https://orcid.org/0000-0001-8138-1746
ABSTRACT
Critical nursing shortages and experiences of burnout present a significant challenge in the home and community care (HCC) health sector. Determining what factors influence resiliency could inform HCC organizations in developing recruitment and retention resources and strategies. This scoping review identified factors that influence professional resilience in nurses working in the HCC sector. From 1819 documents identified from database searches, using a librarian-informed strategy, eight articles were included. Two domains emerged for HCC nurses, that is, i) professional and work-related characteristics of being resilient; and ii) strategies to promote professional nurse resilience. One domain emerged addressing organizational infrastructure, policy and practices contributing to professional nurse resilience in the HCC sector. The findings revealed that resiliency in HCC nurses extends beyond individual characteristics as nurse professionals, and their personal “self-care” strategies as individual people. Further research is needed to disentangle personal and professional resilience in nurses working in the HCC sector.
Introduction
A growing demand for home care services conjoined with the global nursing shortage has had repercussions for home and community care (HCC) sectors worldwide (Jarrín, Pouladi, & Madigan, Citation2019), creating an underpinning for challenging working conditions. The COVID-19 pandemic further exacerbated this nursing shortage, posing further challenges for point of care nurses working in HCC settings (Ghezeljeh, Shahrestanaki, Majdabadikohne, & Fakhari, Citation2022; Nyashanu, Pfende, & Ekpenyong, Citation2020). The challenges in the HCC context in Canada are similar to other countries such as Australia and United Kingdom, who are also experiencing a nursing shortage (Drennan & Ross, Citation2019). Similar to Canada, there is a need to improve the HCC sector to accommodate for the rapidly growing aging population, relieve pressure on acute care settings and mitigate the rising costs of healthcare (Ganann, Weeres, Lam, Chung, & Valaitis, Citation2019; Landers et al., Citation2016; Palesy, Jakimowicz, Saunders, & Lewis, Citation2018).
Registered Practical Nurse (RPN) staff shortages in the home and community care (HCC) sector have become particularly critical within the Ontario health care system during and following the Coronavirus-19 (COVID-19) pandemic. HCC services are formal provisions of care within the homes, schools, and communities (Government of Ontario, Citation2022) of individuals requiring support for living at home (Government of Canada, Citation2016). Amid a historical and continuing nursing shortage in Ontario, the RPN profession is at risk of losing almost half of their nurses across all health care sectors based on a 2022 survey (Registered Practical Nurses Association of Ontario [WeRPN], Citation2022b). Between 2019 and 2021, job vacancy rates for Registered Nurses (RNs) in Ontario increased to a level higher than any other occupation (Registered Nurses’ Association of Ontario [RNAO], Citation2021). Further, the Ontario Community Support Association (OCSA) reported in 2021 that, in the HCC sector in Ontario, 26.1% of all RN positions and 17.4% of other point-of-care healthcare worker positions (e.g., personal support workers, and occupational and physical therapists) were vacant (OCSA, Citation2022). Therefore, nurses in the Ontario HCC sector have the highest vacancy rate among all health professionals, providing evidence that the recruitment and retention of nurses in this sector represents a significant challenge. The concerning nursing vacancy rates and increasing reliance of the health care system on HCC services (Expert Group on Home and Community Care, Citation2015) make it an important area of focus.
