Journal of Nursing Management, 2015

Surviving workplace adversity: a qualitative study of nurses and

midwives and their strategies to increase personal resilience

GLENDA MCDONALD P h D , B S o c S c 1, DEBRA JACKSON P h D , MN, BHSc, RN

2,3
, MARGARET H. VICKERS P h D 4
and LESLEY WILKES P h D , R N 5
1
Lecturer, School of Nursing and Midwifery, University of Western Sydney, Penrith, NSW, 2Professor of Nursing,
Oxford Brookes University, Oxford, UK, 3Professor of Nursing, University of New England, NSW, Australia,
4
Professor of Management, School of Business, University of Western Sydney, Sydney, NSW and 5Professor, Clinical
Nursing Research Unit, University of Western Sydney & Sydney West Area Health Service, Penrith, NSW, Australia

Correspondence
Glenda McDonald
University of Western Sydney,
School of Nursing & Midwifery,
Locked Bag 1797 Penrith DC
NSW
Australia
E-mail: g.e.mcdonald@uws.edu.au
MCDONALD G., JACKSON D., VICKERS M.H. & WILKES L. (2015) Journal of Nursing
Management
Surviving workplace adversity: a qualitative study of nurses and midwives
and their strategies to increase personal resilience
Aim To explore the experiences of Australian nurses and midwives who perceived
themselves as resilient. The focus of this paper is to report the strategies used by
a group of nurses and midwives to develop and maintain their resilience, despite
encountering serious workplace adversity.
Background Despite the potentially adverse effects of nursing work, many nurses
and midwives thrive through exercising self-efficacy and coping skills. The
relationship between thriving and resilience is clear, as resilience refers to the
ability to cope well with adversity and change.
Methods The participants were part of an instrumental, collective case study
investigation of personal resilience amongst nurses and midwives. Prior to an
innovative, work-based intervention including workshops and mentoring,
participants were interviewed to collect baseline perceptions and experiences of
personal resilience and workplace adversity. Interview transcripts were analysed
thematically.
Results Participants attributed their ability to thrive in the workplace to three
major influences: support networks, personal characteristics and ability to
organise work for personal resilience.
Conclusions Participant insights contributed to a deeper understanding of
personal resilience and highlight future initiatives to enhance the ability of nurses
and midwives to thrive within health organisations and systems.
Implications for nursing management It is vital that resilience-enhancing
initiatives, such as peer mentoring and tailored work options to increase
autonomy, are implemented at earlier career phases.
Keywords: health workforce, interviews, midwives, nurses, resilience, workplace
adversity

Accepted for publication: 1 February 2015

around the world (Appel et al. 2013, Foureur et al.

Introduction
2013). Research literature highlights the challenges
Sustainability of nurses and midwives is a key interest of that nurses face in the workplace; both personal
health organisations, nursing researchers and clinicians and organisational demands that can impact on work

