Digital Repository Masters Projects Spring 2024 Effect of Resilience Training on Change Fatigue and Job Satisfaction of Apheresis Nurses Roy Sellers Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Sellers, R. 2024. Effect of Resilience Training on Change Fatigue and Job Satisfaction of Apheresis Nurses Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Effect of Resilience Training on Change Fatigue and Job Satisfaction of Apheresis Nurses Project Title by Roy Sellers Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 4/26/24 Date Roy Sellers, RN, BSN, MSN Student 4/26/24 Student Name, Credentials (electronic signature) Date JoAnn Tolman, DNP, MSN-Ed, RN, CNE 04/26/2024 MSN Project Faculty Date (electronic signature) 04/26/2024 (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Effect of Resilience Training on Change Fatigue and Job Satisfaction of Apheresis Nurses Roy Sellers BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: This project aims to provide resilience training for a small apheresis nursing unit by instructing the nurses in techniques of self-resilience, alleviating stressors of change fatigue, tolerating work-related changes, and improving job satisfaction. Rationale/Background: Change fatigue leads many nurses to burn out. Apheresis nurses are susceptible to change fatigue due to the low number of staff and how fast apheresis technology and science are developing. Addressing the apheresis nurses' knowledge gap and being selfresilient when confronting significant change is essential to nursing job satisfaction and retention. Healthcare workers trained in resilience skills mitigate the adverse effects of change fatigue. Methods: The Iowa Model of Evidence-Based Practice guides this project. The project manager provides resilience training to the five apheresis nurses to address the knowledge gap in selfresilience and help people cope with the effects of workplace changes. Training is scheduled once a week for five weeks. A week before and after the training, the nurses take a pre-and postsurvey to evaluate change fatigue, job satisfaction, and resilience techniques. Results: The literature shows that resilience training benefits nurses by improving job satisfaction and tolerating workplace changes. This project's expected results are that the nurses will have less fatigue from the planned change and increased job satisfaction at each stage of the changes implemented in the unit. Conclusions: Resilience training should continue as part of nursing unit and clinic staff education. Keywords: change fatigue, resilience, burnout, job satisfaction, retention, apheresis. 3 Effect of Resilience Training on Change Fatigue and Job Satisfaction of Apheresis Nurses Change fatigue, marked by persistent mental and physical exhaustion from organizational change, is becoming increasingly challenging in nursing (Beaulieu et al., 2022; McMillan & Perron, 2020). Nurses often experience a high volume of organizational and clinical changes as science progresses, technology advances, and care delivery changes (Tremolada et al., 2015). Change fatigue occurs when multiple professional and organizational changes occur in the same period. The stress and pressure of the changes can cause mental and physical fatigue (McMillan & Perron, 2020). Even capable nurses who can tolerate multiple changes can be susceptible to change fatigue due to dynamic working conditions and environment (Beaulieu et al., 2022; McMillan & Perron, 2020). Significant changes have impacted nurses who work in apheresis units in the last several years, making apheresis nurses susceptible to change fatigue (Tremolada et al., 2015). For example, apheresis nurses must learn the protocols for collecting cellular products for a growing number of gene, regenerative, chimeric antigen receptor T-cell (CAR-T), and stem cell transplant therapies (Association for the Advancement of Blood & Biotherapies [AABB], 2022). Many changes during the same period can push nurses to exhaustion and negatively impact their job satisfaction (McMillan & Perron, 2020). People experiencing change fatigue display apathy, disengagement, fatigue, and frustration, and they frequently lack enthusiasm and optimism about the ongoing changes (Beaulieu et al., 2022; McMillan & Perron, 2020). Resilience training strategies are known to help nurses reduce the symptoms of change fatigue (Cleveland Clinic, 2019; McMillan & Perron, 2020; National Institute for Children's Health Quality [NICHQ], 2023; National Institute of Environmental Health Sciences [NIEHS], n.d.). Strategies include building individual and team resilience and preparing the team for 4 engagement in the change process (Cleveland Clinic, 2019; McMillan & Perron, 2020; National Institute for Children's Health Quality [NICHQ], 2023). However, nurses may need to learn about resilience techniques or how to apply them. Nurses and nursing teams would benefit from resilience training to avoid increased stress and decreased job satisfaction during significant change (Cleveland Clinic, 2019; McMillan & Perron, 2020; National Institute for Children's Health Quality [NICHQ], 2023). Statement of Problem The nursing profession is known for its dynamic nature with changing technologies, practices, and policy updates (Association for the Advancement of Blood & Biotherapies [AABB], 2022; Beaulieu et al., 2022; Nam et al., 2019; Paine & Prochnow, 2022). The stress associated with adapting to constant changes can negatively affect nurses' mental and physical well-being (Tremolada et al., 2015). Apheresis nurses are susceptible to change fatigue due to the organization of their training and the required procedures completed. Nurses working in apheresis units must be competent in using specialized equipment, assessing different age groups, and diagnosing people treated with apheresis procedures (Cojocari, 2015). They coordinate routine and urgent treatment procedures, complete therapeutic exchange and cellular collection procedures, and perform data collection, audits, and unit maintenance (Cojocari, 2015). The apheresis unit utilized for this MSN project is undergoing significant changes in the form of an organizational merger, needing to harmonize procedures, align standards of practice, and adopt a new electronic health record (EHR). Amidst change, the apheresis nurses also provide on-call support during the night, weekends, and holidays (R. Sellers, personal communication, October 30, 2023). These process changes can create a change fatigue crisis for the nurses (McMillan & Perron, 2020). 