Worldwide, nurses are facing increased pressure to provide high-quality complex patient care to patients within environments with scarce resources in terms of staffing, infrastructure, or financial reward [1,2]. The constant strain and demand placed on nurses working in highly pressurized and often unsafe conditions, and a lack of career structure or progression means many registered nurses’ resilience levels are tested due to stress and burnout [2-4]. This stress has intensified over the last couple of years due to the COVID-19 pandemic with nurses supporting the delivery of expert patient care and rapidly responding to substantial health care challenges [1]. While nurses’ contribution to keeping the public safe and protecting the National Health Service (NHS) in the United Kingdom during COVID-19 has been widely recognized, the resulting psychological impact on health and well-being has been substantial; resilience enhancement interventions are one way to tackle this growing problem within health care services [5-8].

The NHS has been facing increased pressure due to the pandemic conditions it is being subjected to [9]. This, in addition to the chronic pressures in terms of staffing, sickness, infrastructure, and financial problems, means that nurses are facing increased pressure [2] and are experiencing burnout, as they struggle to cope with the never ceasing demands of their job roles, which are in continuous high demand [4]. The NHS Health and Wellbeing Framework [10] sets the standards for how NHS organizations should support staff to feel well, healthy, and happy at work, and advocates for the delivery of evidence-based staff health and well-being plans [10]. Resilience-building programs [11-14] are recognized as important in contributing to increased psychological health and well-being in nurses as well as aiding recruitment and retention within international health care organizations [15,16].

Recent literature has recommended that resilience-building initiatives, including mentorship programs outside of nurses’ immediate workplace settings, are incorporated into nursing education, as well as specific self-development strategies to help enhance personal resilience [15]. Resilience programs have been found to build and enhance nurses’ resilience and can also support recruitment and retention for health care workers [16]. This has been evidenced in a number of recent workplace resilience enhancement interventions within nursing [17-22].

As a result of the need for targeted resilience enhancement interventions within the nursing setting, a UK-based resilience enhancement program was developed [22,23]. A detailed description of the theoretical background of the program is available elsewhere [22]. This face-to-face program targets four core components to improve the ability of the nurses to bounce back from day-to-day problems and to remain resilient in the workplace: workplace hardiness, emotional intelligence, critical thinking, and achieving life balance and enabling spirituality. These components were informed by a 2014 integrative review [15] that reported difficult workplace situations, feelings of emptiness, and a diminishing sense of inner balance as main contributing factors for resilience in nurses. Various strategies such as reflecting on emotions, interactions and guidance from peers and mentors, and skills to develop work-life balance and toughening up are shown to be helpful in building resilience.

The program consisted of six sessions with nurses that covered topics including building hardiness, maintaining a positive outlook, achieving work-life balance, reflective and critical thinking, and enabling spirituality [22,23]. In addition, one-to-one mentor sessions were provided over a 12-week period; senior nurse leaders within the participating trust took on these mentorship roles [23]. The face-to-face program was evaluated using pre- and postsurveys and interviews with nurses. Findings showed that nurses’ resilience levels were significantly higher after the training, with reported positive impacts on personal resilience, self-awareness, confidence, well-being, and professional and team-working relationships [22]. As a result, a wider rollout of the training was proposed. However, this planned rollout was disrupted by the onset of the COVID-19 pandemic due to social-distancing measures, making the face-to-face training untenable.

Due to the restrictions imposed by COVID-19, the face-to-face training program [22,23] was adapted and transformed to online training as a means of increasing accessibility for all nurses who were no longer able to attend face-to-face training. The online training was also informed by a recent systematic review examining the effectiveness of online interventions to enhance resilience in health care professionals (C Henshall, unpublished data, 2022) and focus groups with nurses to gather information on what they felt should be key features of an online resilience training program. An online format was felt necessary due to its potential to be rolled out widely to all nurses working in health care settings due to ease of accessibility, flexible access, and a decreased need for other resources such as physical space and in-person facilitation. The online resilience training, entitled Resilience Enhancement Online Training for Nurses (REsOluTioN), is relevant in the COVID-19 climate, where consideration about how to optimize the experiences of the nursing workforce and the resulting impacts on patient care are urgently needed.

