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https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/08/17/de-la-resilience-a-la-prosilience

A system-level initiative to preparing nurses for emotional and ethical demands

By Sherry Hole
August 17, 2026

Nurses across Canada are navigating increasingly complex practice environments marked by staffing shortages, rising patient acuity, moral distress, workplace bullying, and escalating emotional and cognitive demands. Correspondingly, rates of burnout, compassion fatigue, PTSD, and vicarious or secondary traumatic stress have risen sharply among the nursing workforce (Aiken et al., 2021).

There has been growing emphasis on promoting resilience as an essential core competency for nurses working in these high-pressure environments. Although resilience — the human capacity to recover from adversity, which nurses bring with them into practice and continue to draw upon throughout their careers — remains important, emphasizing it without addressing structural contributors to stress may unintentionally imply that challenges stem from individual limitations, rather than systemic issues. As a result, discussions of resilience can leave nurses feeling unsupported and misunderstood, particularly when organizational conditions remain unchanged.

This article introduces prosilience as a more comprehensive, proactive approach to supporting nurse well-being. Prosilience goes beyond recovery and focuses on preparing nurses before they encounter occupational stressors. Through an integrated, system-level lens, prosilience better aligns with evidence-informed strategies for sustaining healthy practice environments.

Resilience in nursing: value and limitations

Resilience is widely described as the ability to “bounce back” after difficult or traumatic experiences. Within nursing literature, resilience has been linked to improved coping, adaptability, and emotional regulation. However, an exclusive focus on resilience can inadvertently shift attention away from environmental factors, such as workload intensity, inadequate staffing, administrative pressures, workplace bullying, and limited psychological support — factors consistently associated with workforce distress.

Furthermore, when resilience is framed as a personal responsibility, nurses may perceive an expectation to endure chronic adversity without adequate organizational support. This perception contributes to frustration and disengagement and may exacerbate feelings of moral injury when workplace conditions compromise a nurse’s ability to provide care aligned with professional standards.

Resilience remains important, but insufficient on its own. A sustainable approach requires the integration of individual strengths with supportive structures in place, transformative leadership, and a workplace culture that values compassion, collaboration, psychological safety, and well-being. It is equally important to acknowledge that nursing’s own professional culture can shape how stress and coping are experienced — including peer expectations, the normalization of self-sacrifice, and unspoken norms around stoicism or endurance. Many nurses internalize these norms to the point where prioritizing their own well-being feels selfish rather than essential (Ramluggun et al., 2025; S. Hole, personal communication, March 2, 2026). These internal cultural dynamics deserve recognition alongside systemic factors — and prosilience actively works to reframe self-care as a professional responsibility, not a personal indulgence.

Prosilience: a proactive, capacity-building framework

Prosilience, a concept grounded in strength-based and positive psychology theory, emphasizes developing internal and external resources ahead of challenging circumstances (Gillham et al., 2015). Rather than focusing solely on recovery, prosilience supports readiness, prevention, and holistic capacity.

It is important to note that prosilience operates on two interconnected levels: it equips individual nurses with proactive skills and self-awareness, while simultaneously calling on systems, leaders, and educators to create the conditions that make that preparation possible and sustainable.

Within nursing practice, prosilience includes:

• Developing self-awareness and early recognition of stress responses
• Grounding practices that regulate the nervous system
• Access to reflective discourse, debriefing, and peer support
• Leadership that promotes psychological safety and open communication
• Trauma-informed approaches that acknowledge emotional and relational labour (the emotional and interpersonal effort required to maintain supportive, compassionate, and effective relationships with patients, families and colleagues)
• Systems that protect adequate rest, mentorship, and manageable workloads
• Nursing education programs that intentionally introduce prosilience frameworks, emotional preparedness, and reflective practice skills before students enter clinical environments

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Health-care workers are not heroes

Importantly, prosilience distributes responsibility for well-being to both individuals and organizations, positioning nurse wellness as a vital component of the practice environment — not an extracurricular task. We need to start acknowledging that nurses’ well-being is a fundamental human right.

The role of leadership in cultivating prosilient environments

Health-care leaders are positioned to influence the conditions in which prosilience can flourish. Research demonstrates that supportive leadership, psychological safety, and healthy team communication significantly reduce burnout and strengthen retention. Effective leadership does not require having all the answers. Rather, leaders can foster trust and engagement by using coaching-informed questions, such as “What do you need?”, and then genuinely listening, acknowledging concerns, and taking them seriously. In doing so, leaders communicate that staff voices, lived experiences, and clinical expertise are valued and belong within organizational conversations  (Aiken et al., 2021; Busis et al., 2025).

A prosilience-oriented leadership environment includes:

• Validating the emotional and relational challenges of nursing practice
• Intervening promptly in bullying or disrespectful behaviours
• Promoting open communication and clear expectations for conduct
• Ensuring structures for debriefing, mentorship, and peer support
• Monitoring workload, staffing adequacy, and team dynamics

These organizational commitments reinforce the emphasis the Canadian Nurses Association (CNA) places on safe, person-centred practice environments and align with the standards embedded within CNA’s Stellar Certification Program.

Honouring the complexity of nursing work

Nursing involves continuous exposure to human vulnerability, suffering, and unpredictable clinical situations. The emotional and relational labour inherent to this is substantial and cannot be addressed through individual coping strategies alone. Prosilience acknowledges this complexity by integrating biological, physical, cultural, spiritual, mental, emotional, and relational support into daily practice structures.