5 Nurses could benefit from resiliency training to help overcome the effects of change fatigue and burnout to improve the quality of care delivery and job satisfaction (Bernerth et al., 2011; Brown et al., 2018; National Institute for Children's Health Quality [NICHQ], 2023). The apheresis nurses in the evaluated apheresis clinic have a knowledge gap in understanding how to have self-resilience when confronting significant changes to decrease change fatigue (Beaulieu et al., 2022). Providing resilience training to apheresis nurses may positively impact their ability to cope with changes, minimize fatigue, and improve their motivation, job satisfaction, and commitment to their roles (Bernerth et al., 2011; Brown et al., 2018; National Institute for Children's Health Quality [NICHQ], 2023; Tremolada et al., 2015). Significance of the Project Change fatigue may contribute to nurse turnover, exacerbating nursing shortages and increasing recruitment and training costs for healthcare organizations (Bernerth et al., 2011; Brown et al., 2018; McMillan & Perron, 2020; Tremolada et al., 2015). This MSN project is significant because it introduces resiliency training to apheresis nurses to enhance their ability to manage the stress from changes at work and improve job satisfaction (Brown et al., 2018). Resilience training is currently unavailable at the apheresis clinic (R. Sellers, personal communication, October 30, 2023), and this MSN project fills this gap. Apheresis units must maintain collection procedure capabilities to sustain the expected growth of rapidly developing research and treatment products of gene and t-cell therapies (Association for the Advancement of Blood & Biotherapies [AABB], 2022; Nam et al., 2019). The demand to produce chimeric antigen receptor T-cells (CAR-T) may grow from 400,000 in 2019 to over 2 million by 2029 (Nam et al., 2019). As a result, Apheresis nurses need to learn new protocols and procedures (Association for the Advancement of Blood & Biotherapies 6 [AABB], 2022), likely increasing stress, causing change fatigue, decreasing job dissatisfaction, and possibly contributing to nurses leaving their jobs (Brown et al., 2018; McMillan & Perron, 2020). Resilience training programs help develop individual and team resilience by building up the ability to cope with stress, adapt to demands and changes in the work environment, and improve overall well-being and job satisfaction (Cleveland Clinic, 2019; National Institute of Environmental Health Sciences [NIEHS], n.d.; Schmuck et al., 2022). When implemented, resilience programs can transform workplace culture, empowering people to support each other in challenging situations (Cleveland Clinic, 2019; National Institute for Children's Health Quality [NICHQ], 2023; National Institute of Environmental Health Sciences [NIEHS], n.d.). Individual and team support helps build and maintain a stable workforce, enhance nursing retention rates, and improve the quality of care delivered. (Cleveland Clinic, 2019; National Institute for Children's Health Quality [NICHQ], 2023; National Institute of Environmental Health Sciences [NIEHS], n.d.). This MSN project aims to provide resilience training before a period of significant changes in an apheresis clinic to teach the nurses how to care for and strengthen themselves to minimize the impact of change fatigue and improve job satisfaction (Cleveland Clinic, 2019; National Institute for Children's Health Quality [NICHQ], 2023; National Institute of Environmental Health Sciences [NIEHS], n.d.). The training helps the nurses understand the impact of change fatigue on themselves and their co-workers, recognize the signs of it earlier, and implement preventative measures before fatigue becomes exhaustion (McMillan & Perron, 2020). 7 Review of the Literature Change is a constant in the healthcare industry, driven by technological advancements, increasingly complicated patient needs, and changing standards of practice and policies (Beaulieu et al., 2022; Paine & Prochnow, 2022). Change fatigue in nurses caused by multiple or significant changes happening at the same period impacts the quality of care delivered and decreases job satisfaction (Beaulieu et al., 2022; McMillan & Perron, 2020). This literature review examines the existing literature for evidence supporting resilience training to reduce change fatigue and improve clinic nurses' job satisfaction. Framework The nurses in an East Coast teaching hospital apheresis clinic have a knowledge gap in understanding how to be self-resilient when confronting significant volumes of change to decrease change fatigue and improve job satisfaction (Beaulieu et al., 2022). The framework model used to develop and implement a nursing resiliency training program for the MSN project is the Iowa Model of Evidence-Based Practice (Buckwalter et al., 