Point-of-care nurses, those providing direct patient care, in the HCC sector broadly are reporting inadequate wages, high levels of “burnout” (Guo et al., Citation2018), declining mental and physical health (American Nurses Foundation, Citation2022), insufficient resources and chronic staffing shortages (RNAO, Citation2021) among the accumulating reasons for leaving this workforce. When nurses do not have the resources needed to provide quality patient care, they experience moral and emotional distress (Connelly et al., Citation2022) because of the tension this creates with their strong duty to care and sense of responsibility to their patients. The WeRPN survey conducted in 2022 reported deterioration in mental health for 59% of RPNs, including those working in the HCC sector, as a direct result of the staffing inadequacies in their workplace. Additionally, 79% of RPNs responding to the survey reported that they had reached a “breaking point” in their nursing career (WeRPN, Citation2022b). Current understanding of the factors leading to the “breaking point” or “burnout” being experienced among RPNs working in HCC is limited. The available research addressing nursing workforce coping or resilience-related constructs is situated mainly in acute and critical care settings (Alharbi, Jackson, & Usher, Citation2020; Ang, Uthaman, Ayre, Lim, & Lopez, Citation2018; Purvis & Saylor, Citation2019), or long-term care homes (Cameron & Brownie, Citation2010; Connelly et al., Citation2022; Cusack et al., Citation2016; Zhao et al., Citation2022). In response to nurse burnout, online resilience resources for non-sector-specific nurse professionals are provided to support mental health self-care. For example, the Lippincott® NursingCenter.com, an online site providing professional development resources for nurses, offers resilience tools and solutions for burnout (https://www.nursingcenter.com/journals-articles/article-collections/building-resilience-as-a-nurse). Mental health self-care and organizational resilience resources for nurses and point-of-care staff are posted on the Ontario WeRPN website (https://www.werpn.com/learn/practice-resources/self-care-for-nurses/mental-well-being/). Norouzinia et al. (Citation2022) recently developed a professional resilience tool for emergency nurses to support professional resilience in their return to the workplace after the traumatic incidents they experienced while on duty. The tool features an amalgamation of factors, including personal characteristics, work processes, and environment-related systems (King & Rothstein, Citation2010; McLarnon & Rothstein, Citation2013).
Given that longevity in nursing is related to the concept of resiliency, exploring professional resilience (Henshall et al., Citation2020) and organizational resilience (Wiig et al., Citation2020), in contrast to individual resilience (Ungar, Citation2011), may reveal professional and workplace factors influencing the experiences of “burnout” and “breaking point” in HCC nurses. A resilient healthcare organization prioritizes high-quality care (Wiig et al., Citation2020) and develops systemic processes to assist staff in appropriately responding to workplace challenges and unanticipated risks and events (Badu et al., Citation2020; Hillmann & Guenther, Citation2021; Mallak, Yildiz, & Mallak, Citation2016). Findings from the literature may help to inform strategies to retain the current workforce and attract new nurses to the HCC sector. To date, however, professional resilience is not well defined in the nursing literature. Jafarianamiri, Qalehsari, and Zabihi (Citation2022) suggest that nursing education lays the groundwork for developing professional identity and resilience in the workplace. Yet as a process and outcome of successful adaptation to challenging experiences, resilience in nurses is suggested by some researchers to be more than a nursing personality trait. For instance, Henshall, Davey, and Jackson (Citation2020) posit that the resilience of a nurse is a fluid process that is shaped by contextual and environmental circumstances (e.g., resources and policies). The intersections of the unique workplace challenges faced by nurses in the HCC sector, the rapid, increased demand for HCC services, and severe workforce shortages suggest that a greater understanding of the factors influencing the resilience of this workforce is needed. Therefore, the aim of this scoping review was to discover the extent of what is known (Grant & Booth, Citation2009) about the characteristics of nurses as professionals and the organizational factors that influence resiliency in HCC nurses. The findings from this review may be helpful in informing retention and recruitment strategies of the RPN workforce in this sector.
Methods
This scoping review was conducted in accordance with the five-step framework devised by Arksey and O’Malley (Citation2005), and refined by Peters et al. (Citation2015), using the Joanna Briggs Institute (JBI) scoping review methodology. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) (Tricco et al., Citation2018). The PRISMA-ScR framework includes items that are specific to scoping reviews and places less emphasis on criteria for systematic reviews, such as risk of bias assessment, effect measures, reporting biases, and the certainty of evidence (PRISMA, Citation2020).
Identification and selection of articles
The search strategy was developed in collaboration with an experienced university librarian and trialed using MEDLINE and CINAHL to identify relevant key words, search terms, and subject headings. MEDLINE, CINAHL, EMBASE, PsycINFO, and Scopus databases were searched, and a hand search was conducted on references of included articles (see ). The final search strategy used in Scopus was: nurs* AND (resilien* OR hardiness) AND (“home care” OR “community care” OR “home health” OR “community health” OR “home-based” OR “home based”). This Scopus search strategy was varied for use in the other databases as per controlled vocabulary/varying subject heading terms, commands, operators, and limiting options, as well as maintaining the same “root” key words (see ). Secondly, a search of the gray literature, using Canada’s Drug and Health Technology Agency (CADTH, Citation2019) checklist was completed on October 28, 2022, to increase transparency and potential for replication, and included 15 websites (see ). The inclusion and exclusion criteria for articles selected in the scoping review can be found in . No time limit was placed on the search, as no historical date could be identified that would make a time limit essential (see ).
