Personal and work-related factors associated with nurse resilience: An updated systematic review using meta-analysis and narrative synthesis

Abstract

Background

Nursing shortages and increased workforce turnover have significantly increased nurses' workloads, thus increasing the risk of burnout and stress, particularly during the COVID-19 pandemic. A systematic review published in 2019 suggested that resilience could act as a buffer to adversity; however, the factors associated with resilience during and after this global pandemic have not been identified.

Objectives

To identify personal and work-related factors associated with nurse resilience, including the period during and after the COVID-19 pandemic.

Design

Systematic review.

Data sources

The search was conducted between January and February 2024 in the following databases: CINAHL Plus, MEDLINE (Ovid), PsycINFO, EMBASE, and Scopus, using the key terms ‘resilience’, ‘hardiness’, ‘work’, ‘employ’, ‘occupation’, ‘job’, and ‘nursing’.

Review methods

Quantitative studies with English full text, published between 2018 and 2024, were selected if they assessed resilience and its associated factors among nurses providing direct patient care. Two authors independently completed the data selection process. Studies with quality assessment grades of 3 or above were included for final analysis. A meta-analysis was utilised for the mean resilience levels from studies using the same measures of resilience, and a narrative synthesis was performed for the demographic and work-related factors.

Results

Fifty-nine cross-sectional studies with a quality assessment score of 3 or above were included. Forty-seven studies were included in a meta-analysis, which reported an estimated mean resilience level of 20.69 using a random-effects model (95 % CI [18.53, 22.85], z = 18.79, p < 0.0001, I² = 95.1 %). Twenty studies with the Connor Davidson Resilience Scale (CD-RISC)-25 and five with the CD-RISC-10 were meta-analysed for the mean resilience levels of 62.85 (95 % CI: [55.60, 70.10], z = 16.97, p < 0.0001, I² = 31.70 %) and 26.34 (95 % CI: [20.85, 31.83], p < 0.0001, I² = 0 %), respectively. A low mean resilience level was identified. Sixteen demographic factors were identified as associated with resilience. Twenty job demand factors negatively associated with resilience were determined and categorised into exhaustion, psychological factors, and work challenges. Thirty-two job resource factors positively related to resilience were identified and classified into the following categories: psychological factors, leadership, work performance, well-being and quality of life, and social and organisational support.

Conclusions

Understanding the job demand and resource factors can help organisations minimise the risks and develop institutional strategies to protect nurses from the negative impact of COVID-19 or future pandemics on nurses' well-being.