2017; Cullen et al., 2022; Titler et al., 2001). The Iowa Model of Evidence-Based Practice uses seven steps to implement change (Buckwalter et al., 2017; Cullen et al., 2022; Titler et al., 2001). The first step includes identifying whether resilience training reduces change fatigue and improves job satisfaction. The second step states that the project aims to improve the job satisfaction of the apheresis nurses by training them in self-resiliency to decrease change fatigue. The third step is to form a project team, including the MSN student and clinic leaders. The fourth step is collecting and evaluating literature to examine current evidence for change fatigue and resiliency strategies (Buckwalter et al., 2017; Cullen et al., 2022; Titler et al., 2001). The fifth step of the model is to implement the 8 developed resilience training program based on the evidence. The sixth step is to analyze and summarize the training outcomes on change fatigue and job satisfaction. Lastly, the seventh step is to evaluate the project for continuous improvement (Buckwalter et al., 2017; Cullen et al., 2022; Titler et al., 2001). Strengths and Limitations Using the Iowa Model of Evidence-Based Practice in the clinical setting has several strengths and limitations. The strengths of the Iowa Model of Evidence-Based Practice include a structured, evidence-based framework for improving healthcare practices, research studies, and quality improvement projects (Cullen et al., 2022; Tucker et al., 2021). In addition, the Iowa Model of Evidence-Based Practice emphasizes the evaluation of evidence, research utilization, and measurable outcomes (Cullen et al., 2022; Titler et al., 2001). Finally, The Iowa Model of Evidence-Based Practice is flexible enough to be used in different settings of different sizes, making it a strong choice for small areas such as an apheresis unit (Cullen et al., 2022). Limitations of the Iowa Model of Evidence-Based Practice include potentially being too complex, time-consuming, and resource-intensive for specific projects (Cullen et al., 2022; Titler et al., 2001). Results and outcomes from the model may also be limited by insufficient evidence and staff training on its proper use (Titler et al., 2001). Analysis of Literature The review aims to gauge the literature support for the benefit of resilience training in improving job satisfaction due to change fatigue. The literature review evaluates the evidential support for the PICOT question: For apheresis clinic nurses, would a resilience training program increase job satisfaction by reducing the symptoms of change fatigue, compared to no resilience training program, throughout a planned organizational change? 9 Most studies in the reviewed literature on nursing stress, change fatigue, and burnout occurred in units with 30 or more nursing staff. None of the studies reviewed were from outpatient facilities with units of ten or fewer nurses. The apheresis unit for this MSN project is small, with five nurses and a nurse manager. Studies reviewed included mixed nursing fatigue variabilities, moral/ethical fatigue, compassion fatigue, and change fatigue. Even though some of the instigating variables for fatigue exist, the underlying aspect for resolution was developing nursing resilience. Search Strategies The literature search for the literature review used the criteria and keywords of causes and mitigating factors of change fatigue and burnout, successful change implementation, helping teams cope with changes, nursing stress, retention, and resilience. Multiple variations of the keywords were used to locate relevant sources and articles. The resulting article resources were reviewed for applicable source leads. Databases utilized for the review search included Medline, PubMed, Wiley, Google Scholar, and CINAHL. Articles from 2001 through 2023 were selected and included in this literature review. Articles written before 2018 were used to broaden the search for historical practice and survey models, as many are still in use. Synthesis of the Literature The assembled literature shared three common themes related to change fatigue. First, organizations requiring a high volume of changes create stress and change fatigue in staff. Second, change fatigue leads to burnout and job dissatisfaction. Third, resilience training can reduce the impact of change and improve job satisfaction. Change Creates Stress in Staff 10 When organizations implement a high volume of changes and transition, staff can experience high levels of stress (Beaulieu et al., 2022; McMillan & Perron, 2020). Stress can be greater than the nurse anticipated and overcome their coping mechanisms (Al Ma'mari et al., 2020; Beaulieu et al., 2022; McMillan & Perron, 2020; Paine & Prochnow, 2022). There is a significant connection observed between the work environment, emotional exhaustion, depersonalization, personal accomplishment, and patient safety culture (Al Ma'mari et al., 2020; Beaulieu et al., 2022; McMillan & Perron, 2020; Paine & Prochnow, 2022). Continuous changes have implications for nurses and their practice. Nursing has become more demanding, resulting in ongoing self-sacrifice (Beaulieu et al., 2022; Brown et al., 2018). Increased service demand and the global pandemic have prompted efforts in innovation, technology integration, quality improvement, fiscal restraint, restructuring, optimization, and time constraints (Castiglione & Lavoie-Tremblay, 2021; McMillan & Perron, 2020). The potential repercussions of change fatigue could significantly affect the nursing workforce, especially in healthcare organizations undergoing substantial change (Beaulieu et al., 2022; Brown et al., 2018; McMillan & Perron, 2020). Changes