DOI: 10.1111/jonm.12293
ª 2015 John Wiley & Sons Ltd 1
G. Mcdonald et al.
performance, health and well-being (Keller et al.
2009, Vessey et al. 2009, Schluter et al. 2011). The
concept of resilience is considered a primary factor in
the resolution of such workplace adversity (Jackson
et al. 2007). This suggestion was confirmed in a case
study involving a work-based, educational interven-
tion to assist participants to develop and maintain
their personal resilience in the face of workplace
adversity (McDonald et al, 2011; 2013). Despite
workplace adversity, many nurses and midwives are
able to sustain themselves physically, mentally and
emotionally (Koen et al. 2011). The insights of these
nurses and midwives contribute to a more complete
understanding of the development and maintenance of
personal resilience, and help to direct future initiatives
that will enhance the ability of others to thrive within
health organisations and health-care systems.
Aim
The focus of this paper is on strategies used by study
participants to develop and maintain their resilience
before the onset of the study intervention, while work-
ing in a context of ongoing workplace adversity. The
findings discussed are drawn from their pre-interven-
tion interviews.
Background
The terms ‘thriving’ or ‘flourishing’ have been used
to describe health-care professionals who self-rate
highly on parameters of job satisfaction, optimism,
sense of belonging and coping, group cohesiveness as
well as clinical competence (Duggleby & Wright
2007, Stordeur & D’Hoore 2007). An important
aspect of thriving is coping self-efficacy, which
defines people who maintain a strong belief that they
not only cope with whatever work stresses they meet,
but positively change the outcome of circumstances
(Koen et al. 2011). Thriving in nursing and mid-
wifery is also understood as the capacity to lead in
dynamic nursing roles and direct changes to practice
within challenging nursing environments (Stavrianop-
oulos 2012).
The relationship between thriving and resilience is
clear; early researchers referred to resilience as the
ability to cope well with significant change, adversity,
risk or stress (Wagnild & Young 1993, Jacelon 1997).
It is a broad term given to the cluster of personal
capacities that maintain equilibrium, despite negative
conditions. Individual attributes of resilience such as
hardiness, positive outlook, emotional intelligence and
2 Journal of Nursing Management
sense of coherence have been used to explain how a
person may absorb and recover from psycho-social
harm caused by adverse events or stressful work (Ab-
lett & Jones 2007, Jackson et al. 2007, Zander et al.
2010).
The construct of resilience is also conceptualised
from an ecological perspective. This view sees resil-
ience as existing within social and physical environ-
ments, influenced by interactions with self and
significant others, but just as importantly at organisa-
tional, community and sociocultural levels. The
quality of the environment or how successfully indi-
viduals adapt to their environment is a predictor of
resilience, in spite of the number and scale of adversi-
ties they face (Ungar 2011). Identified environmental
factors associated with resilience in nurses include the
presence of teamwork, interpersonal communication
practices, mentoring and support, clinical supervi-
sion, organisational recognition and reward for effort
(Jarman & Newcombe 2010, Breen & Sweeney
2013).
Methods
The study used a case study approach and qualitative
data collection methods to focus on the phenomenon
in question (Jirojwong et al. 2011). The study design
was an instrumental collective case study, investigating
a particular case of nurses and midwives over time.
The study aimed to investigate personal resilience by
means of an instrument; examining the ‘wholeness’ of
the specific case facilitated understandings (de Vaus
2014). Potential participants were recruited via flyers
and posters in the unit that promoted the study inter-
vention of six resilience workshops and a mentoring
programme where participants were matched with
retired nurse and midwife mentors. The nurses and
midwives who responded were provided with full
details of the study and, upon consenting to partici-
pate, were invited to discuss their experiences of
workplace adversity and perceptions of personal resil-
ience in a qualitative, face-to-face interview. Inter-
views were conducted at least 1 month prior to the
study intervention.
Study setting
The case study was set in a women’s and children’s
health unit within a tertiary, public hospital in metro-
politan Australia. The study’s unit of analysis com-
prised an ante-natal clinic, delivery suite, ante-natal
and post-natal wards.
ª 2015 John Wiley & Sons Ltd
 Strategies to increase personal resilience

