Greetings everyone and welcome to the Haelan Nurse Chronicles podcast. I’m your host, Dr. Lorre Laws. For those of you who are just tuning in, I’m an author, nurse scientist, educator, and trauma/burnout expert. I’m so happy that you’re here!
Today, we are diving into a critical topic resilience . . .which is a hot term that millions of nurses are feeling gaslit by. And for good reason, because resilience, as currently touted, fails to address the substantial avoidable trauma exposure that nurses endure secondary to system or organizational inadequacies.
The resilience concept came to the forefront amid the pandemic. Organizations and healthcare systems are pounding the resilience drums 🥁🪘🥁to the point where many (many!) nurses feel gaslighted by the term. Rather than focusing on the system, organizational, and setting factors that are taking nurses to or beyond their capacity, the mainstream messaging has shifted to focus (dare I say blame?) to nurses who should, essentially, suck it up buttercup? 🌻🌻🌻
Here’s a few examples I pulled from a quick internet search:
Media and social media are replete with resilience artifacts that imply that there is an infinite wealth of resilience within every nurse. That no matter what happens, no matter how much stress, how much trauma exposure, nurses can always dig a little deeper within to be the “backbone of patient recovery”.
Well, guess what.
Every nurse, every human has their breaking point.
In current practice conditions, we aren’t talking about the stressors that are inherent with the professions. We’re talking about avoidable nurse-specific trauma exposure that is almost always attributable to system, organization, and/or setting inadequacies.
Let’s unpack resilience and then examine it through the lens of Porges’ Polyvagal Theory.
The American Psychological Association defines resilience as “the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands.”
Now, with that in mind, let’s check the popular assumption in the media, which is frequently used to gaslight nurses, if there is a never-ending well of resilience within any given nurse.
Below is a chart that is widely available, and I believe it is an excerpt from Deb Dana’s(LSW) work.
For those of you who aren’t familiar with Polyvagal Theory, it describes the hierarchy of responses from midbrain processes of neuroception, which Porges refers to as the “Threat Detector”. The Threat Detector has one job . . .to keep you safe. Every waking nanosecond, the Threat Detector scans the external conditions and triangulates that data with internal conditions – including similar experiences or traumas from the past that are unintegrated . . . or what I like to call unhealed bits of wisdom.
The Threat Detector then signals to the autonomic nervous system and/or the ventral vagal aspect of the vagus nerve and/or the dorsal aspect of the vagus nerve. As we all know, the ANS and vagus nerve are huge physiological modulators that drive physical, emotional, behavioral, and social responses.
As nurses, our role is to be fully present with those in our care to deliver safe, high quality, heart-centered, and patient-centered care. For a nurse to be optimally present and open, the external conditions must be perceived by the Threat Detector as safe. If external conditions are perceived as safe, then a signal for the ventral aspect of the vagus nerve comes online – as shown in the lower green part of the chart. below.
So, let’s say for the purposes of this example, that you’re coming on to shift, getting report, and the unit is calm and your patients are settled in for now. Chances are that your Threat Detector is detecting a relatively safe environment, and signals for the ventral vagal circuit to come online. You’re feeling grounded, open, compassionate, and present. In other words, you’re calm, cool, collected, and connected (within and with others).
The day starts ramping up as does the stress level. No problem. We’re all hard wired to manage stressors of daily life and even stressors of nursing absent the avoidable nurse trauma exposure. The Threat Detector signals for the SNS to come online to address the stressors. You’re probably feeling a little more alert and activated. You’re in the “I can” zone, meaning the stressors are perceived as manageable. This is reflected by the lower part of the red zone.
What should happen in a nurse’s practice, is that the stressors and trauma exposures should be such that they can vacillate between ventral vagal and SNS “I can” activation, as shown by the sine wave between the green and red zones. That’s where nurses are practicing within their Window of Tolerance. Nurses should always be practicing primarily from their Window for it is from that place that they are most present, open, compassionate, and mindful. There would be a whole crap-ton less of medical errors, near misses, and adverse or sentinel events if the healthcare system and organizations would prioritize safety and professional wellbeing.
But. That. Is. Not. The. Case.
Instead, nurses are burdened with more and more stress. More and more nurse trauma exposure, most of which is avoidable. Do more with less. Do more with less. Do more with less. It’s a common mantra in healthcare these days.
Nurses are doing amazing work, despite harsh practice conditions. But they can only do so much with less. As the stress and trauma exposure presses on . . .for hours, days, weeks, months, and years . . .it takes a huge cumulative toll. Nurses practice from a place of sympathetic overdrive – the I should, I must zones. They are so overworked, stretched so thin that their SNS can’t sustain them. Physiologically and emotionally, nurses reach the point of overwhelm, the “I can’t” zone at the bottom of the blue chart section.
That’s when the Threat Detector signals for the dorsal aspect of the vagus nerve to come online and start shutting you down to conserve energy. The mitochondria literally cannot make ATP fast enough. The stressors and trauma exposures are simply too great. Millions of nurses are practicing in an overwhelmed physiological state, feeling hopeless, shame, guilt, shut down, depressed, hopeless . . .and the list goes on.
This. Is. Why. Nurses. Are. Leaving. The. Profession. En. Masse.
It’s not because they’re burned out, per say. It’s because there is only so much the human body can do. We are not built for hyperacute levels of stress on a chronic timeline. If the mitochondria can’t keep up, we have a much bigger problem, for that leads to oxidative stress, metabolic rigidity, and a host of chronic health conditions. I’ll drop a chart in the show notes that describe how this happens, with immense gratitude to Dr. Robert Naviaux who brought for the Cell Danger Response Theory.
To be clear, this is the limiting factor where resilience is concerned. There is not an unlimited supply of resilience, and it’s inversely proportional to a host of homeostasis altering stressors. Among those stresses is nurse-specific psychological trauma, most of which being avoidable.
Until health systems, organizations, and units get to the root cause of resilience challenges, the mass nurse exodus will continue.
Practice conditions are so unsafe that nurses are being affected right down to the level of their mitochondria.
But there is hope, a pathway from surviving in practice to thriving in it. It is mission critical for nurses to learn how to insulate themselves from harsh practice conditions, learn the language of their nervous system and vagus nerve so they can practice within their Window of Tolerance, safely.
I discuss all this and more in my book, Nursing Our Healer’s Heart: A Recovery Guide for Nurse Trauma and Burnout, which is available to order wherever books are sold, or you can visit
If you’d like to learn more about if and how you’re being affected, please take my five-question self-survey that literally takes less than 30 seconds to do. I’ll send you a detailed report outlining how you’ve been impacted along with steps you can take today to start your healing journey.
Nurses are incredibly resilient people or they wouldn’t have made it through nursing school in the first place 😅😅😅
It’s not about resilience. It’s about the need for safe and supportive working conditions to ensure that every nurse is thriving within their Window of Tolerance. For when nurses are thriving, patients do too by way of improved safety, care quality, and outcomes.
Safe and supportive working conditions are the backbone of patient outcomes . . .not just resilience.
Until next time, thank you for all that you are and do. From my healer’s heart to yours, namaste.
Dr. Lorre 💕