Can Cause Fatigue and Burnout Nurses experience stress, burnout, change fatigue, and exhaustion due to increasing workplace demands and new and ongoing changes (Al Ma'mari et al., 2020; Beaulieu et al., 2022; McMillan & Perron, 2020; Paine & Prochnow, 2022). Beaulieu et al. (2022) and McMillan and Perron (2020) highlight the negative impact of rapid and continuous change on nurses and their practice, which is associated with behaviors associated with change fatigue. Behaviors and feelings related to change fatigue include self-sacrifice schema, passive acceptance, disengagement, apathy, disempowerment, disillusionment, and burnout among nurses (Al 11 Ma'mari et al., 2020; Beaulieu et al., 2022; Hovelius et al., 2021; McMillan & Perron, 2020; Paine & Prochnow, 2022). Nurses facing rapid changes may struggle with personal and job-related stability (Beaulieu, 2022; McMillan & Perron, 2020). Confusion over role expectations during large-scale changes and increased responsibilities within limited timeframes lead to change resistance (Castiglione & Lavoie-Tremblay, 2021). Some nurses report becoming desensitized to these changes, while others resent sacrificing personal well-being for ongoing changes in patient care standards (Beaulieu et al., 2022; Schmuck et al., 2022). Additionally, administrative decisions significantly influence nurses' experience of change fatigue (Paine & Prochnow, 2022). The push for rapid changes without proper staff involvement may cultivate change fatigue. Organizational consequences include absenteeism, nurse turnover, decreased productivity, low morale, difficulties in nurse retention, and failure to sustain the intended change (Beaulieu, 2022; McMillan & Perron, 2020). Resilience Training Reduces the Impact of Change Resilience training helps nurses understand the concepts of resilience and how they can be applied to offset the effects of change fatigue and regain or maintain job satisfaction (Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). The greater the resilience of a nurse, the higher the chance that the nurse tolerates psychological and emotional stresses (Cooper et al., 2021). Resilience is a learned skill and can be taught with resilience training (Beaulieu et al., 2022; McMillan & Perron, 2020). Resilience training is a critical strategy to address change fatigue (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). MintzBinder et al. (2021) define resilience as managing adversity with available resources and 12 resilience-building practices focusing on self-care, communication, team relationships, and trust. Mintz-Binder et al. (2021) conducted a quasi-experimental interventional study using a self-care toolkit given to each of the involved nurses to use when feeling stressed at work over six weeks. The study showed a decrease in work stress (P < 0.02) and increased resiliency (P < 0.001) throughout ten working shifts (Mintz-Binder et al., 2021). Studies suggest that job satisfaction may increase with resiliency training. Antonsdottir et al. (2021) study showed a positive correlation between higher moral resilience and lower burnout and turnover rates. Further, Cooper et al. (2021) found that nurse resilience protects against mental distress and enhances well-being, encouraging interventions such as stress management programs and resilience training to help adapt to change. Finally, Brown et al. (2018) conducted a descriptive correlational design study showing that job satisfaction declined with change fatigue (p < 0.001) and improved with resilience (p < 0.03). Literature suggests resilience training reduces stress and emotional fatigue (Gillman et al., 2015). Pehlivan and Güner (2020) used a randomized controlled trial to evaluate the effect of a Compassion Fatigue Resiliency Program on nurses’ professional lives, stress, and resilience, noting a marked improvement in the nurses who went through the program, especially as the program continued over time, (three-month p < 0.03; six-month p < 0.13; one year p < 0.006). Schmuck et al. (2022) also found a positive correlation between higher resiliency levels and lower stress and anxiety (p < 0.001). Additionally, Wei et al. (2019) completed a qualitative descriptive study to look for strategies to develop nurse resilience, highlighting seven strategies: work connections, positivity, strengths, growth, self-care, mindfulness, and altruism. Strategies for developing resilience are a priority, impacting nurses' work performance and well-being. Staff engagement and empowerment are core components of resilience-building 13 (Gillman et al., 2015). Creating a culture of partnership through open communication and valuing nurses' input reduces stress and emotional fatigue, enhancing both internal and external drivers of resiliency (Mintz-Binder et al., 2021). Stress-reducing interventions during work promote resilience, a critical factor in nurse well-being (Mintz-Binder et al., 2021; Pehlivan & Güner, 2020). Workplace stress, a top hazard, underscores the need for stress reduction and resilience-building programs supported by leadership (Mintz-Binder et al., 2021; Paine & Prochnow, 2022). Nurse leaders must identify and model strategies that help grow a culture of nursing resilience in their units and clinics (Wei et al., 2019). Strategies may include building relationships and connections in the nursing team and providing resilience training to develop habits that prevent, limit, or help recover from stress (Gillman et al., 2015; Wei et al., 2019). Work environment and conditions should be assessed and modified to facilitate nurse resilience, well-being, and retention (Cooper et al., 2021). Nurse leaders play a pivotal role in fostering