Using Measures of Psychological Resilience to Predict Burnout among NICU Nurses

Abstract

Objective

Psychological resilience (PR) is a trait that supports individuals as they attempt to overcome the negative factors and stressors experienced in life. Neonatal intensive care unit (NICU) nurses encounter considerable stress while providing care for medically vulnerable infants and because of this, are at risk for emotional burnout (EB). Literature suggests that PR may protect against burnout but investigation of PR and its relationship with EB in NICU nurses is limited.

Study Design

The ResMed PR questionnaire and the Emotional Burnout scale (EBS) were distributed to both day and night-shift neonatal nurses with over 6 months of experience working at a large academic NICU in order to investigate the relationship between these two concepts.

Results

In total 92 of 124 NICU nurses returned the survey, resulting in a response rate of 74%. The mean years of NICU nursing experience was 9.30. The average total ResMed score was 68.65 with domain scores of 21.78 for job-related gratification, 28.69 for protective practices, and 18.2 for protective attitudes. Regression analysis demonstrated a negative relationship between PR and EB, indicating that higher PR was associated with lower EB and suggesting a protective effect of PR against EB.

Conclusion

This study provides insight into levels of PR and burnout amongst NICU nurses within a large academic NICU. These findings allow for the development of programs and strategies by healthcare leaders and institutions to maximize neonatal nursing health and well-being.

Key Points

• This study found a negative relationship between PR subscales and EB.

• This indicates that higher PR is associated with lower burnout.

• In this study, 40% of nurses tested positive for EB.

• Interventions targeted at improving nursing PR may be effective in managing EB.

