Nursing is a profession that offers both extraordinary rewards and profound challenges. The intensity of nursing education often stretches students to their limits, preparing them for the realities of patient care. However, the significant concern of nurse burnout, which often originates in nursing school and intensifies as new graduate nurses enter the workforce, cannot be overlooked (Kong et. al., 2023). The urgency of this issue is underscored by the fact that burnout rates among new graduate nurses surpass those of more experienced colleagues (Catarelli et.al., 2023).
The Challenge of Burnout in Nursing
This alarming trend of burnout among new graduate nurses is often accompanied by decreased job satisfaction and difficulty adapting to the profession. With 42.5% of new graduate nurses (NGN) expressing an intention to leave nursing (Ulupinar & Aydogan, 2021) and 13% of NGN leaving the profession after one year (Siegle & New Mexico Nurses Association, 2023), it is clear that we need to focus on building resilience during this critical period. New Mexico needs an additional 5,704 registered nurses (RNs) to meet the national benchmark of 92 RNs per 10,000 population (New Mexico Health Care Workforce Committee, 2023). With the ongoing decline in nurses working in rural areas (Wakefield et al., 2021), it is essential to strengthen resilience to retain NGN in the profession.
Addressing Burnout and Building Resilience
Several scholars have explored resilience and coping skills development to support nurse and nursing student well-being (Diffley & Duddle, 2022). Mindfulness training (MT), self-care, and reflective journaling have emerged as valuable tools for this purpose (Hughes et al., 2021) leading hospitals and academic programs to promote them to staff and students. Unfortunately, these well-intentioned but mandated self-care training initiatives increased nurse and student workloads, exacerbating mental and emotional fatigue while implying that vulnerability to workplace stressors is a personal failure (Taylor, 2019). Attributing burnout solely to a lack of resilience oversimplifies a complex issue influenced by systemic factors like unrealistic job demands, toxic workplace cultures, and burdensome administrative tasks (Wakefield et al., 2021). Time constraints, negative work environments, and cultural norms that valorize self-sacrifice contribute to burnout, underscoring the need for holistic, systemic change.
The Future of Nursing 2020-2030 report (Wakefield et al., 2021) advocates for “integrated, systematic, organization-focused interventions” (p. 326) involving diverse stakeholders to support nurse well-being and foster resilience. While some organizations can address structural, policy, and environmental factors, nursing education programs are uniquely suited to facilitate skill development supporting well-being and resilience. This approach can reduce early burnout by incorporating student-centered activities that prioritize personal well-being as an ethical responsibility (American Nurses Association, 2015; Wakefield et al., 2021) while enhancing protective factors associated with increased resilience (Hughes et al., 2021; Hughes et al., 2022). Ultimately, our goal as educators is to equip students with the skills and knowledge needed for a long, rewarding career providing high-quality patient care.
Integrating Mindfulness into Nursing Education
Mindfulness as a Nursing Skill
To achieve this goal, we restructured a pre-licensure nursing skills lab course that requires faculty validation of safe performance. This often causes significant stress and anxiety among students, and for some, this stress can be debilitating, necessitating multiple performance evaluations that increase their academic workload and consume valuable time.
Mindfulness emerged as a promising tool to help students better cope with skill-performance anxiety while also supporting resilience development (Hughes et al., 2021). Defined as a mental state “characterized by full attention to present-moment experience without judgment” (Jha et al., 2010, p. 54), mindfulness has been shown to reduce stress symptoms and protect against future negative effects on physical and mental health. Studies have demonstrated mindfulness training’s (MT) effectiveness in improving sustained attention in students (Morrison et al., 2014) and military personnel (Jha et al., 2015), as well as its positive impact on the psychological resilience of firefighters (Denkova et al., 2020). Given these findings and the current challenges of stress and burnout in nursing, including mindfulness as a foundational nursing skill seemed essential. This was further supported by the American Association of Colleges of Nursing’s Essentials (2021), which emphasizes the importance of personal health and well-being.
Initial Implementation and Student Feedback
As part of our skills lab format, we initiated a weekly MT skill station, providing information and practice opportunities within the established schedule. Dr. Heidi Taylor, a holistic nurse coach, volunteered to curate the content for this pilot project. Initially, some students were skeptical, viewing it as a waste of time. However, students increasingly reported using mindfulness practices before skill checkoffs, simulations, and tests. A summative student survey captured this shift, noting the benefits of mindfulness for managing stress and enhancing their nursing skills.
Expanding Well-being Practices Across the Curriculum
This led faculty to further explore student well-being and resilience strategies within the curriculum. We currently integrate mindfulness and self-care resources into our program orientation and Evidence-Based Practice course, embed them into the Stress and Coping concept, and include optional faculty-led guided imagery sessions before tests. The weekly mindfulness skill station and self-care plan assignments continue, as do reflective assignments on mindfulness experiences with patient care relevance. Clinical intensive courses include a commercial resilience training program and begin clinical days with brief mindfulness practices. Students in the final clinical intensive course lead group mindfulness practices as part of the charge nurse role. Our simulation activities focus on preparing for patient care through micro-stress experiences, quality debriefing, and reflection. Additionally, holistic nurse coaches support students within our Holistic Model for Student Retention and Success. To further cultivate student well-being, healthy snacks such as fresh fruit, cereal bars, and popcorn are provided in our commons area, addressing student food insecurity. This initiative, currently funded by faculty and community members, nourishes students physically, models healthy habits, and builds connections (Hughes et al., 2022).
These strategies foster resilience without significantly increasing student or faculty workload. Similarly, these strategies could be seamlessly integrated into nurse residency programs, orientations, and continuing education by incorporating mindful pauses, debriefing, and reflection, strengthening well-being and resilience without imposing additional time demands.
Ongoing Support of NGN Well-Being
Our responsibility for shaping student well-being extends beyond the classroom as faculty maintain contact with NGN through clinical visits and supportive texts as they navigate the challenges of orientation and imposter phenomenon (Edwards & Maddox, 2022). These efforts, while not formalized in accreditation documents or tested on the NCLEX, significantly influence the caliber of our NGN and reflect our commitment to cultivating resilience, fostering mindfulness, and prioritizing personal well-being—qualities indispensable for navigating the multifaceted demands of a nursing career.
Conclusion
Equipping students with essential skills for a sustainable and fulfilling career will be transformational for systems historically plagued by burnout. Nurse educators bear the responsibility for shaping both competent clinicians and resilient professionals capable of thriving in healthcare’s ever-evolving landscape. Celebrating dedicated nurses across New Mexico requires acknowledging the profound impact of fostering resilience in our nursing students. Nurturing their well-being throughout their educational journey empowers them to navigate the profession’s challenges with fortitude and perseverance, ensuring a brighter future for healthcare in our state.
References
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