ing in the workplace, understandings of resilience and

Participants their views on resilience enhancement through profes-
Table 1 below outlines the demographic details of the sional development.
16 case study participants and potential factors influ-
encing their experience of nursing work. Most of the
Data analysis
participants were Australian-born residents; three had
migrated from Europe or Asia. Although the partici- Thematic analysis was based on a non-linear process
pants told of negative effects of workplace adversity of comprehending, synthesising, theorising and re-con-
such as exhaustion, emotional labour and stress dur- textualising the words of the participants into an
ing the pre-intervention phase, there were six who authentic explanation of experiences (Polit & Beck
perceived themselves as ‘thriving’ within this environ- 2006). The process began with several readings of the
ment. transcripts, taking note of essential ideas, experiences
and opinions of participants (Borbasi & Jackson,
2012). Thick description was used to form clear,
Ethical considerations
articulate interpretations of the phenomena being
Ethics approval for the study was granted by the rele- explored. Then key aspects of both individual and col-
vant university and health service human research eth- lective perspectives were integrated to form themes.
ics committees. Specific ethical issues of anonymity
and confidentiality were encountered due to a small,
Rigour
closely knit target population. It was critical that great
care was taken during analysis so that nuances of In keeping with a qualitative, exploratory approach,
excerpts relating to participant experiences did not trustworthiness, rather than generalisability, was the
identify them or their colleagues. aim in this study (Polit & Beck 2006). Although find-
ings were based on a small sample, conclusions were
drawn from replication in a number of cases and rival
Data collection
explanations were maintained during analysis. Inter-
After giving their informed consent, the participants pretations of the participants’ insights and resilience
were interviewed at a convenient time and place on- strategies were considered in terms of their alignment
site at the hospital. The interviews were designed to with current resilience discourse and refined by the
be semi-structured and conversational, covering topics entire research team.
from the participants’ personal support networks,
work environment, experiences of surviving and thriv-
Results
The study participants were aware of the negative
Table 1
effects that nursing work caused to the health and
Demographical information of study participants
well-being of their colleagues, and reported that they
Years Employment
experienced similar burdens themselves at various
Pseudonym Age nursing Position mode
stages of their careers. Six of the 16 participants were
Vicky 59 15 Registered Nurse/Midwife PT, nights positive and confident about using protective mecha-
Rose 53 >19 Clinical Nurse Specialist FT, days
Patrice 53 23 Enrolled Nurse FT, rotation
nisms to limit the harmful effects of their everyday
Lynette 51 31 Registered Nurse/Midwife PT, days work. They drew on collegial support networks and
Marika 51 31 Clinical Nurse Specialist FT, days described other strategies that they believed enhanced
Lisa 48 3 Registered Nurse PT, rotation
Talia 46 20 Registered Nurse/Midwife PT, days their resilience in the workplace. Three major themes
Jodie 45 18 Clinical Nurse Specialist PT, rotation revealed how these nurses and midwives resolved the
Karin 41 18 Clinical Nurse Specialist PT, days
negative impact of workplace adversity: support net-
Alice 40 3 Registered Nurse/Midwife FT, rotation
(left at Phase 1) works for resilience, personal characteristics for resil-
Lauren 39 10 Enrolled Nurse FT, rotation ience and organising work for resilience (Table 2).
Neralie 37 20 Enrolled Nurse FT, rotation
Monica 34 0.6 Registered Midwife PT, rotation
(left after Phase 1)
Lucinda 33 12 Registered Nurse/Midwife PT, days
Support networks for resilience
Gillian 30 8 Registered Nurse/Midwife PT, rotation
Tina 26 3 Registered Nurse FT, rotation Interpersonal factors were identified as being useful for
the embodiment of personal resilience and thriving