resilience and should actively seek staff input for problem-solving and practice improvement (Brown et al., 2018; Wei et al., 2019). Nurse leader's closed-loop communication with clinical staff helps front-line workers know their voices are heard and enhance empowerment and engagement (Al Ma'mari et al., 2020; Beaulieu et al., 2022; McMillan & Perron, 2020). This approach leads to job satisfaction, reduced burnout, fewer reported patient safety events, and improved quality of care (Camilleri et al., 2018). Summary of Literature Review Findings and Application to the Project The literature is clear that nursing fatigue is detrimental to nurses, the quality of the care they provide, and their overall job satisfaction (Beaulieu et al., 2022; McMillan & Perron, 2020; Nam et al., 2019; Paine & Prochnow, 2022). The literature shows that nurses have physical, 14 emotional, spiritual, and moral fatigue, compounded with change fatigue, as they must change routines, learn to implement new treatments and procedures, and adapt to organizational changes (Beaulieu et al., 2022; McMillan & Perron, 2020; Nam et al., 2019; Paine & Prochnow, 2022; Tremolada et al., 2015). In the literature, change is noted as a constant attribute in nursing and demonstrates that change fatigue significantly contributes to nurse burnout and staffing turnover (Beaulieu et al., 2022; Cooper et al., 2021; McMillan & Perron, 2020; Nam et al., 2019; Paine & Prochnow, 2022; Tremolada et al., 2015). The evidence shows that fatigue may be minimized when nurses are involved in resilience training and team building (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). The information from the literature review has substantiated the need for a resilience training program in any nursing setting, including smaller clinical units (Wei et al., 2019). The literature supports engaging the nursing team in training, building individual and team resilience, and preparing for team engagement in the upcoming change processes (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). Project Plan and Implementation Having a strategy and action resiliency plan for preparing and engaging nurses for upcoming change processes benefits how well the nurses cope with the effects of change (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). Training can take multiple forms, such as teaching modules, presentations, inservices, and hands-on classes for self-care and team-building instruction and techniques (McMillan & Perron, 2020; Wei et al., 2019). Nurse resiliency training helps nurses understand the process of change fatigue, how to prepare for it, identify it, and build resilience against it 15 (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). The nurses' stress and resiliency can be evaluated through a series of questions. For this project, the project manager gives the apheresis nurses a pre-evaluation to assess a stress and resiliency baseline. Then, they participate in a series of five small group in-services.A five-week training series gradually builds the nurses' resilience and confidence in themselves, their coworkers, and the work environment. At each in-service, the nurses receive a 15 to 30-minute presentation on the weekly resilience topic, including an inspirational message, a self-care opportunity, and the resilience techniques discussed to practice in the coming week. At the end of the five weeks, a post-evaluation evaluates the change in stress management, change fatigue, and coping mechanisms. The project manager and clinical educator compile the evaluation data and validate whether resilience training supports the PICOT question. Plan and Implementation Process The Iowa Model of Evidence-Based Practice, applied to this MSN project, guides identifying a project team for planning and implementing the resiliency training program. First, the program manager holds an informational meeting on the resiliency training program with the key stakeholders, including the apheresis nurses, the unit educator, the unit manager, the quality manager, and the director of nursing. The meeting reviews the importance of nurse resilience in coping with the significant changes in healthcare and its role in job satisfaction. This meeting introduces the project's intent, evidence-based principles of nursing resilience, the expected time commitment of the project, and the potential benefit. Once a week for five weeks, the nurses receive a series of resiliency training presentations during the weekly staff huddle in the apheresis outpatient clinic. Each presentation 16 focuses on one of five topics to build the nurses' understanding and confidence in coping with stress and changes. During this time, the project manager gives the nurses a 15 - 30 minute presentation with a group discussion on the weekly resilience topic, a self-care opportunity, and resilience techniques to practice. The five topics were developed for this project based on symptoms and support mechanisms for change fatigue from the reviewed literature (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). The five project topics include team and social support, self-care, building on strengths, professional engagement, and continuing commitment. At the start of the first training presentation, the nurses take a pre-training survey concerning their baseline personal and work resiliency. The data from this survey evaluates the nurses’ perspective on factors including manager and teammate support and their ability to cope with changes. At the end of the five weeks, the project manager administers a post-survey to the participating nurses to evaluate the change in stress management, change fatigue, and coping mechanisms. The project manager and clinical educator then compile the survey data to validate the project PICOT question and show the implication of resiliency training on job satisfaction related to change fatigue. Interdisciplinary Team When considering the systemic role of change fatigue on the well-being of the clinic nurses, this project requires an interdisciplinary team to ensure the plan is objective, supportive, and ethically and professionally appropriate. The key stakeholders, including the project manager, the clinic educator, the apheresis nurses, the quality manager, and the director of nursing, are required to implement a nursing resiliency plan. Each stakeholder plays an essential role in the plan's implementation and outcomes. 