Figure 1. Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) flow chart.
Table 1. Data extraction of eight included articles.
Table 2. Medical subject heading (MeSH) terms used for the MEDLINE database.
Table 3. The websites included in the gray literature search.
Table 4. Inclusion and exclusion criteria for the included scoping review articles.
Results from the searches were imported to Covidence (www.covidence.org), a web-based collaboration software platform that supports the completion of systematic and other literature reviews or syntheses. This software removes duplicates automatically and tracks actions needed to complete a review of the literature (Levac et al., Citation2010). Titles and abstracts were scanned independently by one author [EB], followed by a full text review of potentially eligible articles. Decisions on the inclusion or exclusion of an article, data extraction, and analysis were performed by two authors [EB, DC]. Discrepancies regarding inclusion/exclusion and data extraction were discussed by three authors [EB, DC, TSC] to reach consensus.
Data extraction
The following data were extracted from included articles into a pre-developed template, under the following headings: author, title, publication year, country, article type, purpose, participant population, methods, and key findings. Data extraction for each article was completed by two authors independently to ensure accuracy and comprehensiveness in content. Extracted data were compared and any discrepancy in the extracted data was resolved among three authors [EB, DC, TSC]. Data extracted from the included papers are presented in . The key findings from each article were categorized into domains to reflect factors influencing resiliency. Two authors [EB, DC] read through the articles several times to determine factors that influenced resiliency in nurses working in HCC. These factors were combined into broader categorizations and then refined into coherent domains (Arksey & O’Malley, Citation2005). Two authors participated in this process to ensure quality (Levac et al., Citation2010).
Results
The initial search identified 993 articles. After duplicates were removed and titles and abstracts were reviewed, and full text-screening was complete, eight articles met the inclusion criteria including: four primary studies (one qualitative, one quantitative, two mixed methods); three narrative reviews; and one commentary. The gray literature search yielded no results that matched the inclusion criteria. Most of the sources included information pertaining to resilience or HCC, but not together. From the gray literature, 826 sources were identified, one duplicate removed, and 825 sources screened. There were 787 records excluded from initial screening and 38 sources eligible for further screening. Sources were excluded because they did not include nurses (n = 6), were not inclusive of resilience (n = 16) or were not specific to the HCC sector (n = 16). The PRISMA-ScR flow chart illustrates the article screening process (). There were three domains identified from the literature, “characteristics of nurses as professionals that impact resilience;” “organizational factors that impact resiliency;” and “strategies to promote resilience among nursing staff.”
Characteristics of included articles
Seven of the eight included articles were published between 2012 and 2022, with one article published in 2005. Most of the included articles were published in England (n = 4), followed by the United States (n = 2), the Netherlands (n = 1), and Canada (n = 1). Individual interviews were used in the one primary research study using a grounded theory approach (qualitative methods; Penz & Duggleby, Citation2012) and focus groups for data collection in the two primary studies using mixed methods (Francis & Bulman, Citation2019; van den Bulck et al., Citation2022), in addition to a secondary analysis of a database and a standardized outcome measure. In the quantitative study (Judkins & Rind, Citation2005) and two mixed methods studies (Francis & Bulman, Citation2019; van den Bulck et al., Citation2022), standardized outcome measures (i.e., hardiness, nurse stress, job satisfaction, and clinical supervision evaluation) were completed independently by study participants. One of the mixed methods studies completed a secondary analysis of a services database (van den Bulck et al., Citation2022). The narrative reviews focused their discussion of findings within the context of strategies in the workplace to support nurses (Duncan, Citation2019; Hitt et al., Citation2012; Rogers, Citation2021). No data collection methods were reported for the commentary article (Moore, Citation2014). Further details are provided in . Definitions of resilience from each article, if included, can be found in .
Table 5. A summary describing the characteristics of the eight papers included in the scoping review.
Table 6. Definitions of resilience found in the articles included in the scoping review.
Participant and workplace characteristics
A total of 138 HCC nurses participated in the four primary research articles included in this review. There were 108 RNs studied and 30 nurses that were uncategorized. The terms used to describe the workplace of these nurses included “district nursing” (Duncan, Citation2019; van del; van den Bulck et al., Citation2022); “community palliative care” (Francis & Bulman, Citation2019; Penz & Duggleby, Citation2012); “home healthcare” (Hitt et al., Citation2012); “rural community” (Moore, Citation2014); “community nursing” (Rogers, Citation2021); and “home care” (Judkins & Rind, Citation2005).
