A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Define and better understand burnout and moral distress. 2. Identify the impact that burnout and resilience have among nurses. 3. Discuss the results of the study.To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue. " No CE test fee for AACN members.Background The high level of stress experienced by nurses leads to moral distress, burnout, and a host of detrimental effects. Objectives To support creation of healthy work environments and to design a 2-phase project to enhance nurses' resilience while improving retention and reducing turnover. Methods In phase 1, a cross-sectional survey was used to characterize the experiences of a high-stress nursing cohort. A total of 114 nurses in 6 high-intensity units completed 6 survey tools to assess the nurses' characteristics as the context for burnout and to explore factors involved in burnout, moral distress, and resilience. Statistical analysis was used to determine associations between scale measures and to identify independent variables related to burnout. Results Moral distress was a significant predictor of all 3 aspects of burnout, and the association between burnout and resilience was strong. Greater resilience protected nurses from emotional exhaustion and contributed to personal accomplishment. Spiritual well-being reduced emotional exhaustion and depersonalization; physical well-being was associated with personal accomplishment. Meaning in patient care and hope were independent predictors of burnout. Higher levels of resilience were associated with increased hope and reduced stress. Resilience scores were relatively flat over years of experience. Conclusions These findings provide the basis for an experimental intervention in phase 2, which is designed to help participants cultivate strategies and practices for renewal, including mindfulness practices and personal resilience plans. (American Journal of Critical Care. 2015; 24:412-421)

Nurse leaders within a 43-bed pediatric intensive care unit introduced a pre-and post-implementation evidence-based practice project to determine which resilience enhancing techniques were helpful among a multidisciplinary team. A statistically significant increase in post-intervention group resilience (79.9 to 83.4, p < 0.0001) was achieved within 6 months of the "resiliency bundle" implementation. Forty-seven critical care staff including registered nurses, respiratory therapists, unit secretaries, medical doctors, chaplains, child life specialists, patient care techs, and nurse practitioners self-selected resiliency bundle components and provided their feedback and resilience level pre-and post-implementation. Preferred uses of resilience enhancement techniques were analyzed by discipline, experience level, and age. Note: We wish to express our gratitude to Mary Cazzell, PhD, RN, for her strategic planning support and statistical expertise. We would also like to show our gratitude to Cynda Rushton, PhD, RN, for sharing pearls of wisdom with us during the course of this project. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

A successful hospital network and university faculty collaboration offered 21 staff nurses and nurse leaders opportunities to develop clinical manuscripts that would be suitable for publishing their innovative ideas. This process prepared them to synthesize relevant literature and develop their ideas into manuscripts. Ten nurses submitted their final manuscripts to refereed journals, and nine individuals or team members had their articles accepted. These accepted publications provided a boost to individual career development and stimulated further valuable professional dissemination goals. One major challenge was to seek further ways to find time to write while working in today's health care arena. Suggestions for future manuscript development are provided.

Given that chief nursing officers (CNOs) play a critical role in hospital organizations and require a diverse set of executive leadership and professional competencies, what competencies are most critical? What kind of support is needed for a leader who is new to this executive role? What is needed to successfully on-board an experienced leader who is new to the organization? How can a CNO demonstrate the unique value he/she brings to the executive "C" suite? The author presents findings from on-boarding 6 new CNOs by using an in-depth 360-degree process to assess competency, an on-boarding development road map, and a CNO scorecard.

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Development of healthy professional practice/work environments (PPWEs) for nursing practice is critical to optimizing patient safety and workforce satisfaction while limiting turnover. Healthy PPWEs are linked with improved outcomes for patients, the workforce, and organizations. Nurses constitute the greatest professional segment of the US health care workforce and influence PPWEs, patient experience, health care quality, and cost per capita, all aspects of the quadruple aim. This article shares a model of leadership identified by executive nurse leaders to address and foster healthy PPWEs. A focus group of 16 expert nurse leaders convened an invitational meeting in Richmond, Virginia, to discuss nurse leaders' roles in optimizing the quadruple aim. The discussions led to shared perceptions about the prevalence of barriers to optimizing PPWEs; nursing leaders' responsibility to address the barriers to supporting improvement of the work-life of nursing professionals; and the need for early integration of leadership education, theory, and practice in every nurse's career.