17 Project Manager. The project manager is a registered nurse, MSN student, and the apheresis clinic nurse manager. The project manager leads the planning and implementation of this MSN project. As such, the project manager collaborates with the other stakeholders for project plan approval, implementation, evaluation, and follow-up. The project manager designs the resilience training plan proposal and then collaborates with the clinical educator to review the proposal, training process, and evaluation. The project manager proposes the training program to the quality manager and the director of nursing for approval. Once approved, the project manager coordinates the training sessions with the apheresis nurses and explains the project's expectations. The project manager administers the training sessions to the participating apheresis nurses, gives the evaluation surveys, conducts weekly training presentations, addresses concerns, compiles and evaluates the project data, and prepares and presents project results. After assessing the data and the training conclusions, the project manager collaborates with the quality manager, nursing director, and apheresis nurses to plan how best to support the nurses in the future. Clinical Educator. The clinical educator is a master's-prepared registered nurse. The clinical educator reviews the proposal, including the training presentations, the apheresis nurses involved, and survey tools. The educator supports the project manager as the project proceeds. After the director of nursing's approval, the project manager and the clinical educator introduce the training plan to the apheresis nursing staff. The clinical educator and the quality manager are resources for the apheresis nurses if they have questions or concerns. The clinical educator assists the project manager in reviewing and evaluating the survey data and trends. Apheresis Nurses. The apheresis clinic nurses are the intended benefactors of the training project. The participating nurses are registered nurses with associate or bachelor's 18 degrees and at least eight years of nursing experience. As adult medical professionals, nurses are responsible for their well-being, mental capacity, and limitations. Each nurse is invited to participate in the project voluntarily. Even if a nurse chooses not to participate in the complete project, each nurse receives the educational materials and can choose to participate in group discussions. The project manager administers the pre- and post-surveys to the apheresis nurses before resilience training begins and at the end of the five weeks. Quality Manager. The quality manager is in a pivotal position to evaluate the benefit of resilience training for nurses and how it fits within the regulatory programs involved in apheresis. The quality manager helps ensure the process aligns with unit, program, and organizational policies. The quality manager reviews the project, training, and evaluation process before final approval. The quality manager may monitor or audit the training. After finalizing the project results, the quality manager reviews the results and conclusion of the project. Director of Nursing. The project manager informs the director of nursing of the project and its intended benefit. The director of nursing collaborates with the project manager about any limitations or needed steps before the project is approved. The nursing director receives a final report on the outcomes and conclusion after the project and expands the project into other areas if benefits are noted. Description and Development of Project Deliverables This MSN project gives four deliverables during the implementation process. These include the stakeholder presentation, change fatigue pre-survey, resilience training post-survey, and resilience training for nurses' presentation. Each deliverable is essential for project approval, buy-in, training, evaluation, and successful completion. 19 Project Presentation for Stakeholders. This presentation introduces change fatigue and resilience training to key stakeholders, building support for and buy-in to the project and its potential benefits (see Appendix A). Change Fatigue Pre-Survey. The Change Fatigue Pre-Survey (see Appendix B) evaluates a baseline understanding and personal perspective on change fatigue at work. Resilience Training Post-Survey. This survey evaluates changes in the nurse's understanding and use of resilience skills to cope with change fatigue following training (see Appendix C). Resilience Training for Nurses Presentation. This PowerPoint presentation (see Appendix D) is the primary training module for this MSN project. It contains information on five resilience training topics that assist nurses in building resilience against stress and change fatigue. The project manager derived the presentation material from support mechanisms and interventions for change fatigue from the reviewed literature (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). Timeline