Domains from the literature shaping resilience
From the synthesis of the extracted data, the findings were categorized within three domains: “characteristics of nurses as professionals that shape resilience;” “organizational factors that shape resiliency;” and “strategies to promote resilience among nursing staff.”
Characteristics of nurses as professionals that shape resilience
Four of the eight articles included in this scoping review discussed personality traits and qualities of resiliency in HCC nurses (see ). Two papers noted that resilient HCC nurses need to feel like their work is making a difference (Judkins & Rind, Citation2005; Penz & Duggleby, Citation2012). Additionally, HCC nurses need to be comfortable working independently, as much of their work is completed alone (Penz & Duggleby, Citation2012; Rogers, Citation2021). Other traits of HCC nurses included being self-compassionate (Hitt et al., Citation2012), easy-going, optimistic, and having a sense of humor (Penz & Duggleby, Citation2012) to cope with challenges at work.
Table 7. A summary of findings describing personality and work-related characteristics of being resilient as an individual person and HCC nurse (domain one).
Organizational factors that shape resiliency
Organizational factors that shape resiliency in nurses working in the HCC setting were noted in seven of the eight included articles (see ). Such factors included specific organizational actions that positively or negatively influence the resilience of their staff, including the level of support they show for their staff. Further, when resources are inadequate, the work is even more challenging and less fulfilling, which burdens the HCC nurse and negatively influences their resilience (Hitt et al., Citation2012). The most common factor shaping resiliency was staffing shortages. Staff shortfalls contribute to increased workloads, longer working hours, and less time for nurses to complete the tasks expected of them (Duncan, Citation2019; Moore, Citation2014; Penz & Duggleby, Citation2012; van den Bulck et al., Citation2022). Thus, a high workload/caseload can challenge nurses’ resiliency (Duncan, Citation2019; Hitt et al., Citation2012; Penz & Duggleby, Citation2012).
Table 8. A summary of findings from the literature describing nature of home and community care work, and organizational infrastructure, policy and practices contributing to being resilient as an HCC nurse (domain two).
Strategies to promote resilience among nursing staff
The third domain, which is discussed in six of the eight included articles, encompassed strategies that organizations and nurses enacted to promote resilience (see ). Resilient organizations prioritized mentorship for staff (Judkins & Rind, Citation2005; Rogers, Citation2021) and provided resilience training to help nurses learn coping strategies, as well as work as a team to overcome challenges together (Judkins & Rind, Citation2005). Such organizations developed a platform for nurses to voice their concerns (Hitt et al., Citation2012) and fostered an environment of appreciation (Judkins & Rind, Citation2005). Nurses used self-care, reward systems and reviewing daily habits as coping strategies (Hitt et al., Citation2012).
Table 9. Strategies to promote resilience amongst nursing staff (domain three).
Discussion
Resiliency is not only a personal characteristic, but reflects a confluence of professional, social, political, economic, and organizational factors that together (de)constructs it. This scoping review focused on the nature and extent of what is known about the characteristics of nurses as professionals and the organizational factors that shape resiliency among HCC nurses. Despite the growing importance of developing and maintaining resilient organizations amid global crises, there has been little research conducted on strategies to promote resilience within the HCC healthcare sector. Indeed, in this review, only eight published articles could be found since 2005 (Duncan, Citation2019; Francis & Bulman, Citation2019; Hitt et al., Citation2012; Judkins & Rind, Citation2005; Moore, Citation2014; Penz & Duggleby, Citation2012; Rogers, Citation2021; van den Bulck et al., Citation2022). None of the articles used the term organizational resilience, but most of them referred to strategies that organizations used to promote resilience. When they did use the term “resilience,” it was operationalized to suggest how individuals working in the organization could enhance their own resilience, that is individual resilience, to avoid stress and burnout.
The literature demonstrated hazy and indistinct conceptualizations of professional and organizational resilience. While it would appear that HCC nurses are at all times expected to demonstrate professional resilience in times of crisis, the operationalization of professional resilience appeared to suggest that nurses merely need adopt self-care strategies (e.g., a regular mindfulness practice; Halm, Citation2017; Shapiro, Astin, Bishop, & Cordova, Citation2005) to develop or exercise it. Self-care approaches, however, cannot be applied or practiced during work hours. Rather, the self-care strategies listed by organizations were expected to be performed by nurses on their own time and not at work, implying that the development of resilience is the responsibility of the nurse alone. This would suggest an individual – not organizational or systemic – understanding of resiliency.