In light of the above, the randomized controlled trial described in this paper aims to pilot REsOluTioN, an online resilience training for nurses working during COVID-19. Specific study objectives are:

The trial is now completed and was conducted online via the participating NHS trust’s LD e-learning platform in England between August 2021 and May 2022.

The trial findings will be presented in accordance with the CONSORT (Consolidated Standards of Reporting Trials) reporting guidelines [27].

The nurse-led REsOluTioN study will aim to empower nurses to maintain and enhance their resilience while working under challenging clinical conditions. The online training delivered will be interactive, with input from mentors, health care leaders, and peers, to promote engagement and enhanced communication between nurses, their teams, and wider health care organizations (C Henshall, unpublished data, 2022). We hypothesize that the online sessions will serve as a forum where nurses can express their views and concerns, without hierarchical infrastructures inhibiting them, while increasing self-knowledge and learning around workplace resilience coping strategies and providing a safe space to validate feelings through mentorship and peer support [23]. With increasing health care pressures and a shortage of health care staff, the need to promote and support nurses’ well-being through these evidence-based interventions is vital. This is even more apparent in the current COVID-19 health care climate, where rapid and innovative approaches to patient care are constantly required; this can have a deleterious impact on health care staff due to the pressures it entails. Strategies and training programs such as REsOluTioN that promote mechanisms that enable nurses to feel better equipped to manage the daily work stressors they encounter can have short- and long-term benefits, with positive impacts on well-being, recruitment, retention, and the quality and safety of patient care [16-23].

The mentor meetings incorporated into REsOluTioN have the potential to provide nurses with a platform to vocalize any challenges, worries, and concerns they are facing in a constructive supportive environment. Effective mentee/mentor relationships and interactions with senior leaders have been found to increase resilience and to help resolve workplace challenges through empowering mentees and increasing their self-confidence, developing personal and professional growth, and supporting career progression opportunities [28-31]. Mentoring relationships can also reinforce more junior nurses’ sense of value in the workplace when they are being mentored by senior colleagues who make time to listen and respond to their problems or concerns [30]. The integration of the regular mentorship support in the REsOluTioN trial will aim to build nurses’ resilience through the promotion of professional development, self-confidence, self-worth, and problem-solving capabilities.

This study is limited to one NHS trust in England, and as a result, demographic and contextual factors may influence the value of the resource to nurses working in a range of settings and environments. As such, if the findings show that the program is effective in improving nurses’ levels of resilience, REsOluTioN will be rolled out at a national level in a larger scale randomized controlled trial design. This will enable the generalizability of the findings across a range of health care settings and contexts. In the long term, it is hoped that REsOluTioN will be a valuable resource for nurses caring for patients in challenging clinical care environments during the global pandemic and beyond.

We will publish peer-reviewed journal reports on the trial process and outcomes. Presentations will be made at national and international conferences, including the Royal College of Nursing research conference (COVID-19 permitting). We will update the Burdett Trust for Nursing (funder) with regular updates for use in newsletters and web pages. We will also collaborate and network with local research infrastructure across the region to strengthen the research profile of the project and widen the reach of our research outputs.

Trialing REsOluTioN will enable preliminary data to be gathered to indicate its effectiveness in enhancing nurses’ resilience in the workplace, with the potential for larger scale follow-up studies to identify its value to nurses working across a range of health care settings. This may lead to REsOluTioN’s widespread implementation as it is embedded within health care organizations’ overarching health and well-being strategies, with resulting improvements in the resilience of the nursing workforce and subsequent improvements in patient safety and care quality outcomes.