The project's timeline (see Appendix E) spans three to four months. The timeline chart aids key stakeholders in understanding the MSN project's progress and ongoing expectations. The planning period should begin three to four months before the start date of the expected organizational or unit changes. During this time, educational materials are developed and approvals completed. The project presentation for stakeholders occurs six to eight weeks before the projected change's start date. Over the following six weeks, the project manager introduces the nurses to the project and its expectations, including the evaluation surveys and the resilience training plan. Within a 20 week before the start of resilience training, the project manager gives the participating nurses the Change Fatigue Pre-Survey. Then, over the following five weeks, the project manager begins instructing the apheresis nurses on one topic each week from the Resilience Training for Nurses Presentation. The project manager administers the Resilience Training Post-Survey a week following the fifth week of training to evaluate how the training affected the nurses' feelings before going into the change period. As the start date occurs for the expected changes, the project's goal is to reinforce and remind the nurses of resiliency skills to help mitigate the stresses of the ongoing changes. Project Evaluation The evaluation of this MSN project is subjective and involves the resilience and coping abilities of the individual nurses who staff the apheresis clinic. Before beginning resilience training, the project manager administers the Change Fatigue Pre-Survey (see Appendix B) to evaluate nurses' feelings about change, stress, support, and job satisfaction on a 5-point Likert scale. When evaluating how best to assess the impact of resilience training on change fatigue, the project manager considers the size of the apheresis clinic's nursing population. While not exact, the surveys deliver a targeted, measurable, and comparable evaluation of the nurses. After five weeks of resilience training, the nurses take the Resilience Training Post-Survey (see Appendix C). Following this, the project manager, clinic educator, and quality manager evaluate the survey results to determine whether resilience strategies improve the survey's key measures of decreased change fatigue and improved job satisfaction. Ethical Considerations 21 Discussions involving key leadership stakeholders identified ethical factors concerning this MSN project. The subject hospital for the project is committed to inclusive, diverse, and non-discriminative patient care. It extends this support to all employees, including apheresis nurses with mixed racial backgrounds and gender statuses. However, the small number of apheresis nurses involved limits the validity of the survey results. Most apheresis units have a small number of employees and nurses. The evaluated clinic for this project has five nurses. It is important to note that participation in this project is entirely voluntary. If a nurse chooses not to participate, the chances of others knowing are high. Even though participation status may be difficult to conceal, the results of the surveys are completely anonymous. The project manager, who is the apheresis clinic's manager, respects the nurses' autonomy and does not exert any undue pressure for participation. The clinical educator could proctor and review the surveys to ensure this respect for autonomy. Furthermore, resilience training is available to all clinic nurses, regardless of their participation status in the project or surveys. Discussion Workplace changes can be stressful, leading to change fatigue, burnout, and low job satisfaction (Beaulieu et al., 2022; McMillan & Perron, 2020). However, preemptive training in self-resiliency techniques can alleviate this stress and exhaustion during change, improving job satisfaction. Resilience training has demonstrated its efficacy in mitigating the adverse effects of change fatigue among healthcare workers (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019), underscoring its potential benefits. Addressing the apheresis nurses' knowledge gap in being self-resilient when confronting significant change is essential in nurse job satisfaction and retention (Beaulieu et al., 2022; Wei et al., 2019). Apheresis units are often smaller, with fewer nurses to manage the workload, 22 making them more susceptible to change fatigue (Cojocari, 2015). This MSN project shows the benefit of using resilience training to counter the adverse effects of change. Evidence-based Solutions for Dissemination This MSN project will be shared with other healthcare professionals in several ways. First, the project will be presented in poster format to MSN students and faculty at the end of the Spring semester of 2024. The project manager will present the project during a nursing grand round meeting with other nurses and managers in the teaching hospital cancer center with the apheresis clinic. The project manager will also submit the project's abstract for the American Society for Apheresis (ASFA) conference. If selected, the abstract will appear in the exhibit for the general conference audience and be published in a special edition of the Journal of Clinical Apheresis. Significance to Advance Nursing Practice This MSN project is significant to nursing because it offers resiliency training to improve the ability of apheresis nurses to manage their stress and fatigue from work changes and improve job satisfaction. Recent changes in the practice of apheresis treatments and patient care make apheresis nurses more susceptible to change fatigue (Tremolada et al., 2015). Change fatigue causes a decline in employee engagement, job satisfaction, and productivity, resulting in role expectation confusion, absenteeism, low morale, and fatigue exhaustion, which leads to declining nurse retention and failure to sustain the intended change (Al Ma'mari et al., 2020; Beaulieu, 2022; Castiglione & Lavoie-Tremblay, 2021; McMillan & Perron, 2020; Paine & Prochnow, 2022). Resilience training helps nurses offset the effects of change fatigue and regain or maintain job satisfaction (Gillman et al., 2015; McMillan & Perron, 2020; Wei et al., 2019). 