The discussion of resilience has largely been individualistic in nature, which is problematic when it comes to understanding the professional perspective and/or organizational factors involved in influencing resilience in the HCC nursing workforce. The message conveyed in the literature currently suggests that the onus is on the individual nurse to navigate their own resilience, while simultaneously releasing organizations from creating environments that build professional and organizational resiliency among their staff (Traynor, Citation2018). Indeed, greater attention to broader organizational, political, and policy constraints could help shift the responsibility for the cultivation of resiliency away from the individual nurse and onto the systems and structures that generate the challenging conditions that adversely impact them and their work (Udod, MacPhee, & Baxter, Citation2021).
It is crucial to highlight, and distinguish between, the types of challenges that nurses experience in their work. Nurses are not only facing challenges that naturally come with the profession, such as working in isolation and dealing with grief, but they are also exposed to organizational and political decisions that affect their careers and physical and mental health and well-being. Understaffing, underfunding, and poor resource allocation all contribute to high turnover rates that erode resiliency (Traynor, Citation2018). As noted in this scoping review, organizations and policymakers need to be held accountable for their role in fostering environments that promote resilience in the nursing workforce. Despite the individual characteristics that can influence the cultivation of resiliency, there are other significant factors that impact the wellbeing of nurses, and their ability to build the resilience needed to effectively do their job. Focusing on resilience from a pluralistic perspective highlights the importance of the environment and workplace culture in resilience development (Aburn, Hoare, Adams, & Gott, Citation2020). Professional organizations can contribute to developing resilience in nurses by creating resources and supports, targeting specific health care sectors. A recent study by Connelly et al. (Citation2022) determined that RPNs’ professional resilience in long-term care homes was affected by their dynamic roles, how they preserved themselves on the job, and the peer and leadership support they received. These findings led to the development of resilience resources for nurses working in long-term care, by the province’s professional organizing body (WeRPN, Citation2022a), to assist nurses in navigating challenges unique to that particular environment. Similarly, Mallon, Mitchell, Carter, McLaughlin, and Wilson (Citation2023) suggested individual centered interventions, such as providing tool kits with adult coloring books, breathing exercises and online resources, are effective in improving nurse resiliency in hospital settings. Although non-sector specific resiliency tools and resources are available, a gap exists related to the development of specialized HCC resources that address the professional identity of the nurse, environment and culture of HCC workplace settings, and the policies and conditions that affect the work of this sector. Such resources could assist with retention in HCC organizations.
The HCC organizational practices, such as the level of support, shaped nurses’ resilience. Nurses in the included papers indicated that poor support from their organization, including from their colleagues, managers, and leaders, negatively shaped their resilience (Labrague, Nwafor, & Tsaras, Citation2020). Some papers discussed how nurses must manage uncertain demands and feelings of a lack of safety in their work environment during times of crisis (Duncan, Citation2019; van den Bulck et al., Citation2022). Many reported that they felt unsupported by their management (van den Bulck et al., Citation2022), causing rifts in their working relationships. However, being supported by one’s management is an important component of fostering organizational resilience, and working in an unsafe environment can constrain it (Wiig et al., Citation2020). Insufficient orientation and training were identified as factors which may have contributed to nurses’ perceptions of low support from their respective organizations. When top-down approaches were adopted to make important decisions in the organization, nurses perceived these tactics as limiting their autonomy and discounting their professional expertise (van den Bulck et al., Citation2022). Conversely, some HCC organizations were able to support their staff by working together. One paper discussed how crisis teams were created within HCC organizations and how they collectively built a strong communication system across the region (van den Bulck et al., Citation2022). Feeling valued and respected by their colleagues helped to offset some of the challenges that nurses felt on the job and promoted resiliency in the workplace (Penz & Duggleby, Citation2012).