Keywords

neonatal nursing - emotional burnout - resiliency - NICU

Publication History

Received: 15 January 2025

Accepted: 13 May 2025

Accepted Manuscript online:
14 May 2025

Article published online:
24 June 2025

• References

• 1 Pijl-Zieber E. et al. Moral distress: an emerging problem for nurses in long-term care?. Qual Ageing Older Adults 2008; 9 (02) 39-48
• 2 Fiske E. Nurse stressors and satisfiers in the NICU. Adv Neonatal Care 2018; 18 (04) 276-284
• 3 Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and factors associated with nurse burnout in the US. JAMA Netw Open 2021; 4 (02) e2036469-e2036469
• 4 Halbesleben JR, Wakefield BJ, Wakefield DS, Cooper LB. Nurse burnout and patient safety outcomes: nurse safety perception versus reporting behavior. West J Nurs Res 2008; 30 (05) 560-577
• 5 Braithwaite M. Nurse burnout and stress in the NICU. Adv Neonatal Care 2008; 8 (06) 343-347
• 6 Shanafelt TD, Boone S, Tan L. et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012; 172 (18) 1377-1385
• 7 Tawfik DS, Sinha A, Bayati M. et al. Frustration with technology and its relation to emotional exhaustion among health care workers: cross-sectional observational study. J Med Internet Res 2021; 23 (07) e26817
• 8 Sexton JB, Adair KC. Forty-five good things: a prospective pilot study of the three good things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness. BMJ Open 2019; 9 (03) e022695
• 9 Wei H, Roberts P, Strickler J, Corbett RW. Nurse leaders' strategies to foster nurse resilience. J Nurs Manag 2019; 27 (04) 681-687
• 10 Fletcher D, Sarkar M. Psychological resilience: a review and critique of definitions, concepts, and theory. Eur Psychol 2013; 18 (01) 12-23
• 11 Kester K, Wei H. Building nurse resilience. Nurs Manage 2018; 49 (06) 42-45
• 12 Mealer M, Jones J, Newman J, McFann KK, Rothbaum B, Moss M. The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey. Int J Nurs Stud 2012; 49 (03) 292-299
• 13 Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care 2015; 24 (05) 412-420
• 14 Bozdağ F, Ergün N. Psychological resilience of healthcare professionals during COVID-19 pandemic. Psychol Rep 2021; 124 (06) 2567-2586
• 15 Windle G, Bennett KM, Noyes J. A methodological review of resilience measurement scales. Health Qual Life Outcomes 2011; 9: 8
• 16 Cooper AL, Roberts G, Hegney DG, Brown JA. A scoping review of instruments used to measure resilience in samples of nurses. J Adv Nurs 2025; (e-pub ahead of print).
• 17 Norouzinia R, Yarmohammadian MH, Ferdosi M, Masoumi G, Ebadi A. Development and psychometric evaluation of the emergency nurses' professional resilience tool. PLoS One 2022; 17 (06) e0269539
• 18 Wei W, Taormina RJ. A new multidimensional measure of personal resilience and its use: Chinese nurse resilience, organizational socialization and career success. Nurs Inq 2014; 21 (04) 346-357
• 19 Squires A, Aiken LH, van den Heede K. et al. A systematic survey instrument translation process for multi-country, comparative health workforce studies. Int J Nurs Stud 2013; 50 (02) 264-273
• 20 O'Connor P, Lydon S, O'Dowd E, Byrne D. The relationship between psychological resilience and burnout in Irish doctors. Ir J Med Sci 2021; 190 (03) 1219-1224
• 21 O'Connor P, Lydon S, Byrne D. Initial psychometric evaluation of a psychological resilience measure for physicians. Int J Healthc Manag 2019; 1-7 https://doi.org/10.1080/20479700.2019.1677024
• 22 Profit J, Sharek PJ, Amspoker AB. et al. Burnout in the NICU setting and its relation to safety culture. BMJ Qual Saf 2014; 23 (10) 806-813
• 23 Maslach C. J.S., Maslach Burnout Inventory. Consulting Psychologists Press, Inc; Palo Alto, CA: 1981
• 24 Whittington KD, Shaw T, McKinnies RC, Collins SK. Emotional exhaustion as a predictor for burnout among nurses. Nurs Manage 2021; 52 (01) 22-28
• 25 Tawfik DS, Phibbs CS, Sexton JB. et al. Factors associated with provider burnout in the NICU. Pediatrics 2017; 139 (05) e20164134
• 26 Barr P. Burnout in neonatal intensive care unit nurses: relationships with moral distress, adult attachment insecurities, and proneness to guilt and shame. J Perinat Med 2020;
• 27 Sullivan D, Sullivan V, Weatherspoon D, Frazer C. Comparison of nurse burnout, before and during the COVID-19 pandemic. Nurs Clin North Am 2022; 57 (01) 79-99
• 28 Zareei M, Tabanejad Z, Oskouie F, Ebadi A, Mesri M. Job burnout among nurses during COVID-19 pandemic: a systematic review. J Educ Health Promot 2022; 11: 107
• 29 Fox S, Lydon S, Byrne D, Madden C, Connolly F, O'Connor P. A systematic review of interventions to foster physician resilience. Postgrad Med J 2018; 94 (1109) 162-170
• 30 Henshall C, Davey Z, Jackson D. The implementation and evaluation of a resilience enhancement programme for nurses working in the forensic setting. Int J Ment Health Nurs 2020; 29 (03) 508-520
• 31 Kriakous SA, Elliott KA, Lamers C, Owen R. The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: a systematic review. Mindfulness (N Y) 2021; 12 (01) 1-28
• 32 Cocchiara RA, Peruzzo M, Mannocci A. et al. The use of yoga to manage stress and burnout in healthcare workers: a systematic review. J Clin Med 2019; 8 (03) 284
• 33 Panagioti M, Panagopoulou E, Bower P. et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med 2017; 177 (02) 195-205
• 34 Jennings BM. Advances in Patient Safety Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions, in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, R.G. Hughes, Editor. 2008. Agency for Healthcare Research and Quality (US); Rockville (MD):
• 35 McDonald K, Rubarth LB, Miers LJ. Job satisfaction of neonatal intensive care nurses. Adv Neonatal Care 2012; 12 (04) E1-E8
• 36 Manomenidis G, Panagopoulou E, Montgomery A. Resilience in nursing: the role of internal and external factors. J Nurs Manag 2019; 27 (01) 172-178
• 37 Hudek-Knezević J, Kalebić Maglica B, Krapić N. Personality, organizational stress, and attitudes toward work as prospective predictors of professional burnout in hospital nurses. Croat Med J 2011; 52 (04) 538-549
• 38 Sood A, Prasad K, Schroeder D, Varkey P. Stress management and resilience training among Department of Medicine faculty: a pilot randomized clinical trial. J Gen Intern Med 2011; 26 (08) 858-861
• 39 Sood A, Sharma V, Schroeder DR, Gorman B. Stress management and resiliency training (SMART) program among Department of Radiology faculty: a pilot randomized clinical trial. Explore (NY) 2014; 10 (06) 358-363
• 40 De Hert S. Burnout in healthcare workers: prevalence, impact and preventative strategies. Local Reg Anesth 2020; 13: 171-183
• 41 McLeod CC, Klabunde CN, Willis GB, Stark D. Health care provider surveys in the United States, 2000-2010: a review. Eval Health Prof 2013; 36 (01) 106-126
• 42 Cho YI, Johnson TP, Vangeest JB. Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response. Eval Health Prof 2013; 36 (03) 382-407
• 43 Mills M, Cortezzo DE. Moral distress in the neonatal intensive care unit: what is it, why it happens, and how we can address it. Front Pediatr 2020; 8: 581
• 44 Fourie C. Who is experiencing what kind of moral distress? Distinctions for moving from a narrow to a broad definition of moral distress. AMA J Ethics 2017; 19 (06) 578-584