23 Developing greater individual and nursing team resilience improves the chances of tolerating the stresses of significant change and avoiding change fatigue and exhaustion (Cooper et al., 2021). Implications This MSN project's strength includes gathering simultaneous survey data from the frontline apheresis nurses during an active organizational change. Even though change in nursing is constant, having an opportunity to complete a project under these circumstances is significant. The resilience training the apheresis nurses receive during this project will give them the resilience tools to support themselves and their teammates through times of change, build teamwork, and strengthen retention efforts. Finally, this project could be applied to other small, high-stress environments in hospital settings. This project’s limitations include the study population size and clinic environment. The survey data is limited, with only five nurses in the project. Appropriate time for training and group discussions may be difficult in a busy apheresis clinic. To eliminate these obstacles, the project would need to be extended to include additional facilities with apheresis clinics, such as a multiorganizational study in collaboration with ASFA. Recommendations This project applies the benefits of resilience training in mitigating the effects of change fatigue on apheresis nurses. More extensive or additional studies with other apheresis clinics and nurses would be beneficial in obtaining a more comprehensive database. The training in this project could have a more significant impact if continued after the completion of the project. Encouraging daily self-care and resilience has long-lasting positive benefits for the nurse and the working environment (Beaulieu et al., 2022; Cooper et al., 2021; Gillman et al., 2015; McMillan 24 & Perron, 2020; Wei et al., 2019). As the training continues, follow-up surveys may be used to further the extent and depth of the project results. Conclusions Significant organizational change creates stress for nurses who must maintain appropriate patient care while conforming to the new organizational expectations. This stress leads to change fatigue, exhaustion, decreased job satisfaction, and increased staff turnover. Providing resiliency training empowers nurses to understand their physical and emotional symptoms and provides tools to help themselves and their teammates through challenging changes and circumstances at work. As nurses recognize the signs and symptoms of change fatigue, how to prevent or handle symptoms, and receive leadership support, they become more secure and satisfied with their employment. 25 References Al Ma'mari, Q., Sharour, L., & Al Omari, O. (2020). Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses. British Journal of Nursing, 29(1), 28–34. https://doi.org/10.12968/bjon.2020.29.1.28 Antonsdottir, I., Rushton, C., Nelson, K., Heinze, K. E., Swoboda, S. M., & Hanson, G. C. (2021). Burnout and moral resilience in interdisciplinary healthcare professionals. 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Implementation science: Application of evidence‐based practice models to improve healthcare quality. Worldviews on Evidence-Based Nursing, 18(2), 76–84. https://doi.org/10.1111/wvn.12495 Wei, H., Roberts, P., Strickler, J., & Corbett, R. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of Nursing Management, 27(4), 681–687. https://doi.org/10.1111/jonm.12736 29 Appendix A Project Presentation for Stakeholders Project Presentation for Stakeholders 30 Appendix B Change Fatigue Training Pre-Survey Change Fatigue Pre-Survey Select 1 Strongly Disagree - 5 Strongly disagree for following: I understand how change at work cause stress. Adapting to changes at work makes me feel exhausted. I engage in self-care activities when I feel stressed and fatigued. I apply resilience strategies while adapting to changes at work. I feel support from my co-workers. I feel support from my manager when I have stress. I have a voice in changes at work. I am included in unit decision-making. I feel overwhelmed at work during times of change. I am satisfied with my job overall. 1 2 3 4 5 31 Appendix C Resilience Training Post-Survey Resilience Training Post-Survey Select 1 Strongly Disagree - 5 Strongly disagree for following: I understand how change at work cause stress. Adapting to changes at work makes me feel exhausted. I engage in self-care activities when I feel stressed and fatigued. I apply resilience strategies while adapting to changes at work. I feel support from my co-workers. I feel support from my manager when I have stress. I have a voice in changes at work. I am included in unit decision-making. I feel overwhelmed at work during times of change. I attended resilience training that taught strategies to cope with change. Team resilience strategies among my co-workers helps me deal with stress. Access to resilience training improves my job satisfaction. I am satisfied with my job overall. 1 2 3 4 5 32 Appendix D Resilience Training for Nurses Presentation Resilience Training for Nurses 33 Appendix E Timeline