Though the literature identified common characteristics of resilient nurses, it was difficult for nurses to develop resilience if their workplace environment did not itself promote resiliency. Congruent with other literature on resilience in the workplace, heavy workloads were one of the defining factors shaping HCC nurses’ resiliency (Banerjee, Armstrong, Daly, Armstrong, & Braedley, Citation2015; Cope, Jones, & Hendricks, Citation2016; Giesbrecht, Stajduhar, Cloutier, & Dujela, Citation2021). The lack of resources in the HCC setting, including shortages of resources (e.g., equipment and staff) challenged HCC nurses to meet the expectations of their clients and those they had set for themselves as professionals (Hitt et al., Citation2012; Penz & Duggleby, Citation2012). Often nurses were expected to adjust to increasing clinical and quality of care standards without an additional influx of resources (Duncan, Citation2019), challenging their ability to remain resilient in their work environment.
The approach healthcare organizations take to human resource management shapes the fostering of resiliency in the workforce. For instance, absenteeism during the COVID-19 pandemic impacted staffing and increased nurses’ workloads. Nurses were not permitted to take days off because replacement staff were not available. Widespread reports of stress and burnout due to high workloads and the fear of COVID-19 (re)infection and transmission impacted nurse resiliency (White, Wetle, Reddy, & Baier, Citation2021). Furthermore, when nurses felt like they were not able to provide the quality of care that they aimed to provide, their resilience was also adversely impacted (Penz & Duggleby, Citation2012). Therefore, strategies and resources (e.g., policies related to the provision of mental health or sick leave) are necessary not only to assure adequate staffing in HCC, but to support HCC nurses to provide high-quality care.
Some HCC nurses could not provide quality care as a result of larger social and political issues in the health care system. For example, some HCC nurses felt like patients were not receiving adequate care due to larger organizational structures, such as poor referral processes (Penz & Duggleby, Citation2012). Additionally, the trickle-down effects of persistent underfunding and retrenchment in the HCC sector impact the wellbeing and resilience of nurses (Duncan, Citation2019; Moore, Citation2014). The health care system is increasingly becoming more dependent on HCC to provide services that were previously offered in institutionalized settings, particularly in hospitals. This increased reliance, combined with an aging population and more people living with complex chronic conditions, means that the demands on HCC nurses are substantially higher than they were previously (Duncan, Citation2019). The increased number of referrals, without corresponding increases to staffing and resources, is having detrimental effects on the resiliency of HCC nurses (Duncan, Citation2019; Rogers, Citation2021).
This scoping review suggests how resilience is linked to the retention of staff. When staffing was in decline, the workloads of those who remained intensified. A high workload and limited time to provide quality care can create feelings of stress, professional worry and burnout for nurses (Guo et al., Citation2018). As a result, nurses are leaving the profession in record numbers, and this is compounding and exacerbating these issues for those who remain (WeRPN, Citation2022b). This scoping review highlights how investing in nursing and organizational resilience is beneficial.
HCC nurses that are more resilient have less stress-related illnesses and improved job satisfaction, contributing to better rates of retention (Rogers, Citation2021). A systematic review on resilience in nurses supports this finding and adds that resilience can help to protect nurses from burnout, anxiety, and depression (Yu et al., Citation2019). Resilience also influences turnover intention, which is critical when there are such significant gaps in the HCC sector (OCSA, Citation2022; Yu et al., Citation2019). Findings from a systematic review on nursing resilience, not specific to HCC, found that social supports are also important in enhancing resilience (Yu et al., Citation2019). This scoping review supports this claim, as clinical supervision and workplace bonding were factors that positively influenced the development of resilience amongst staff (Connelly et al., Citation2022; Francis & Bulman, Citation2019; Penz & Duggleby, Citation2012). Additionally, resilience can be cultivated when organizations show support for their staff (Connelly et al., Citation2022; McGilton, McGillis Hall, Wodchis, & Petroz, Citation2007; Zhao et al., Citation2021), provide adequate training (Zhao et al., Citation2021), and managerial leaders empower the nurses on their teams to feel like their work is making a difference in the lives of others (Cameron & Brownie, Citation2010). These strategies can be used across sectors to help build resiliency in health care organizations which could lead to higher rates of retention.
