Purpose: To determine the effect of integrating mindfulness training into an existing nurse residency program on stress, burnout, and mindfulness.
Significance/background: Anxiety, stress, and burnout are endemic in the health care profession. Lyndon (2016) estimated the prevalence of burnout in health care providers at 50-70%. Researchers have demonstrated that increasing mindfulness and resilience could mitigate stress and burnout, limit the adverse sequelae, and improve both the workplace environment and patient outcomes (Perla et al., 2017; van den Riet, Levett-Jones, & Aquino-Russell, 2018). Gilmartin et al. (2018) demonstrated that even brief mindfulness practices were associated with favorable changes in stress, anxiety, and burnout in acute care providers. Moreover, transition to practice can be associated with stress and anxiety for newly licensed nurses (Boehm & Tse, 2013).
Description: This scholarly project assesses the impact of integrating mindfulness training into a large system nurse residency program for newly licensed nurses by offering four 1-hour-long interactive learning activities along with tools, reminders, and a log for self-practice throughout their first six months of practice. Burnout, stress, and mindfulness were measured via an online survey at the beginning of the February 2020 residency cohort with repeat measures at three and six months. Validated assessment tools used: burnout – Physician Work-Life Study’s Single Item (PWLSSI) (Dolan et al., 2015) and the Oldenburg Burnout Inventory (OBI) (Demerouti, 2008); stress - The Perceived Stress Scale (PSS) (Cohen, Kamarck, & Mermelstein, 1983); and mindfulness - The Mindfulness Attention and Awareness Scale (MAAS) (Brown & Ryan, 2003). The surveys were completed anonymously online, and there was minimal risk to the participants in this improvement project. The outcome measures were analyzed using an unpaired t-test comparing scores from a non-intervention cohort and the intervention cohort.
Evaluation/outcome: The scores were compared for stress, burnout, and mindfulness scales were compared at pre-program and post-program (6 months). Pre-program, there was no significant difference between cohorts for PSS, WLSSI, or the MAAS. There was a significant difference in the OBI scores. MAAS scores were higher pre-program for the intervention cohort than the non-intervention cohort, and there was a significant difference between the non-intervention and intervention cohorts on all three areas at post-program. Perceived stress was higher for the non-intervention cohort compared to the intervention cohort. Burnout was higher for the non-intervention cohort compared to the intervention cohort. Finally, mindfulness was lower for the non-intervention cohort compared to the intervention cohort.
Given the COVID-19 pandemic, this was a timely intervention that appears to have help mitigate stress and burnout for this population while increasing their mindfulness. Therefore, mindfulness training will be fully integrated in the nurse residency program for future cohorts and possible added to other curricula. Outcome measures will continue to be tracked and the mindfulness training adjusted based on stress measures and resident feedback.