ª 2015 John Wiley & Sons Ltd

Journal of Nursing Management 3
G. Mcdonald et al.
Table 2
Strategies to increase personal resilience
Theme Sub-theme
Support networks for resilience Collegial networks in the workplace
External support
Personal characteristics for Self-care
resilience Self-motivation
Organising work for resilience Autonomy
Optimistic approaches to work
within a potentially damaging workplace. Support
between colleagues in the workplace was an effective
form of protection against the effects of workplace
adversity for a majority of participants, and particularly
for those who considered themselves to be thriving.
Sub-themes of collegial networks in the workplace and
external support were identified.
Collegial networks in the workplace
The thriving participants were very aware of the role of
collegial support, believing it provided the most signifi-
cant benefit when facing challenges or negative out-
comes at work, even more effective than that of
support from partners or close friends. These partici-
pants had built an atmosphere conducive for positive
communication within their work environments. Rose
described her workplace as one where colleagues would
‘talk with each other a lot at work, we help each other’
and ‘download throughout the day’ when necessary.
Lynette, an experienced midwife, stated that her first
action when dealing with work concerns was informal
discussion with a colleague, signifying a depth of trust
and confidence in the support of her colleagues:
If we have any problems we can follow one of the
other girls up and say look, this is happening and
what do you suggest?. . . Just talking to someone
about it is fairly important and it would be hard to
cope if you didn’t have someone else to talk with.
[Lynette]
An important element of these support networks
was that colleagues shared ‘insider’ knowledge of the
organisational hierarchies and issues and understood
the subtleties of the relationship dynamics within the
department. These participants had built reciprocal,
supportive relationships with each other over years of
working together, sharing similar experiences of car-
ing for clients and dealing with workplace challenges.
They believed, because of these shared experiences,
their colleagues could best understand their feelings
and circumstances. Lynette recounted her experience
4 Journal of Nursing Management
of finding resolution from feelings of guilt and shame,
and regaining confidence in her nursing abilities after
mis-interpreting a client’s adverse test result:
You’d wake up and think ‘Oh no. This hap-
pened and I feel really badly about it,’ and then
you’d think about it all day. Eventually, talking
to [colleagues], getting their positive feedback,
reflecting on what happened, different ways of
responding and how I can improve in the future,
it just sort of gradually faded away. [Lynette]
Notably the majority of thriving participants
enjoyed work processes and conditions which sup-
ported sustainable relationships at work; they were
generally able to take meal breaks together, and they
worked regular hours so it was easier to arrange
opportunities for interaction and reciprocity, such as
car-pools. Thriving participants nominated support
they received from managers as also important for
their sense of coping and resilience. For Rose, having
an approachable person in the NUM (nursing unit
manager) position was an integral part of feeling
secure and satisfied in the job, and influenced her
sense of belonging and desire to stay in nursing:
[Her] door is always open if you’re stressed, you
can always knock on her door, sit down in her
office and go through it. [Rose]
External support
Another important factor associated with participants’
sense of resilience was supportive external relation-
ships – with partners, family and friends. The partici-
pants strongly believed these networks of support
increased their ability to feel emotionally secure and
to sustain a positive self-concept when dealing with
the negative events and conditions of their working
lives. Lucinda expressed the value she placed upon her
husband and her peer group who provided emotional
and practical support:
I have a very supportive husband, he’s good to
talk to and he does more than me on the home
front. . . I go to a Mothers Group. . . they’re a
really great support network. . . [Lucinda]
Personal characteristics for resilience
Personal factors associated with resilience were seen
as crucial to withstanding the effects of workplace
ª 2015 John Wiley & Sons Ltd