The study conducted by Judkins and Rind (Citation2005) was the only one identified by this review to have administered a resilience measurement tool (i.e., the Hardiness Scale; Bartone et al., Citation1989) to their sample of nurses. The Hardiness Scale (Bartone et al., Citation1989) views hardiness as a personality trait consisting of three components (i.e., control, challenge, and commitment), and not as attributes of the individual that can be nurtured or altered. In contrast, other resilience measurement scales, such as the Connor Davidson Resilience Scale focus on broader concepts than the nurse’s personality, such as how supported nurses feel at work (Connor & Davidson, Citation2003). Other studies focused on nurse resilience, although not in the HCC sector, used the Connor Davidson Resilience Scale (Connelly et al., Citation2023; Connor & Davidson, Citation2003), Resilience @ Work Scale (Connelly et al., Citation2023; Winwood, Colon, & McEwen, Citation2013), and Resilience at Work Team Scale (Connelly et al., Citation2023; McEwen & Boyd, Citation2018). Mallon, Mitchell, Carter, McLaughlin, and Wilson (Citation2023) also identified several studies measuring nurse resilience; however, all studies occurred in institutionalized settings, with the majority taking place in the hospital. HCC is a unique sector in which nurses have greater autonomy, which may affect the results of resilience for nurses working in that setting. Therefore, research assessing resiliency in nurses working in HCC is needed.
Of note, there were no RPNs explicitly represented in the HCC-specific literature reviewed. The majority of HCC nurses included in these papers were RNs, leaving a gap in understanding about the effects of organizational resilience in the HCC sector on RPNs during crises. Many RPNs provide HCC services (CNO, Citation2022) and have discussed the myriad of issues confronting their work environments (WeRPN, Citation2022b). To compound the nursing workforce resource problem, the number of individuals relying on HCC has increased in recent years and is expected to continue to grow as Ontario’s population ages (Expert Group on Home and Community Care, Citation2015). As a result of health care worker vacancies and the high demand for HCC services, organizations in this sector are hard-pressed to offer the same level and quality of services as before and are challenged under the weight of long wait lists (OCSA, Citation2022). In 2021, Home Care Ontario, an organization that represents home-care providers across the province, reported that around 4,000 nurses had left the HCC sector since the beginning of the COVID-19 pandemic. As a result, only 56% of care requests were fulfilled in 2021, compared to 95% of such requests being achieved before the start of the health emergency (Thompson, Citation2022). To combat higher vacancy rates and the resulting reduction in care services derived from them, strategies need to be enacted and resources developed to effectively recruit and retain nurses in the HCC sector into the future.
Limitations
A limitation to note is that it is possible that our inclusion criteria were too strict, such as only including papers that used “resilience” and not other terms that related to the concept; this specific criterion may have excluded relevant papers to the review. Even so, with no time limits or geographical restrictions placed on this search, only eight articles were found that discussed the concept of resilience or hardiness in HCC nurses. No quality assessment of the included articles was completed; although not required for a scoping review, this should be noted when considering the implications for practice and policy creation (Peters et al., Citation2015). Though nurse resilience as a construct has become increasingly more popular in the literature, significant gaps in the research evidence remain. As such, a dearth of research is available about resilience in nurses working in the HCC sector. However, this is the first scoping review focusing on the resilience of nurses working in the HCC sector, which is a strength of this review.
Conclusion
This scoping review identified several factors that influence resiliency in nurses working in the HCC sector. Certain characteristics of nurses, such as optimism and humor, are associated with being resilient; however, this should not be construed as a responsibility placed solely upon the individual to nurture and sustain. Characteristics of the work that HCC nurses do (e.g., performed in isolation), the expectations of their professional role as a nurse, and characteristics of the organization (e.g., staffing shortages, resource allocation practices, policies), strongly impact the cultivation of resiliency in nurses working in this sector. Social and political factors, such as chronic underfunding and the impact of an aging population, create added challenges to building and maintaining resilience in the nursing workforce. Regrettably, the conclusions drawn from this paper are supported by only a few (eight) articles on this topic. Further research needs to be conducted to measure and assess resiliency, particularly a more fulsome understanding of the construct of professional resiliency, which includes organizational and systemic factors, in the nursing HCC workforce, using both qualitative research (to gather nurses’ experiences and perceptions of resiliency) and quantitative methods (to construct valid and reliable resiliency scales).
Declaration
Nancy Snobelen is a research consultant contracted to WeRPN to design and implement WeRPN’s research strategic plan to encourage and pursue research involving registered practical nurses. Dr. Snobelen served as a member of the research team as in-kind resources from WeRPN to support the research, and conduct knowledge translation and exchange activities for WeRPN members and non-members.
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Supplemental data for this article can be accessed online at https://doi.org/10.1080/01621424.2024.2349526.
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References
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