Friday, 28 July 2017

Resilience as a Buffer of Stress in Nurses

Julie J. Lanz & Valentina Bruk-Lee

Lanz, J. J. and Bruk-Lee, V. (2017), Resilience as a Moderator of the Indirect Effects of Conflict and Workload on Job Outcomes among Nurses

Where have all the nurses gone? According to Lafer (2005), “the stress, danger, exhaustion, and frustration that have become built into the normal daily routine of hospital nurses constitute [the] single biggest factor driving nurses out of the industry” (p. 36). This is important because researchers have projected that there will be a significant shortage of 300,000 to 1 million registered nurses in the U.S. by 2020 (Juraschek et al, 2012). Indeed, the World Health Organization (WHO, 2016) reports that there is a global shortage of healthcare workers, and this shortage is reaching a crisis level in 57 countries.

Urban, rural, and student nurses all report similar stressors:
  • Caring for the dying 
  • Conflict with patients, families, and staff 
  • Workload 
  • Inadequate nursing staff 
  • Feeling unprepared to meet the emotional needs of patients 
  • Fear of failure 

These stressors are frequent – enough so that nurses are burnt out, getting injured, and even leaving the profession altogether. The two most frequently reported negative workplace events among a sample of Oregon nurses were interpersonal conflict at work and work role demands such as workload (Sinclair et al., 2009). One report estimated that U.S. employees spend 2.8 hours every week dealing with workplace conflict (Hayes, 2008). Thus, there is a critical need to investigate the effects of conflict and workload on job outcomes, as well as explore factors like resilience that may mitigate this stressful work environment.

A framework by which we can understand the stress process in nurses is the Emotion-Centered Model of Occupational Stress, which theorizes a causal flow from job conditions such as job-related stressors to job outcomes (i.e., strains, or reactions to a stressor; Spector & Goh, 2001). According to this model, a job stressor is a situation or condition that prompts a negative affective (i.e., emotional) response like frustration or anger. These negative emotions serve as a mechanism through which conflict and workload exert their influence on the experience of job outcomes (i.e., burnout, turnover intent, and injuries). Some variables, such as resilience, have previously been found to moderate the relationship between stressors and emotions (see Figure 1). In other words, highly resilient individuals under high levels of stress don’t experience as many negative emotions.

Figure 1. The Proposed Role of Resilience in the Emotion-Centered Model of Occupational Stress

The first objective of this study was to assess the relative effects of conflict and workload on burnout, turnover intentions, and injuries. Second, the mediating role of negative affect in the relationships between stressors and job outcomes was tested. Last, the study assessed resilience as a condition to the indirect effects of stressors on outcomes through the experience of negative emotional states. This study used a quantitative self-report two-wave design whereby 97 nurses were surveyed two weeks apart was used. Data from Time 1 and 2 were matched.

We found that conflict predicted turnover intentions and burnout; workload predicted injuries. Second, emotions were a mediating mechanism for most of the studied relationships consistent with Emotion-Centered Model of Occupational Stress, but not for workload and injuries, for which a direct relationship was found. Finally, resilience moderated the indirect effects of conflict on job outcomes via job-related negative affect. This effect was not found for the stressor workload, however.

Conflict is a social stressor that leads to negative outcomes, and it is likely that resilient nurses use positive emotions to deflect the negative effects of conflict. Resilience interventions may be a promising avenue to ameliorate the negative effects of conflict on nurses' job attitudes and well-being. This pattern was not seen for workload, so using a human factors (i.e., ergonomic) approach to understanding the negative effects of workload might be more valuable (Holden et al., 2011). For organizations seeking to reduce costs associated with injuries, reducing nurse workload and increasing support for safe patient handling are critical factors.

Dr Julie Lanz
Department of Psychology
University of Nebraska at Kearney

Dr Valentina Bruk-Lee
Department of Psychology
Florida International University

Hayes, J. (2008). Workplace conflict and how businesses can harness it to thrive [WWW document]

Holden, R.J., Scanlon, M.C., Patel, N.R., Kaushal, R., Escoto, K.H., Brown, R.L. ... & Karsh, B.T. (2011). A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life. BMJ Quality & Safety, 20, 15–24. doi:10.1136/bmjqs.2008.028381

Juraschek, S.P., Zhang, X., Ranganathan, V., & Lin, V.W. (2012). United States registered nurse workforce report card and shortage forecast. American Journal of Medical Quality, 27, 241–249. doi:10.1177/1062860611416634

Lafer, G. (2005). Hospital speedups and the fiction of a nursing shortage. Labor Studies Journal, 30, 27–46. doi:10.1177/0160449X0503000103

Lanz, J. J. and Bruk-Lee, V. (2017), Resilience as a Moderator of the Indirect Effects of Conflict and Workload on Job Outcomes among Nurses. Journal of Advanced Nursing. doi:10.1111/jan.13383

Sinclair, R.R., Mohr, C.P., Davidson, S., Sears, L.E., Deese, M.N., Wright, R.R. … Cadiz, D. (2009). The Oregon Nurse Retention Project: Final Report to the Northwest Health Foundation [WWW document].

Spector, P. E., & Goh, A. (2001). The role of emotions in the occupational stress process. In P. L. Perrew√© & D. C. Ganster (Eds.), Exploring theoretical mechanisms and perspectives (pp. 195–232). Bingley: Emerald Group Publishing Limited.

World Health Organization (2016). Health worker occupational health. Retrieved from


This study was funded by CDC/NIOSH through the Sunshine Education and Research Center (ERC) at USF (5T42OH008438-09). The opinions expressed are those of the authors and do not represent either NIOSH or USF.

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