adversity. These nurses and midwives perceived that
their personal skills and resilient attributes which had
developed over time contributed to their sense of com-
petency and wellness. In addition, personal practices
supporting holistic health and well-being, and self-
affirming beliefs about themselves and their ability to
change situations to their advantage had helped them
to persevere, sometimes over long careers, despite per-
sistent and potentially damaging problems with their
workplace. Two sub-themes of self-care and self-moti-
vation emerged as significant personal characteristics
for resilience.
Self-care
Participants who felt they flourished in the work envi-
ronment described how they purposefully engaged in
a range of therapeutic activities when not working
which allowed rest, relaxation and distraction from
worrying aspects of work. The concept of self-care
outside work was more widely understood and preva-
lent amongst the participants than work-based strate-
gies. Participants believed that reflective activities,
such as music, yoga, reading, journaling and massage
were relaxing and helpful for dealing with workplace
stress. Higher energy or interactive activities such as
dancing, gardening, socialising with friends and spe-
cial interest groups were also helpful for some partici-
pants. Alice described gardening among her self-care
strategies:
I just go home, put some music on and I’ll go
and do some gardening. . . start digging away, do
some pruning, cut all my trees down! And I do
reflect. [Alice]
As with Alice, solitary activities contributed to self-
care for several participants. They found it useful to
disengage completely from other people through activ-
ities such as solitary swimming or running, seeing a
movie or having a regular day alone:
Going for a run is very therapeutic. I love the en-
dorphins. They’ve got music video screens in the
gym and I’ll just zone out of what’s happening,
I’ll not be aware that anyone else is actually
beside me, just. . . in this completely other place.
[Neralie]
Some participants found that knowing their limits
and protecting personal energy levels was a necessary
part of self-care. Although Lisa did not consider her-
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management
Strategies to increase personal resilience
self to be thriving, she revealed insights into self-pres-
ervation when she stated her need to conserve energy
outside working hours and linked this practice to pro-
tecting herself from the effects of workplace adversity:
I have a tendency to do more than I should, but
I know I have to rest, so I’m careful about what
I do [off shift], that’s a priority. I have to be
aware of the limits because I don’t want to do
anything that’s going to prevent me from contin-
uing work. [Lisa]
Self-motivation
The use of intentional, self-motivating thought pat-
terns and behaviours was also beneficial in sustaining
the participants’ sense of hardiness and well-being.
Cognitive strategies, such as self-affirmations and posi-
tive self-talk, were helpful for some in mitigating some
of the harsher effects of the workplace. Other partici-
pants motivated themselves through reading self-help
or inspirational books. One participant, Rose, who
described herself as thriving, recounted how she man-
aged stressful work experiences, such as caring for
women having terminations or those whose babies
had died. By drawing on her philosophical approach
to her work in such circumstances, she motivated her-
self to maintain effective nursing practice while man-
aging the stress:
If I can make that woman’s stay as pleasant as
possible, I know I’ve done a good job. . . and it
doesn’t hurt [me] as much. I’ve learnt these strat-
egies over the years and it’s only experience that
gives it to you. [Rose]
Organising work for personal resilience
Participants described the ability to fashion their roles
within the health organisation as a means of enhanc-
ing their sense of fulfillment. They found ways to
increase their personal autonomy within their roles
and organised their work to emphasise the satisfying
aspects, which helped them cope with the work-based
difficulties they faced. These measures facilitated self-
recognition of their contribution in an atmosphere of
little formal acknowledgement, instilling some intrin-
sic rewards. Work became more personally rewarding
with greater scope for leadership, decision-making and
enjoyable challenges. Further, sub-themes of auton-
omy and optimistic approaches to work emerged from
5
G. Mcdonald et al.
the analysis of the process of organising work for per-
sonal resilience.
Autonomy
One area of work that provided job satisfaction and
influenced feelings of competence and control was the
degree of autonomy. Participants recalled how, when
they were able to focus on those elements of their prac-
tice they found personally fulfilling, or were performing
roles of greater responsibility but also greater control,
there was a positive effect on their feelings of psycho-
social health and well-being. They found working in
interesting specialised roles, even if for only part of the
time, was a good strategy for resilience. These specialist
roles also provided respite from the overloaded pace of
the wards and the harsh gaze of colleagues:
When I have my own clinic I have autonomy
and it’s great. . . I’m thriving. . . I get lots of posi-
tive feedback from the people I see, and I know
I do a good job. [Lucinda]
The participants who had greater control over their
work were able to concentrate on providing person-
centred care and meaningful engagement with their
clients, which reinforced feelings of efficacy, confi-
dence and job satisfaction. In fact, understanding the
links between autonomy and resilience to negative
workplace effects had led some participants to take
actions at work that enhanced feelings of autonomy.
Talia recounted how she followed up the women she
had cared for in the ante-natal clinic after they moved
out of her work sphere:
It’s very hard to find the time to see [women] on
the ward. I look up their birth on the com-
puter. . . make follow-up calls and speak to them
at home in between [appointments]. . . it could
be just 5 minutes touching base. . . but one little
thing can make a difference. [Talia]
Optimistic approaches to work
Fortunately, the participants’ enjoyment of their work
counteracted, to an extent, the more negative factors
of their jobs. The thriving participants unanimously
stated that they loved the work they were doing, it
was interesting, stimulating and rewarding. They felt
their work gave them purpose and fulfilled a need for
their clients, as Lisa expressed, ‘my special interest is
talking to those mums who have difficult circum-
6 Journal of Nursing Management
stances’. They valued the scope for change and variety
within their roles and enjoyed the diverse range of
women and families they engaged with in their every-
day practice. One participant, Marika, who had
enjoyed a long career, summed up this positive atti-
tude to the nature of her work.
We do something different each day. . . this
morning I was team leader. . . tomorrow morning
I’ll have a clinic. It is a good job. [Marika]
Discussion
For the participants in this study the most significant
form of protection from workplace adversity was col-
legial networks of support. This is in keeping with
earlier literature identifying collegial networks as a
crucial element of workplace resilience (Jackson et al.
2007). In this study, the participants who believed
they were thriving had established reciprocal relation-
ships which resulted in helpful information being con-
veyed when needed, reduced stress in individuals and
enabled smoother, effective processes of patient care.
Their supportive networks enabled successful naviga-
tion through the organisational hierarchy, which less-
ened the personal burden experienced and positioned
participants for greater job satisfaction and potential
career advantage. Their collegial networks reinforced
a sense of belonging which influenced the positive atti-
tudes towards the workplace and kept their commit-
ment to work alive. The link between a sense of hope
and purpose in nurses and the quality of their work-
place relationships was found to be significant in ear-
lier research (Duggleby & Wright 2007). The role of
collegial support in helping to resolve negative self-
judgements and loss of confidence as a result of clini-
cal errors or adverse effects on patients was revealed.
The participants perceived that the most effective
source of support for this kind of setback was colle-
gial support. The importance of experiencing authen-
tic peer support and mentoring to overcome
challenges in nursing work has been discussed in other
research findings (Cortese et al. 2010).
Personal practices of self-care and motivation also
emerged as primary ways that nurses and midwives
help themselves maintain a sense of equilibrium in
challenging, sometimes chaotic, workplaces. Previous
research proposed the advantages of workers in large-
scale organisations possessing optimism and flexibility
(Avey et al. 2010). Generally, the study participants
were pro-active and committed to ensuring they did
ª 2015 John Wiley & Sons Ltd

