The COVID-19 pandemic was an intensely taxing time to be a nurse. An unprecedented number of critically ill patients combined with the constant unknowns of this deadly, contagious virus produced the perfect conditions for record burnout among nurses. Loma Linda University School of Nursing (LLUSN) Professor Elizabeth Johnston Taylor, PhD, RN, FAAN recalls, “I was reading how awful it was inside hospitals, how burned out and stressed nurses were. Indeed, data from national surveys of RNs showed how difficult work (and life) was for them. Yet, I wasn’t at the bedside, and wondered: ‘What could I do to help?’” This question motivated Dr. Johnston Taylor to design and complete a study, funded and supported by LLUSN, to generate evidence that would potentially improve nurses’ personal and professional experience at the bedside. Though she wasn’t “boots on the ground” she hoped her research would further the timely conversation around nurse well-being and perhaps illuminate ways to ease suffering and bolster resilience for nurses in a particularly demanding time.
As a researcher, Dr. Johnston Taylor has long been interested in the spiritual well-being of nurses and patients as it relates to patient care. Her research has spanned the spiritual needs of patients and families, nurse-chaplain collaboration, and how nurses provide spiritually based therapeutics for chronically and critically ill patients. This background was a natural segue to her most recent LLUSN-funded research initiated in 2020, which was recently published in two prominent research journals.
The first report, “Do Nurse Spiritual Responses to Trauma Explain Nurse Outcomes? A Correlational Observational Study,” was published in the Journal of Clinical Nursing in 2023. At the outset, Dr. Johnston Taylor conjectured nurses may experience both positive spiritual growth and traumatic spiritual struggling in tandem. The study was designed to measure moral injury (psychological distress experienced when personal values or ethical codes are violated), spiritual struggle (distress caused by doubts, threats to meaningfulness, relationship with God, and other aspects of spirituality or religiosity), and post-traumatic growth (positive growth experienced following highly challenging circumstances). Dr. Johnston Taylor and her research team’s initial report showed that in a sample of over 500 nurses across three Southern California hospitals, 41% experienced spiritual growth, roughly 50% experienced moral injury, and between 25-33% experienced spiritual struggle. Moderate correlations between these variables supported Dr. Johnston Taylor’s initial hypothesis, confirming nurses often experience both positive and negative spiritual consequences simultaneously. Apparently, hardship and growth can go hand in hand, though neither is comfortable.
The second report on this research, just released in Nursing Outlook in 2024, presents the findings of how these spiritual responses to providing nursing care were associated with nurse outcomes. Nurse outcomes measured included job satisfaction, burnout, and intent to leave the nursing profession. The research team found significant associations between these responses and nurse outcomes. Of particular significance was how much a nurse’s spiritual struggle contributed to burnout and intent to leave nursing. Dr. Johnston Taylor said, “I was surprised—and privately pleased—because this concept is new in nursing science and is an especially important one: to find that spiritual struggle so significantly explained nurse burnout and intention to leave nursing. Spiritual struggle predicted these nurse outcomes even more than moral injury.”
Though the 2020 pandemic was the catalyst for this research, Dr. Johnston Taylor was surprised to find the frequency with which nurses provided direct care to people with COVID-19 was not correlated with moral injury or spiritual struggle! This insight was unexpected and could be the result of a few factors. One explanation could be that providing care in the pandemic environment was similarly spiritually stressful for all nurses, creating a new baseline for how nurses assessed their stress. An alternative explanation is that the most stressed nurses simply were unable to respond to the survey. Despite this surprising discovery, the study ultimately showed what Dr. Johnston Taylor suspected: “... a nurse’s inner, supposedly hidden, spiritual responses to providing patient care does affect him/her in measurable ways.”
We know nurse burnout is a serious concern—a somber reality not only impacting nurses personally and professionally but one that ripples outward to affect health care on a large scale. For these reasons, there is great interest in caring for and supporting nurses before burnout occurs. Dr. Johnston Taylor suggests a key first step to achieving this is, “ … recognizing and addressing spiritual struggle—a hidden, yet profound inner response to witnessing suffering.” She goes on to say, on a hopeful note, “The findings [of this study] also indicate that post-traumatic growth is possible and likewise can impact nurse outcomes.”
By supporting research like Dr. Johnston Taylor’s study, LLUSN continues to contribute to the nursing field and deepen collective understanding of the challenges nurses face daily. This study reinforces the importance of providing holistic support to nurses to create a more sustainable and compassionate work environment. By investing in the well-being of nurses, we not only improve their lives but ultimately elevate the quality of care delivered to patients.