Shared reflection, grounding practices, and community support can reduce isolation and strengthen nurses’ ability to navigate ethical tensions and emotional strain without compromising their own well-being.

As a nurse with more than 30 years of experience, I have witnessed firsthand the profound impacts that emotionally demanding environments have on nurses’ well-being. I often reflect on how being better prepared — mentally, emotionally, spiritually and relationally — would have allowed me to navigate challenging situations and difficult conversations with greater clarity, confidence and compassion. As nurse educators, we hear countless stories from nurses who express similar frustration and heartache. Many describe entering the profession without adequate preparation for the emotional intensity, ethical dilemmas, and cumulative stress inherent in nursing. Their experiences reinforce the urgent need for proactive approaches that cultivate well-being, build capacity, and where possible, prevent or mitigate the impact of these challenges.

When nurses’ health and well-being are recognized and supported as a fundamental human right, both nurses and patients benefit. Nurses thrive within their role as care providers and are able to provide safe, compassionate, evidence-informed care contributing to healthier workplace cultures and improved patient outcomes (Aiken et al., 2021).

Implications for workforce sustainability and patient care

Adopting prosilience as a guiding framework also supports both nurse well-being and broader health system goals. Evidence suggests that establishing environments that foster psychological safety, teamwork, and emotional support experience improved retention, lower absenteeism, and better patient outcomes (Aiken et al., 2021).

Prosilience therefore contributes to:

• Reduced burnout and turnover
• Enhanced job satisfaction and professional fulfilment
• Improved continuity of care
• Strengthened organizational culture
• Sustained capacity for ethical, person-centred practice

By integrating prosilience into policy, leadership, and everyday clinical practice, health-care systems can build a workforce that is better equipped to manage the emotional and ethical demands of modern nursing.

Moving from concept to practice

Integrating prosilience does not require a complete system overhaul. In nursing education, this may look like embedding deep self-awareness practices, emotional intelligence development, mindfulness, and peer support skills into existing curricula — going beyond technical reflection to cultivate the inner resources nurses need to sustain themselves in practice. In clinical settings, organizations can begin by establishing structured debriefing practices, integrating brief mindful moments into the workday, fostering peer compassion and intentional check-ins that honour the emotional alongside the clinical, and designating psychological safety champions within teams. The integration of nurse coaches into organizational structures represents a particularly promising strategy; coaching in nursing has been shown to enhance leadership, improve performance, and provide meaningful peer support for well-being and professional development (Dossey et al., 2015; Richardson et al., 2023).

Leadership training should also explicitly address the emotional dimensions of supervisory roles. At the unit level, even small commitments — clear pathways for reporting moral distress and protected time for peer connection — can meaningfully shift workplace culture over time. The goal is not perfection but intentionality: a shared commitment to nurturing well-being, building capacity, and creating the conditions in which nurses can truly thrive.

Conclusion

Nurses need more than resilience after harm has occurred; they need preparation, protection, and environments intentionally designed to support their holistic well-being from the outset. That preparation should begin in nursing education, but it must be reinforced and sustained in practice settings through shared commitment and action. Schools of nursing, health-care organizations, leaders, educators, and nurses must work together to create cultures where well-being is not treated as an individual burden, but as a collective responsibility. Prosilience provides a proactive, evidence-supported framework for this shift by connecting personal capacity with organizational accountability, leadership commitment, and healthier systems of practice. When education and workplace culture align in this way, nurses are not merely asked to survive the profession — they are given the conditions to thrive within it.

Transitioning from a resilience-focused narrative to a prosilience-oriented culture affirms that nurse well-being is essential to ethical, safe, and sustainable health care. Embracing this shift supports CNA’s mandate to foster healthy practice environments and reinforces the shared commitment to a thriving nursing profession across Canada.

References

Aiken, L. H., Sloane, D., Griffiths, P., et al. (2021). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 30(7), 522–531. https://pubmed.ncbi.nlm.nih.gov/28626086/

Busis, N. A., Alexander, C. M., Castner, J., Singer, S., Smith, C. D., Bernstein, C. A., Hoyt, D. B., Tran, T. A., & Cipriano, P. (2025). A Path to Improved Health Care Worker Well-being: Lessons from the COVID-19 Pandemic. NAM perspectives, 2025, 10.31478/202504a.

https://doi.org/10.31478/202504a

Gillham, J., Reivich, K., & Shatté, A. (2015). Building resilience in healthcare professionals: A proactive approach. Journal of Positive Psychology, 10(5), 447–458.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7223999/

Dossey, B. M., Luck, S., & Schaub, B. G. (2015). Nurse coaching: Integrative approaches for health and wellbeing. International Nurse Coach Association. https://inursecoach.com/nurse-coaching-textbook/?srsltid=AfmBOooQdspwpn-tm0HarB0pwhfpx_RkADx7mhlpfRBPbWX0QF5nbkLk

Ramluggun, P., et al. (2025). Integrating self-care into nursing education and practice: Strategies for sustainable wellbeing. Education Sciences, 15(6), 721. https://doi.org/10.3390/educsci15060721

Richardson, C., Wicking, K., Biedermann, N., & Langtree, T. (2023). Coaching in nursing: An integrative literature review. Nursing Open, 10(10), 6635–6649. https://doi.org/10.1002/nop2.1925

Sherry Hole, RN, BN, MN, HWNC-BC, is an integrative mental health coach, board -certified health and wellness nurse coach,  and founder and CEO of the Canadian Institute of Integrative Nursing Development & Education Ltd. (TheCIINDE™).

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