not become overwhelmed and devised their own strat-
egies to manage or disconnect from stressors. It is vital
that nurses and midwives are encouraged and sup-
ported to set up and maintain their psycho-social
health and well-being in a habitual and disciplined
way. Although self-care and self-motivation emerged
as the most important factors for these nurses and
midwives, they may be considered part of a range of
resilient personal characteristics, including optimism,
flexibility, hardiness, emotional insight and life bal-
ance (Jackson et al. 2007). Recent research has
expanded the notion of self-care to more than tempo-
rary, pleasurable activities that distract from work-
place stressors and boost energy levels (Richards
2013). Rather, habitual maintenance of physical and
emotional health and well-being should be seen as key
to personal and professional resilience.
Adapting one’s work for improved resilience is
another way that nurses and midwives can thrive
within environments affected by workplace adversity
(Hodges et al. 2008). Most study participants who
perceived themselves as coping well despite the diffi-
culties they faced at work were older, senior women
who had worked in the unit longer than their peers.
They had gained influential positions, sometimes
informally, due to their clinical expertise and experi-
ence coupled with tacit, insider knowledge about the
people and processes of the workplace. Finding ways
to incorporate satisfying elements into their daily
work routines or re-framing a positive approach to
negative situations brought them a sense of job satis-
faction. In most cases this had taken some time to
accomplish; as well, perseverance through times of dif-
ficulty and disillusionment had been required.
Although the dictates of working in large, complex
health organisations can make this difficult (Schreuder
et al. 2010), the insights of the study participants sug-
gest that even small or incremental changes can pro-
vide significant benefits and protection from the
effects of workplace adversity. Of course, health or-
ganisations should not be excused from taking action
broadly, definitively and systematically to improve the
work experiences of their employees.
Implications for nursing management
There are significant and timely implications from
these findings for nursing management. It was note-
worthy that routinely taking meal, water or toilet
breaks were not a feature of these study participants’
workplace behaviours promoting self-care. Further
determinations about the beliefs of nurses and mid-
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management
Strategies to increase personal resilience
wives regarding self-care in the workplace could lead
to better implementation of work-based programmes
to improve health and well-being. The experiences
and insights of the study participants reinforce the
importance of sustained workforce initiatives that
encourage and support nurses and midwives as they
develop, enhance and maintain their personal resil-
ience. There are clear potential benefits of facilitating
opportunities at work for nurses and midwives to
uncover and build on their personal strengths, and to
promote strategies that they create themselves – for
themselves. This could mean nursing managers
become more open to new and different activities in
work spaces during work time that allow team mem-
bers to share and reaffirm their collective knowledge
about thriving amongst workplace adversity. Positive
steps could range from simple, having a ‘resilience rec-
ipe swap’ in the tea-room, to more elaborate, regular
training and development about resilience. The signifi-
cant feature of initiatives is that of team members pre-
senting and sharing their abilities with colleagues,
building a cohesive professional identity of resilience.
Fostering informal peer mentoring, with particular
attention to building supportive networks between
new graduates or newcomers and more established cli-
nicians, could more rapidly develop a sense of belong-
ing amongst staff.
The introduction of measures that assist nurses and
midwives to increase their personal autonomy at ear-
lier career stages would be another step forward, tai-
loring roles and work tasks wherever possible to align
with the aspects that staff members find personally
satisfying. This requires creating a work environment
where team members feel secure in putting forward
their genuine likes and dislikes about their job.
Responding to team member attributes and prefer-
ences for work tasks and variety, within reason, may
also support them to feel hopeful and recognised
within the workplace, even when their perceived goals
are not immediately achievable.
The findings of this study confirm previous argu-
ments (McAllister & McKinnon 2009) that nursing
management must ensure new graduates and early-
career nurses and midwives are aware of the potential
effects of workplace adversity on their health and
well-being. Nursing graduates may be forewarned of
the potential dangers of professional burnout and may
have practised self-reflection techniques; they should
also understand how developing personal resilience
could assist them to meet the demands of their
careers. Ample opportunities exist in the workplace
