh realities of the current system, new graduate nurses must develop resiliency: an ability to withstand stressful conditions and adapt to develop positive strategies. Promoting resilience can take many forms, but if self-care is not present, resilience will be difficult to negotiate.

Jean Watson, renowned nurse theorist and founder and director of the Watson Caring Science Institute (WCSI), suggests that because nurses have an “insatiable need to care for others, which is both their greatest strength and fatal flaw,” they often neglect their own self-care and the critical importance of being kind to themselves and each other.

Because current nursing education doesn’t include courses specifically designed to address nursing self-care and the compassionate self, nurse graduates have little understanding of the importance it plays in building their own resilience as a mechanism for self-preservation and sustainability within the profession.

If this isn’t re-examined moving forward, there is a real possibility that even with guarantees of employment, nurse retention will prove challenging, as few will have capacity to work in a system that is so deeply flawed.