for including reflection on the aspects of personal
7
G. Mcdonald et al.
resilience described in this study. Individual team mem-
bers could then develop personally meaningful resil-
ience strategies. This element of workplace culture
requires substantial attention by those endeavouring to
improve the work environment of nurses and midwives.
Limitations
The self-selected nature of the participants means
there was potential for other nurses and midwives
working at the selected hospital department, or
another site, to have different perceptions and experi-
ences than those expressed in the findings.
Conclusion
The insights of resilient nurses and midwives have
important benefits for new graduates, mid-career health
professionals and health organisation management
regarding the personal and organisational initiatives
that may enable all nurses and midwives to enhance
their ability to withstand workplace adversity.
Source of funding
The authors would like to acknowledge this research
study was supported by the Australian Research
Council LP0668875. The views expressed herein are
those of the authors and are not necessarily those of
the Australian Research Council.
Ethical approval
This research study, HREC 07/106, was granted ethics
approval by the UWS Human Research Ethics Com-
mittee & Sydney West Area Health Service Human
Research Ethics Committee.
References
Ablett J. & Jones R.S. (2007) Resilience and well-being in palli-
ative care staff: a qualitative study of hospice nurses’ experi-
ence of work. Psycho-Oncology 16, 733–740.
Appel L., Labhart L., Balczo P., McCleary N., Raley M. &
Winsett R. (2013) A comparative study of a happiness inter-
vention in medical-surgical nurses. MEDSURG Nursing 22
(5), 319–324.
Avey J.B., Luthan F., Smith R.M. & Palmer N.F. (2010) Impact of
positive psychological capital on employee well-being over time.
Journal of Occupational Health Psychology 15 (1), 17–28.
Borbasi S. & Jackson D. (2012) Navigating the Maze of
Research: Enhancing Nursing and Midwifery Practice, 3rd
edn. Elsevier Australia, Chatswood, NSW.
8 Journal of Nursing Management
Breen M. & Sweeney J. (2013) Burnout: the experiences of
nurses who work in inner city areas. Mental Health Practice
17 (2), 12–20.
Cortese C., Colombo L. & Ghislieri C. (2010) Determinants of
nurses’ job satisfaction: the role of work–family conflict, job
demand, emotional charge and social support. Journal of
Nursing Management 18, 35–43.
Duggleby W. & Wright K. (2007) The hope of professional
caregivers caring for persons at the end of life. Journal of
Hospice and Palliative Nursing 9 (1), 42–49.
Foureur M., Besley K., Burton G., Yu N. & Crisp J. (2013)
Enhancing the resilience of nurses and midwives: pilot of a
mindfulness-based program for increased health, sense of
coherence and decreased depression, anxiety and stress. Con-
temporary Nurse 45 (1), 114–125.
Hodges H.F., Keeley A. & Troyan P.J. (2008) Professional resil-
ience in baccalaureate-prepared acute care nurses: first steps.
Nursing Education Perspectives 29 (2), 80–89.
Jacelon C. (1997) The trait and process of resilience. Journal of
Advanced Nursing 25 (1), 123–129.
Jackson D.E., Firtko A. & Edenborough M. (2007) Personal
resilience as a strategy or surviving and thriving in the face of
workplace adversity: a literature review. Journal of Advanced
Nursing 60 (1), 1–9.
Jarman H. & Newcombe P. (2010) Support for nurses who are
new to emergency care. Emergency Nurse 17 (9), 16–19.
Jirojwong S., Johnson M. & Welch A. (2011) Research Meth-
ods in Nursing & Midwifery: Pathways to Evidence-based
Practice. Oxford University Press, South Melbourne.
Keller S.M., Berryman P. & Lukes E. (2009) Effects of
extended work shifts and shift work on patient safety, pro-
ductivity, and employee health. AAOHN Journal 57 (12),
497–502.
Koen M., van Eeder C. & Wissing M. (2011) The prevalence of
resilience in a group of professional nurses. Health SA Ges-
ondheid 16 (1), 1–11.
McAllister M. & McKinnon J. (2009) The importance of teach-
ing and learning resilience in the health disciplines: a critical
review of the literature. Nurse Education Today 29, 371–379.
McDonald G., Jackson D., Wilkes L. & Vickers M. (2011) A
work-based educational intervention to promote personal
resilience in nurses and midwives. Nurse Education Today 32
(4), 378–84. doi:10.1016/j.nedt.2011.04.012
McDonald G., Jackson D., Wilkes L. & Vickers M. (2013) Per-
sonal resilience in nurses and midwives: Effects of a work-
based educational intervention. Contemporary Nurse 45(1),
139–148.
Polit D. & Beck C. (2006) Essentials of Nursing Research:
Methods, Appraisal, and Utilization, 6th edn. Lippincott Wil-
liams & Wilkins, Philadelphia, PA.
Richards K. (2013) Self-care is a lifelong journey. Nursing Eco-
nomic 3 (4), 198–202.
Schluter P.J., Turner C., Huntington A., Bain C. & McClure R.
(2011) Work/life balance and health: the Nurses and Midwives
e-cohort study. International Nursing Review 58, 28–36.
Schreuder J.A., Roelen C.A., Koopmans P.C., Moen B.E. &
Grodhof J.W. (2010) Effort–reward imbalance is associated
with the frequency of sickness absence among female hospital
nurses: a cross-sectional study. International Journal of Nurs-
ing Studies 47 (5), 569–576.
ª 2015 John Wiley & Sons Ltd

Stavrianopoulos T. (2012) The clinical nurse leader. Health Sci-
ence Journal 6 (3), 392–401.
Stordeur S., D’Hoore W. (2007) Organizational configuration
of hospitals succeeding in attracting and retaining nurses.
Journal of Advanced Nursing 57 (1), 45–58.
Ungar M. (2011) The social ecology of resilience: addressing
contextual and cultural ambiguity of a nascent construct.
American Journal of Orthopsychiatry 81 (1), 1–17.
de Vaus D. (2014) Surveys in Social Research, 6th edn. Allen &
Unwin, Crows Nest. Available at: http://www.eblib.com,
accessed 4th December 2014).
ª 2015 John Wiley & Sons Ltd
Journal of Nursing Management
Strategies to increase personal resilience
Vessey J.A., DeMarco R.F., Gaffney D.A. & Budin W. (2009)
Bullying of staff registered nurses in the workplace: a prelimin-
ary study for developing personal and organizational strategies
for the transformation of hostile to healthy workplace environ-
ments. Journal of Professional Nursing 25 (5), 299–306.
Wagnild G. & Young H. (1993) Development and psychometric
evaluation of the Resilience Scale. Journal of Nursing Mea-
surement 1 (2), 165–178.
Zander M., Hutton A. & King L. (2010) Coping and resilience
in pediatric oncology nurses. Journal of Pediatric Oncology
Nursing 27 (2), 94–108.
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